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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1016753

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Case Details

VAERS ID: 1016753 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-01-28
Onset:2021-02-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Haemorrhage, Human chorionic gonadotropin, Pregnancy, Pregnancy test urine positive
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenate DHA
Current Illness: None
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: serum quantitative beta-hCG drawn on 2/4/21 (results not available).
CDC Split Type:

Write-up: 42yo G2P0010 at 3+6 weeks GA by LMP 1/1/2021 with EDD 10/8/2021 on day of Vaccine Dose #2 (1/28/2021), positive urine pregnancy test on 1/30/21. Bleeding began on 2/4/2021, and complete miscarriage occurred on 2/5-2/6.


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