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This is VAERS ID 1017013

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1017013
VAERS Form:2
Age:28.0
Sex:Female
Location:Texas
Vaccinated:2021-01-19
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abortion spontaneous, Pain, Pyrexia, Ultrasound scan

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, fluoxetine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Sonogram showing 6 weeks 4 days embryonic demise, corresponding to approx. 01/20/2021 as the date of demise.
CDC 'Split Type':

Write-up: Gravida 1 with last menstrual period of 12/05/2020. Patient received 2nd dose of vaccine on 01/19/2021. Patient had fever and body aches the next day 1/20/2021 and subsequently (3 weeks later) was diagnosed with a miscarriage of pregnancy at 6 weeks 4 days, which exactly corresponds with the date of the vaccine and symptoms.


Changed on 5/21/2021

VAERS ID: 1017013 Before After
VAERS Form:2
Age:28.0
Sex:Female
Location:Texas
Vaccinated:2021-01-19
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abortion spontaneous, Pain, Pyrexia, Ultrasound scan

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, fluoxetine
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: Sonogram showing 6 weeks 4 days embryonic demise, corresponding to approx. 01/20/2021 as the date of demise.
CDC 'Split Type':

Write-up: Gravida 1 with last menstrual period of 12/05/2020. Patient received 2nd dose of vaccine on 01/19/2021. Patient had fever and body aches the next day 1/20/2021 and subsequently (3 weeks later) was diagnosed with a miscarriage of pregnancy at 6 weeks 4 days, which exactly corresponds with the date of the vaccine and symptoms.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=1017013&WAYBACKHISTORY=ON


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