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From the 5/14/2021 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 1033412



Case Details

VAERS ID: 1033412 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-01-12
Onset:2021-02-09
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Exposure during pregnancy, Foetal death, Foetal heart rate normal, Stillbirth
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Montelukast, loratidine, prenatal vitamin, magnesium supplement, 81mg aspirin
Current Illness: 20 weeks pregnant at time of vaccine 1/12/21; intrauterine fetal demise noted at regular OB visit 2/9/21
Preexisting Conditions: Asthma, migraines
Allergies: No known allergies
Diagnostic Lab Data: Fetal autopsy pending
CDC Split Type:

Write-up: 20 weeks gestation at time of vaccine administration. Saw OB that morning (1/12/21), normal exam and fetal heart rate. Normal anatomy scan 1/8/21, normal genetic screening. Fetal demise noted at 24 week OB visit on 2/9/21, stillborn baby delivered 2/12/21.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210514&IDNUMBER=1033412

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