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This is VAERS ID 1033412

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1033412
VAERS Form:2
Age:35.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-12
Onset:2021-02-09
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: Stillbirth, Autopsy, Foetal heart rate normal, Foetal death, Exposure during pregnancy

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? Yes, days: 2     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.


Changed on 5/7/2021

VAERS ID: 1033412 Before After
VAERS Form:2
Age:35.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-12
Onset:2021-02-09
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: Stillbirth, Autopsy, Foetal heart rate normal, Foetal death, Exposure during pregnancy

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? Yes, days: 2     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 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.


Changed on 5/14/2021

VAERS ID: 1033412 Before After
VAERS Form:2
Age:35.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-12
Onset:2021-02-09
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: Stillbirth, Autopsy, Foetal heart rate normal, Foetal death, Exposure during pregnancy

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? Yes, days: 2     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 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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