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This is VAERS ID 1036567

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1036567
VAERS Form:2
Age:34.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-27
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Headache, Nausea, Pyrexia, Foetal death, Exposure during pregnancy, Ultrasound foetal abnormal

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: Pre-natal vitamin and Bonjesta
Current Illness: Reports only morning sickness, related to pregnancy.
Preexisting Conditions: Denies
Allergies: NKDA, NKA
Diagnostic Lab Data: 2/1/21 Fetal US reported as showed fetal demise during week 8, which is the same week as she received the #2 COVID vaccine
CDC 'Split Type':

Write-up: reports that she was approximately 8 weeks pregnant at the time of her #2 COVID vaccine on 1/27/21. She reports she had a normal prenatal US at 7 weeks. She reports on 1/27/21, she had vaccine side effects of fever/chills, headache, and nausea. She notes on 1/29/21 most of her vaccine side effect symptoms resolved, but she is still suffering from headaches. She also notes that her morning sickness was gone on 1/29/21. She reports she called her OB, he brought her in for a repeat US on 2/1/21. Notes that she has two healthy children and suffered a miscarriage in May 2020.


Changed on 5/21/2021

VAERS ID: 1036567 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-27
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Headache, Nausea, Pyrexia, Foetal death, Exposure during pregnancy, Ultrasound foetal abnormal

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: Pre-natal vitamin and Bonjesta
Current Illness: Reports only morning sickness, related to pregnancy.
Preexisting Conditions: Denies
Allergies: NKDA, NKA NKA
Diagnostic Lab Data: 2/1/21 Fetal US reported as showed fetal demise during week 8, which is the same week as she received the #2 COVID vaccine
CDC 'Split Type':

Write-up: reports that she was approximately 8 weeks pregnant at the time of her #2 COVID vaccine on 1/27/21. She reports she had a normal prenatal US at 7 weeks. She reports on 1/27/21, she had vaccine side effects of fever/chills, headache, and nausea. She notes on 1/29/21 most of her vaccine side effect symptoms resolved, but she is still suffering from headaches. She also notes that her morning sickness was gone on 1/29/21. She reports she called her OB, he brought her in for a repeat US on 2/1/21. Notes that she has two healthy children and suffered a miscarriage in May 2020.

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