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From the 4/30/2021 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 1063650



Case Details

VAERS ID: 1063650 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-06
Onset:2021-01-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Exposure during pregnancy, Foetal death, Pain in extremity, Ultrasound abdomen
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Tendinopathies and ligament disorders (broad)

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? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: I am allergic to penicillin, clindamycin and tree nuts.
Diagnostic Lab Data: I had an US ABD and Transvaginal.
CDC Split Type: vsafe

Write-up: I had a soreness in my arm. The two weeks later on the 21st of January, I had a routine OB appointment and we did an US only to find out that the fetus was no longer alive. I had to have a DNC the following week. Participant is not sure if it is vaccine related but wanted to file a report anyway.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210430&IDNUMBER=1063650

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