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This is VAERS ID 1117428

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1117428
VAERS Form:2
Age:30.0
Sex:Female
Location:Indiana
Vaccinated:2021-01-30
Onset:2021-03-12
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Abortion spontaneous, Multigravida, Ultrasound antenatal screen abnormal, Human chorionic gonadotropin decreased, Exposure during pregnancy, Anembryonic gestation

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
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 vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: Ultrasound on 3-12-21 with empty gestational sac Blood tests performed with dropping hcg levels on 3-12-21 and 48hrs later on 3-14-21
CDC 'Split Type':

Write-up: I miscarried with a blighted ovum. Pregnancy history. I have no medical conditions and have had 2 healthy pregnancies prior. I had the first vaccine the week I ovulated and then found out I was pregnant the following month. Jan 19th was the date of my last menstrual cycle Est il mated date of delivery: oct 26, 2021


Changed on 5/7/2021

VAERS ID: 1117428 Before After
VAERS Form:2
Age:30.0
Sex:Female
Location:Indiana
Vaccinated:2021-01-30
Onset:2021-03-12
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Abortion spontaneous, Multigravida, Ultrasound antenatal screen abnormal, Human chorionic gonadotropin decreased, Exposure during pregnancy, Anembryonic gestation

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
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 vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin Amoxicillin
Diagnostic Lab Data: Ultrasound on 3-12-21 with empty gestational sac Blood tests performed with dropping hcg levels on 3-12-21 and 48hrs later on 3-14-21
CDC 'Split Type':

Write-up: I miscarried with a blighted ovum. Pregnancy history. I have no medical conditions and have had 2 healthy pregnancies prior. I had the first vaccine the week I ovulated and then found out I was pregnant the following month. Jan 19th was the date of my last menstrual cycle Est il mated date of delivery: oct 26, 2021


Changed on 5/21/2021

VAERS ID: 1117428 Before After
VAERS Form:2
Age:30.0
Sex:Female
Location:Indiana
Vaccinated:2021-01-30
Onset:2021-03-12
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Abortion spontaneous, Multigravida, Ultrasound antenatal screen abnormal, Human chorionic gonadotropin decreased, Exposure during pregnancy, Anembryonic gestation

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
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 vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin Amoxicillin
Diagnostic Lab Data: Ultrasound on 3-12-21 with empty gestational sac Blood tests performed with dropping hcg levels on 3-12-21 and 48hrs later on 3-14-21
CDC 'Split Type':

Write-up: I miscarried with a blighted ovum. Pregnancy history. I have no medical conditions and have had 2 healthy pregnancies prior. I had the first vaccine the week I ovulated and then found out I was pregnant the following month. Jan 19th was the date of my last menstrual cycle Est il mated date of delivery: oct 26, 2021

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