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From the 11/26/2021 release of VAERS data:

This is VAERS ID 917350

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Case Details

VAERS ID: 917350 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2020-12-26
Onset:2020-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Blood test, Dizziness, Exposure during pregnancy, Fatigue, Foetal heart rate abnormal, Impaired work ability, Injection site discomfort, Injection site swelling, Malaise, Pregnancy test positive, Ultrasound scan
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood work and ultrasound - emergency dept.
CDC Split Type:

Write-up: 27Dec2020 - patient developed some swelling (went about 1 inch out from injection site) and discomfort at the injection site - had taken Advil and was using a cool compress. 29Dec2020 - patient had to leave work early since she was not feeling well - very fatigued and a little dizzy (able to eat/drink) - denied any COVID illness s/s (no cough, fever, loss of taste/smell, etc). She ended up going to the local ED - since she was still very fatigued and was feeling like she was going to pass out - blood work and U/S done - this is where she found out she had been pregnant but had lost the pregnancy (no heart beat). Per her report - all other blood work was unremarkable. No other medications given to her during this visit and was just told that she would be ''passing the products of conception within this next week''.


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