VAERS ID: 1153914

AGE: 72| SEX: M|STATE: NY (United States)

Description

dark blood clot coming out of his penis; Gross Hematuria; dark urine; Redness arm; Sore Arm; Swelling arm; A spontaneous report was received from a healthcare professional who was also a 72-year old, male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced events redness arm/ vaccination site erythema, sore arm/ vaccination site pain, swelling arm/ vaccination site swelling, gross hematuria/ hematuria, dark blood clot coming out of his penis/ hemorrhage urinary tract, and dark urine/ chromaturia. The patient's medical history was not provided. No relevant concomitant medications were reported. On 10 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot batch: 013L20A) intramuscularly for prophylaxis of COVID-19 infection. On 11 Jan 2021, the patient experienced the events redness, sore arm and swelling. On 20 Jan 2021, the patient experienced the events gross hematuria, with dark blood clot coming out of his penis. The patient had urine analysis (no results provided), and was still urinating dark urine. No treatment information was provided. Action taken with mRNA-1273 in response to the events was unknown. The outcomes of the events, vaccination site erythema, vaccination site pain, and vaccination site swelling, were considered recovered on an unspecified date. The outcomes of the events, hematuria, hemorrhage urinary tract, and chromaturia, were unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Further information has been requested.

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Symptoms

Haematuria, Chromaturia, Haemorrhage urinary tract, Vaccination site pain, Vaccination site erythema, Vaccination site swelling

Vaccines

VAX DATE: 01-10-2021| ONSET DATE: 01-11-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 013L20A OT

RECVDATE:04-01-2021
RPT_DATE:
CAGE_YR:72
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:Medical History/Concurrent Conditions: No adverse event (No reported medical history.)
PRIOR_VAX:
SPLTTYPE:USMODERNATX, INC.MOD20210
FORM_VERS:
TODAYS_DATE:03-30-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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