VAERS ID: 1331089

AGE: 54| SEX: M|STATE: WA (United States)

Description

54yo male w/suspected Penile Mondor's disease (PMD) 2 weeks after receiving j&j vaccine 4.30.21 Penile Mondor's disease (PMD) is a benign, self-limiting thrombophlebitis of the superficial dorsal vein of the penis.

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Symptoms

Phlebitis superficial

Vaccines

VAX DATE: 04-30-2021| ONSET DATE: 05-13-2021| DAYS TO ONSET: 13
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (JANSSEN)) 0 COVID19 JANSSEN Unknown Unknown

RECVDATE:05-19-2021
RPT_DATE:
CAGE_YR:54
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:none
V_ADMINBY:PVT
OTHER_MEDS:none
CUR_ILL:none
HISTORY:none
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:05-19-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:U
ALLERGIES:none
V_FUNDBY:

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