VAERS ID: 1380756

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

Description

blood clot on the shaft of their penis; Bruise; This spontaneous case was reported by a patient family member or friend and describes the occurrence of THROMBOSIS (blood clot on the shaft of their penis) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced THROMBOSIS (blood clot on the shaft of their penis) (seriousness criterion medically significant) and CONTUSION (Bruise). At the time of the report, THROMBOSIS (blood clot on the shaft of their penis) and CONTUSION (Bruise) outcome was unknown. No concomitant or treatment medications were reported. Reporter did not allow further contact; Sender'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. However, very limited information regarding this event/s has been provided at this time. Further information cannot be requested because Consent to a follow up from safety was not granted. The reporter did not provide further contact information.

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Symptoms

Thrombosis, Contusion

Vaccines

VAX DATE: | ONSET DATE: | DAYS TO ONSET:
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 2 COVID19 MODERNA OT Unknown

RECVDATE:06-08-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:USMODERNATX, INC.MOD20211
FORM_VERS:
TODAYS_DATE:06-05-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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OpenVAERS is a private organization that posts publicly available CDC/FDA data of injuries reported post-vaccination. Reports are not proof of causality.