VAERS ID: 1595019

AGE: 86| SEX: M|STATE: WI (United States)

Description

Extreme hemorrhaging from penis; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 27-Feb-2021 and was forwarded to Moderna on 27-Feb-2021. This spontaneous case was reported by a consumer and describes the occurrence of HAEMATURIA (Extreme hemorrhaging from penis) in an 86-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007M20A) for COVID-19 vaccination. The patient's past medical history included Prostate cancer, Macular degeneration and Kidney failure. Concomitant products included RIVAROXABAN (XARELTO), BICALUTAMIDE, METOPROLOL SUCCINATE, DUTASTERIDE, ALOPURINOL, ASCORBIC ACID, BETACAROTENE, CUPRIC OXIDE, TOCOPHERYL ACETATE, ZINC OXIDE (PRESERVISION AREDS) and hormone injection for an unknown indication. On 18-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Feb-2021, the patient experienced HAEMATURIA (Extreme hemorrhaging from penis). At the time of the report, HAEMATURIA (Extreme hemorrhaging from penis) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Platelet count:. On an unknown date, Urine analysis normal:. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) was unknown.

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Symptoms

Haematuria, Urine analysis normal, Platelet count

Vaccines

VAX DATE: 02-18-2021| ONSET DATE: 02-20-2021| DAYS TO ONSET: 2
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 007M20A RA

RECVDATE:08-21-2021
RPT_DATE:
CAGE_YR:86
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:Test Date: 2021; Test Name: Platelet count; Result Unstructured Data: Normal; Test Date: 2021; Test Name: Urine test; Result Unstructured Data: Normal
V_ADMINBY:
OTHER_MEDS:XARELTO; BICALUTAMIDE; METOPROLOL SUCCINATE; DUTASTERIDE; ALOPURINOL; PRESERVISION AREDS; hormone injection
CUR_ILL:
HISTORY:Medical History/Concurrent Conditions: Kidney failure; Macular degeneration; Prostate cancer
PRIOR_VAX:
SPLTTYPE:USMODERNATX, INC.MOD20210
FORM_VERS:
TODAYS_DATE:08-13-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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