VAERS ID: 1617841

AGE: 57| SEX: M|STATE: AR (United States)

Description

Possible Proctitis Inflammation and swelling on both sides above penis . 10 Days earlier blood in urine with what was thought to be a Kidney Stone

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Symptoms

Swelling, Urine analysis, Inflammation, Blood urine present, SARS-CoV-2 test negative

Vaccines

VAX DATE: 02-06-2021| ONSET DATE: 07-15-2021| DAYS TO ONSET: 159
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 041L20A IM RA
COVID19 (COVID19 (MODERNA)) 2 COVID19 MODERNA 012M20A IM LA

RECVDATE:08-22-2021
RPT_DATE:
CAGE_YR:57
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:Negative Urine Test, Negative COVID test
V_ADMINBY:PHM
OTHER_MEDS:Multivitamin
CUR_ILL:none
HISTORY:Kidney Stones
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:08-22-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:U
ALLERGIES:KNA
V_FUNDBY:

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