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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1375801

Case Details

VAERS ID: 1375801 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Georgia  
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Blood urine, Complement factor C3, Complement factor C4, Full blood count, Metabolic function test, Prothrombin time, Streptococcus test, Ultrasound kidney, Urine analysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: sertraline
Current Illness: otitis media, cold
Preexisting Conditions: anxiety, asthma
Allergies: none
Diagnostic Lab Data: cbc, cmp, pt, ptt, c3, c4, aso titer, Ua, microscopic urine, renal ultrasound
CDC Split Type:

Write-up: blood in the urine

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