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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1396856



Case Details

VAERS ID: 1396856 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-25
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Erectile dysfunction, Eye haemorrhage, Sexual dysfunction, Spinal pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retinal disorders (broad), Arthritis (broad), Sexual dysfunction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CZMODERNATX, INC.MOD20212

Write-up: Impotence; Broken blood vessel in eye; Decreased sensitivity in the pelvic area; Lower back pain; This regulatory authority case was reported by a consumer and describes the occurrence of ERECTILE DYSFUNCTION (Impotence), EYE HAEMORRHAGE (Broken blood vessel in eye), SEXUAL DYSFUNCTION (Decreased sensitivity in the pelvic area) and SPINAL PAIN (Lower back pain) in a 48-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No Medical History information was reported. On 25-Mar-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. In March 2021, the patient experienced ERECTILE DYSFUNCTION (Impotence) (seriousness criterion medically significant), EYE HAEMORRHAGE (Broken blood vessel in eye) (seriousness criterion medically significant), SEXUAL DYSFUNCTION (Decreased sensitivity in the pelvic area) (seriousness criterion medically significant) and SPINAL PAIN (Lower back pain) (seriousness criterion medically significant). At the time of the report, ERECTILE DYSFUNCTION (Impotence), EYE HAEMORRHAGE (Broken blood vessel in eye), SEXUAL DYSFUNCTION (Decreased sensitivity in the pelvic area) and SPINAL PAIN (Lower back pain) had not resolved. Concomitant medication use was not provided. No Treatment information was provided. Very limited information regarding these events has been provided at this time. Further information is not expected.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information is not expected.


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