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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1022055

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Case Details

VAERS ID: 1022055 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-20
Onset:2021-01-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Blood urine present, Cerebrovascular accident, Dysstasia, Electrocardiogram, Fall, Flushing, Glycosylated haemoglobin increased, Magnetic resonance imaging, Mobility decreased, Myocardial infarction, Positron emission tomogram, Pyrexia, Sepsis, Urinary tract infection, Urine analysis abnormal
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LEVOTHYROXINE; MEMANTINE; FISH OIL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dementia; Hypertension; Thyroid disorder
Allergies:
Diagnostic Lab Data: Test Date: 20210124; Test Name: Temperature; Result Unstructured Data: Test Result:101; Test Date: 20210124; Test Name: electrocardiogram; Result Unstructured Data: Test Result:Unknown results; Test Name: A1C; Result Unstructured Data: Test Result:6.5; Test Date: 20210124; Test Name: MRI; Result Unstructured Data: Test Result:Unknown results; Test Date: 20210124; Test Name: PET scans; Result Unstructured Data: Test Result:Unknown results; Test Name: Urine test; Result Unstructured Data: Test Result:there was a little blood in his urine
CDC Split Type: USPFIZER INC2021081319

Write-up: Had a mild a heart attack and mild stroke; had a mild a heart attack and mild stroke; urinary tract infection; Blood infection; A1C was 6.5; there was a little blood in his urine; he fell out of bed and couldn''t get up; he was flushed; he had a fever of 101; This is a spontaneous report from a contactable consumer (patient''s wife). A 74-year-old male patient (husband) received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number: EL1283) at 0.3 mL single on 20Jan2021 for COVID-19 immunization. Medical history included thyroid; hypertension, was under control with the medication; dementia, taking memantine as a treatment for dementia, no other impairment other than what he normally has from his dementia. Concomitant medications included levothyroxine; memantine for dementia; fish oil tablet; Vitamins. Patient had a mild heart attack and a slight stroke and he did have urinary tract and blood infection on 24Jan2021. They both had the first dose of the Pfizer covid vaccine on 20Jan2021, Saturday night into Sunday. He was a dementia patient, alert to his name. On 24Jan2021, he fell out of bed and couldn''t get up, he was flushed, so patient''s wife took his temperature, he had a fever of 101. Patient''s wife couldn''t move him, so called the paramedics and they took him to Hospital. Patient''s wife just found out that he had a very mild heart attack and slight stroke, no impairment other than what he normally had from the dementia. Patient''s wife was wondering should he get the second shot and what was the timing of the 2nd dose of vaccine. Reporter seriousness for mild heart attack, slight stroke, urinary tract and blood infection was hospitalization. They also have him on some sort of penicillin derivative for a urinary tract infection. Since he had been to the hospital, he had at his doctor''s office about 2 weeks ago today, he had a blood test, a urine test. His A1C was 6.5, there was a little blood in his urine. For that since Sunday (24Jan2021) he was having MRI, he had a couple of PET scans, he had an electrocardiogram. The neurologist came in to check on him. He was in hospital now. Hospitalization date was 25Jan2021 early in the morning. The outcome of events was unknown.


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