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From the 1/7/2022 release of VAERS data:

This is VAERS ID 1038609

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Case Details

VAERS ID: 1038609 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-27
Onset:2021-02-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Internal capsule infarction, Ischaemic stroke
SMQs:, Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: st johns wort metformin 500mg bid
Current Illness: type 2 diabetes
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: hospitalized at hospital 9 days
CDC Split Type:

Write-up: Atrial fibrillation, ischemic stroke right internal capsule, ER, tpa, recovered much of neurologic deficit


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