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

This is VAERS ID 1042458

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Case Details

VAERS ID: 1042458 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-26
Onset:2021-02-16
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Cerebral infarction, Cerebrovascular accident, Computerised tomogram head, Hyperlipidaemia, Magnetic resonance imaging brain abnormal, Thrombosis
SMQs:, Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Lipodystrophy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eye drops for glaucoma, omeprazole
Current Illness: None
Preexisting Conditions: Glaucoma
Allergies: None
Diagnostic Lab Data: 2/16/21 CT head: (similar findings on subsequent CT angio and MRI) Large low-density area in left posterior MCA distribution consistent with an acute to early subacute infarct with local mass effect and sulcal effacement as discussed above. There are high density left middle cerebral artery posterior sylvian branches suspicious for thrombosis.
CDC Split Type:

Write-up: Patient admitted with acute stroke, no prior history of same. Mild hyperlipidemia, but otherwise no clear risk factors for stroke. Unclear if anything to do with COVID vaccine.


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