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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1242694

Case Details

VAERS ID: 1242694 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Kentucky  
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Computerised tomogram, Gait disturbance, Hypoaesthesia, Impaired driving ability, Lacunar infarction, Magnetic resonance imaging head abnormal, Scan with contrast, Thrombosis, Ultrasound scan
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Ischaemic 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), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinapril 10mg daily Montelukast 10mg daily Timolol Maleate 1 drop both eyes 2 times per day Venlafaxine 75mg daily Vitamin D3 25mcg daily Biotin 10,000mcg
Current Illness: UVitis - Retasert Implant Colon Rectal Cancer - Surgically removed no treatment or prescription required
Preexisting Conditions: Hypertension - no issues with daily Medication
Allergies: MRI dye
Diagnostic Lab Data: Chest Xray 03/20/21 CT scan with and without contrast 03/20/21 MRI with and without contrast 03/20/21 Echo with and without Bubble test 03/21/21 Cholesterol panel 03/21/21 Misc Blood work-specific test unknown
CDC Split Type:

Write-up: 03/19/21 woke up with numbness on whole right side of body (head to toe). Referred to ER by Family Physician on 03/20/21. admitted to hospital for testing. MRI confirmed a blood clot caused a Lacuna Infarcts Event (type of mini stroke) The patient continues to have numbness and difficulty walking, driving and has affected her normal daily activities. The patient will be required to start Plavix and baby aspirin. Waiting for requirement for Prolong numbness which affects her daily activity.

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