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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1258576

Case Details

VAERS ID: 1258576 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Arkansas  
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Cerebral infarction, Intensive care, Thrombosis
SMQs:, Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: There are several for the long term conditions listed below. I can submit that information a little later today.
Current Illness: None
Preexisting Conditions: Diabetes High blood pressure High Cholesterol
Allergies: None
Diagnostic Lab Data: We will have to get the from the hospital.
CDC Split Type:

Write-up: Heart went into Atrial fibrillation causing blood clotting. He has no prior heart condition. A blood clot traveled to his brain causing a Posterior Cerebral Artery Stroke. He has been in ICU since 04/22/2021.

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