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

This is VAERS ID 1264537



Case Details

VAERS ID: 1264537 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-03
Onset:2021-04-19
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ophthalmological examination, Retinal artery occlusion
SMQs:, Embolic and thrombotic events, arterial (narrow), Retinal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 81mg, atorvastatin 80mg, metoprolol 50mg bid, hydralazine 25mg q8, amlodipine 5mg bid
Current Illness:
Preexisting Conditions: thoracic aneurysm, aortic valve regurgitation, cataract, CKD 3, HTN, hyperlipidemia, osteopenia, psoriasis,
Allergies: ciprofloxacin, iv contrast, lisinopril, penicillins, sulfonylureas, vicodin
Diagnostic Lab Data: dilated eye exam
CDC Split Type:

Write-up: left central retinal artery occlusion


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