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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1352774

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Case Details

VAERS ID: 1352774 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-12
Onset:2021-05-27
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Aphasia, Arteriogram carotid, Basilar artery occlusion, Cerebrovascular accident, Computerised tomogram head abnormal, Disorganised speech, Magnetic resonance imaging head, Mental status changes, NIH stroke scale score increased
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5 mg QD Aspirin 325 mg QD Lipitor 40 mg QD Lisinopril 40 mg QD
Current Illness: None reported. Patient was baseline functional.
Preexisting Conditions: Hypertension, Hyperlipidemia, possible controlled diabetes (unclear report from family)
Allergies: None
Diagnostic Lab Data: CT Head, CTA head/neck, MRI Brain - all performed on 5/27/2021
CDC Split Type:

Write-up: Acute basilar artery occlusion resulting in CVA: Patient presented as a stroke alert with rapid onset of altered mental status with nonsensical speech, followed by aphasia. Initial NIH of 20. No history of stroke. No history of COVID.


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