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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1402424

Case Details

VAERS ID: 1402424 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Georgia  
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Brain stem stroke, Cerebrovascular accident, Computerised tomogram head abnormal, Dysphagia, Feeding disorder, Gastrostomy, Headache, Hemiparesis, Illness, Intensive care, Magnetic resonance imaging head abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

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? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hbp medicine Hbp been under control maintained Multi vitamin Type 2 diabetic Blood sugar was under control maintained
Current Illness: None
Preexisting Conditions: Hbp
Allergies: Penicillin
Diagnostic Lab Data: All test done in hospital . MRI CT scan etc
CDC Split Type:

Write-up: Patient had a stroke on June 4. Developed unusual headache evening of June 3. Went to see doctor on June 4 . Bp remained elevated even after taking bp medicine . Doctors office sent him to ER. First it was said he had a aneurysm in heart which was ruled out . Then it was advised to us he had a brain stem stroke . Patient still in icu. Still in hospital as of today .06/16/2021. Patient will be going to pt therapy snd of therapy . Has dysphagia unable to eat and left side weakness . Peg tube inserted . Want to establish if Johnson and Johnson vaccination was linked to him having stroke . Patient current illness was maintained and under control until this event happened suddenly .

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