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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1696287

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Case Details

VAERS ID: 1696287 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral ischaemia, Cerebrovascular accident, Embolic stroke, Hemiparesis, Internal capsule infarction, Magnetic resonance imaging head abnormal
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic 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), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

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: Acetaminophen, Atorvastatin, Calcium Carbonate, Clopidogrel, Cyclobenzaprine, Folic Acid, Lisinopril, Methotrexate, Metoprolol, Nitroglycerin, Prednisone, Triamcinolone nasal spray
Current Illness:
Preexisting Conditions: rheumatoid arthritis, coronary artery disease, hypertension, hyperlipidemia, patient is a smoker
Allergies: Allergy to Bactrim
Diagnostic Lab Data: MRI: "multifocal areas of acute ischemia in a pattern suggestive of thromboembolic stroke."
CDC Split Type:

Write-up: Patient received 2nd dose of COVID vaccine on 9/11/21. Presented to hospital on 9/13/21 with worsening right-sided weakness. Teleneurology consult assessment with findings of "stroke, probably left posterior limp interal capsule/small vessel."


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