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

This is VAERS ID 1764588

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Case Details

VAERS ID: 1764588 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-04-01
Onset:2021-09-12
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Blindness unilateral, Computerised tomogram, Echocardiogram, Gene mutation identification test, Hyperhidrosis, Vertebral artery dissection, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Sleep Apnea
Preexisting Conditions:
Allergies: NA
Diagnostic Lab Data: MRA, CT, Echo, Genetics, etc.
CDC Split Type:

Write-up: Left vetribral artery dissection (Spontaneous) higher than where they normally occur. This occured in the area protected by the skull. No known trauma to the area. Sweating, vomiting, temporary loss of vision in one eye.


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