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From the 3/26/2021 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 1105748



Case Details

VAERS ID: 1105748 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-16
Onset:2021-03-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Balance disorder, Blood test abnormal, Computerised tomogram abnormal, Dysarthria, Heart rate irregular, Ischaemic stroke, Magnetic resonance imaging abnormal, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Cardiac arrhythmia terms, nonspecific (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine (NORVASC) asprin (ECOTRIN) metoprolol (LOPRESSOR)
Current Illness: none
Preexisting Conditions: hypertension
Allergies: shellfish, iodine
Diagnostic Lab Data: CT Scan - March 11 MRI - March 11 Blood Tests - March 11-13
CDC Split Type:

Write-up: Thursday, March 11, 2021 (approximately 8:30 am) Patient experienced blurred vision, unbalance, and slurred speech and had an irregular heartbeat. March 11, 2021 (approximately 11:30 am) Patient was admitted to Hospital administered CT scan, MRI and multiple blood tests. Diagnosis - Ischemic Stroke


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210326&IDNUMBER=1105748

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