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From the 10/14/2018 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 413664

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Case Details

VAERS ID: 413664 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Male  
Location: Rhode Island  
   Days after vaccination:14
Submitted: 2010-12-28
   Days after onset:41
Entered: 2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia
SMQs:, Peripheral neuropathy (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), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-12-02
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Diagnostic Lab Data: No record available.
CDC Split Type:

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.

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