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

This is VAERS ID 1018448

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Case Details

VAERS ID: 1018448 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-01
Onset:2021-02-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Condition aggravated, Death
SMQs:, 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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg qd. vitamin D. duloxetine, cymbalta 20 mg qd. Jalyn one daily. ferrous sulfate. namenda. spiriva inhaler. zinc 50 mg qd
Current Illness: none
Preexisting Conditions: dementia. hx stroke. carotid disease. emphysema. hyperlipidemia. BPH
Allergies: oxycodone. penicillin. simvastatin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2/6/2021 stroke. 2/8/2021 he died


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