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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1026534



Case Details

VAERS ID: 1026534 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-03
Onset:2021-02-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cerebrovascular accident, 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: 2021-02-09
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: senna, pantoprazole, vit D2, fluoxetine, folic acid, melatonin, metoprolol
Current Illness:
Preexisting Conditions: , HTN, CKD, Alzheimer''s
Allergies: ciprodex
Diagnostic Lab Data:
CDC Split Type:

Write-up: resident had a stroke, sent to the hospital and died 4 days later


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1026534


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