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

This is VAERS ID 1028166



Case Details

VAERS ID: 1028166 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-09
Onset:2021-02-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cerebral haemorrhage, Computerised tomogram head abnormal, Death, Unresponsive to stimuli
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: See Continuation Page MEDICATION, DOSAGE, FREQUENCY Coreg,6.25 mg,Twice daily Hydralazine HCL,10 mg,Twice daily Isosorbide mononitrate ,30 mg,Once Daily Warfarin,20.5 mg,per week Acyclovir ,800mg,4x Daily Atropine Sulphate, 1% Op Sol,Tw
Current Illness: Glaucoma, corneal virus in right eye, IBS
Preexisting Conditions: IBS with Constipation/Diarrhea, atrial fibrillation, heart failure, and osteoporosis. Had a known brain aneurysm that had been scanned annually which showed no signs of change. Dr. was her primary care physician and has most of her medical records. CNA gave her cardiology care. Endocrinologist, treated her osteoporosis and gave her a Prolia injection twice yearly. Her newest medication was Acyclovir, 800mg, 4x Daily prescribed by doctor for her right eye.
Allergies: ALLERGIC to monopril
Diagnostic Lab Data: CT Scan
CDC Split Type:

Write-up: Patient was found unresponsive on her kitchen floor about 9:45 AM on February 10, 2021 approximately 18 hours after receiving her first Covid-19 vaccination. Exact time of the event is unknown. She was known to get up between 6:30 and 7:30 AM. It appeared that she had not eaten breakfast nor taken any medication that morning. She was taken by ambulance to Medical Center where a CT scan showed an unrecoverable massive brain hemorrhage. She died at approximately 3:50 PM after the respirator was removed. She was sent to the local Medical Examiner afterwards.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1028166


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