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From the 5/7/2021 release of VAERS data:

This is VAERS ID 1110537



Case Details

VAERS ID: 1110537 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-03-12
Onset:2021-03-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Brain herniation, Cerebral haemorrhage, Cerebral mass effect, Computerised tomogram head abnormal, Endotracheal intubation, Neurological symptom
SMQs:, Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN, AMIODARONE, ELIQUIS, LEVOTHYROXINE, LOSATAN, PRIMADONE, TRIMETHOPRIM, NORCOAR, VALIUM
Current Illness: FX FEMUR
Preexisting Conditions: A-FIB, ARTHRITIS, COLON CA COPD, SAD, GERD, HYPERSHOLESTEREMIA, HYPERTENSION, NEUROPATHY
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was found to be having stroke like symptoms 3/15 in the morning at nursing home. he was evaluated and was transported by ambulance from one hospital to another hospital as the CT scanner was down. patient had an injury on march 1 with a cabinet falling on him breaking his femur and family not sure if at that time he had hit his head. Patient was intubated in the ER CT scan showed a massive cerebral bleed with midline shift and transtentorial herniation


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