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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1124671



Case Details

VAERS ID: 1124671 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-05
Onset:2021-03-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Death, Disorientation, Fall, Head injury, Subdural haematoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-10
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ATORVASTATIN; GLIMEPIRIDE; LISINOPRIL; METFORMIN XR; PROPANOLOL ; COUMADIN; CENTRUM SILVER VITAMIN DAILY
Current Illness:
Preexisting Conditions: Type 2 diabetes, High Cholesterol, Hypertension, sequelae of heart valve replacement and double bypass 30 yrs ag
Allergies:
Diagnostic Lab Data: Cat scans on 3/9 (negative for bleeding); 3/10 (positive for bleeding and hematoma)
CDC Split Type:

Write-up: 3 days after vaccination, person was somewhat disoriented. 4th day after vaccination, patient fell, hit head and developed subdural hematoma from which he subsequently died.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1124671

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