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

This is VAERS ID 1124826



Case Details

VAERS ID: 1124826 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-26
Onset:2021-02-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebrovascular accident, Computerised tomogram head, Death, Magnetic resonance imaging head, Transient ischaemic attack
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: Mini Stroke (TIA) following 1st vaccine
Other Medications: Plavix, Atenolol 50mg, Rosuvastin Calcium 5mg, Tamsulosin 4mg, and Aspirin 81mg
Current Illness: None
Preexisting Conditions: Taking Atenolol for blood pressure.
Allergies: None
Diagnostic Lab Data: Head CTs and MRIs on January 22nd following the 1st vaccine and again February 28th following the 2nd vaccine.
CDC Split Type:

Write-up: Patient had a mini stroke (TIA) approximately 14 hours after the 1st Moderna COVID vaccine which is when the doctors put him on Plavix, the blood thinner and an aspirin. The patient had a massive stroke with brain hemorrhage within 24 hours of the 2nd Moderna COVID vaccine which resulted in his death.


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