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

This is VAERS ID 1228903



Case Details

VAERS ID: 1228903 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-06
Onset:2021-04-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral, Cerebral haemorrhage, Cerebral venous sinus thrombosis, Computerised tomogram head, Magnetic resonance imaging head
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol amiodarone asa digoxin diltiazem esomeprazole heparin sq ipratropium lactulose ativan metoprolol seroquel
Current Illness: covid19
Preexisting Conditions: rheumatoid arthritis gibleed afib hx cva hx recurrent uti
Allergies: none
Diagnostic Lab Data: ct and cta head 4/9/21 mri brain 4/9/21
CDC Split Type:

Write-up: patient had massive intracerebral hemorrhage 3 days after vaccination. family claims patient was doing well until vaccination. there is a suspicion that patient might have had sinus venous thrombosis that lead to the the ICH.


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