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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1334899



Case Details

VAERS ID: 1334899 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-01-01
Onset:2021-04-21
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Computerised tomogram head abnormal, Encephalopathy, Generalised tonic-clonic seizure, Magnetic resonance imaging head abnormal
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Keppra; phenobarbital; cozaar; pristiq; invega
Current Illness: none
Preexisting Conditions: Seizure disorder; mental retardation; cerebral palsy
Allergies: none
Diagnostic Lab Data: ER; CT head 4/21/21 MRI brain 4/22/2021
CDC Split Type:

Write-up: Grand mal seizure; encephalopathy


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1334899

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