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

This is VAERS ID 1362130



Case Details

VAERS ID: 1362130 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-17
Onset:2021-04-13
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary, Aortic thrombosis, Brain herniation, Cerebrovascular accident, Computerised tomogram head abnormal, Computerised tomogram thorax abnormal, Death, Ischaemic stroke, Laboratory test, Magnetic resonance imaging, Neurological symptom, Peripheral artery thrombosis
SMQs:, 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), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   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: Abaloparatide 80mg sc daily Colestipol 1gm BID Famotidine 20mg daily Gabapentin HCTZ 25mg daily Metformin 500mg BID Venlafaxine 1 cap daily Hydromorphone 4mg prn pain
Current Illness:
Preexisting Conditions: T2DM HTN Obesity Esophageal stricture Depression Eczema He H pylori infection
Allergies: Benzoic acid
Diagnostic Lab Data: Multiple labs, head & chest CT scans, CTA chest, MRI?s.
CDC Split Type:

Write-up: Acute onset stroke symptoms the afternoon of 4/13/21 after returning home from room. EMS transported pt to local hospital. Dx with aortic arch/proximal subclavian artery thrombus, migration into axillary artery. Treated at local hospital with TNK for aortic arch clot & ischemic stroke. Transferred to tertiary medical center. Pt had massive stroke (left & right side) with brain stem herniation. Pt CMO after 16hrs and expired on 4/14, <32 hrs after symptom onset.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1362130

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