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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1434359

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Case Details

VAERS ID: 1434359 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOSARTAN; SOMAC; BRILIQUE; BISOPROLOL; DIURAMIN; DISPERIN; SEPRAM; ATORVASTATIN
Current Illness:
Preexisting Conditions: Comments: No significant medical history reported.
Allergies:
Diagnostic Lab Data:
CDC Split Type: FIMODERNATX, INC.MOD20212

Write-up: Cerebral haemorrhage; This regulatory authority case was reported by a consumer and describes the occurrence of CEREBRAL HAEMORRHAGE (Cerebral haemorrhage) in a 65-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No significant medical history reported. Concomitant products included LOSARTAN from 04-Jan-2021 to an unknown date for Blood pressure high, TICAGRELOR (BRILIQUE) from 04-Jan-2021 to an unknown date and BISOPROLOL from 04-Jan-2021 to an unknown date for Coronary artery disease, Acetylsalicylic acid (DISPERIN) for Thrombosis prophylaxis, PANTOPRAZOLE SODIUM SESQUIHYDRATE (SOMAC), AMILORIDE HYDROCHLORIDE, HYDROCHLOROTHIAZIDE (DIURAMIN), CITALOPRAM HYDROBROMIDE (SEPRAM) and ATORVASTATIN for an unknown indication. On 20-May-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 21-May-2021, after starting mRNA-1273 (COVID 19 Vaccine Moderna), the patient experienced CEREBRAL HAEMORRHAGE (Cerebral haemorrhage) (seriousness criteria death and medically significant). The patient died in 2021. The reported cause of death was Cerebral haemorrhage. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) was unknown. Date of death was not reported . The action taken with mRNA-1273 was not applicable. This is a case of sudden death in a 63-year-old male subject on medications for high blood pressure, coronary artery disease, thrombosis prophylaxis, who died after receiving first dose of vaccine, the date of death is Unknown. Very limited information has been provided at this time.; Sender''s Comments: This is a case of sudden death in a 63-year-old male subject on medications for high blood pressure, coronary artery disease, thrombosis prophylaxis, who died after receiving first dose of vaccine, the date of death is Unknown. Very limited information has been provided at this time.; Reported Cause(s) of Death: Cerebral haemorrhage


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