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

This is VAERS ID 1460035

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Case Details

VAERS ID: 1460035 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-16
Onset:2021-06-24
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA C039B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cerebrovascular accident, Death
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatin 5mg qd HCTZ 12.5mg qd Allopurinol 100mg qd
Current Illness:
Preexisting Conditions: HTN, HLD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: According to family and certificate of death, patient suffered from an acute mid-brain cerebrovascular accident and died on 6/24/2021.


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