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

This is VAERS ID 1740571

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Case Details

VAERS ID: 1740571 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Intracranial aneurysm
SMQs:, Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: brain aneurism; This spontaneous case was reported by an other health care professional and describes the occurrence of INTRACRANIAL ANEURYSM (brain aneurism) in an adult female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced INTRACRANIAL ANEURYSM (brain aneurism) (seriousness criteria death and medically significant). The reported cause of death was brain aneurism. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication details were provided. It was reported that the person around it''s 30''s died from a brain aneurism right after receiving the Moderna Vaccine. No treatment information was mentioned. This case concerns female patient of unknown age with no relevant medical history reported, who experienced the unexpected event of intracranial aneurysm. The event occurred on an unknown number of days after the first dose of mRNA-1273 and had a fatal outcome on an unknown date. No autopsy report was provided. The rechallenge was not applicable, as the event happened after the first dose. The benefit-risk relationship of mRNA-1273 is not affected by this report. Further information was requested.; Sender''s Comments: This case concerns female patient of unknown age with no relevant medical history reported, who experienced the unexpected event of intracranial aneurysm. The event occurred on an unknown number of days after the first dose of mRNA-1273 and had a fatal outcome on an unknown date. No autopsy report was provided. The rechallenge was not applicable, as the event happened after the first dose. The benefit-risk relationship of mRNA-1273 is not affected by this report. Further information was requested.; Reported Cause(s) of Death: brain aneurism


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