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From the 5/7/2021 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 1018146

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Case Details

VAERS ID: 1018146 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-28
Onset:2021-02-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       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: 2021-02-03
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, carpidopa-levodopa, colchicine, januvia, sertraline HCL, finasteride, valsartan, febuxostat, daily vitamin centrum, vitamin d
Current Illness: None
Preexisting Conditions: Type 2 diabetes, BPH, gout, high blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Four days later, my father had a severe brain aneurysm.


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