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From the 4/16/2021 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 1172711

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Case Details

VAERS ID: 1172711 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-27
Onset:2021-03-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Computerised tomogram head abnormal, Death, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Benefiber, Duloxetine, Ezetimibe, Famotidine, finasteride, pantoprazole, Tamsulosin, telmisartan-HCT Trulance, Vitamin D3
Current Illness:
Preexisting Conditions: HTN, BPH, GERD, Depression
Allergies: Sulfa
Diagnostic Lab Data: CT Brain; March 29, 2021
CDC Split Type:

Write-up: @nd dose Pfizer on March 27 without immediate problems. Had sudden collapse on March 29, found to have large intracerebral hemorrhage; at local hospital after discussion placed on comfort measures only; died 04/02/2021


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