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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1333061

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Case Details

VAERS ID: 1333061 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-31
Onset:2021-03-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 30042460 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Aneurysm ruptured, Blood pressure measurement, C-reactive protein, Fatigue, Glomerular filtration rate, Headache, Nausea, Procalcitonin, Pyrexia, Subarachnoid haemorrhage
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ATACAND; ASPIRIN CARDIO; CALCIMAGON; ZANIDIP; TORASEMID; NEPHROTRANS
Current Illness: Arterial hypertension; Chronic renal insufficiency; Ischaemic heart disease; Penicillin allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Acute myocardial infarction; Stroke
Allergies:
Diagnostic Lab Data: Test Date: 20210408; Test Name: Blood pressure; Result Unstructured Data: 197/68; Test Date: 20210403; Test Name: C-reactive protein; Test Result: Inconclusive ; Result Unstructured Data: 7.43 mmol/L; Test Date: 20210406; Test Name: C-reactive protein; Test Result: Inconclusive ; Result Unstructured Data: 167 mg/L; Test Date: 20210406; Test Name: Estimated glomerular filtration rate; Test Result: Inconclusive ; Result Unstructured Data: 7 ml/min/1.73m2; Test Date: 20210406; Test Name: Procalcitonin; Test Result: Inconclusive ; Result Unstructured Data: 2.26 microgram per litre
CDC Split Type: CHMODERNATX, INC.MOD20211

Write-up: aneurysm rupture; headache; fever; Fatigue; Nausea; This regulatory authority case was reported by a pharmacist (subsequently medically confirmed) and describes the occurrence of SUBARACHNOID HAEMORRHAGE, ANEURYSM RUPTURED (aneurysm rupture), HEADACHE (headache), PYREXIA (fever), FATIGUE (Fatigue) and NAUSEA (Nausea) in a 78-year-old female patient who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch no. 30042460) for COVID-19 vaccination. The patient''s past medical history included Acute myocardial infarction and Stroke. Concurrent medical conditions included Arterial hypertension, Ischaemic heart disease, Chronic renal insufficiency and Penicillin allergy. Concomitant products included CANDESARTAN CILEXETIL (ATACAND), ACETYLSALICYLIC ACID (ASPIRIN CARDIO) from 03-Apr-2021 to an unknown date, CALCIUM (CALCIMAGON [CALCIUM]), LERCANIDIPINE HYDROCHLORIDE (ZANIDIP), TORASEMIDE (TORASEMID) and SODIUM BICARBONATE (NEPHROTRANS) for an unknown indication. On 31-Mar-2021, the patient received first dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 31-Mar-2021, the patient experienced HEADACHE (headache) (seriousness criteria medically significant and life threatening), PYREXIA (fever) (seriousness criterion medically significant), FATIGUE (Fatigue) (seriousness criterion medically significant) and NAUSEA (Nausea) (seriousness criterion medically significant). On 03-Apr-2021, the patient experienced SUBARACHNOID HAEMORRHAGE (seriousness criteria death and medically significant) and ANEURYSM RUPTURED (aneurysm rupture) (seriousness criteria death and medically significant). On 17-Apr-2021, PYREXIA (fever) and FATIGUE (Fatigue) outcome was unknown. The patient died on 17-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, HEADACHE (headache) and NAUSEA (Nausea) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Apr-2021, C-reactive protein: 7.43 mmol/l (Inconclusive) 7.43 mmol/L. On 06-Apr-2021, C-reactive protein: 167 mg/l (Inconclusive) 167 mg/L. On 06-Apr-2021, Glomerular filtration rate: 7 ml/min/1.73m2 (Inconclusive) 7 ml/min/1.73m2. On 06-Apr-2021, Procalcitonin: 2.26 (Inconclusive) 2.26 microgram per litre. On 08-Apr-2021, Blood pressure measurement: 197/68 (High) 197/68. For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter considered HEADACHE (headache), PYREXIA (fever), FATIGUE (Fatigue) and NAUSEA (Nausea) to be probably related and SUBARACHNOID HAEMORRHAGE and ANEURYSM RUPTURED (aneurysm rupture) to be unlikely related. No treatment medications were reported. This is a case of death in a 78-year-old female subject with a medical history of Ischaemic heart disease, Chronic renal insufficiency and Penicillin allergy, who died 17 days after receiving the first dose of vaccine. Although a temporal association exists, based on the current available information, that the aneurysm rupture leading to subarachnoid hemorrhage and death, the events are assessed as unlikely related to mRNA-1273. Most recent FOLLOW-UP information incorporated above includes: On 06-May-2021: MAH causality and narrative updated according to the company comment. Serious criteria for some events changed.; Sender''s Comments: This is a case of death in a 78-year-old female subject with a medical history of Ischaemic heart disease, Chronic renal insufficiency and Penicillin allergy, who died 17 days after receiving the first dose of vaccine. Although a temporal association exists, based on the current available information, that the aneurysm rupture leading to subarachnoid hemorrhage and death, the events are assessed as unlikely related to mRNA-1273.; Reported Cause(s) of Death: Unknown cause of death


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