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From the 6/4/2021 release of VAERS data:

This is VAERS ID 992372

Case Details

VAERS ID: 992372 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Oregon  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Atrophy, Cerebral haemorrhage, Cerebral small vessel ischaemic disease, Chest X-ray normal, Computerised tomogram head normal, Death, Embolic cerebellar infarction, Embolic cerebral infarction, Erythema, Laboratory test normal, Magnetic resonance imaging brain abnormal, Mental status changes, SARS-CoV-2 test negative, Troponin increased, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-24
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: (1) Acetaminophen 500mg PO Q4H PRN pain (2) Albuterol inhaler 1 puff Q4H PRN (3) Cyanocobalamin 1000mg PO daily (4) Diazepam 5mg PO daily PRN anxiety (5) Ergocalciferol 48,000 units PO daily (6) Fluoxetine 20mg PO daily (7) Arnicare cream 1
Current Illness:
Preexisting Conditions: (1) Advanced dementia (2) Hypothyroidism (3) Anxiety (4) Hx falls
Allergies: (1) Etodolac (rxn = n/v, diarrhea, SOB) (2) Bee Pollen (3) Escitalopram (rxn = ''intolerance'') (4) Paroxetine (rxn = ''ineffective'') (5) Venlafaxine (rxn = ''ineffective'')
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600. Within one hour, the patient developed altered mental status and increasing weakness. She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94. Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63. Head CT negative. Physical exam was only notable for ''slight superficial erythema over distal right forearm and dorsal hand. No significant edema.'' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR. She was admitted for monitoring given continued altered mental status/weakness. The next day, she continued to show no improvement, so a head MRI was ordered. MRI showed " 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2. Minimal right parietal petechial hemorrhage. 3. Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia " Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis. The patient''s advanced dementia and timeline preclude other intervention. The patient''s status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence). It was reported that date of death was 1/24/21.

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