Joao Maria de Souza, 45, had been in bed with his wife Leni when the animal fell through the ceiling of their home in Caratinga, southeastBrazil.
The cow is believed to have escaped from a nearby farm and climbed onto the roof of the couple's house, which backs onto a steep hill on Wednesday night.
The corrugated roof immediately gave way and the one-and-a-half-ton animal fell eight feet onto Mr de Souza's side of the bed.
His wife, and the cow, both reportedly escaped unharmed.
Rescuers took Mr de Souza to hospital with a fractured left leg but no other obvious injuries, reporting that he was conscious and talking normally.
Hours later however he died from internal bleeding while still waiting to be seen by doctors, according to his family.
Mr de Souza's brother-in-law Carlos Correa told Brazil's Hoje em Dia newspaper: "Being crushed by a cow in your bed is the last way you expect to leave this earth.
"But in my view it wasn't the cow that killed our Joao, it was the unacceptable time he spent waiting to be examined."
His grieving mother, Maria de Souza, told Brazil's SuperCanal TV channel: "I didn't bring my son up to be killed by a falling cow."
Police in Caratinga, Minas Gerais state, have launched an inquiry into the bizarre death.
The owner of the cow could be charged with involuntary manslaughter.
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