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From the 4/30/2021 release of VAERS data:

This is VAERS ID 1126732



Case Details

VAERS ID: 1126732 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-16
Onset:2021-03-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Carbidopa / Levodopa, Losartan, Metformin, Methenamine, Metoprolol, Clopidogrel, Venlafaxine, Vitamin D3, Baclofen, Felodipine . No over the counter medications/dietary supplements/ or herbal remedies
Current Illness: None
Preexisting Conditions: Parkinson''s Disease, Multiple System Atrophy (MSA)
Allergies: None
Diagnostic Lab Data: The decedent was transported to the Medical Examiner and an autopsy was performed.
CDC Split Type:

Write-up: The decedent had significant medical conditions. The wife stated, the appointment for the vaccine shot was made on-line. Dept. of Health visited their home on 3/16. The shot was administered into the decedent''s left arm at 0930hrs. The decedent expressed no health complaints and had no visible indications of adverse affects. The decedent was found not breathing supine in bed at 2347hrs 3/16 (same day as vaccine shot).


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