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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1147888



Case Details

VAERS ID: 1147888 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-07
Onset:2021-03-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, COVID-19, Decreased appetite, Dialysis, Dysstasia, Hepatic failure, Mechanical ventilation, Multiple organ dysfunction syndrome, Myocardial infarction, Parosmia, SARS-CoV-2 test positive, Sepsis, Staphylococcal infection, Staphylococcus test positive
SMQs:, Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Taste and smell disorders (narrow), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Chronic kidney disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin for controlled type 2 diabetes and blood pressure medicine.
Current Illness:
Preexisting Conditions: Type 2 diabetes
Allergies: None.
Diagnostic Lab Data: Sepsis 03/27/2021. Fully vented. Full dialysis. Liver failure. Heart Attack, positive for COVID-19 and Staph.
CDC Split Type:

Write-up: No appetite for days. The smell of food made patient sick. On week two after vaccine, oxygen stayed at 84%, patient couldn?t stand as he had no energy. Patient began to eat after lots of convincing and seemed to be doing at least 20% by week 3, but oxygen was still in mid 80%. On day 20 after vaccine patient had to be rushed to the ER due to sepsis. All vital organs began to fail and on transport patient suffered a mild heart attack. Patient was a healthy 78 year old male that lived alone and drove and had no major health issues before the date of the vaccine.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1147888

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