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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1168352



Case Details

VAERS ID: 1168352 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-26
Onset:2021-03-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / UN

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Confusional state, Diarrhoea, Flushing, Gait inability, Malaise, Muscle spasms, Nausea, SARS-CoV-2 test negative, Toxicologic test, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none other than eye drops
Current Illness: none
Preexisting Conditions: hypertension
Allergies: unknown
Diagnostic Lab Data: Autopsy including toxicology ( pending tax). COVID 19 test done at autopsy was negative.
CDC Split Type:

Write-up: Started feeling ill a few hours after vaccination. Became increasingly ill over the next few days with nausea and vomiting, severe diarrhea, leg cramps that progressed to where he was not able to ambulate, flushed, confused.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1168352


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