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

This is VAERS ID 1220223



Case Details

VAERS ID: 1220223 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-22
Onset:2021-04-06
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Work       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   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: OFEV, Metformin, Remeron, Prilosec, Prednisone, Xopenex, jardiance, Gabapentin
Current Illness: Interstitial Lung Disease, Bronchiectasis, Coronary Artery Disease, Diabetes
Preexisting Conditions: Interstitial Lung Disease, Bronchiectasis, Diabetes, Coronary Artery Disease
Allergies: Heparin, Furosemide, lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1220223

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