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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1276522

Case Details

VAERS ID: 1276522 (history)  
Form: Version 2.0  
Sex: Male  
Location: Texas  
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Adverse reaction, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210453204

Write-up: DEATH; COMPLICATIONS FROM THE VACCINE; This spontaneous report received from a consumer concerned an adult male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported, once total for prophylactic vaccination. The batch number was not reported. In this scenario follow-up is not required to obtain batch/lot numbers. No concomitant medications were reported. On an unspecified date, two months after vaccination, the patient died of unknown cause. The patient death occurred in hospital. It was also stated that patient had some unspecified complications. iT was also reported that, patient was healthy man in his early sixties. It was unknown, whether autopsy was performed or not. On an unspecified date, the subject experienced death, and complications from the vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on an unspecified date, and the outcome of complications from the vaccine was not reported. This report was serious (Death).; Sender''s Comments: V0:-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s); Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH

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