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

This is VAERS ID 1354740



Case Details

VAERS ID: 1354740 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-24
Onset:2021-05-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   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: oxycodone
Current Illness: hip fracture, metastatic prostate cancer
Preexisting Conditions: COPD, A Fib, HTN, DM
Allergies: No known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1354740

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