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

This is VAERS ID 1354796



Case Details

VAERS ID: 1354796 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Autopsy, Death, Dyspnoea, Headache, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Symbicort, Proair, Lasix, Cozaar, Lopressor, Crestor, Vitamin D, Synthroid, Metformin
Current Illness:
Preexisting Conditions: Hypertension, Diabetes mellitus, Obesity, COPD
Allergies: Unknown
Diagnostic Lab Data: External examination performed on May 24, 2021 (no knowledge of vaccination date). Autopsy performed on May 27, 2021. No blood clots identified. Evidence of COPD, prior MI, coronary artery disease, aortic atherosclerosis, atrophic left kidney, prior stroke. Condition of the body (decomposition) affects the appearance/condition of the organs which precludes a full evaluation.
CDC Split Type:

Write-up: According to the family, he had symptoms of weakness, nausea, headache, difficulty breathing beginning May 15, 2021. They spoke with him on Sunday, May 16, 2021 and he was continuing to have symptoms. On Monday, May 17, he called one of his daughters, but she missed the call. The family tried to call him on May 18- and May 19, but they couldn''t reach him. A welfare check was initiated on May 20; however, the police didn''t enter the residence. He was found dead in his bed on May 21, 2021, with changes of decomposition.


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