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

This is VAERS ID 1364855



Case Details

VAERS ID: 1364855 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-29
Onset:2021-04-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Headache, Laboratory test, Nausea, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: High blood pressure
Preexisting Conditions: High blood pressure, high cholesterol, CAD
Allergies: None
Diagnostic Lab Data: Vertigo test
CDC Split Type:

Write-up: Dizziness, blurred vision, headache, nausea


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1364855

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