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

This is VAERS ID 1366333



Case Details

VAERS ID: 1366333 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-04-21
Onset:2021-05-04
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Call the Coroners office
CDC Split Type:

Write-up: Death


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1366333

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