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

This is VAERS ID 1426149



Case Details

VAERS ID: 1426149 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-25
Onset:2021-04-23
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, Amyotrophic lateral sclerosis, COVID-19 pneumonia, Condition aggravated, Death, Nucleic acid test, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID 19 Pneumonia
Preexisting Conditions: advanced amyotrophic lateral sclerosis
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 4/29/2021 Causes of death listed on death certificate: 1) COVID 19 Pneumonia 2) Acute hypoxic respiratory failure 3) advanced amyotrophic lateral sclerosis


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1426149

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