From the 12/8/2009 release of VAERS data (an older release, current is 1/15/2021):

This is VAERS ID 26463

Case Details

VAERS ID:	26463 (history)
Form:	Version .0
Age:	62.9
Sex:	Female
Location:	Michigan

Vaccinated:	1990-10-01
Onset:	1990-10-01
Days after vaccination:	0
Submitted:	1990-10-17
Days after onset:	16
Entered:	1990-11-02
Days after submission:	16

Vaccination / Manufacturer	Lot / Dose	Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) / WYETH PHARMACEUTICALS, INC	4908209 / -	LA / IM

Administered by: Private Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-16
Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC Split Type: 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX

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