From the 12/31/2003 release of VAERS data (an older release, current is 1/15/2021):

This is VAERS ID 26803

Case Details

VAERS ID:	26803 (history)
Form:	Version .0
Age:	79.8
Sex:	Male
Location:	Massachusetts

Vaccinated:	1990-11-01
Onset:	1990-11-02
Days after vaccination:	1
Submitted:	0000-00-00
Entered:	1990-12-03

Vaccination / Manufacturer	Lot / Dose	Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS	0F11224 / -	RA / SC

Administered by: Public Purchased by: Unknown
Symptoms: COUGH INC, FEVER, FLUTTER ATR, HEART FAIL RIGHT, MYALGIA
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC Split Type:

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=26803