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From the 5/14/2017 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: 79.0  
Sex: Male  
Location: Massachusetts  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Pulmonary hypertension (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: ~ ()~~~In patient
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
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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