From the 12/30/2020 release of VAERS data (an older release, current is 2/18/2021):

This is VAERS ID 27529

Case Details

VAERS ID:	27529 (history)
Form:	Version 1.0
Age:	78.0
Sex:	Female
Location:	New Hampshire

Vaccinated:	1990-11-06
Onset:	1990-11-07
Days after vaccination:	1
Submitted:	1991-01-18
Days after onset:	72
Entered:	1991-01-24
Days after submission:	6

Vaccination / Manufacturer	Lot / Dose	Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES	0F11226 / UNK	- / -

Administered by: Unknown Purchased by: Unknown
Symptoms: Right ventricular failure
SMQs:, Cardiac failure (narrow), Pulmonary hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-12-10
Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.

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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20201230&IDNUMBER=27529