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From the 12/31/2003 release of VAERS data (an older release, current is 1/7/2021):

This is VAERS ID 38869

Case Details

VAERS ID: 38869 (history)  
Form: Version .0  
Age:   
Sex: Unknown  
Location: Illinois  
Vaccinated:1991-11-01
Onset:1991-12-01
   Days after vaccination:30
Submitted: 1991-12-19
   Days after onset:18
Entered: 1992-01-21
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH - / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: CEREBROVASC ACCID
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Not specified;
CDC Split Type:

Write-up: Nursing home pt devel a stroke approx 1 month p/being administered flu vax, pt subsequently expired;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=38869


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