From the 10/14/2018 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 1.0
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:	1992-01-17
Days after submission:	29

Vaccination / Manufacturer	Lot / Dose	Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH	- / UNK	- / -

Administered by: Private Purchased by: Private
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

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: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Not specified;
CDC Split Type: 891360001J

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=20181014&IDNUMBER=38869