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From the 2/14/2018 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 435707

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Case Details

VAERS ID: 435707 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Male  
Location: Washington  
Vaccinated:2011-09-22
Onset:2011-09-25
   Days after vaccination:3
Submitted: 2011-09-26
   Days after onset:1
Entered: 2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 3 NS / IN

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-09-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC Split Type:

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.


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