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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 46526

Case Details

VAERS ID: 46526 (history)  
Form: Version .0  
Age: 56.2  
Sex: Male  
Location: California  
Vaccinated:1992-10-12
Onset:1992-10-14
   Days after vaccination:2
Submitted: 1992-10-16
   Days after onset:2
Entered: 1992-10-30
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1992-1993 / WYETH 4928234 / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: APNEA, CARDIOMEGALY, CONFUS, EDEMA LUNG, HYPOTENS
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-10-16
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: following Hemodialysis
Preexisting Conditions: pt had chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd flu vax & devel sudden onset of hypotension, hypoglycemia & chills; pt suffered a cardiac arrest & was hospitalized & died;


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