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From the 5/14/2017 release of VAERS data (an older release, current is 1/7/2021):

This is VAERS ID 58135

Case Details

VAERS ID: 58135 (history)  
Form: Version .0  
Age: 73.0  
Sex: Male  
Location: Massachusetts  
Submitted: 1993-12-07
Entered: 1993-12-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Infection, Marrow hyperplasia, Pericardial effusion, Pneumonia, Pulmonary haemorrhage, Respiratory disorder, Thrombocytopenia, Thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Myelodysplastic syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Diagnostic Lab Data:
CDC Split Type: CO5163

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;

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