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From the 10/8/2021 release of VAERS data:

This is VAERS ID 27159

Case Details

VAERS ID: 27159 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: North Carolina  
Submitted: 1990-12-17
Entered: 1990-12-26
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC Split Type:

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.

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