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From the 11/12/2021 release of VAERS data:

This is VAERS ID 313132

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Case Details

VAERS ID: 313132 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2007-11-29
Onset:2007-12-14
   Days after vaccination:15
Submitted: 2008-05-21
   Days after onset:158
Entered: 2008-05-23
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Dizziness, Herpes zoster, Myocardial infarction, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-01-12
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC Split Type: 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


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