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From the 6/11/2021 release of VAERS data:

This is VAERS ID 405951



Case Details

VAERS ID: 405951 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Male  
Location: New York  
Vaccinated:2010-10-26
Onset:2010-10-27
   Days after vaccination:1
Submitted: 2010-10-29
   Days after onset:2
Entered: 2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 1 UN / IM

Administered by: Other       Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-10-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: HEADACHE, Swolen painful arms


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