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From the 4/8/2021 release of VAERS data:

This is VAERS ID 58871



Case Details

VAERS ID: 58871 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Florida  
Vaccinated:1993-09-28
Onset:1993-12-18
   Days after vaccination:81
Submitted: 1994-01-03
   Days after onset:16
Entered: 1994-01-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 324906 / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Pneumonia
SMQs:, Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC Split Type:

Write-up: respiratory failure, usual interstital pneumonia, death;


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