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

This is VAERS ID 58884



Case Details

VAERS ID: 58884 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1993-10-14
Onset:1993-10-28
   Days after vaccination:14
Submitted: 1993-12-29
   Days after onset:62
Entered: 1994-01-10
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock
SMQs:, Acute renal failure (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-11-27
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=58884


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