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From the 9/10/2021 release of VAERS data:

This is VAERS ID 27168



Case Details

VAERS ID: 27168 (history)  
Form: Version 1.0  
Age: 27.0  
Sex: Female  
Location: Illinois  
Vaccinated:1990-10-24
Onset:1990-11-12
   Days after vaccination:19
Submitted: 1990-12-17
   Days after onset:35
Entered: 1990-12-26
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Chills, Hypersensitivity, Nausea, Pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin 2x daily to manage diabetes
Current Illness:
Preexisting Conditions: Diabetes, type 1
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 11/7/90, developed chills, nausea, 103 fever, achiness, lasted 24-36 hrs treated w/aspirin/rest. 11/12/90 severe allergic rxn, hives on arms, neck, back, legs, face & throat. ER gave adrenaline inject. Treated hives w/Benadryl.


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