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From the 9/17/2021 release of VAERS data:

This is VAERS ID 27252



Case Details

VAERS ID: 27252 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: West Virginia  
Vaccinated:1990-11-02
Onset:1990-11-03
   Days after vaccination:1
Submitted: 1990-11-20
   Days after onset:17
Entered: 1990-12-31
   Days after submission:41
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02780P / UNK LA / -

Administered by: Public       Purchased by: Public
Symptoms: Myalgia, Pharyngitis
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: In pt; flu-like symptoms; 69yr old; FLU; 1 dose~ ()~~~In patient
Other Medications: Indural, Lanoxin, Ascriptin
Current Illness:
Preexisting Conditions: hx of cardiac problems
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated w/Influenza 1 day after immunization pt c/o throat & aching all over.


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