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

This is VAERS ID 27281



Case Details

VAERS ID: 27281 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Female  
Location: Florida  
Vaccinated:1990-11-29
Onset:1990-12-04
   Days after vaccination:5
Submitted: 1990-12-12
   Days after onset:8
Entered: 1991-01-02
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / 5 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: Lanoxin
Current Illness:
Preexisting Conditions: past hx of PVC; pulmonary hypertension Down''s synd
Allergies:
Diagnostic Lab Data: EEG - 24 hrs halter monitor
CDC Split Type: FL9003

Write-up: Pt vaccinated with FLUOGEN passed out at school. Taken to private MD for evaluation.


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