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

This is VAERS ID 27316



Case Details

VAERS ID: 27316 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: Florida  
Vaccinated:1990-10-02
Onset:1990-10-02
   Days after vaccination:0
Submitted: 1990-12-14
   Days after onset:73
Entered: 1991-01-07
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Malaise, Myalgia, Pruritus, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: FL9006

Write-up: Pt vaccinated with FLUOGEN developed rash over trunk w/intense itching 13 hrs after injection. Felt "very bad". Myalgia.


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