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

This is VAERS ID 27339



Case Details

VAERS ID: 27339 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Female  
Location: Arizona  
Vaccinated:1990-10-29
Onset:1990-10-30
   Days after vaccination:1
Submitted: 1990-12-27
   Days after onset:58
Entered: 1991-01-08
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11208 / UNK - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Asthenia, Hyperhidrosis, Influenza, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (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 patient
Other Medications:
Current Illness:
Preexisting Conditions: CHF
Allergies:
Diagnostic Lab Data: Blood/Urine Cultures
CDC Split Type: AZ9003

Write-up: Pt vaccinated with Influenza c/o achiness & flu-like s/s first wk. Confirmed febrile - becomes febrile 3-4PM & as high as 102 by 6-7PM, nigh sweats, weakness, nausea.


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