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From the 10/8/2021 release of VAERS data:

This is VAERS ID 28558



Case Details

VAERS ID: 28558 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Illinois  
Vaccinated:1989-12-19
Onset:1989-12-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 9F01230 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Haemoptysis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC Split Type: CO3279

Write-up: Fever up to 103F; Coughed up thick mucus which was blood tinged; Seen in ER; 23DEC89 temp down; %JAN90 cough still present; MD did not think cough related to inject;


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