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

This is VAERS ID 28564



Case Details

VAERS ID: 28564 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Arthropathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: CO3604

Write-up: Developed myalgis & arthralgias soon p/receiving flu vax in fall of 1987; Seen by rheumatologist who felt she had a polymyalgia synd; Tx nonsteroidal antiinflammatory medication, local injects, physical therapy - (report inc);


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=28564

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