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From the 10/15/2021 release of VAERS data:

This is VAERS ID 28832



Case Details

VAERS ID: 28832 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Male  
Location: Maryland  
Vaccinated:1990-10-25
Onset:1990-10-27
   Days after vaccination:2
Submitted: 1990-11-08
   Days after onset:12
Entered: 1991-03-06
   Days after submission:118
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289906 / UNK RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Back pain, Headache, Injection site reaction
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (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:
Allergies:
Diagnostic Lab Data: BP 130/70
CDC Split Type: MD91003

Write-up: Local rxn rt deltoid/lt deltoid; pain in joints - especially back; headaches.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=28832

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