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

This is VAERS ID 30871



Case Details

VAERS ID: 30871 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Massachusetts  
Vaccinated:1990-11-13
Onset:1990-11-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular
SMQs:, Agranulocytosis (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


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