From the 8/31/2010 release of VAERS data (an older release, current is 1/15/2021):

This is VAERS ID 26504

Case Details

VAERS ID:	26504 (history)
Form:	Version .0
Age:	66.0
Sex:	Female
Location:	Pennsylvania

Vaccinated:	1990-09-26
Onset:	1990-10-14
Days after vaccination:	18
Submitted:	0000-00-00
Entered:	1990-11-06

Vaccination / Manufacturer	Lot / Dose	Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS	01770P / -	LA / IM

Administered by: Unknown Purchased by: Unknown
Symptoms: Cough, Ear pain, Headache, Pharyngitis, Sinusitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow)

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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Physical Exam only
CDC Split Type:

Write-up: Pt vaccinated with FLUOGEN developed sore throat, headache, earache, sinus drainage thru 22OCT90. Cough, congestion chest appt w/ Dr. Given antibiotic & expectorant by MD dx URI. "Symptoms not due to influenza injection."

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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100831&IDNUMBER=26504