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From the 12/31/2003 release of VAERS data (an older release, current is 1/7/2021):

This is VAERS ID 26605

Case Details

VAERS ID: 26605 (history)  
Form: Version .0  
Age: 75.8  
Sex: Male  
Location: Virginia  
Vaccinated:1990-10-30
Onset:1990-10-30
   Days after vaccination:0
Submitted: 1990-11-01
   Days after onset:2
Entered: 1990-11-13
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS OF11200 / - RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: CHILLS, FEVER
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC Split Type:

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=26605


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