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From the 12/31/2003 release of VAERS data (an older release, current is 1/15/2021):

This is VAERS ID 26708

Case Details

VAERS ID: 26708 (history)  
Form: Version .0  
Age: 44.9  
Sex: Male  
Location: New York  
Vaccinated:1990-11-07
Onset:1990-11-07
   Days after vaccination:0
Submitted: 1990-11-08
   Days after onset:1
Entered: 1990-11-27
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: CHILLS, COUGH INC, FEVER, RHINITIS, SWEAT
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: In pt at 38yo flu.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with FLU developed fever, chills & sweating, cough, runny nose.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=26708


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