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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 26711

Case Details

VAERS ID: 26711 (history)  
Form: Version .0  
Age: 63.6  
Sex: Male  
Location: California  
Vaccinated:1990-10-18
Onset:1990-10-18
   Days after vaccination:0
Submitted: 1990-11-09
   Days after onset:22
Entered: 1990-11-27
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11203 / 1 - / -

Administered by: Public       Purchased by: Unknown
Symptoms: EDEMA FACE
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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Fluzone developed facial swelling seen on 19OCT90 face was red with periorbital swelling. Benadryl 25 mg 1 or 2 caps every 8 hours.


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