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From the 12/31/2003 release of VAERS data (an older release, current is 9/10/2021):

This is VAERS ID 27073



Case Details

VAERS ID: 27073 (history)  
Form: Version .0  
Age: 64.5  
Sex: Male  
Location: Washington  
Vaccinated:1990-11-19
Onset:1990-11-20
   Days after vaccination:1
Submitted: 1990-11-27
   Days after onset:7
Entered: 1990-12-19
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1989-1990 / CONNAUGHT LABS OJ11163 / 2 RA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: FLU SYND, HEADACHE, PAIN NECK, PHOTOPHOBIA
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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC Split Type:

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27073


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