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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 27093



Case Details

VAERS ID: 27093 (history)  
Form: Version .0  
Age: 64.4  
Sex: Female  
Location: Florida  
Vaccinated:1990-11-16
Onset:1990-11-16
   Days after vaccination:0
Submitted: 1990-11-21
   Days after onset:5
Entered: 1991-01-08
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 01570P / 0 RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: FEVER, HEADACHE, MALAISE, NAUSEA
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: lactose, demerol, morphine, Irritable bowel
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Influenza developed headache, felt nauseated,temp rose to 101 oral. ""Felt very sick.""


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27093


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