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From the 12/31/2003 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 27174



Case Details

VAERS ID: 27174 (history)  
Form: Version .0  
Age: 20.5  
Sex: Female  
Location: Colorado  
Vaccinated:1990-12-07
Onset:1990-12-07
   Days after vaccination:0
Submitted: 1990-12-11
   Days after onset:4
Entered: 1991-01-11
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 02480P / 0 LA / -

Administered by: Public       Purchased by: Unknown
Symptoms: DIZZINESS, NAUSEA, TINNITUS
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vacc''d w/influenza. Within 10 min., developed dizziness, nausea, & ears rang; assisted to supine position on floor. Felt better in 5 mins. BP 130/70, Pulse 84. No swelling. ER doctor said vasovagal reaction.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27174

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