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From the 5/14/2017 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: 20.0  
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: 1990-12-26
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02480P / 0 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Dizziness, Nausea, Tinnitus
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad)

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO901

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=20170514&IDNUMBER=27174

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