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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 27218



Case Details

VAERS ID: 27218 (history)  
Form: Version .0  
Age: 89.7  
Sex: Female  
Location: Louisiana  
Vaccinated:1990-11-01
Onset:1990-11-06
   Days after vaccination:5
Submitted: 1990-12-06
   Days after onset:30
Entered: 1991-01-04
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11221 / 1 A / IM

Administered by: Other       Purchased by: Unknown
Symptoms: COUGH INC, SPUTUM INC
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC Split Type:

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27218

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