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From the 12/30/2020 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 1.0  
Age: 89.0  
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: 1990-12-27
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 2 - / IM A

Administered by: Other       Purchased by: Public
Symptoms: Cough, Productive cough
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (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: 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: LA90121

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=20201230&IDNUMBER=27218

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