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From the 12/8/2009 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 27222



Case Details

VAERS ID: 27222 (history)  
Form: Version .0  
Age: 73.4  
Sex: Female  
Location: Alabama  
Vaccinated:1990-11-02
Onset:1990-11-03
   Days after vaccination:1
Submitted: 1990-12-20
   Days after onset:47
Entered: 1990-12-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS 02380P / - LA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 289905 / 0 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal lesions, non-neoplastic, non-infectious and non-allergic (narrow)

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: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stomatitis one day /p injection


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=27222

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