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From the 6/14/2018 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 1.0  
Age: 73.0  
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
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289905 / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: ~ ()~~~In patient
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=20180614&IDNUMBER=27222

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