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From the 8/31/2010 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 27227



Case Details

VAERS ID: 27227 (history)  
Form: Version .0  
Age: 63.0  
Sex: Female  
Location: Maine  
Vaccinated:1990-11-01
Onset:1990-11-10
   Days after vaccination:9
Submitted: 1990-12-18
   Days after onset:38
Entered: 1990-12-28
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 904090016

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100831&IDNUMBER=27227

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