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From the 2/14/2018 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 1.0  
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
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
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=20180214&IDNUMBER=27227

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