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From the 9/14/2017 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 27278



Case Details

VAERS ID: 27278 (history)  
Form: Version 1.0  
Age: 57.0  
Sex: Male  
Location: Maine  
Vaccinated:1990-12-19
Onset:1990-12-20
   Days after vaccination:1
Submitted: 1990-12-20
   Days after onset:0
Entered: 1991-01-02
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11200 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 287907 / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site oedema, Injection site reaction, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (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: ~ ()~~~In patient
Other Medications: Advil, Theolair
Current Illness: Emphysema no acute
Preexisting Conditions: emphysema/Rt shoulder injury/smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Pneumococcal/FLU ZONE developed malaise, vomited x 1, redness across site rt arm w/swelling. Improved by 12/26/90.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=27278

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