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From the 12/24/2020 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 27290



Case Details

VAERS ID: 27290 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: Ohio  
Vaccinated:1990-10-30
Onset:1990-11-15
   Days after vaccination:16
Submitted: 1990-12-05
   Days after onset:20
Entered: 1991-01-04
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / UNK - / -

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: In pt; aching; 70yrold; Flu vax;~ ()~~~In patient
Other Medications: Capoten
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: kidney infection
CDC Split Type: OH9055

Write-up: Pt vaccinated with FLU experienced vomiting (forceful); Diarrhea.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20201224&IDNUMBER=27290

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