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From the 12/31/2003 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 27291



Case Details

VAERS ID: 27291 (history)  
Form: Version .0  
Age: 68.6  
Sex: Male  
Location: Ohio  
Vaccinated:1990-11-01
Onset:1990-11-01
   Days after vaccination:0
Submitted: 1990-11-17
   Days after onset:16
Entered: 1991-01-08
   Days after submission:52
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11222 / - LA / -

Administered by: Public       Purchased by: Unknown
Symptoms: ASTHMA, BRONCHITIS, NECK RIGID, PHARYNGITIS
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BP, diuretics, K+, & heart med
Current Illness: developed stiff neck at clinic.
Preexisting Conditions: Increased BP, Heart trouble, asthmatic Bronchitis.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated w/FLU developed sore throat & stiff neck. Dr told pt that he''d seen 5 other people who had got flu shots (seen same day as pt).


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27291

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