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From the 12/31/2003 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 27304



Case Details

VAERS ID: 27304 (history)  
Form: Version .0  
Age: 82.0  
Sex: Female  
Location: Florida  
Vaccinated:1990-10-30
Onset:1990-11-09
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS - / - - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: ASTHENIA, BRAIN STEM DIS, DYSPHAGIA, HYPERGLYCEM, HYPERTENS
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Catapres, Tambocor, Digoxin, ASA, Clonidine
Current Illness:
Preexisting Conditions: A CVA & Myasthenia gravis have been ruled out.
Allergies:
Diagnostic Lab Data: Spinal Tap & Ct head Scan WNL; Tensilon test - Negative. CSF = wnl, EMG - planned.
CDC Split Type:

Write-up: Pt vac w/FLUOGEN developed brain stem disorder, weakness of extremities & hypertension, bilat ptosis, difficulty speaking & swallowing. Admitted to Hosp BP 217/87, P 70min, R 20min, BS 225 mg/DL. Botulism suspected. Tensilon test neg.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27304

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