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From the 8/14/2018 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 27346



Case Details

VAERS ID: 27346 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Female  
Location: Michigan  
Vaccinated:1990-11-09
Onset:1990-11-09
   Days after vaccination:0
Submitted: 1991-01-02
   Days after onset:54
Entered: 1991-01-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02070P / UNK RA / -

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Injection site reaction, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Synthroid
Current Illness:
Preexisting Conditions: hypothyroid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with FLU developed persistent muscle aches, weakness at inject site. Lasting 2 months now - no other hx of injury of other arthritic/rheumatic symptoms.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180814&IDNUMBER=27346

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