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From the 9/14/2018 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 27347



Case Details

VAERS ID: 27347 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Male  
Location: Illinois  
Vaccinated:1990-11-06
Onset:1990-11-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Petechiae, Stomatitis, Thrombocytopenia
SMQs:, Severe cutaneous adverse reactions (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Mantle radiation.
Current Illness:
Preexisting Conditions: Stage I Hodgkin''s receiving mantle irradiation.
Allergies:
Diagnostic Lab Data: Platelet CT on 9NOV90 - 2000 per cubic millimeter
CDC Split Type: 904090010

Write-up: Pt vaccinated w/FLUOGEN developed thrombocytopenia & petechiae, sore mouth, CBC & platelet count revealed a platelet count of 2000 per cubic mm. Diffuse petechial hemorrhages. MD feel prob unrelated to the FLUOGEN to do bone marrow analysis


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180914&IDNUMBER=27347

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