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From the 8/31/2010 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 27363



Case Details

VAERS ID: 27363 (history)  
Form: Version .0  
Age: 66.5  
Sex: Male  
Location: Georgia  
Vaccinated:1990-11-19
Onset:1990-11-19
   Days after vaccination:0
Submitted: 1990-12-10
   Days after onset:21
Entered: 1991-01-10
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 1 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 0 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100831&IDNUMBER=27363

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