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From the 9/14/2017 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 27363



Case Details

VAERS ID: 27363 (history)  
Form: Version 1.0  
Age: 66.0  
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
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 2 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 1 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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: ~ ()~~~In patient
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=20170914&IDNUMBER=27363

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