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

This is VAERS ID 27741



Case Details

VAERS ID: 27741 (history)  
Form: Version .0  
Age: 76.7  
Sex: Female  
Location: California  
Vaccinated:1990-11-19
Onset:1990-11-24
   Days after vaccination:5
Submitted: 1991-01-04
   Days after onset:41
Entered: 1991-02-05
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Rhinitis
SMQs:

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:
Allergies:
Diagnostic Lab Data: PE only
CDC Split Type: CA917

Write-up: Onset 24NOV profuse coryza. MD dx''d sinus infection; tx''d w/Seldane q 12 hrs x 7 days & TCN x 7 days.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100831&IDNUMBER=27741

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