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From the 6/14/2018 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 27742



Case Details

VAERS ID: 27742 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: California  
Vaccinated:1990-11-16
Onset:1990-11-30
   Days after vaccination:14
Submitted: 1991-01-04
   Days after onset:35
Entered: 1991-02-05
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Chest pain, Chills, Diarrhoea, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA918

Write-up: Slight fever - 99.6 w/onset 30NOV chills x 7 day. Diarrhea; weakness; pain in chest. MD visit on 4DEC90. no dx made.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180614&IDNUMBER=27742

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