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From the 12/31/2003 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 27743



Case Details

VAERS ID: 27743 (history)  
Form: Version .0  
Age: 77.3  
Sex: Female  
Location: California  
Vaccinated:1990-11-06
Onset:1990-11-06
   Days after vaccination:0
Submitted: 1991-01-04
   Days after onset:59
Entered: 1991-02-07
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11203 / 0 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: PAIN INJECT SITE
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:
CDC Split Type:

Write-up: Developed injection site pain; no lump or discoloration. MD visit inconclusive. Advised warm, wet compresses.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27743

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