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From the 12/8/2009 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: 1991-02-05
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABORATORIES 0F11203 / 0 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA919

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


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=27743

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