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From the 2/14/2017 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 30075

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Case Details

VAERS ID: 30075 (history)  
Form: Version .0  
Age: 67.0  
Sex: Male  
Location: Illinois  
   Days after vaccination:16
Submitted: 1991-01-11
   Days after onset:55
Entered: 1991-04-22
   Days after submission:100
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Diagnostic Lab Data:
CDC Split Type: 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;

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