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From the 1/7/2022 release of VAERS data:

This is VAERS ID 266811

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Case Details

VAERS ID: 266811 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Female  
Location: Illinois  
   Days after vaccination:40
Submitted: 2006-11-10
   Days after onset:25
Entered: 2006-11-15
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Back pain, Condition aggravated, Pain, Sleep disorder
SMQs:, Retroperitoneal fibrosis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Allopurinol, aspirin, Carbatrol, Furosemide, Synthroid, Zocor, Spironolactone.
Current Illness:
Preexisting Conditions: Upper extremity mass, mass excision, gout, skin cancer, cellulitis, heart attack, cholelithiasis, Arthritis, coronary artery disease, shingles, cholesterol levels raised.
Diagnostic Lab Data:
CDC Split Type: WAES0611USA00187

Write-up: Information has been received from a medical assistant and an 89 year old female consumer with arthritis, increased cholesterol levels, coronary artery disease and shingles. since 9/28/1992 and a history of a mass in the right hand with surgery, gout, skin cancer on her face in 1984, cellulitis, cholelithiasis in 1978 and a heart attack in 1988 and 1989, she had angiogram in 1990 and a 30% double vessel occlusion. On 9/6/06 was vaccinated SC in the right arm with a dose of Varicella zoster virus vaccine live. There was no concomitant vaccinations. Concomitant therapy included Carbatrol, Allopurinol, Synthroid, Simvastatin, Spironolactone, aspirin and Tylenol. The pt thought that one shot of the vaccine would cure her shingles. It was noted that the pt was not experiencing pain from the injection site. the medical assistant also stated that the pt had pain from a previous shingles experience, however, the pain is reportedly worse since receiving the vaccine. The pt was worse later in the day and has interrupted the pts ability to sleep at night. It was reported that the pt did not experienced a rash. The pt had reported that she was previously seen by a neurologist, had acupuncture but nothing works for her shingles. About 3 weeks ago, on approx 10/16/06, the pt was experiencing severe pain in her back area after receiving varicella zoster virus vaccine live. At the time of this report, the pt had not recovered. It was reported that the pts experienced were disabling. Additional information has been requested.

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