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From the 12/31/2003 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 104611



Case Details

VAERS ID: 104611 (history)  
Form: Version .0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1997-10-24
Entered: 1997-11-14
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH - / - - / -

Administered by: Other       Purchased by: Unknown
Symptoms: REACT UNEVAL
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax & exp injuries which will be w/pt throughout the rest of life;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=104611

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