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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 105751



Case Details

VAERS ID: 105751 (history)  
Form: Version .0  
Age: 34.4  
Sex: Female  
Location: California  
Vaccinated:1995-10-03
Onset:1995-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1997-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1997-1998 / CONNAUGHT LABS 5F61113 / 2 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: ARTHRITIS RHEUMAT, LAB TEST ABNORM, MALAISE, MYASTHENIA, PARESTHESIA
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:
Current Illness: NONE
Preexisting Conditions: rheumatoid arthritis;
Allergies:
Diagnostic Lab Data: low blood platelets;elevated rheumatoid factor;carpal tunnel synd
CDC Split Type:

Write-up: muscle fatigue/overall malaise poss rheumatoid arthritis recently dx;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=105751

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