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From the 12/31/2003 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 134075

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Case Details

VAERS ID: 134075 (history)  
Form: Version .0  
Age: 47.0  
Sex: Female  
Location: Missouri  
Vaccinated:1999-11-02
Onset:1999-11-05
   Days after vaccination:3
Submitted: 2000-02-07
   Days after onset:94
Entered: 2000-02-18
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1999-2000 / CONNAUGHT LABS U0163AA / 3 RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: ARTHRALGIA, EDEMA PERIPH, RASH
SMQs:

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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: tested for lupus, lyme, etc
CDC Split Type:

Write-up: 1 wk following vax, pt dvlped rash & was dxed w/ poison ivy. 2 wks following vax, pt dvlped pain in joints; tx w/ Celebrex & cortisone. On 11/18, pain was so bad & hands were swollen that pt went to ER.Tx w/ Tylenol w/ codeine.


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