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From the 12/30/2006 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 167584

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Case Details

VAERS ID: 167584 (history)  
Form: Version .0  
Age: 39.0  
Sex: Male  
Location: Utah  
   Days after vaccination:0
Submitted: 2001-03-06
   Days after onset:102
Entered: 2001-03-22
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUSHIELD 00-01) / WYETH 4008202 / 1 - / IM

Administered by: Other       Purchased by: Unknown

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Diagnostic Lab Data:
CDC Split Type:

Write-up: After pt received the vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble and on the 3rd day his mouth was not working. They bandaged eye up to keep it moist. As of 3/7/0"1, don''''t have data available. Have to request medical records.

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