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From the 8/14/2018 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 1.0  
Age: 39.0  
Sex: Male  
Location: Utah  
   Days after vaccination:0
Submitted: 2001-03-06
   Days after onset:102
Entered: 2001-03-21
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder
SMQs:, Peripheral neuropathy (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Corneal disorders (broad), Retinal disorders (broad)

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 the patient received his 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. On the third day his mouth was not working. They bandaged the eye up to keep it moist.

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