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From the 12/31/2003 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 169665

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Case Details

VAERS ID: 169665 (history)  
Form: Version .0  
Age: 80.0  
Sex: Female  
Location: New York  
Vaccinated:2000-04-21
Onset:2000-04-25
   Days after vaccination:4
Submitted: 2001-05-01
   Days after onset:371
Entered: 2001-05-17
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUSHIELD 99-00) / WYETH 4008179 / - - / -

Administered by: Public       Purchased by: Unknown
Symptoms: PAIN INJECT SITE
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: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC Split Type:

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


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