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From the 5/7/2021 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 1.0  
Age: 80.0  
Sex: Female  
Location: New York  
   Days after vaccination:4
Submitted: 2001-05-01
   Days after onset:371
Entered: 2001-05-10
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: Other
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
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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