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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 28572

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Case Details

VAERS ID: 28572 (history)  
Form: Version .0  
Age: 52.0  
Sex: Female  
Location: Montana  
Submitted: 0000-00-00
Entered: 1991-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1989-1990 / CONNAUGHT LABS 0J11163 / - A / -

Administered by: Unknown       Purchased by: Unknown

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: not available
Diagnostic Lab Data: not available
CDC Split Type:

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;

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