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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 29302

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Case Details

VAERS ID: 29302 (history)  
Form: Version .0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:1990-11-01
Onset:1990-11-01
   Days after vaccination:0
Submitted: 1991-02-19
   Days after onset:110
Entered: 1991-03-28
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11203 / - LA / IM
PPV: PNU-IMUNE(R)23 / LEDERLE 285909 / 0 RA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: HYSN INJECT SITE, MOVEMENT DIS, PAIN
SMQs:

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: Heart valve condition, lower back pathology, allergic Iodine
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rt arm "extremely sore since pneumonia shot"; States "fever @ site when touched @ exactly where needle went in"; "Can''t raise arm w/out excruciating pain"; "cannot hook bra"; Sleeping w/heating pad; Has not seen MD for arm; Aches X 8 hrs/dy


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