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From the 12/31/2003 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 95597

Case Details

VAERS ID: 95597 (history)  
Form: Version .0  
Age: 78.1  
Sex: Female  
Location: Michigan  
   Days after vaccination:1
Submitted: 1997-01-15
   Days after onset:98
Entered: 1997-03-14
   Days after submission:58
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1996-1997 / WYETH 4968172 / - RA / IM

Administered by: Public       Purchased by: Unknown

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: pt son devel eczema as teenger p/flu vax;
Other Medications: NONE weekly allergy inj
Current Illness: NONE
Preexisting Conditions: allergies to tree, grass & molds;no food allergies;
Diagnostic Lab Data:
CDC Split Type: allergies to tree, grass & molds;no food allergies;

Write-up: pt devel weakness (total body) 9OCT96 AM;pain localized to upper rt arm (?deltoid muscle);felt like tightness-nerve pain that radiated to back (rt scapula area over the next few days);pain went up into face;saw MD-sinus infect/teeth p

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