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From the 9/17/2021 release of VAERS data:

This is VAERS ID 105612

Case Details

VAERS ID: 105612 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Male  
Location: Maryland  
   Days after vaccination:0
Submitted: 1997-12-10
   Days after onset:50
Entered: 1997-12-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (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: NONE~ ()~~~In patient
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Diagnostic Lab Data: NONE
CDC Split Type: MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;

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