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From the 11/12/2021 release of VAERS data:

This is VAERS ID 172356

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Case Details

VAERS ID: 172356 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Arizona  
Vaccinated:1998-12-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2001-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Abdominal distension, Anaphylactic reaction, Bradyphrenia, Diarrhoea, Dyspnoea, Electrolyte depletion, Headache, Influenza, Nasopharyngitis, Nervousness, Pain, Paralysis, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Pseudomembranous colitis (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: electrolyte drop, and more, etc.
CDC Split Type:

Write-up: General paralysis, cloudiness of mind, breathing difficulties, bloating, chronic colds, flu, runny nose, phlegm, aches, pains in muscles, excessive diarrhea, nervousness, headaches, fever, anaphylaxis and more, etc.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=172356


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