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From the 1/14/2022 release of VAERS data:

This is VAERS ID 196595

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Case Details

VAERS ID: 196595 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: Massachusetts  
   Days after vaccination:0
Submitted: 2002-12-30
   Days after onset:38
Entered: 2003-01-22
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: Other
Symptoms: Chills, Erythema, Headache, Injection site induration, Injection site pain, Joint range of motion decreased, Nausea, Oedema, Pyrexia, Shoulder pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid; Lipitor, Avapro, Nadalol; Hydrochort; Ranitidine; Folic Acid
Current Illness: NONE
Preexisting Conditions: High BP; cardiac ischemia ISCHEMIA MYOCARD hypertension HYPERTENS hypothyroid HYPOTHYR esophageal reflux GI DIS anxiety ANXIETY depression DEPRESSION bilateral carpal tunnel TENOSYNOVITIS hypercholesterolemia HYPERCHOLESTEREM
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: I have been receiving flu shots for years. I received a pneumonia shot about 1991. I haven''t had any reaction to either type, on any of those occasions. This 11/22/02, I was advised by those offering innoculations at the senior center that now, all those that had pneumonia shots before they were 65 if 5 or more years have passed, they should have a second shot. On 11/22/03 at about 2:30PM, I was given both the flu shot and the pneumonia shot in the shoulder of my left arm. I was told that both shots were given in the same arm with no problem. About 4PM, first symptoms: increasing pain in the area of where the shots were given. About 5 to 6PM, increased pain and couldn''t lift my arm; upper arm hard at touch and white. About 7:30PM increase in pain in arm and shoulder, headache and sick to my stomach. Was very cold and couldn''t get warm even with additional clothes. At 9PM, went to bed in a lot of pain. 10PM couldn''t put any weight on arm. Shivering constantly even under multiple blankets; temperature of 101 and couldn''t move arm. Very sick all night and fever continued, but was too ill to bother taking temperature and go to the hospital. Just wanted to stay in bed. 11/23 AM brought relief from fever, somewhat; arm hard and now red from shoulder to inner elbow; still extremely painful. Called CDC and couldn''t get to talk to anyone. Was in pain all weekend and Monday called CDC again and was told to call VAERS. I was told that I should fill out a form to report the experience and it would be mailed to me, which I received a few weeks later. I went to the visiting nurse association to get the vaccine information requested on the form sent to me, but had to wait until after the director came back from days off. I am still having weakness and at times pain and soreness in upper arm and shoulder. I am concerned now as to if I should continue to receive either of these types of innoculations, as I have no idea which vaccine was the problem. Nurse follow up on 06/08/044 states: swelling.

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