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

This is VAERS ID 199311

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Case Details

VAERS ID: 199311 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2002-11-19
Onset:2002-11-20
   Days after vaccination:1
Submitted: 2003-03-11
   Days after onset:111
Entered: 2003-03-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0983AA / UNK - / -

Administered by: Military       Purchased by: Military
Symptoms: Anxiety, Apnoea, Cholecystitis, Goitre, Influenza like illness, Leukocytosis, Lung disorder, Myositis, Otitis media, Pain, Pharyngitis, Pneumonia, Pneumonitis, Polymyositis, Pulmonary fibrosis, Rhinitis, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Eosinophilic pneumonia (narrow), Hypothyroidism (broad), Hyperthyroidism (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 94 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Several negative-will provide data upon request
CDC Split Type:

Write-up: Body ache, flu-like symptoms that rapidly progressed. Was diagnosed with polymyositis and desquamative interstitial pneumonitis. The discharge summary states polymyositis, pulmonary fibrosis, pneumonia, staph aureus, bacteremia, cholecystitis, respiratory failure, anxiety disorder, and leukocytosis. The 60 day follow up received states polymyositis, interstial lung disease-receiving chemotherapy and steroids. Required to use oxygen 24/7. Readmitted to hospital-3 wk stay-8 days in ICU on ventilator. Must now consider medical retirement. The follow up received on 3/31/03 states, "triggered: polymyositis, interstitial lung disease, MRSA, respiratory failure, original diagnosis congestive heart failure, 94 days in hospital."


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