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

This is VAERS ID 199740

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Case Details

VAERS ID: 199740 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2002-11-06
Onset:2002-11-07
   Days after vaccination:1
Submitted: 2003-02-24
   Days after onset:109
Entered: 2003-03-18
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0950AA / 7+ RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0445M / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Hot flush, Injection site erythema, Injection site oedema, Injection site pain, Injection site warmth, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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? No
Previous Vaccinations:
Other Medications: Tylenol with codeine 2 prn day, Elavil at HS 25mg, Triamt/HTZ 5 day
Current Illness: NONE
Preexisting Conditions: Heart surgery at age 35 ? ductus arterosus; 1986 injury to neck C5-6 followed by ?, shoulder dislocation 1983
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Received vaccine 11/6/02. Saw physician 11/8/02 with localized pain. Large area of erythema, warmth, tenderness and edema affecting the upper extremity. Pt states symptoms have slightly improved over last 12-24 hrs. Pt noticed tingling in arm on evening 1/6/02 felt like "a warm fluid." Symptoms stayed constant 2 days going away on 3rd day. Now arm really really tender. Has hot flashes of arm being hot. Always tingly. The information entered in box #13 is from the documentation in the pt''s medical record. However, the pt insists he was given the pneumonia shot in the right arm and that is what he reacted to. He stated the nurse told him which arm each was injected into-states he remembers his left arm bled after the flu shot and he didn''t bleed after the pneumonia shot. Per 60 day follow up: It is unknown if the patient has recovered. The patient has not been seen at clinic since 11/08/2002. Pt. returned for an influenza vaccination 11/20/03. He had no other physician visits since 11-08-02.


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