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

This is VAERS ID 210605

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Case Details

VAERS ID: 210605 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2002-10-14
Onset:2003-02-11
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2003-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Erythema, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Other Medications: Gliglazide, Zalbutamol, Gaviscom Liquid, Mizatidine, Adalai, Metformin, Guinine Sulfmate, Peppermint Oil, Frosemde
Current Illness:
Preexisting Conditions: Hypertension, Diabetes Mellitus, Diverticular Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: PJP200300756

Write-up: A report was received from a health care professional on 10/6/03 concerning a female vaccinee of unspecified age who experienced a red, sore arm with swelling and frozen shoulder with muscle wastage, was considered medically significant an unspecified length of time after receiving Fluvirin on an unspecifieed date in October 2002. On an unspecified date the vaccinee experienced a red, sore arm with swelling which lasted 4 to 6 weeks. The vaccinee had an orthopaedic referral which diagnosed a frozen shoulder with muscle wastage. The outcome of the event was not reported. There was insufficient info to determine the reporter''s causality assessment. Follow up pending.


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