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

This is VAERS ID 212546

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Case Details

VAERS ID: 212546 (history)  
Form: Version 1.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2003-10-20
Onset:2003-10-20
   Days after vaccination:0
Submitted: 2003-11-07
   Days after onset:18
Entered: 2003-11-19
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES 765799 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site haemorrhage, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (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:
Current Illness:
Preexisting Conditions: End state renal disease; No known allergies; Had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 58 year old female with previous history of flu vaccination, developed severe pain and ecchymosis from site of injection from right arm to upper portion of arm (above elbow starting 5 hours after injection). The pain was severe requiring treatment with Vicodin. After 20 days, pain subsided, but ecchymosis still present.


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