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From the 1/7/2021 release of VAERS data:

This is VAERS ID 25536

Case Details

VAERS ID: 25536 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Male  
Location: Pennsylvania  
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Unknown
Symptoms: Anorexia, Arthritis, Blood creatine phosphokinase increased, Chills, Confusional state, Dehydration, Haematuria, Hepatic function abnormal, Myasthenic syndrome, Oedema, Pain, Purpura, Pyrexia, Synovitis, Tremor, Urinary incontinence, Urine analysis abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (narrow), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes mellitus, allergies to codeine, sulfa drugs
Diagnostic Lab Data: BUN- 30, WBC- 12600, platelet- 695000, ESR- 110, Hct-29, Hgl-10.3 EXTENSIVE SEE WORM
CDC Split Type: WAES90040623

Write-up: Pt dev pain in arms & legs which inc til unable to walk. T to 105, shaking, chills, arthritis, incontinent, poor oral intake. Rt wrist edematous /w pain on mvmt, erythema & effusion. Extensive pt hx & hospital course

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