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From the 9/10/2021 release of VAERS data:

This is VAERS ID 80704



Case Details

VAERS ID: 80704 (history)  
Form: Version 1.0  
Age: 51.0  
Sex: Female  
Location: Ohio  
Vaccinated:1994-11-01
Onset:1994-11-12
   Days after vaccination:11
Submitted: 1995-11-30
   Days after onset:383
Entered: 1996-01-04
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK LA / SC

Administered by: Other       Purchased by: Private
Symptoms: Arthralgia, Emphysema, Hypokinesia, Infection, Influenza, Mental retardation severity unspecified, Thinking abnormal, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: PPD neg; mumps 5mm (24hrs neg 48 hrs; candida neg; Trichapuyton neg
CDC Split Type:

Write-up: frozen shoulder sick in bed w/flu;muscle relaxant & osteopathy,ultrasound 12NOV94,14NOV94,15NOV94 ER severe pain in shoulder,diaphoresis,shaking (like a leaf on a tree in the wind);adm ER to ICU;t101.4;staph aureus septicemia;emphysema


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=80704


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