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From the 9/17/2021 release of VAERS data:

This is VAERS ID 92049



Case Details

VAERS ID: 92049 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:1996-10-15
Onset:1996-10-15
   Days after vaccination:0
Submitted: 1996-10-26
   Days after onset:11
Entered: 1996-11-18
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968146 / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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: ~ ()~~~In patient
Other Medications: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=92049


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