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

This is VAERS ID 93771



Case Details

VAERS ID: 93771 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1996-09-30
Onset:1996-10-02
   Days after vaccination:2
Submitted: 1996-10-09
   Days after onset:7
Entered: 1997-01-13
   Days after submission:96
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Arthralgia, Myalgia, Thinking abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament 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:
Current Illness:
Preexisting Conditions: hx of renal stone
Allergies:
Diagnostic Lab Data: no spinal tap done as per daughter
CDC Split Type:

Write-up: pt recv vax & devel myalgia & arthralgia, abd pain followed by change of mental status;


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=93771


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