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From the 9/14/2017 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 100801



Case Details

VAERS ID: 100801 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1993-10-15
Onset:1993-11-04
   Days after vaccination:20
Submitted: 1997-07-25
   Days after onset:1358
Entered: 1997-07-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Amblyopia, Eye disorder, Eye haemorrhage, Hypertension, Laboratory test abnormal, Neuropathy, Visual disturbance, Visual field defect
SMQs:, Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Hypertension (narrow), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: no history of ocular pain, cephalgia, jaw cladication, or preceding illness;NKA;no hx of cat bite, or exposure to cats;no family hx of impaired vision;
Allergies:
Diagnostic Lab Data: The following tests were neg or nl: bilat temporal artery biopsy, MRI of brain & orbits w/ & w/o gadoliniu, lytes, BUN, creatine, alk phos, LDH, SOGT< GGT, SGTP, ESR< CBC, PT, PTT< lupus anticoagulant, Lyme titer, B-12, folate, flucose;
CDC Split Type: 010150970125000

Write-up: pt devel visual loss in both eyes 3wk p/vax;4NOV93 noted blurring of both eyes rt $g lt;BP 130/100;pupillary defect;visual field testing revealed upper nasal island of vision;optic disc swollen & peripapillary hem;allerg react;neuropathy;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=100801

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