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From the 12/31/2003 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 104490



Case Details

VAERS ID: 104490 (history)  
Form: Version .0  
Age: 55.6  
Sex: Female  
Location: Georgia  
Vaccinated:1996-11-01
Onset:1996-11-08
   Days after vaccination:7
Submitted: 1997-09-10
   Days after onset:305
Entered: 1997-11-12
   Days after submission:63
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1996-1997 / MEDEVA PHARMS LI E3036GA / - RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: ANA, CEREBROVASC ACCID, HEADACHE, NEUROPATHY, PAIN
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=104490

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