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From the 12/8/2009 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: 1997-11-10
   Days after submission:61
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN 96-97) / MEDEVA PHARMA, LTD. E3036GA / - RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Antinuclear antibody, Cerebrovascular accident, Condition aggravated, Headache, Neuropathy, Pain, Paraesthesia, Visual disturbance
SMQs:, Peripheral neuropathy (narrow), Ischaemic cerebrovascular conditions (narrow), Haemorrhagic cerebrovascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad)

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: GA97124

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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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=104490

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