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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 104866



Case Details

VAERS ID: 104866 (history)  
Form: Version .0  
Age: 64.2  
Sex: Female  
Location: South Carolina  
Vaccinated:1996-11-07
Onset:1996-11-08
   Days after vaccination:1
Submitted: 1997-10-31
   Days after onset:357
Entered: 1997-11-21
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1996-1997 / PARKE-DAVIS - / 0 A / SC

Administered by: Public       Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND, HYPOKINESIA, MYALGIA, PARESTHESIA, TENOSYNOVITIS
SMQs:

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:
Other Medications: Dyazide, premarin, hysterectomy 1980;poss allergy to APAP #3;
Current Illness: NONE
Preexisting Conditions: borderline HTN;
Allergies:
Diagnostic Lab Data: nerve conduction test indicated severe carpal tunnel synd testing for rheumatoid arthritis was negative;
CDC Split Type:

Write-up: pt recv vax 7NOV96 & 8NOV96 pt exp v;13NOV96 pt exp muscle pain in legs, back, shoulder, hands & fingers;exp numbness & tingling in fingertips only;pt dx w/severe CTS;diff performing daily activities;tested for GBS;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=104866

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