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From the 5/14/2017 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: 64.0  
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: 1997-11-19
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 0 - / SC A

Administered by: Public       Purchased by: Other
Symptoms: Guillain-Barre syndrome, Hypokinesia, Myalgia, Paraesthesia, Tenosynovitis, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (narrow)

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: 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: 10150970130000

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=20170514&IDNUMBER=104866

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