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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 104867

Case Details

VAERS ID: 104867 (history)  
Form: Version .0  
Age: 38.0  
Sex: Male  
Location: Missouri  
   Days after vaccination:0
Submitted: 1997-11-02
   Days after onset:6
Entered: 1997-11-21
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1997-1998 / CONNAUGHT LABS 7F81755 / - - / IM

Administered by: Unknown       Purchased by: Unknown

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC Split Type:

Write-up: Guillain-Barre synd;

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