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From the 5/7/2021 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 1.0  
Age: 38.0  
Sex: Male  
Location: Missouri  
Vaccinated:1997-10-27
Onset:1997-10-27
   Days after vaccination:0
Submitted: 1997-11-02
   Days after onset:6
Entered: 1997-11-19
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
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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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=104867

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