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From the 12/31/2003 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 172391

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Case Details

VAERS ID: 172391 (history)  
Form: Version .0  
Age: 69.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2000-10-06
Onset:2000-10-20
   Days after vaccination:14
Submitted: 2001-05-14
   Days after onset:206
Entered: 2001-06-27
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUVIRIN 00-01) / MEDEVA PHARMS LI E68780KA / - - / IM

Administered by: Public       Purchased by: Unknown
Symptoms: ASTHENIA, COUGH INC, DYSARTHRIA, DYSPHAGIA, PARALYSIS
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-03-20
   Days after onset: 516
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC Split Type:

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2"002 from ALS, unassociated with flu vaccine.


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