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From the 12/31/2003 release of VAERS data (an older release, current is 9/17/2021):

This is VAERS ID 27094



Case Details

VAERS ID: 27094 (history)  
Form: Version .0  
Age: 0.0  
Sex: Female  
Location: Oregon  
Vaccinated:1990-10-25
Onset:1990-11-29
   Days after vaccination:35
Submitted: 1990-12-17
   Days after onset:18
Entered: 1991-01-10
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908191 / 0 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: ASTHENIA, CHILLS, DIARRHEA, FEVER, GUILLAIN BARRE SYND
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone?
Current Illness:
Preexisting Conditions: allergy to Septra, Hypertension
Allergies:
Diagnostic Lab Data: Nerve conduction studies suggestive of atypical Guillain Barre, CSF protein normal on 30Nov & 2Dec
CDC Split Type:

Write-up: Guillain Barre Synd onset of weakness on 29Nov90, had illness /w vomiting diarrhea, chills & fever /w onset of 19Nov90 & lasting about 2-3 days


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27094


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