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From the 10/14/2018 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 1.0  
Age: 64.0  
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: 1990-12-18
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908191 / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Chills, Diarrhoea, Guillain-Barre syndrome, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20181014&IDNUMBER=27094


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