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From the 12/14/2016 release of VAERS data (an older release, current is 9/10/2021):

This is VAERS ID 27095



Case Details

VAERS ID: 27095 (history)  
Form: Version .0  
Age: 64.4  
Sex: Male  
Location: Oregon  
Vaccinated:1990-11-02
Onset:1990-12-10
   Days after vaccination:38
Submitted: 1990-12-14
   Days after onset:4
Entered: 1990-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)

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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC Split Type:

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20161214&IDNUMBER=27095


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