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From the 12/31/2003 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 27179



Case Details

VAERS ID: 27179 (history)  
Form: Version .0  
Age: 70.2  
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:1990-10-12
Submitted: 1990-12-17
   Days after onset:66
Entered: 1991-01-08
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - RA / -

Administered by: Private       Purchased by: Unknown
Symptoms: NEUROPATHY
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: s/d recent CVA
Preexisting Conditions: diabetes, HTN
Allergies:
Diagnostic Lab Data: EMG''s x2, CT & MRI of head
CDC Split Type:

Write-up: Pt vaccinated with Influenza developed rt brachial plexopathy - primarily in distribution of axillary nerve.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27179

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