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From the 7/7/2013 release of VAERS data (an older release, current is 10/15/2021):

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: 1990-12-26
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RA / -

Administered by: Private       Purchased by: Unknown
Symptoms: Neuropathy
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad)

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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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20130707&IDNUMBER=27179

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