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From the 12/31/2003 release of VAERS data (an older release, current is 1/7/2021):

This is VAERS ID 35526

Case Details

VAERS ID: 35526 (history)  
Form: Version .0  
Age: 55.8  
Sex: Female  
Location: Wisconsin  
Vaccinated:1990-11-09
Onset:1990-11-24
   Days after vaccination:15
Submitted: 1991-06-07
   Days after onset:194
Entered: 1991-10-22
   Days after submission:137
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908194 / - - / -

Administered by: Other       Purchased by: Unknown
Symptoms: ASTHENIA, GUILLAIN BARRE SYND, HYPERTENS, PARESTHESIA
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC Split Type: NONE

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


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