From the 12/8/2009 release of VAERS data (an older release, current is 1/15/2021):

This is VAERS ID 38114

Case Details

VAERS ID:	38114 (history)
Form:	Version .0
Age:	67.6
Sex:	Female
Location:	Ohio

Vaccinated:	1991-11-22
Onset:	1991-11-30
Days after vaccination:	8
Submitted:	1991-12-06
Days after onset:	6
Entered:	1991-12-23
Days after submission:	17

Vaccination / Manufacturer	Lot / Dose	Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS	01481P / 0	- / IM

Administered by: Private Purchased by: Unknown
Symptoms: CSF test abnormal, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC Split Type:

Write-up: Guillian Barre Synd

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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=38114