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From the 2/14/2017 release of VAERS data (an older release, current is 1/7/2021):

This is VAERS ID 38114

Case Details

VAERS ID: 38114 (history)  
Form: Version .0  
Age: 67.0  
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
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / 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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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=38114


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