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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 44800

Case Details

VAERS ID: 44800 (history)  
Form: Version .0  
Age: 40.3  
Sex: Female  
Location: Massachusetts  
Vaccinated:1991-11-21
Onset:1991-12-01
   Days after vaccination:10
Submitted: 1992-09-06
   Days after onset:279
Entered: 1992-09-14
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918152 / 0 A / IM
IPV: IPV / MERIEUX INST C1150 / 0 A / SC
MEN: MENOMUNE A/C/Y/W / CONNAUGHT LABS 0M21074 / 0 A / SC

Administered by: Private       Purchased by: Unknown
Symptoms: CHORIORETINITIS, CONJUNCTIVITIS, NEURITIS OPTIC, PHOTOPHOBIA, PUPIL DIS
SMQs:

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, 3 days
   Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE prior to onset began Nafaralin 1DEc & 14DEc d/c
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: inflammation resolved showed multiple bilat retinal defects;
CDC Split Type: NONE

Write-up: 1DEC91 h/a, photophobia; 7DEC91 paralysis of rt pupil, adie''s pupil; pt seen in ER for unequal pupils to r/o aneurysm; inc chemosis; 20DEC91 impaired central vision, bilat, retinas showed mutiple serous detachments, bilat opic disc edema;


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