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From the 6/14/2018 release of VAERS data (an older release, current is 9/10/2021):

This is VAERS ID 71379



Case Details

VAERS ID: 71379 (history)  
Form: Version 1.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:1994-11-08
Onset:1994-12-14
   Days after vaccination:36
Submitted: 1995-01-24
   Days after onset:41
Entered: 1995-02-09
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948195 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Amblyopia, CSF test abnormal, Lymphadenopathy, Meningitis, Myalgia, Nuchal rigidity, Papilloedema, Visual field defect
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (narrow), Optic nerve disorders (narrow), Eosinophilic pneumonia (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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? No
Previous Vaccinations: pt 20-30 years old had photophobia p/measles vax;~ ()~~~In patient
Other Medications: none
Current Illness: unk
Preexisting Conditions: asthma--stable;
Allergies:
Diagnostic Lab Data: MRI nl; LP white cells in CSF, "suggestive of meningitis"; visual field testing--unspecified visual field defect;
CDC Split Type: 895027002A

Write-up: pt recvd vax;devel fever 101;myalgia,ha & noc sweats;stiff neck,swollen glands lt axilla;4th wk began to abate,devel pain over both eyes;c/o blurred vision,saw ophtalmologist who saw a "central blind spot in rt eye" dx:papilledema,cause vax


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