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From the 12/31/2003 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 79638



Case Details

VAERS ID: 79638 (history)  
Form: Version .0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1995-11-09
Entered: 1995-11-30
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH - / - - / -

Administered by: Other       Purchased by: Unknown
Symptoms: ASTHENIA, ATAXIA, DYSPNEA, GUILLAIN BARRE SYND, NEUROPATHY
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? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax in 1990 & devel GBS which resulted in pain, fatigue, neuropathies, muscle weakness, paralyzation, numbness, tingling in the extremities, balance disturbances, SOB, sense of coldness in extremities, paresthesias;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=79638

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