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From the 12/31/2003 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 80136



Case Details

VAERS ID: 80136 (history)  
Form: Version .0  
Age: 52.1  
Sex: Female  
Location: South Carolina  
Vaccinated:1995-10-27
Onset:1995-11-04
   Days after vaccination:8
Submitted: 1995-12-06
   Days after onset:32
Entered: 1995-12-21
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 / WYETH 4958079 / 0 LA / -

Administered by: Public       Purchased by: Unknown
Symptoms: CSF ABNORM, GUILLAIN BARRE SYND
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prinivil, Lopid, Glucotrol xl, Synthyroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: protein inc in CSF
CDC Split Type:

Write-up: acute Guillain-Barre Synd; hospitalized 5 days-recvd 5 rounds of immune globulin


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=80136

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