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From the 2/14/2017 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: 52.0  
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: 1995-12-19
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958079 / 0 LA / -

Administered by: Public       Purchased by: Unknown
Symptoms: CSF test abnormal, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)

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=20170214&IDNUMBER=80136

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