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From the 2/14/2018 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 80345



Case Details

VAERS ID: 80345 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: Washington  
Vaccinated:1995-10-12
Onset:1995-10-23
   Days after vaccination:11
Submitted: 1995-12-12
   Days after onset:50
Entered: 1995-12-27
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958112 / 1 RA / IM

Administered by: Public       Purchased by: Private
Symptoms: Dry mouth, Guillain-Barre syndrome, Headache, Hypokinesia, Myasthenic syndrome, Paraesthesia, Paralysis, Tongue oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA951192

Write-up: pt left WA state on 23OCT95 11 days p/vax to travel by car-1st sxs dry throat, lips tingling, tongue felt thick;3NOV h/a, legs shaky, legs gave out-hosp 20NOV-27NOV ascending paralysis;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180214&IDNUMBER=80345

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