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From the 12/24/2020 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), Immune-mediated/autoimmune disorders (narrow)

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=20201224&IDNUMBER=80345

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