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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 80782



Case Details

VAERS ID: 80782 (history)  
Form: Version .0  
Age: 55.6  
Sex: Male  
Location: Washington  
Vaccinated:1995-10-09
Onset:1995-11-20
   Days after vaccination:42
Submitted: 1995-12-12
   Days after onset:22
Entered: 1996-01-16
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 / WYETH 4958112 / 3 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: CSF ABNORM, GUILLAIN BARRE SYND, HYPOKINESIA, MYASTHENIA, NEUROPATHY
SMQs:

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hiv positive in 1987 w/ burkitt''s symphoma;tx w/ xrt & no occurence since;a symptomatic inc amylase due to alcohol;
Allergies:
Diagnostic Lab Data: CSF:0cells, prot=225;CMV pcr neg;EMG consistent w/GBS or severe multifocal mononeuropathy multiplex w/ underlying peripheral sensorimotor poly neuropathy
CDC Split Type:

Write-up: pt recvd vax;30 days later,foot pain,trouble walking;weakness progressed;by day 50 unable to walk;unable to crawl,dress,roll over in bed;EMG consistent w/ GBS or severe non neuropathy multiplex;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=80782

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