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From the 12/31/2003 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 86284

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Case Details

VAERS ID: 86284 (history)  
Form: Version .0  
Age: 64.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1995-10-11
Onset:1995-10-16
   Days after vaccination:5
Submitted: 1996-05-01
   Days after onset:198
Entered: 1996-05-28
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 / WYETH 4958113 / 0 - / IM

Administered by: Other       Purchased by: Unknown
Symptoms: APNEA, EEG ABNORM, ENCEPHALOPATHY, HALLUCIN, MYOCLONUS
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Haldol
Current Illness: unk
Preexisting Conditions: pt was described as prev healthy;has hx of depression
Allergies:
Diagnostic Lab Data: MRI''s- nondiagnostic; EEG''s-abnormal;Spinal Tap- nondiagnostic
CDC Split Type:

Write-up: pt recv vax 11OCT95&4 days later pt devel hallucinations¶noid ideation;pt hosp w/resp arrest&required mechanical ventilation;pt is now vegetative state;poss creutzfeldt-Jakob disease;also therapy for depression;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=86284


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