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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 92803



Case Details

VAERS ID: 92803 (history)  
Form: Version .0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:1996-10-24
Onset:1996-10-25
   Days after vaccination:1
Submitted: 1996-11-05
   Days after onset:11
Entered: 1996-12-13
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968145 / - - / -

Administered by: Private       Purchased by: Private
Symptoms: Coordination abnormal, Deafness, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Hypoglycaemia (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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 24OCT96 pt recv flu vax, woke up next morning w/dysequilibrium, tinnitus progressive hearing loss in one ear;profound sensorineural hearing loss;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=92803

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