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From the 5/14/2021 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 93142



Case Details

VAERS ID: 93142 (history)  
Form: Version 1.0  
Age: 58.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:1996-10-29
Onset:1996-11-13
   Days after vaccination:15
Submitted: 1996-12-09
   Days after onset:26
Entered: 1996-12-19
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 2 - / -

Administered by: Other       Purchased by: Unknown
Symptoms: Asthenia, Facial palsy, Guillain-Barre syndrome, Hypokinesia, Lacrimal disorder, Myasthenic syndrome, Paraesthesia, Speech disorder
SMQs:, Peripheral neuropathy (narrow), Dementia (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Hearing impairment (broad), Lacrimal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Immune-mediated/autoimmune disorders (narrow)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CAT scan, MRI, back & chest x-ray, EKG;
CDC Split Type:

Write-up: pt recv flu vax 29OCT96 & exp tingling sensation & back pain NOV 12, 14, & 15; severe back pain & numbness in face & lower leg;16 & 17 & 18NOV complete facial & lt leg paralysis;(no prior illness);dx GBS


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210514&IDNUMBER=93142

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