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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 93862



Case Details

VAERS ID: 93862 (history)  
Form: Version .0  
Age: 79.8  
Sex: Female  
Location: Illinois  
Vaccinated:1996-11-01
Onset:1996-11-12
   Days after vaccination:11
Submitted: 1997-01-10
   Days after onset:59
Entered: 1997-01-19
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1996-1997 / PARKE-DAVIS 00675P / 1 RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: CHILLS, GUILLAIN BARRE SYND, HYPOKINESIA, HYPONATREM, PARESTHESIA
SMQs:

Life Threatening? No
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: NA
Other Medications: ASA, Ibuprofen
Current Illness: NONE
Preexisting Conditions: coronary (4-way) bypass 7OCT96;diabetes
Allergies:
Diagnostic Lab Data: EMG (2)
CDC Split Type: coronary (4-way) bypass 7OCT96;diabetes

Write-up: 12NOV96 unable to stand or walk;low (125) sodium, hands tingling, no reflex in both knees, GBS;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=93862

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