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From the 6/14/2018 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 1.0  
Age: 79.0  
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: 1997-01-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00675P / 2 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Chills, Guillain-Barre syndrome, Hypokinesia, Hyponatraemia, Hyporeflexia, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Hyponatraemia/SIADH (narrow), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad)

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~ ()~~~In patient
Other Medications: ASA, Ibuprofen
Current Illness: NONE
Preexisting Conditions: coronary (4-way) bypass 7OCT96;diabetes
Allergies:
Diagnostic Lab Data: EMG (2)
CDC Split Type:

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=20180614&IDNUMBER=93862

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