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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 97013



Case Details

VAERS ID: 97013 (history)  
Form: Version .0  
Age: 38.0  
Sex: Male  
Location: New York  
Vaccinated:1996-10-23
Onset:1996-10-23
   Days after vaccination:0
Submitted: 1997-02-14
   Days after onset:114
Entered: 1997-04-21
   Days after submission:65
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / 0 LA / -

Administered by: Private       Purchased by: Other
Symptoms: Back pain, CSF test abnormal, Encephalitis, Infection, Muscle atrophy, Myositis, Neuropathy, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EMG/Nerve conduction lower extremities: reportedly abn;CPK: reportedly elevated;CSF: reportedly contained protein;
CDC Split Type: 897072001L

Write-up: pt devel back pain p/vax;exp paresthesias, described as band-like feeling around the abd, arms, & legs as well as flip-flop sensation in feet & puffiness in hands;nerve damage;muscle atrophy;encephalomyelitis;myositis;polyneuropathy synd;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=97013

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