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From the 9/17/2021 release of VAERS data:

This is VAERS ID 105543



Case Details

VAERS ID: 105543 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Male  
Location: Indiana  
Vaccinated:1996-11-12
Onset:1996-11-18
   Days after vaccination:6
Submitted: 1997-12-02
   Days after onset:379
Entered: 1997-12-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F71277 / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hypotension, Hypoxia, Infection, Influenza, Neck pain, Paralysis, Pneumonia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad)

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, 35 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: ASA;Valium, Vicodin, Procan, Daypro
Current Illness:
Preexisting Conditions: SDMA coumpound, nalfon;degenerative disc disease lumars
Allergies:
Diagnostic Lab Data: blood test, spinal tap, MRI, NCV, EMG, EKG
CDC Split Type:

Write-up: flu like sx wk of 17NOV96 & again wk of 8DEC96;pain in neck & shoulders 23DEC96;weakness 24DEC96;collapsed in floor 26DEC96;hosp 27DEC97 transferred to rehab ctr 31JAN97;totally paralyzed staph pneumonia;T107.4;


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=105543


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