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From the 11/12/2021 release of VAERS data:

This is VAERS ID 26721

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Case Details

VAERS ID: 26721 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Male  
Location: Iowa  
   Days after vaccination:9
Submitted: 1990-11-14
   Days after onset:12
Entered: 1990-11-26
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Hypertension (narrow), Demyelination (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC Split Type:

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.

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