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From the 12/30/2020 release of VAERS data:

This is VAERS ID 28077

Case Details

VAERS ID: 28077 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1990-10-16
Onset:1990-10-31
   Days after vaccination:15
Submitted: 1991-02-07
   Days after onset:99
Entered: 1991-02-12
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / UNK - / -

Administered by: Military       Purchased by: Other
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.


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