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

This is VAERS ID 28340

Case Details

VAERS ID: 28340 (history)  
Form: Version 1.0  
Age: 58.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1990-11-09
Onset:1990-11-20
   Days after vaccination:11
Submitted: 1991-02-14
   Days after onset:86
Entered: 1991-02-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02680P / UNK LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paralysis
SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC Split Type:

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91


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