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

This is VAERS ID 28416

Case Details

VAERS ID: 28416 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Male  
Location: Georgia  
Vaccinated:1991-01-02
Onset:1991-01-28
   Days after vaccination:26
Submitted: 1991-01-28
   Days after onset:0
Entered: 1991-02-25
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 3 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), 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, 7 days
   Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC Split Type: GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease


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