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From the 4/8/2021 release of VAERS data:

This is VAERS ID 59828



Case Details

VAERS ID: 59828 (history)  
Form: Version 1.0  
Age: 58.0  
Sex: Male  
Location: Georgia  
Vaccinated:1993-10-07
Onset:1993-10-21
   Days after vaccination:14
Submitted: 1993-11-19
   Days after onset:29
Entered: 1994-02-14
   Days after submission:87
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 631923 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder
SMQs:, Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-09
   Days after onset: 19
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:
Current Illness: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


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