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From the 1/15/2021 release of VAERS data:

This is VAERS ID 92037

Case Details

VAERS ID: 92037 (history)  
Form: Version 1.0  
Age: 34.0  
Sex: Male  
Location: New York  
Vaccinated:1996-11-01
Onset:1996-11-11
   Days after vaccination:10
Submitted: 1996-11-12
   Days after onset:1
Entered: 1996-11-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 1 - / IM A

Administered by: Private       Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia
SMQs:, Asthma/bronchospasm (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC Split Type: 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;


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