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

This is VAERS ID 92507

Case Details

VAERS ID: 92507 (history)  
Form: Version 1.0  
Age: 39.0  
Sex: Female  
Location: Michigan  
Vaccinated:1996-10-18
Onset:1996-10-18
   Days after vaccination:0
Submitted: 1996-11-22
   Days after onset:35
Entered: 1996-12-03
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Amnesia, Asthenia, Myasthenic syndrome, Neuropathy, Paraesthesia, Peripheral vascular disorder, Pyrexia, Vasodilatation
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 0010150960040

Write-up: pt felt flushed & warm;by evening pt feet were cold like had bad circulation & devel numbness & tingling & felt like was walking on pins;also devel weakness 19OCT96;22OCT96 exp fluttering in abd;exp memory loss, neuro c/o weakness, fatigue


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