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From the 1/7/2022 release of VAERS data:

This is VAERS ID 107142

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Case Details

VAERS ID: 107142 (history)  
Form: Version 1.0  
Age: 25.0  
Sex: Male  
Location: Connecticut  
Vaccinated:1998-01-28
Onset:1998-01-28
   Days after vaccination:0
Submitted: 1998-01-29
   Days after onset:1
Entered: 1998-02-03
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 553B6 / 1 RA / IM

Administered by: Other       Purchased by: Private
Symptoms: Anaphylactoid reaction, Cyanosis, Dyspnoea, Hypoxia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

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

Write-up: anaphylactic shock rxn occurred 2min p/vax;pt became unconscious, color gray breathing labored while sitting in chair 2min p/vax;epi given by MD;02 started;alert & oriented w/i 1min;monitored 2 1/2hr;


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