From the 9/14/2017 release of VAERS data (an older release, current is 2/18/2021):

This is VAERS ID 106427

Case Details

VAERS ID:	106427 (history)
Form:	Version 1.0
Age:	46.0
Sex:	Male
Location:	Tennessee

Vaccinated:	1997-10-03
Onset:	0000-00-00
Submitted:	1997-11-21
Entered:	1998-01-16
Days after submission:	56

Vaccination / Manufacturer	Lot / Dose	Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM	230086 / 2	LA / IM

Administered by: Other Purchased by: Other
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1997-10-07
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:

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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=106427