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From the 12/31/2003 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 74483

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Case Details

VAERS ID: 74483 (history)  
Form: Version .0  
Age: 56.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1995-05-15
Onset:1995-05-19
   Days after vaccination:4
Submitted: 1995-05-30
   Days after onset:11
Entered: 1995-06-07
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE - / - - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: CHILLS, CONJUNCTIVITIS, FEVER, INSOMNIA, MYALGIA
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin, hytrin, prozac;
Current Illness: none
Preexisting Conditions: Insulin-dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CBC, U/A, ESR, SMA-12 (incl CPK), CXR, EKG all nl;
CDC Split Type:

Write-up: pt recv vax;lower limb girdle ache followed w/in 24 hr upper limb girdle aches;awakened fr sleep;ASA, codeine; no tenderness or weakness;fever to 102R; chills & mild conjunctivitis but disappeared on 28may95;


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