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From the 12/30/2020 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 1.0  
Age: 56.0  
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: 1995-06-02
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / UNK - / -

Administered by: Unknown       Purchased by: Private
Symptoms: Chills, Conjunctivitis, Insomnia, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: ~ ()~~~In patient
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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