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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 75247

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Case Details

VAERS ID: 75247 (history)  
Form: Version .0  
Age: 31.5  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1995-05-12
Onset:1995-05-15
   Days after vaccination:3
Submitted: 1995-06-10
   Days after onset:26
Entered: 1995-06-26
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE V8A427A6 / 0 RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: PRURITUS, RASH MAC PAP
SMQs:

Life Threatening? No
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: Tri-levlin BCP''s;
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Nonerythematous papular rash, pruritic, generalized @ 10 days; began @ 3 d p/immunization; rx: DPH/chlortrimeton;


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