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From the 8/14/2018 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 80969

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Case Details

VAERS ID: 80969 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
   Days after vaccination:10
Submitted: 1996-01-11
   Days after onset:19
Entered: 1996-01-22
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Coordination abnormal
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt also recvd cholera & typhoid vax
Current Illness:
Preexisting Conditions: epilepsy
Diagnostic Lab Data:
CDC Split Type: 950143761

Write-up: pt recvd vax 13DEC95 & 10 days p/vax pt exp broad based ataxia & was hospitalized x 2 days;pt is currently being evaluated by neurologist & is receiving physical therapy;No further details are available @ this time;

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