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From the 12/31/2003 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 81047

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Case Details

VAERS ID: 81047 (history)  
Form: Version .0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:1995-09-01
Onset:1995-09-01
   Days after vaccination:0
Submitted: 1995-09-20
   Days after onset:19
Entered: 1996-01-24
   Days after submission:126
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE - / 0 - / IM

Administered by: Public       Purchased by: Unknown
Symptoms: ANOREXIA, DEPRESSION, DYSPEPSIA, EOSINOPHILIA, FEVER
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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: liver enzymes elev
CDC Split Type:

Write-up: pt recvd vax;8 days later, elev liver enzymes, fever, n, noc sweats;to hosp;


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