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From the 5/7/2021 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 81059

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Case Details

VAERS ID: 81059 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:1995-08-14
Onset:1995-09-10
   Days after vaccination:27
Submitted: 1995-10-31
   Days after onset:51
Entered: 1996-01-03
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: in pt, nonresponder at age 64 w/ 1st havrix;~ ()~~~In patient
Other Medications: vasotec
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: anti HAV neg on 12aug95, neg on 10sep95 & neg on 26oct95;
CDC Split Type: 950114251

Write-up: pt recvd vax; 5apr95 & 14aug95 non-responder


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