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From the 1/7/2021 release of VAERS data:

This is VAERS ID 25521

Case Details

VAERS ID: 25521 (history)  
Form: Version 1.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1990-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Unknown
Symptoms: Back pain, Dizziness, Drug ineffective, Dyspnoea, Hepatic function abnormal, Hypokalaemia, Nausea, Pallor, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow)

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, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ogen, Prinzide, Synthroid, Vivactil
Current Illness: Gallbladder removed 30 yrs ago;
Preexisting Conditions: Hypothyroid, Hypertension; Allergic to Codeine, sulfa;
Diagnostic Lab Data: LDH inc, GGTP inc, SGOT inc, Liver func Abnorm, CAT SCAN of ADBOMEN was negative
CDC Split Type: EBU900128

Write-up: Pt given Engerix-B experienced dizziness, non responder, feeling of faintness, flank pain rt side, nausea became very pale, decreased potassium, and back pain rt side. Was admitted to hospital given Phenergan 25 mg & Demerol to relieve pain

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