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From the 11/26/2021 release of VAERS data:

This is VAERS ID 81040

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Case Details

VAERS ID: 81040 (history)  
Form: Version 1.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:1995-08-31
Onset:1995-08-31
   Days after vaccination:0
Submitted: 1995-09-13
   Days after onset:13
Entered: 1996-01-03
   Days after submission:112
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: premarin, provera
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950090971

Write-up: pt recvd vax;w/in few hrs exp itching, red welts all over & rash on trunk; to er; tx w/ dph;


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