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From the 1/14/2022 release of VAERS data:

This is VAERS ID 85389

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Case Details

VAERS ID: 85389 (history)  
Form: Version 1.0  
Age: 38.0  
Sex: Male  
Location: Florida  
Vaccinated:1996-03-12
Onset:1996-03-12
   Days after vaccination:0
Submitted: 1996-03-20
   Days after onset:8
Entered: 1996-04-29
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA460A6 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0229 / 2 LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5F71086 / 2 RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Convulsion, Hyperhidrosis, Pallor, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: head CT neg;EEG neg; electrolytes WNL
CDC Split Type: FL96023

Write-up: passed out, tonic-clonic activity w/incontinence of urine;treated w/2 ammonia capsules;skin pale, diaphoretic BP & HR nl;


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