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From the 4/30/2021 release of VAERS data:

This is VAERS ID 1012692



Case Details

VAERS ID: 1012692 (history)  
Form: Version 2.0  
Age: 1.42  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-10-26
Onset:2020-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 49TM3 / 4 RL / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 2SM24 / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. T001208 / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH DL2861 / 4 LL / IM

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Death, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-10-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: mild URI symptoms the month prior, so didn''t have her vaccines at that time. She came back for vaccines on 10/26/2020.
Preexisting Conditions: none
Allergies: Amoxicillin allergy
Diagnostic Lab Data: She had not been ill, had no testing done prior to her death.
CDC Split Type:

Write-up: This child died unexpectedly the following morning in her sleep. She has been diagnosed with SUDC (sudden unexplained death of a child). Preliminary autopsy did not uncover any medical issues or problems. There is further testing being done and it may be a few months before all tests are done and final report is available. I do not submit this event as evidence of the cause of this child''s death. However, I need to report this event as it is not clear whether or not the vaccine(s) are related. I had initially planned to wait until final autopsy results were available, but that is taking very long and I wanted to make this report. I submit it today and can provide final autopsy report when I receive it.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1012692


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