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From the 9/17/2021 release of VAERS data:

This is VAERS ID 288181



Case Details

VAERS ID: 288181 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:2007-08-03
Onset:2007-08-09
   Days after vaccination:6
Submitted: 2007-08-14
   Days after onset:5
Entered: 2007-08-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-08-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


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