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

This is VAERS ID 288921



Case Details

VAERS ID: 288921 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Iowa  
Vaccinated:2007-08-21
Onset:2007-08-23
   Days after vaccination:2
Submitted: 2007-08-24
   Days after onset:1
Entered: 2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 3 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-08-23
   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: none
Current Illness: none - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC Split Type:

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


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