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From the 10/15/2021 release of VAERS data:

This is VAERS ID 307158



Case Details

VAERS ID: 307158 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Arkansas  
Vaccinated:2008-02-20
Onset:2008-02-26
   Days after vaccination:6
Submitted: 2008-03-14
   Days after onset:16
Entered: 2008-03-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-03-12
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC Split Type:

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=307158

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