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

This is VAERS ID 308149



Case Details

VAERS ID: 308149 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New Hampshire  
Vaccinated:2008-03-13
Onset:2008-03-14
   Days after vaccination:1
Submitted: 2008-03-20
   Days after onset:6
Entered: 2008-03-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Autopsy, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-03-14
   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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC Split Type: NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


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