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From the 10/8/2021 release of VAERS data:

This is VAERS ID 309426



Case Details

VAERS ID: 309426 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New York  
Vaccinated:2008-04-03
Onset:2008-04-06
   Days after vaccination:3
Submitted: 2008-04-08
   Days after onset:2
Entered: 2008-04-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Death, Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-04-06
   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
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC Split Type:

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=309426

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