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From the 11/12/2021 release of VAERS data:

This is VAERS ID 314113

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Case Details

VAERS ID: 314113 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Michigan  
Vaccinated:2008-05-19
Onset:2008-05-29
   Days after vaccination:10
Submitted: 2008-05-29
   Days after onset:0
Entered: 2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-05-29
   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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


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