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From the 4/30/2021 release of VAERS data:

This is VAERS ID 378368



Case Details

VAERS ID: 378368 (history)  
Form: Version 1.0  
Age: 0.51  
Sex: Male  
Location: Michigan  
Vaccinated:2010-01-21
Onset:2010-01-21
   Days after vaccination:0
Submitted: 2010-01-26
   Days after onset:5
Entered: 2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 3 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 1 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 3 MO / PO

Administered by: Other       Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Noninfectious meningitis (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-01-26
   Days after onset: 5
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC Split Type:

Write-up: upper respiratory complaints - admitted to ICU.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=378368


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