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From the 9/17/2021 release of VAERS data:

This is VAERS ID 379004



Case Details

VAERS ID: 379004 (history)  
Form: Version 1.0  
Age: 0.11  
Sex: Male  
Location: Oklahoma  
Vaccinated:2010-01-20
Onset:2010-01-21
   Days after vaccination:1
Submitted: 2010-02-01
   Days after onset:11
Entered: 2010-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB762BA / 2 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Asphyxia, Death, Sudden infant death syndrome
SMQs:, Acute central respiratory depression (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-01-21
   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: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: well child check 1-20-2010. Infant received Hepatitis B vaccine on 1-20-2010. Aunt found infant ,on the morning of 1-21-2010, dead in the bed with mother,who was asleep. suspect SIDS or accidental suffocation.


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