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

This is VAERS ID 379725



Case Details

VAERS ID: 379725 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Male  
Location: Virginia  
Vaccinated:2010-01-08
Onset:2010-01-12
   Days after vaccination:4
Submitted: 2010-02-08
   Days after onset:27
Entered: 2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-01-12
   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: SIDS 1/12/09
CDC Split Type:

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


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