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From the 6/11/2021 release of VAERS data:

This is VAERS ID 406994



Case Details

VAERS ID: 406994 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Male  
Location: Kentucky  
Vaccinated:2010-11-03
Onset:2010-11-04
   Days after vaccination:1
Submitted: 2010-11-06
   Days after onset:2
Entered: 2010-11-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 1 LL / UN

Administered by: Public       Purchased by: Public
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-11-04
   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 reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


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