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From the 10/15/2021 release of VAERS data:

This is VAERS ID 414023



Case Details

VAERS ID: 414023 (history)  
Form: Version 1.0  
Age: 0.27  
Sex: Unknown  
Location: New Hampshire  
Vaccinated:2010-10-08
Onset:2010-10-27
   Days after vaccination:19
Submitted: 2011-01-04
   Days after onset:69
Entered: 2011-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB807CA / 2 RL / UN
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3670AA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E57643 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. D07962 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-10-27
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH01042011

Write-up: Pt got birth dose of Hep B 7/31/10 SIDS baby.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=414023

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