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

This is VAERS ID 414065



Case Details

VAERS ID: 414065 (history)  
Form: Version 1.0  
Age: 0.38  
Sex: Female  
Location: Ohio  
Vaccinated:2010-11-01
Onset:2010-11-16
   Days after vaccination:15
Submitted: 2011-01-05
   Days after onset:50
Entered: 2011-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B099BA / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0524Z / 2 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Bacterial test negative, Brain oedema, Cardiac arrest, Computerised tomogram abnormal, Respiratory arrest, Scan brain, Viral test negative
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2010-11-17
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Patient was tested for viral and bacterial infections, all results were negative. CT showed significant swelling of the brain but no evidence of trauma or bleed.
CDC Split Type:

Write-up: Cessation of respiration, cardiac arrest


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=414065

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