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From the 11/19/2021 release of VAERS data:

This is VAERS ID 414074

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Case Details

VAERS ID: 414074 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Male  
Location: Colorado  
Vaccinated:2010-08-09
Onset:2010-08-10
   Days after vaccination:1
Submitted: 2011-01-05
   Days after onset:148
Entered: 2011-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3614AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV833DA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E46124 / 2 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-08-10
   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: No
Preexisting Conditions: gastroesophageal reflux treated with ranitidine
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


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