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From the 11/12/2021 release of VAERS data:

This is VAERS ID 417195

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Case Details

VAERS ID: 417195 (history)  
Form: Version 1.0  
Age: 0.19  
Sex: Female  
Location: Florida  
Vaccinated:2011-02-09
Onset:2011-02-10
   Days after vaccination:1
Submitted: 2011-02-18
   Days after onset:8
Entered: 2011-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3771AA/C3613AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914515 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0525Z / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Death, Hypoxia, Resuscitation
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-02-16
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synagis given on 1/17/2011
Current Illness: No
Preexisting Conditions: History of prematurity
Allergies:
Diagnostic Lab Data: Please refer to hospital records.
CDC Split Type:

Write-up: Baby was found apneic in bed with parents. She was resuscitated, but died of complications of hypoxia.


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