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From the 11/26/2021 release of VAERS data:

This is VAERS ID 418246

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Case Details

VAERS ID: 418246 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: Massachusetts  
Vaccinated:2011-01-19
Onset:2011-02-28
   Days after vaccination:40
Submitted: 2011-03-03
   Days after onset:3
Entered: 2011-03-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3756AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0319Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914514 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0912Z / 1 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: 2011-02-28
   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: NUTRAMIGEN Lipid with ENFLORA LGG
Current Illness: None
Preexisting Conditions: Allergy to milk products; Esophageal Reflux
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Infant was immunized 1/19/11 DTaP, Hib, IPV, HepB, PCV13, Rotavirus. Infant died ? SIDS.


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