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

This is VAERS ID 418984

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Case Details

VAERS ID: 418984 (history)  
Form: Version 1.0  
Age: 0.21  
Sex: Female  
Location: Virginia  
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted: 2011-03-11
Entered: 2011-03-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 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: 2011-02-23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS.


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