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

This is VAERS ID 420242

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Case Details

VAERS ID: 420242 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Female  
Location: New Jersey  
Vaccinated:2011-02-25
Onset:2011-03-05
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2011-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1510Z / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 91497Z / 4 UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1321Z / 1 UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Death, Lethargy, Nasopharyngitis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-03-05
   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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her shots on Feb 25, 2011. On Thursday March 3rd patient seemed like she was coming down with a cold. We bathed her and she ended up throwing up what little food she ate for dinner. On Friday March 4th patient seemed OK during the day according to her daycare, but at home that night she seemed lethargic and was running a 100.4 fever. Was given a little infants ADVIL and was put to bed at 8:15pm, checked her at 10:15pm, and then at 3:15 am when she had already passed in her sleep.


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