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

This is VAERS ID 421334

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Case Details

VAERS ID: 421334 (history)  
Form: Version 1.0  
Age: 0.82  
Sex: Male  
Location: New Hampshire  
Vaccinated:2010-12-09
Onset:2011-01-27
   Days after vaccination:49
Submitted: 2011-04-19
   Days after onset:81
Entered: 2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 3 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-01-27
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 04192011

Write-up: None stated.


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