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

This is VAERS ID 422085

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Case Details

VAERS ID: 422085 (history)  
Form: Version 1.0  
Age: 0.16  
Sex: Female  
Location: Arizona  
Vaccinated:2011-04-22
Onset:2011-04-24
   Days after vaccination:2
Submitted: 2011-04-29
   Days after onset:5
Entered: 2011-05-02
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder
SMQs:, Cardiomyopathy (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-04-24
   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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC Split Type:

Write-up: Death.


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