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

This is VAERS ID 422585

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Case Details

VAERS ID: 422585 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Female  
Location: Texas  
Vaccinated:2011-05-09
Onset:2011-05-10
   Days after vaccination:1
Submitted: 2011-05-10
   Days after onset:0
Entered: 2011-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3882AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0230AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915371 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0259AA / 1 MO / PO

Administered by: Unknown       Purchased by: Private
Symptoms: Death, Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-05-10
   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: Fluconazole prescribed for thrush.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy to be performed.
CDC Split Type:

Write-up: Pt noted to be lifeless on awaking in morning. Epistaxis reported by father.


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