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

This is VAERS ID 424300

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Case Details

VAERS ID: 424300 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Male  
Location: Kentucky  
Vaccinated:2011-05-18
Onset:0000-00-00
Submitted: 2011-05-25
Entered: 2011-05-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (NO BRAND NAME) / SANOFI PASTEUR C3548AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915706 / 2 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Asphyxia, Autopsy, Death, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-05-20
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: Born addicted to drugs. Weaned off morphine & phenobarbital.
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: No known vaccine adverse reactions; parents report father rolled over on infant found unresponsive per mother; preliminary autopsy: asphyxiation per suffocation.


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