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

This is VAERS ID 425289

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Case Details

VAERS ID: 425289 (history)  
Form: Version 1.0  
Age: 0.19  
Sex: Female  
Location: Illinois  
Vaccinated:2011-06-10
Onset:2011-06-11
   Days after vaccination:1
Submitted: 2011-06-13
   Days after onset:2
Entered: 2011-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3879AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB972AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1269Z / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-06-11
   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: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: unexplained death


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