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

This is VAERS ID 427564

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Case Details

VAERS ID: 427564 (history)  
Form: Version 1.0  
Age: 0.37  
Sex: Male  
Location: Idaho  
Vaccinated:2011-05-31
Onset:0000-00-00
Submitted: 2011-06-22
Entered: 2011-07-18
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3741AA / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915375 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1135Z / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-06-21
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: None stated.


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