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

This is VAERS ID 427623

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Case Details

VAERS ID: 427623 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Female  
Location: Missouri  
Vaccinated:2011-06-07
Onset:2011-06-07
   Days after vaccination:0
Submitted: 2011-07-18
   Days after onset:41
Entered: 2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 2 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Autopsy, Death, Irritability, Sudden infant death syndrome
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-06-12
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC Split Type:

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


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