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

This is VAERS ID 432687

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Case Details

VAERS ID: 432687 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Male  
Location: California  
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted: 2011-09-01
Entered: 2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / UNK - / -

Administered by: Unknown       Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Retinal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-08-12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


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