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From the 4/30/2021 release of VAERS data:

This is VAERS ID 787241



Case Details

VAERS ID: 787241 (history)  
Form: Version 2.0  
Age: 1.25  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2018-11-15
Onset:2018-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2018-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 57JT9 / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI906AA / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH W28770 / 3 LL / IM

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Drug screen, Resuscitation, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2018-11-16
   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:
Preexisting Conditions: FTT; plagiocephaly
Allergies: NKDA
Diagnostic Lab Data: Drug screen pending. Autopsy pending
CDC Split Type:

Write-up: Patient was found unresponsive in her bed on 11/16/2018 by mom and HH nurse. CPR performed. Patient did not respond. ? possible adverse reaction.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=787241


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