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From the 5/7/2021 release of VAERS data:

This is VAERS ID 801449



Case Details

VAERS ID: 801449 (history)  
Form: Version 2.0  
Age: 1.33  
Sex: Male  
Location: North Carolina  
Vaccinated:2019-02-07
Onset:2019-02-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2019-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS GD47F / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. R013302 / 1 RL / SC

Administered by: Private       Purchased by: ?
Symptoms: Influenza virus test negative, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: Anemia diagnosed on 2/7/19
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: Flu test at ER - negative results
CDC Split Type:

Write-up: 2/7/19 - well visit - VARIVAX and FLULAVAL given. 2/8/19 - phone call from parent - fever "high" no temp avail. gave MOTRIN. 2/9/19 - ER visit high fever Tmax 102.5 exam normal d/c to home. 2/12/19 - phone call from parent - concern for vomiting at 4:30pm. Advice given.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=801449


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