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From the 10/8/2021 release of VAERS data:

This is VAERS ID 906303



Case Details

VAERS ID: 906303 (history)  
Form: Version 2.0  
Age: 0.58  
Sex: Female  
Location: North Carolina  
Vaccinated:2020-12-17
Onset:2020-12-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ350AA / UNK RL / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS DE7TB / UNK LL / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 4CL44 / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH D12971 / UNK LL / IM

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Cyanosis, Death, Resuscitation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (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: 2020-12-18
   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: Tylenol
Current Illness: none
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: body sent for autopsy
CDC Split Type:

Write-up: unknown if adverse effect, parents found baby unresponsive and blue and called 911 and CPR started and baby expired unknown cause


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=906303

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