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From the 1/14/2022 release of VAERS data:

This is VAERS ID 178756

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Case Details

VAERS ID: 178756 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2001-11-30
Onset:2001-12-03
   Days after vaccination:3
Submitted: 2001-12-03
   Days after onset:0
Entered: 2001-12-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 516A2 / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0952L / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0395 / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 418320 / 1 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-12-03
   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: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity 31 weeks. Post gestational age 39 weeks.
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: Infant given 2 month immunizations on Friday 11/30/2001. Monday 12/03/2001 infant was found dead in crib. Paramedics called and were unable to resuscitate. Medical examiner called. Autopsy pending. COD as per autopsy report -- SIDS


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