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

This is VAERS ID 178823

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Case Details

VAERS ID: 178823 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Ohio  
Vaccinated:2001-11-14
Onset:2001-11-17
   Days after vaccination:3
Submitted: 2001-11-29
   Days after onset:12
Entered: 2001-12-11
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484131 / 2 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-11-17
   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: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


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