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

This is VAERS ID 179926

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Case Details

VAERS ID: 179926 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Maryland  
Vaccinated:2001-12-26
Onset:2001-12-27
   Days after vaccination:1
Submitted: 2001-12-31
   Days after onset:4
Entered: 2002-01-14
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 477385 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0909 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 481815 / 1 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Abnormal sleep-related event, Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-12-27
   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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


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