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

This is VAERS ID 263520

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Case Details

VAERS ID: 263520 (history)  
Form: Version 1.0  
Age: 0.14  
Sex: Male  
Location: South Carolina  
Vaccinated:2006-08-31
Onset:2006-09-05
   Days after vaccination:5
Submitted: 2006-09-25
   Days after onset:20
Entered: 2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-10-08
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC Split Type:

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


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