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

This is VAERS ID 267625

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Case Details

VAERS ID: 267625 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted: 2006-11-21
   Days after onset:11
Entered: 2006-11-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


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