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From the 1/7/2022 release of VAERS data:

This is VAERS ID 352162

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Case Details

VAERS ID: 352162 (history)  
Form: Version 1.0  
Age: 0.21  
Sex: Female  
Location: Nevada  
Vaccinated:2009-07-17
Onset:2009-07-22
   Days after vaccination:5
Submitted: 2009-07-22
   Days after onset:0
Entered: 2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-07-22
   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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood culture - no growth. Chest X-ray - abnormal, right pneumothorax.
CDC Split Type:

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


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