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

This is VAERS ID 379398

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Case Details

VAERS ID: 379398 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Male  
Location: Iowa  
Vaccinated:2009-12-30
Onset:0000-00-00
Submitted: 2010-01-27
Entered: 2010-02-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3565AB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E06427 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA963A / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-01-16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


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