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

This is VAERS ID 381218

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Case Details

VAERS ID: 381218 (history)  
Form: Version 1.0  
Age: 0.46  
Sex: Male  
Location: Arkansas  
Vaccinated:2010-02-17
Onset:2010-02-19
   Days after vaccination:2
Submitted: 2010-02-22
   Days after onset:3
Entered: 2010-02-24
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3554AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D94433 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA817 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-02-19
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AR1004

Write-up: 2-19-2010 Notified by coroner that child had died today requesting copy of immunization record. No other information available.


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