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From the 11/26/2021 release of VAERS data:

This is VAERS ID 79601

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Case Details

VAERS ID: 79601 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Utah  
Vaccinated:1995-11-03
Onset:1995-11-04
   Days after vaccination:1
Submitted: 1995-11-07
   Days after onset:3
Entered: 1995-11-28
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428039 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1664B2 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0227 / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Cyanosis, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-11-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: baby found blue & unresponsive


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