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From the 12/31/2003 release of VAERS data (an older release, current is 2/26/2021):

This is VAERS ID 151619

Case Details

VAERS ID: 151619 (history)  
Form: Version .0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:2000-04-10
Onset:0000-00-00
Submitted: 2000-04-26
Entered: 2000-05-05
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE DTPA919A2 / 0 RL / IM
HBHEPB: COMVAX / MSD 1975J / 0 LL / IM
IPV: IPV / MERIEUX INST R02352 / 0 RL / SC

Administered by: Public       Purchased by: Unknown
Symptoms: ACIDOSIS, DEHYDRAT, DIARRHEA, EFFUS PLEURAL, FEVER
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-17
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: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC Split Type:

Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acid"osis, hyperkalalemia


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=151619


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