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From the 5/14/2017 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 27510

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Case Details

VAERS ID: 27510 (history)  
Form: Version .0  
Age: 0.2  
Sex: Female  
Location: California  
   Days after vaccination:1
Submitted: 1991-01-16
   Days after onset:25
Entered: 1991-01-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal distension, Apnoea, Brain oedema, Haemorrhage, Haemothorax, Lung disorder, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pedi-Care Decongestant Drops
Current Illness: Decongested
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt given HIB titer 21DEC90 aprox 1230PM pt died 22DEC90 738 HRS.F/U 19Apr91 Autopsy rept-Acute respiratory failure,SIDS.Petechial hemorrhages of pleurae,epicardium & thymus.Pulmonary/cerebral edema &congestion.Congestion of abdo viscera.

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