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From the 9/14/2017 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 307188

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Case Details

VAERS ID: 307188 (history)  
Form: Version 1.0  
Age: 0.21  
Sex: Male  
Location: Texas  
Vaccinated:2008-03-03
Onset:2008-03-05
   Days after vaccination:2
Submitted: 2008-03-17
   Days after onset:11
Entered: 2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 1 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Death, Hyperventilation, Irritability, Resuscitation, Somnolence
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC Split Type:

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


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