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From the 9/14/2017 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 376710



Case Details

VAERS ID: 376710 (history)  
Form: Version 1.0  
Age: 0.53  
Sex: Male  
Location: New York  
Vaccinated:2010-01-08
Onset:2010-01-11
   Days after vaccination:3
Submitted: 2010-01-12
   Days after onset:1
Entered: 2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / UNK UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / UNK UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Death, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (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: 2010-01-11
   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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=376710

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