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From the 9/14/2017 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 421048

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Case Details

VAERS ID: 421048 (history)  
Form: Version 1.0  
Age: 1.51  
Sex: Female  
Location: California  
Vaccinated:2010-10-15
Onset:2010-11-08
   Days after vaccination:24
Submitted: 2011-04-14
   Days after onset:156
Entered: 2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-11-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC Split Type:

Write-up: Sudden unexplained death.


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