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From the 12/24/2020 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 425334

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Case Details

VAERS ID: 425334 (history)  
Form: Version 1.0  
Age: 1.66  
Sex: Male  
Location: New Jersey  
   Days after vaccination:2
Submitted: 2011-06-14
   Days after onset:38
Entered: 2011-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Autopsy, Cerebral haemorrhage, Child maltreatment syndrome, Computerised tomogram abnormal, Computerised tomogram head, Cough, Death, Dyskinesia, Mechanical ventilation, Nasopharyngitis, Neurosurgery, Respiratory tract congestion, VIIth nerve paralysis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dyskinesia (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-05-13
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: None, just got over a cold prior to vaccine
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Baby had cold symptoms, cough, congestion, a little vomiting. My son came home at 7:20 p.m. On 5/10 to babysitter advising baby was napping from 6 p.m. Patient was face down on bed. My son laid next to him and put his hand on his back and he noticed he wasn''t breathing right. He lifted him and turned him over and his one side of face and mouth was drooping and his right arm and leg kept jolting. No left side movement at all. 911 was immeidately called. CT scan showed bleeding on brain. Three hours later transferred by ambulance to Hospital (not airlifted) was put on respirator at Medical Center. Got to another hospital had another CT scan, bleed was worse underwent neurosurgery and brains was hemorrhaging too bad. Neurosurgeons said bleed was too bad and injuries were consistent with shaken baby syndrome. Patient had no brain activity or breathing capacity at all. Passed away on 5/13 at 10:30 a.m. Initial Autopsy was inconclusive. Undergoing more tests. Patient on 5/5 had PVC (Pneumococcal Vaccine and Varicella Vaccine). It is being treated as a homicide by Prosecutor''s office. A local chiropractor told us about a link with vaccines and brain injuries similar to shaken baby. We wanted to report this since he did get these two recent injections. Awaiting second autopsy. They said brain and eyes were sent to specialist around the country.

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