From the 10/14/2018 release of VAERS data (an older release, current is 2/18/2021):

This is VAERS ID 475176

Case Details

VAERS ID:	475176 (history)
Form:	Version 1.0
Age:	0.33
Sex:	Male
Location:	Washington

Vaccinated:	2012-10-29
Onset:	2012-11-01
Days after vaccination:	3
Submitted:	0000-00-00
Entered:	2012-11-26

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B351BA / 1	LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR	UH624AA / 2	LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH	F70997 / 2	RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0059AE / 2	MO / PO

Administered by: Private Purchased by: Public
Symptoms: Death, Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2012-11-01
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died of SIDS 2 days after receiving vaccines.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20181014&IDNUMBER=475176