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From the 1/14/2022 release of VAERS data:

This is VAERS ID 119248

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Case Details

VAERS ID: 119248 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Missouri  
Vaccinated:1999-02-12
Onset:1999-02-14
   Days after vaccination:2
Submitted: 1999-02-17
   Days after onset:3
Entered: 1999-02-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457788 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1190H / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 110211 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0726 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 1190H / 1 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Drug ineffective, Infection, Sudden infant death syndrome
SMQs:, Lack of efficacy/effect (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pericardial draw post mortem-blood cult grew type B H flu
CDC Split Type:

Write-up: DOA in hosp ER 14FEB99;blood cult grew H. flu type B;


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