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From the 1/7/2022 release of VAERS data:

This is VAERS ID 120597

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Case Details

VAERS ID: 120597 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: California  
Vaccinated:1999-02-18
Onset:1999-02-21
   Days after vaccination:3
Submitted: 1999-03-19
   Days after onset:26
Entered: 1999-03-29
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 858A2 / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0003H / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 2 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Apnoea, Cardiac arrest, Pyrexia, Sudden infant death syndrome, Unevaluable event
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-21
   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~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed-results unavailable @ this time;
CDC Split Type:

Write-up: pt found by parent not breathing, CPR started, transported to nearest ER on 21FEB99, unable to resuscitate;


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