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

This is VAERS ID 122135

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Case Details

VAERS ID: 122135 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1999-04-21
Onset:1999-04-22
   Days after vaccination:1
Submitted: 1999-05-03
   Days after onset:11
Entered: 1999-05-14
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457788 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 410303A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0400 / 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988075 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-22
   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: NONE
Current Illness: NONE
Preexisting Conditions: prematurity
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: sudden infant death w/in 24hr;autopsy was nl;


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