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

This is VAERS ID 127057

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Case Details

VAERS ID: 127057 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1999-03-11
Onset:1999-03-20
   Days after vaccination:9
Submitted: 1999-07-23
   Days after onset:124
Entered: 1999-08-10
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-03-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC Split Type: 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


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