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

This is VAERS ID 178822

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Case Details

VAERS ID: 178822 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Mississippi  
Vaccinated:2001-06-13
Onset:2001-06-13
   Days after vaccination:0
Submitted: 2001-12-03
   Days after onset:173
Entered: 2001-12-11
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR R14372 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 477450 / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Sudden infant death syndrome
SMQs:, Acute central respiratory depression (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-06-13
   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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


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