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

This is VAERS ID 192409

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Case Details

VAERS ID: 192409 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: West Virginia  
Vaccinated:1999-06-25
Onset:1999-06-30
   Days after vaccination:5
Submitted: 2001-09-18
   Days after onset:811
Entered: 2002-11-01
   Days after submission:409
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Infection, Sepsis
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-06-30
   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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


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