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

This is VAERS ID 263568

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Case Details

VAERS ID: 263568 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Female  
Location: North Carolina  
Vaccinated:2006-09-12
Onset:2006-09-21
   Days after vaccination:9
Submitted: 2006-09-21
   Days after onset:0
Entered: 2006-09-26
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-09-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06


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