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

This is VAERS ID 264995

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Case Details

VAERS ID: 264995 (history)  
Form: Version 1.0  
Age: 0.11  
Sex: Male  
Location: New York  
Vaccinated:2006-09-20
Onset:2006-10-13
   Days after vaccination:23
Submitted: 2006-10-17
   Days after onset:4
Entered: 2006-10-20
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR - / UNK UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-10-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


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