From the 12/31/2003 release of VAERS data (an older release, current is 2/26/2021):

This is VAERS ID 110675

Case Details

VAERS ID:	110675 (history)
Form:	Version .0
Age:	0.2
Sex:	Male
Location:	California

Vaccinated:	1998-03-24
Onset:	1998-04-04
Days after vaccination:	11
Submitted:	1998-05-06
Days after onset:	31
Entered:	1998-05-11
Days after submission:	5

Vaccination / Manufacturer	Lot / Dose	Site / Route
DTAP: ACEL-IMUNE / LEDERLE	450639 / 0	RL / IM
HEP: ENGERIX-B / SMITHKLINE	2404A2 / 1	RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS)	M285RJ / 0	LL / IM
IPV: POLIOVAX / CONNAUGHT LTD	M1163 / 0	LA / SC

Administered by: Private Purchased by: Unknown
Symptoms: SIDS
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-04-04
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk
Other Medications: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC Split Type: NONE

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;

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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=110675