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From the 5/14/2021 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 858436



Case Details

VAERS ID: 858436 (history)  
Form: Version 2.0  
Age: 0.42  
Sex: Male  
Location: Florida  
Vaccinated:2020-01-09
Onset:2020-01-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2020-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ126AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH T81219 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1660112 / 2 MO / PO

Administered by: Private       Purchased by: ?
Symptoms: Bed sharing, Death, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired on 1/12/2020 of unknown cause. Patient was found unresponsive next to his father in father''s bed. Patient was pronounced dead in ER.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210514&IDNUMBER=858436

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