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From the 10/8/2021 release of VAERS data:

This is VAERS ID 308717



Case Details

VAERS ID: 308717 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: North Carolina  
Vaccinated:2008-03-17
Onset:2008-03-23
   Days after vaccination:6
Submitted: 2008-03-24
   Days after onset:1
Entered: 2008-04-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-03-23
   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:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=308717

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