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From the 11/12/2021 release of VAERS data:

This is VAERS ID 414262

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Case Details

VAERS ID: 414262 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:2011-01-03
Onset:2011-01-04
   Days after vaccination:1
Submitted: 2011-01-07
   Days after onset:3
Entered: 2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Autopsy, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-01-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC Split Type:

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


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