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

This is VAERS ID 422775

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Case Details

VAERS ID: 422775 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Male  
Location: Alabama  
Vaccinated:2011-05-02
Onset:2011-05-12
   Days after vaccination:10
Submitted: 2011-05-12
   Days after onset:0
Entered: 2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-05-12
   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: None
Preexisting Conditions: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS


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