Is Your Child Sick? TM


Immunization Reactions

Is this your child's symptom?

  • You think your child is having a reaction to a recent immunization (vaccine)
  • Types of Reactions:
  • Reactions at the shot site (such as pain, swelling, redness)
  • General reactions (such as a fever or being fussy)
  • Reactions to these vaccines are covered:
  • Chickenpox (varicella) virus
  • DTaP (Diphtheria, Tetanus, Pertussis)
  • Hemophilus influenzae type b
  • Hepatitis A virus
  • Hepatitis B virus
  • Human Papilloma virus
  • Influenza virus
  • MMR (Measles, Mumps, Rubella)
  • Meningococcal
  • Polio virus
  • Pneumococcal
  • Rotavirus
  • Tuberculosis (BCG vaccine)

Symptoms of Vaccine Reactions

  • Local Reactions. Shot sites can have swelling, redness and pain. Most often, these symptoms start within 24 hours of the shot. They most often last 3 to 5 days. With the DTaP vaccine, they can last up to 7 days.
  • Fever. Fever with most vaccines begins within 24 hours and lasts 1 to 2 days.
  • Delayed Reactions. With the MMR and chickenpox shots, fever and rash can occur. These symptoms start later. They usually begin between 1 and 4 weeks.
  • Anaphylaxis. Severe allergic reactions are very rare, but can occur with any vaccine. They start within 2 hours.

When to Call for Immunization Reactions

Call 911 Now

  • Trouble breathing or swallowing
  • Not moving or very weak
  • Can't wake up
  • You think your child has a life-threatening emergency

Call Doctor Now or Go to ER

  • Age under 12 weeks old with fever. (Caution: Do NOT give your baby any fever medicine before being seen)
  • Fever over 104° F (40° C)
  • High-pitched crying lasts more than 1 hour
  • Crying nonstop lasts more than 3 hours
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Redness or red streak starts more than 48 hours (2 days) after the shot
  • Redness around the shot becomes larger than 3 inches (7.5 cm)
  • Fever lasts more than 3 days
  • Fever returns after gone for more than 24 hours
  • Measles vaccine rash (starts day 6 to 12 after shot) lasts more than 4 days
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Redness or red streak around shot is larger than 1 inch (2.5 cm)
  • Redness, swelling or pain is getting worse after 3 days
  • Fussiness from vaccine lasts more than 3 days
  • You have other questions or concerns

Self Care at Home

  • Normal immunization reaction

Call 911 Now

  • Trouble breathing or swallowing
  • Not moving or very weak
  • Can't wake up
  • You think your child has a life-threatening emergency

Call Doctor Now or Go to ER

  • Age under 12 weeks old with fever. (Caution: Do NOT give your baby any fever medicine before being seen)
  • Fever over 104° F (40° C)
  • High-pitched crying lasts more than 1 hour
  • Crying nonstop lasts more than 3 hours
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Redness or red streak starts more than 48 hours (2 days) after the shot
  • Redness around the shot becomes larger than 3 inches (7.5 cm)
  • Fever lasts more than 3 days
  • Fever returns after gone for more than 24 hours
  • Measles vaccine rash (starts day 6 to 12 after shot) lasts more than 4 days
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Redness or red streak around shot is larger than 1 inch (2.5 cm)
  • Redness, swelling or pain is getting worse after 3 days
  • Fussiness from vaccine lasts more than 3 days
  • You have other questions or concerns

Self Care at Home

  • Normal immunization reaction

Care Advice for Immunization Reactions

Treatment for Common Immunization Reactions

  1. What You Should Know About Common Shot Reactions:
    • Immunizations (vaccines) protect your child against serious diseases.
    • Pain, redness and swelling are normal where the shot was given. Most symptoms start within the first 12 hours after the shot was given. Redness and fever starting on day 1 of the shot is always normal.
    • All of these reactions mean the vaccine is working.
    • Your child's body is making new antibodies to protect against the real disease.
    • Most of these symptoms will only last 2 or 3 days.
    • There is no need to see your doctor for normal reactions, such as redness or fever.
    • Medicine is only needed if your child has pain. Also, use a fever medicine for fever over 102° F (39 ° C).
    • Here is some care advice that should help.
  2. Reaction at Shot Site:
    • Cold Pack: For pain at the shot site, use a cold pack. You can also use put ice in a wet washcloth on the sore shot site. Use for 20 minutes as needed.
    • Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed.
    • Hives at the Shot Site: If itchy, can put on 1% hydrocortisone cream (such as Cortaid). No prescription is needed. Use twice daily as needed.
  3. Fever Medicine:
    • Fever with most vaccines begins within 12 hours and lasts 2 to 3 days. This is normal, harmless and possibly helpful.
    • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
    • If over 6 months old, can give an ibuprofen product (such as Advil).
    • For all fevers: Give extra fluids. Do not use too many clothes or blankets on your child.
  4. General Symptoms From Vaccines:
    • All vaccines can cause mild fussiness, crying and restless sleep. This is usually due to a sore shot site.
    • Some children sleep more than usual. A decreased appetite and activity level are also common.
    • These symptoms are normal. They do not need any treatment.
    • They will usually go away in 24-48 hours.
  5. Call Your Doctor If:
    • Redness starts after 2 days (48 hours)
    • Redness becomes larger than 2 inches (5 cm)
    • Pain or redness gets worse after 3 days (or lasts more than 7 days)
    • Fever starts after 2 days (or lasts more than 3 days)
    • You think your child needs to be seen
    • Your child becomes worse

Specific Immunization Reactions

  1. Chickenpox Vaccine:
    • Pain or swelling at the shot site for 1 to 2 days. (20% of children)
    • Mild fever lasting 1 to 3 days begins 14 to 28 days after the shot (10%). Give acetaminophen or ibuprofen for fever over 102° F (39°C).
    • Never give aspirin for fever, pain or within 6 weeks of getting the shot. Reason: Risk of Reye syndrome, a rare but serious brain disease.
    • Chickenpox-like rash (usually 2 red bumps) at the shot site (3%)
    • Chickenpox-like rash (usually 5 red bumps) scattered over the body (4%)
    • This mild rash begins 5 to 26 days after the shot. Most often, it lasts a few days.
    • Children with these rashes can go to child care or school. Reason: For practical purposes, vaccine rashes are not spread to others.
    • Exception: Do not go to school if red bumps drain fluid and are widespread. Reason: can be actual chickenpox.
    • Caution: If vaccine rash contains fluid, cover it with clothing. You can also use a bandage (such as Band-Aid).
  2. Diphtheria, Tetanus, Pertussis (DTaP) Vaccine:
    • The following harmless reactions to DTaP can occur:
    • Pain, tenderness, swelling and redness at the shot site are the main side effects. This happens in 25% of children. It usually starts within the first 12 hours. Redness and fever starting on day 1 of the shot is always normal. It lasts for 3 to 7 days.
    • Fever (in 25% of children) and lasts for 24 to 48 hours
    • Mild drowsiness (30%), fretfulness (30%) or poor appetite (10%) and lasts for 24 to 48 hours.
    • Large swelling over 4 inches (10 cm) can follow the later doses of DTaP. The area of redness is smaller. This usually occurs with the 4th or 5th dose. It occurs in 5% of children. Most children can still move the leg or arm normally.
    • The large thigh or upper arm swelling goes away without treatment by day 3 (60%) to day 7 (90%).
    • This is not an allergy. Future DTaP vaccines are safe to give.
  3. Hemophilus Influenza Type B Vaccine (Hib):
    • No serious reactions reported.
    • Sore injection site or mild fever only occurs in 2% of children.
  4. Hepatitis A Vaccine:
    • No serious reactions reported.
    • Sore injection occurs in 20% of children.
    • Loss of appetite occurs in 10% of children.
    • Headache occurs in 5% of children.
    • Most often, no fever is present.
    • If these symptoms occur, they most often last 1-2 days.
  5. Hepatitis B Virus Vaccine (HBV):
    • No serious reactions reported.
    • Sore shot site occurs in 30% of children and mild fever in 3% of children.
    • Fever from the vaccine is rare. Any baby under 2 months with a fever after this shot should be examined.
  6. Influenza Virus Vaccine:
    • Pain, tenderness or swelling at the injection site occurs within 6 to 8 hours. This happens in 10% of children.
    • Mild fever under 103° F (39.5° C) occurs in 20% of children. Fevers mainly occur in young children.
    • Nasal Influenza Vaccine: Congested or runny nose, mild fever. The nasal spray version of the flu vaccine is not recommended for the 2016-2017 flu season (CDC). Reason: not effective.
  7. Measles Vaccine (part of MMR):
    • The measles shot can cause a fever (10% of children) and rash (5% of children). This occurs about 6 to 12 days after the shot.
    • Mild fever under 103° F (39.5°C) in 10% and lasts 2 or 3 days.
    • The mild pink rash is mainly on the trunk and lasts 2 or 3 days.
    • No treatment is needed. The rash cannot be spread to others. Your child can go to child care or to school with the rash.
    • Call Your Doctor If:
      • Rash changes to blood-colored spots
      • Rash lasts more than 3 days
  8. Meningococcal Vaccine:
    • No serious reactions.
    • Sore shot site for 1 to 2 days occurs in 50%. Limited use of the arm occurs in 15% of children.
    • Mild fever occurs in 5%, headache in 40% and joint pain in 20%
    • The vaccine never causes meningitis.
  9. Mumps or Rubella Vaccine (part of MMR):
    • There are no serious reactions.
    • Sometimes, a sore shot site can occur.
  10. Papillomavirus Vaccine:
    • No serious reactions.
    • Sore injection site for few days in 90%.
    • Mild redness and swelling at the shot site (in 50%).
    • Fever over 100.4° F (38.0° C) in 10% and fever over 102° F (39° C) in 2%.
    • Headache in 30%.
  11. Pneumococcal Vaccine:
    • No serious reactions.
    • Pain, tenderness, swelling or redness at the injection site in 20%.
    • Mild fever under 102° F (39° C) in 15% for 1-2 days.
  12. Polio Vaccine:
    • Polio vaccine given by shot sometimes causes some muscle soreness.
    • Polio vaccine given by mouth is no longer used in the U.S.
  13. Rotavirus Vaccine:
    • No serious reactions to this vaccine given by mouth.
    • Mild diarrhea or vomiting for 1 to 2 days in 3%.
    • No fever.
  14. BCG Vaccine for Tuberculosis (TB):
    • Vaccine used to prevent TB in high-risk groups or countries. It is not used in the US or most of Canada. Note: This is different than the skin test placed on the forearm to detect TB.
    • BCG vaccine is given into the skin of the right shoulder area.
    • Timing: Mainly given to infants and young children.
    • Normal reaction: After 6 to 8 weeks, a blister forms. It gradually enlarges and eventually drains a whitish yellow liquid. The blister then heals over leaving a scar. The raised scar is proof of BCG protection against TB.
    • Abnormal reaction: Abscess (infected lump) occurs in the shoulder or under the arm. Occurs in 1% of patients.
    • Call Your Doctor If:
      • Blister turns into a large red lump
      • Lymph node in the armpit becomes large

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Copyright 1994-2017 Schmitt Pediatric Guidelines LLC. All rights reserved.

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