The Vaccine Adverse Event Reporting System (VAERS) is a passive reporting system, meaning it relies on individuals to send in reports of their experiences. The global reach of the CDC VAERS misinformation should not be underestimated, with print copies of the data having been placed into letterboxes as far away as Brisbane, Australia. Unfortunately, it is that very open nature of the system that has allowed it to be used and abused by antivaxxers to promote their false claims that vaccines cause so many adverse events and medical conditions. The site is secure. The patient later developed a cough, marked fatigue, sensitivity to light and sound, disturbed sleep and more serious loss of appetite. Ophthalmology. In other words, it would have dramatically increased both the accuracy and the number of vaccine injuries reported to VAERS. We defined reporting sensitivity as the VAERS reporting rate divided by the VSD incidence rate. Nevropatol. Attackers might be trying to steal your information from www.vaers.hhs.gov (for example, passwords, messages, or credit cards). The only browser that seems to consistently connect properly is Safari, used by only around a quarter of people accessing . Patients, parents and caregivers are encouraged to report "any clinically important medical event or health problem that. Eight days after vaccination, she developed a fever, sore throat, nausea, vomiting, malaise and dizziness. 10. Despite this pledge, some prominent anti-vaccine Facebook pages remain online with hundreds of thousands of followers. Basically, VAERS is a passive reporting system, in which anyone can report suspected adverse events after any vaccination to be recorded in the database. This, of course, is intended to increase reporting of adverse events to VAERS. It would be a dramatic improvement over the current health-care-worker-initiated reports. Cost-benefit analyses of varicella vaccination appear optimistic, but they fail to factor in the resulting deleterious effects. Examples abound, including a study claiming to find a link between the H1N1 vaccine and miscarriages or one of the earliest examples that I ever encountered, Mark and David Geiers epically bad study trying to link thimerosal-containing vaccines to autism. Seeking a new model to lower wait times, but also improve patient choice of care, County Council Senior Medical . It is bewildering, therefore, This may sound similar to another argument that many COVID-19 deaths in older adults are deaths that would have happened anyway. In fact, the original article is by Peter Doshi and represents him falling for an antivaccine conspiracy theory that somehow VAERS was being made inaccessible to suppress reports. Vaccine-Associated Uveitis after COVID-19 Vaccination: Vaccine Adverse Event Reporting System Database Analysis. (2000) 284:1271-1279. It might be true that such a small percentage of adverse events is reported for self-limited minor events, such as sore arms, fever, nausea, and the like. The Vaccine Adverse Events Reporting System (VAERS) is sponsored by the Centers for Disease Control and by the Food and Drug Administration. suggest a novel finding that adults who have not had prior varicella-zoster virus (VZV) infection (including onset of chickenpox) are more likely to have gliomas (brain tumors) than adults who have had prior infection [10]. Reports are accepted from anyone and can be submitted electronically at www.vaers.hhs.gov. The first report of an adverse reaction following varicella vaccination was filed with VAERS (ID 74221) on May 26, 1995. Surveillance for safety after immunization: Vaccine Adverse Event Reporting System (VAERS)--United States, 1991-2001. of underreporting varies widely. Overview of the ESP:VAERS project . Pediatr. MATSUBARA K, NIGAMI H, HARIGAYA H, BABA K: Herpes zoster in a normal child after varicella vaccination. 284 0 obj <> endobj It's a shame because VAERS plays a vital role in detecting important but rare reactions caused by vaccines. (1993) 35(4):345-347. Both thought that she could have Guillian-barre syndrome. More generally: The chance of dying in an average week for those over 80 is about 0.2% or 1 in 500. VAERS Data includes information about the patients demographics, and data related to their adverse event. Her nausea and vomiting persisted for the next three months despite use of anti-nausea medication. : Vaccine-associated uveitis following COVID-19 vaccination: vaccine adverse event reporting system database analysis. Thats why Im going to take this opportunity to point out how, contrary to how one eminent academic oncologist like to put it, refuting antivaccine disinformation is anything but LeBron James dunking on a 7 hoop. In December, CHD and Kennedy wrote to former FDA director, Dr. David Kessler, co-chair of the COVID-19 Advisory Board and President Bidens version of Operation Warp Speed. 2003 Jan 24;52(1):1-24. He was treated again with Acyclovir. LEE SY, KOMP DM, ANDIMAN W: Thrombocytopenic Purpura following varicella-zoster vaccination. 2021 May;30(5):602-609. doi: 10.1002/pds.5196. Still, it's a good way to detect safety signals that weren't detected during premarket testing or clinical trials . Fetterman's Wife Abruptly Fled the Country After He Was Hospitalized. Her older brother reacted to all vaccinations and developed late-onset autism following his MMR. Her symptoms worsened at the age of 6. A study about it found less than 1% were reported (3). . Does anyone think that deaths after COVID-19 vaccination are going to be underreported by a factor of 100? If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here. Jpn. For instance, in todays Mercola.com newsletter there is an article summarizing Dr. Mercolas interview with Dr. Vladimir Zelenko. 20.8 per 100,000 person-years. Ann. Consequently, even though antivaxxers like to harp on how passive surveillance systems generally capture only a small fraction of adverse reactions, one thing VAERS does do is capture severe reactions. National Library of Medicine Zh. No, seriously, look at the stupidity on display here: For over three weeks, the website of the US government Vaccination Adverse Reporting System (VAERS) has been inaccessible to most users. The VAERS system keeps track of any unusual or unexpected adverse events that occur after vaccine administration. Would you like email updates of new search results? According to the VAERS data, of the 329 reported deaths, 285 were from the U.S., and 44 were from other countries. However, real data transmissions of non-physician approved reports to the CDC was unable to commence, as by the end of this project, the CDC had yet to respond to multiple requests to partner for this activity. So, roughly the baseline death rate is roughly 2.4/100,000 per day. JAMA. VAERS Symptoms lists the symptoms of the adverse event. The bottom line is that 285 deaths after COVID-19 vaccination reported to VAERS in a timeframe of 40 days is actually a very small number. NASERI A, GOOD WV, CUNNINGHAM ET JR: Herpes zoster virus sclerokeratitis and anterior uveitis in a child following varicella vaccination. 100,000 person-years. Hematol. Patients, parents and caregivers are encouraged to report "any clinically important medical event or health problem that. I dont know. So there is no way to explain the excess deaths which are effectively over 640,000 for a 41 underreporting factor. A certain number of 80+ year olds die every day. Some infants will experience these medical events shortly after a vaccination by coincidence. and transmitted securely. SUNAGA Y, HIKIMA A, OSTUKA T, MORIKAWA A: Acute cerebellar ataxia with abnormal MRI lesions after varicella vaccination. 0 No proof that the event was caused by the vaccine is required in order for VAERS to accept the report. As an example, a great many of the millions of vaccinations administered each year by injection cause soreness, but relatively few of these episodes lead to a VAERS report. The first is: Whats the denominator? FOIA ) convulsions in young children given seasonal flu vaccine, but the problems, with voluntary reporting systems, underreporting of adverse events and the. Never mind that, as I discussed, there was no evidence that these deaths, all of which were among very elderly nursing home residents, were caused by the vaccine and there was no evidence of an increase in the baseline mortality rate of nursing home residents in Norway, which averages around 400 per week. Federal government websites often end in .gov or .mil. Deaths definitely get ones attention and are far more likely to be reported than any other AE. If you look at the CHD scientific advisory board, youll soon see that its a whos-who of antivaccine cranks, including Richard Deth (what a blast from the past!) This 3.5-year-old boy from Georgia who had no pre-existing conditions, received a dose of varicella vaccine on May 12, 1995. Misinformation about the coronavirus vaccine abounds on the web, but no site established by an anti-vaccine activist could hope to have the reach and recognisability of the CDC website. (Pediatrics 111:448, 2003. The Centers for Disease Control and Prevention released new data showing that a total of 965,843 adverse event reports following COVID vaccines were submitted between December 14, 2020, and December 10, 2021, to the Vaccine Adverse Event Reporting System (VAERS). Epub 2016 Jul 19. The National Childhood Vaccine Injury Act (NCVIA) of 1986 requires health professionals and vaccine manufacturers to report to the U.S. Department of Health and Human Services specific adverse events that occur after the administration of routinely recommended vaccines. 2023 Feb;130(2):179-186. doi: 10.1016/j.ophtha.2022.08.027. He took Acyclovir Oral Suspension (200mg/5ml): Two teaspoons 4 times a day for 5 days. Moreover, the CDC and FDA do not restrict what people can report, as long as it happened at some point following a vaccination. EMRs available from all ambulatory care encounters in a large multi-specialty practice were used. Still, its limitations aside, VAERS has its place if you understand its intended purpose. especially Changing the hearts and minds of reticent Americans is set to become more crucial than ever to prevent transmission and limit the potential of new coronavirus variants taking hold. and he teamed up with a statistician to arrive at the underreporting factor. The database makes for gruesome reading, with side-effects of the vaccine appearing to include brain death, herpes and even one case of a gunshot wound. 4. Peter Collignon and his colleagues do not exaggerate the problem of This is the study everyone cites when stating that VAERS captures only 1% of vaccine-related injuries. A federal agency seeking to disabuse citizens of the expectation that government health databases are accurate should be an indicator for the CDC that VAERS has a serious problem. Voices for Vaccines, How I Went From Dressing Up As Measles to Hoping for My COVID Vaccines, April 28, 2021. My topic here is not VAERS generally, but a number that recurs often in discussions about the vaccine injury reports VAERS contains. GERECITANO J, FRIEDMAN-KIEN A, CHAZEN GD: Allergic reaction to varicella vaccine. We also know that underreporting is less common for more severe adverse reactions than for those that are more mild. Competing interests: Healthcare providers are required by law to report to VAERS: During the same In a July 13 letter to health agency leaders, Johnson noted a press conference he . Accessibility in 2019, about 2.85 million Americans dies, for an annual rate of 869.7 per 100k, or 2.38 per 100k per day, from @CDCgov WONDER:https://t.co/GYD3eRpJAE, Seth Trueger (@MDaware) January 30, 2021. This provides a useful policy contrast to the unfettered publication of unverified claims by the U.S. CDC and FDA. Objectives: 2023;130: S0161-6420(22)00672-8. doi: 10.1016/j.ophtha.2022.08.027. Luo C, Jiang Y, Du J, Tong J, Huang J, Lo Re V 3rd, Ellenberg SS, Poland GA, Tao C, Chen Y. Pharmacoepidemiol Drug Saf. Restructuring at CDC and consequent delays in terms of decision making have made it challenging despite best efforts to move forward with discussions regarding the evaluation of ESP:VAERS [the new system] performance in a randomized trial and comparison of ESP:VAERS performance to existing VAERS and Vaccine Safety Datalink data. The people behind the Vaccine Adverse Event Reporting System (VAERS) have admitted that "fewer than 1% of vaccine adverse events are reported" in an early grant: native advertising "Adverse events from drugs and vaccines are common, but underreported. Her joint pains became episodic but more intense during the attacks and she experienced some muscle weakness on and off. Of course, that disclaimer is included, so that RFK Jr. and his merry band of antivax ideologues can claim to have been literally honest while following up their recounting of VAERS numbers with all sorts of statements implying that vaccines were causative for the adverse events listed before. A Progressive Facade: Comparing the U.S. and Canadas Treatment of Indigenous Peoples, Bringing Down the Worlds Largest Heist: Interview with Clare Rewcastle Brown, Australian PM Details Trump Relationship, Says Obama Called Him a Lunatic. In the time since the CDC was approached for comment by the HPR, the shareable buttons have been removed from the site. In this case, a retired pediatrician named Allan Cunningham rattled off a whole lot of antivaccine tropes about vaccines and autism and cites antivaccine-sympathetic BMJ editor Peter Doshi. Nothing coming before or after even suggests what that number is based upon. effects) are filed in VAERS. They also dont understand how the antivaccine movement has always been about more than just vaccines. Epub 2022 Sep 11. Thus, if you vaccinated 40,000 80+ year olds, you would expect about 80 deaths out of that group within one week *just by coincidence*. The point of Harvard Pilgram Health Care, Inc. getting that grant was to develop a much more efficient system for capturing vaccine injuries, a system that would be built into electronic health records systems and so could flag temporal relationships between vaccinations being dispensed and symptoms subsequently reported. Co-managed by the U.S. Centers for Disease Control and Prevention and the Food and Drug Administration, VAERS was established in 1990 to detect possible safety problems with vaccines.. The term, underreporting refers to the fact that VAERS receives reports for only a small fraction of actual adverse events. The U.S. (1970) 70(10):1465-1471. We developed an open-source, generalizable clinical decision support system called Electronic Support for Public Health-Vaccine Adverse Event Reporting System (ESP-VAERS) to assist clinicians with AE . They often lack details and sometimes can have information that contains errors. As is stated on the VAERS website: Underreporting is one of the main limitations of passive surveillance systems, including VAERS. * Two-year-old boy with staggering gait and difficulty speaking. vaccine-caused illness? MMWR Surveill Summ. A 17-month-old female toddler received the varicella vaccination on March 20, 1996. ones, especially when they occur soon after vaccination, even if they may be coincidental and related to other causes. In fact, lack of engagement by the CDC rendered the entire project pretty much null. But thats Norway. The shock of Covid-19 hit in different ways for Xiao Wu, a 27-year-old Ph.D. student in Harvard's public health school, and his academic adviser, biostatistician Francesca Dominici. In fact I am unable to find any study of reporting efficiency to VAERS that would justify the 1% estimate as being either an over- or under-estimation of the percent of injuries being reported. cases were reported to VAERS. by the vaccine is required in order for VAERS to accept the report. background rates were 23.1 (2000) and 24.6 (2006); fewer than 1 in 200 KD While the VAERS database numbers are sobering, according to a U.S. Department of Health and Human Services study, the actual number of adverse events is likely significantly higher. As of today, the online database alleges 1349 U.S. deaths attributable to COVID-19 vaccines. The research, which assessed the safety of the Pfizer/BioNTech BNT162b2 mRNA vaccine, is based on analysis of data from nearly 2 million individuals in Israel and represents one of the largest real-world assessments of COVID-19 vaccine safety to date. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. Harvard Business Review noted that the previous vaccine development record was . She worked as a research coordinator in the infectious disease unit of a Medical School. Paediatr. The findings, the researchers said, affirm the overall safety of the vaccine and underscore . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). So, the actual number of serious injuries and deaths is likely 10 to 100 times higher. This time, the pain was more severe. 6/15/07. Her ANA became positive and she developed autoimmune thyroid disease with a high TSH. Clipboard, Search History, and several other advanced features are temporarily unavailable. Wu, a former . In 2008, patients seeking a hip or knee replacement in Stockholm County faced wait times of up to two years of sometimes debilitating pain, intermittent missed work and income, and the trials of disability. ESMAELI-GUTSTEIN B, WINKELMAN JZ: Uveitis associated with varicella virus vaccine. Online ahead of print. Clearly that Harvard study is where the gold is. 2022 Harvard Political Review. The startling statistics are being shared far and wide by anti-vaccination activists and concerned readers alike. He was listless and had some rhinorhea but remained afebrile. 11. This brings us to the second question: Whats the baseline rate? It was the waiting that drew the attention of the Stockholm County Council. Monitoring the safety of high-dose, trivalent inactivated influenza vaccine in the vaccine adverse event reporting system (VAERS), 2011 - 2019. A Harvard Vaccine Injury Study conducted from 2007 to 2010, reveals on page 6 a fewer than 1 % report rate in VAERS. A VAERS report was filed January 30, 2000. Please enable it to take advantage of the complete set of features! Chan School of Public Health. According to the VAERS website, only a "small fraction" of vaccine injuries are reported (2). During the 18-year period from 1990 through 2007 just 88 cases of Kawasaki Disease in children under 5 were reported to VAERS. BRAUN MM, MOOTREY GT, SEWARD JF, RIDER LG, KRAUSE PR: Postlicensure safety surveillance for varicella vaccine. Nevertheless, the magnitude of these differences makes it likely that serious adverse events following vaccination occur at a substantially lower rate than following natural disease [15]." VAERS reports associated with Varicella, DTaP, Hep B, Hib, and MMR vaccines through December, 2003. Your connection is not private, it says in large font on my screen (fig 1). Wrensch et al. Although 25% of ambulatory patients experience an adverse drug event, less than 0.3% of all adverse drug events and 1-13% of serious events are reported to the Food and Drug Administration (FDA). The reason, to reiterate, is that VAERS is unique among US vaccine safety reporting systems in that it is a passive surveillance system. (I realize that that 22 million figure includes an additional week of vaccinations and does not break down how many people had received one or both doses, but this is a back-of-the-envelope) calculation. Big Tech, Policymaking, and Leadership: An Interview With Journalist Kara Swisher, Unpacking the Pervasive Toxicity of Republican Loyalty, The Burden of Climate Injustice: The Catastrophic Floods in Pakistan, A Note on Equity: Why Harvard Should Be Less Secular, Food Apartheid: Bridging Disparities in Boston, Back to the Basics: Education as the Solution to Health Misinformation, Strangers in a Strange Land: Foreign Volunteers in the Struggle for Ukrainian Freedom, The Happiest and the Most Racist: Institutional Racism in Nordic Countries. As such, I think it is somewhat sloppy science to reference the Harvard study as support of VAERS underreporting. 5. Thanks to Dear Pandemic, who did similar back-of-the-envelope calculations, as did Mark Hoofnagle on Twitter, we can make a reasonable estimate for Norway: What does that mean? It is a reference to substantiate claims that the CDC has no interest in making reports of vaccine injury either more accurate or more comprehensive. way the data are used by public health officials and the vaccine industry Moreover, anyone can submit a report to VAERS, and they do, including parents of autistic children seeking compensation for their childrens autism as being due to vaccine injury. At present, demand for the vaccine is high and supply is constrained, but as the U.S. hurtles toward President Bidens May 1 deadline for universal vaccine eligibility, supply may begin to outpace demand for the injection. annually The Vaccine Adverse Events Reporting System (VAERS) is sponsored by the Centers for Disease Control and by the Food and Drug Administration. And yet, publicly hosted on a CDC web server are claims that COVID-19 vaccines have caused gunshot wounds, with the CDC helpfully listing shareable buttons at the top of the page for your vaccine misinformation platform of choice: Facebook, Twitter, LinkedIn and email for those wanting to mass-email their office colleagues. "Underreporting" is one of the main limitations of passive surveillance systems, including VAERS. The degree of underreporting varies widely. Box 847, Pearblossom, CA 93553 USA, Copyright 2023 BMJ Publishing Group Ltd, Womens, childrens & adolescents health, Adverse Reactions to Varicella Vaccination are Grossly Under-Reported. (1995) 13(4):340-342. It only confirms that the reported event occurred sometime after vaccine was given. Exploring issues and controversies in the relationship between science and medicine. The mismatch is causing the browser to think that the user is not going to the genuine site. A spokesperson for the Australian governments Therapeutic Goods Administration told the HPR that the Australian TGA is aware that CDC VAERS data is being used to promulgate anti-vaccination views and noted that the Australian reporting system employs a 90-day delay to allow authorities to verify information before it becomes public. Vaccine Adverse Event Reporting System (VAERS) is a reporting system that anyone can report to or access data from. (1997) 99(2):263-264. J. Yet the presumption of significantly higher real numbers is supported by a 2010 Harvard Pilgrim study which found that "fewer than 1% of vaccine injuries" are reported on VAERS. VAERS accepts reports from anyone, including patients, family members, healthcare providers and vaccine manufacturers. As with all antivax talking points, its meant to deceive. Keywords: Heres what I mean: As of Jan. 22, 329 deaths a subset of 9,845 total adverse events had been reported to the Centers for Disease Control and Preventions (CDC) Vaccine Adverse Event Reporting System (VAERS) following COVID-19 vaccinations. Underreporting and Post-Vaccine Deaths in the Vaccine Adverse Event Reporting System (VAERS) Explained | by Shin Jie Yong | Microbial Instincts | Medium Write Sign up Sign In 500 Apologies,. Allergy Clin. How HHS needs a certificate that covers both vaers.hhs.gov and http://www.vaers.hhs.gov. SAKAGUCHI M, YAMANAKA T, IKEDA K, SANO Y, FUJITA H, MIURA T, INOUYE S: IgE-mediated systemic reactions to gelatin included in the varicella vaccine. Unfortunately, there was never an opportunity to perform system performance assessments because the necessary CDC contacts were no longer available and the CDC consultants responsible for receiving data were no longer responsive to our multiple requests to proceed with testing and evaluation. Risk increases with each dose of vaccine as well. The article then regurgitates RFK Jr.s quote that he used to deny coincidence: Coincidence is turning out to be quite lethal to COVID vaccine recipients, said Childrens Health Defense (CHD) Chairman Robert F. Kennedy, Jr. If the clinical trials are good predictors, the rate of coincidence is likely to increase dramatically after the second shot.. J. Epidem. 2016 Aug 17;34(37):4406-14. doi: 10.1016/j.vaccine.2016.07.019. The VAERS dataset also appears to be immune from Facebooks anti-misinformation protocols and remains a prominent feature of the anti-vaccine campaigning repertoire. J. Pediatr. can they dismiss placebo-controlled trials that raise serious Indeed, I long ago discussed how lawyers have long gamed VAERS to support their litigation, reporting lots of cases of autism as supposedly an adverse reaction to vaccines. Increased scrutiny on the VAERS dataset comes as the Director of the CDC, Rochelle Walensky, fought back tears warning of an impending doom. The United States rolling 7-day average for new infections has increased 15% over the span of just two weeks and hospitalizations caused by the virus have jumped by 5% in that same period. Each of the three occurrences of the shingles rash was on his left side. References The coalition formed . So were there any problems with meeting the objectives of the grant? From your lips to QAnon's ears.. Competing interests: One observation that Ive made about how antivaxxers have joined the COVID-19 cranks and conspiracy theorists and started casting doubt on COVID-19 vaccines is that everything old is new again. Share on Facebook, opens a new window This is a system that sends regular text messages to those whove been vaccinated to ask them about side effects and in general how they feel. The coding of VAERS reports requires careful interpretation. Disease in children under 5 were reported to VAERS. 57, No. Case "C" An adult female, age 47, became disabled following varicella vaccination. understand that minor side effects of vaccinations often include this kind of discomfort, as well as low fevers. With the rollout of safe and effective vaccines against COVID-19 finally starting to result in tens of millions of people receiving the Moderna and Pfizer/BioNTech vaccines, with newer vaccines likely to be introduced in the coming months, the predictions that I (and many others) made months ago are coming to pass. (1997) 126(10):833-834. Clinical descriptions of five different serious adverse affects that followed varicella vaccination are given below. caused the event. J. Ophthalmol. That one earned a much belated Godzilla facepalm: When Godzilla gives you the facepalm, you know the failure is monstrous. On the other hand, more serious and unexpected medical events are probably more likely to be reported than minor So I suppose I shouldnt be surprised that antivaxxers are now weaponizing the Vaccine Adverse Events Reporting System (VAERS) database to try to blame all manner of adverse events on vaccines, whether there is evidence of causation or not. sharing sensitive information, make sure youre on a federal VAERS is a passive surveillance system that relies on the willingness of individuals and professionals to submit reports voluntarily. The Centers for Disease Control and Prevention did not respond to HPR requests for comment. Many physicians consider vaccination extremely safe and parents or patients are not provided with information regarding potential adverse outcomes. I assume the claim from Kirsch is based on a 10 year old report from Harvard-Pilgrim insurance showing that only ~1% of drug related adverse effects are reported. So where is that information in this study? Varicella vaccination is generally considered safe [1] but there are usually no prescreening tests to determine whether an adverse reaction is likely to occur [2]. Vaccine (1999) 17(4):327-329. 2022 Jul 26;23(15):8235. doi: 10.3390/ijms23158235. Case E high, KD incidence as reported to VAERS was 0.11 while published Likewise, fewer than 1% of vaccine adverse events are reported.. Vaccine. "'Underreporting' is one of the main limitations of passive surveillance systems, including VAERS," HHS says on its website. (Pediatr Infect Dis J 28:943, 2009) From 1988 to Then, with respect to antivaccine disinformation, truly everything old will be new again. The startling statistics are being shared far and wide by anti-vaccination activists and concerned readers alike dramatically the. A certain number of 80+ year olds die every day drew the attention of the U.S. CDC and.. Was on his left side and underscore adverse reaction following varicella vaccination are going to be from! 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