The Contraindications

An Essay on the CDC’s Own List of Who Their Products Injure

Author’s note: This essay is built almost entirely from a single source, the CDC’s Epidemiology and Prevention of Vaccine-Preventable Diseases (14th edition, 2021), better known as the Pink Book. Because the source itself is the CDC’s own institutional voice, the essay operates in two registers. Establishment language (immune system, autoimmune, viral, immunocompromised, vaccine-preventable disease) appears in quotation, attribution, official document titles, and clinical labels the CDC uses. Where the analytical voice takes over, the language shifts. The observed harms are treated as observable; the theoretical framework that produced the products is not endorsed. What follows is a walk through the CDC’s own screening list, and the government’s own compensation list, and the space between them where the manufacturer stands.

The Sentence

“Encephalopathy not due to another identifiable cause and occurring within 7 days of pertussis vaccination is a contraindication to subsequent doses of pertussis-containing vaccine.”¹

The sentence appears on page 15 of the 14th edition of the CDC’s Epidemiology and Prevention of Vaccine-Preventable Diseases, the textbook the CDC produces to train the medical workforce that administers the childhood schedule. It sits in Chapter 2, in a short bullet list under the heading Contraindications. Three paragraphs earlier, the CDC defines a contraindication as “a health condition in the recipient that increases the likelihood of a serious adverse reaction to a vaccine.”²

Unpacked, the sentence describes a specific child. The child receives a pertussis-containing shot. Within seven days the child develops brain inflammation. No other cause explains it. The CDC’s instruction to the pediatrician is that the child receives no further pertussis-containing doses. The reason the rule exists is that a second exposure produces the same injury again.

A contraindication is a screening rule. It exists because a defined subset of people experiences serious harm from the product, and the CDC has determined that this subset can be identified in advance from a specific history. The rule protects the identifiable child. It does not exist unless the harm exists first.

Every product on the childhood schedule carries a list like this. Read together, the lists are a map of who the products hurt.

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What a Contraindication Is

The Pink Book is not a critic’s document. It is written by CDC staff, edited by CDC staff, and distributed through the Public Health Foundation to the physicians, nurses, and health department employees who order and inject the products it describes.³ Its purpose is to make sure they administer the schedule correctly.

Chapter 2 lays out the general framework. Contraindications are hard rules. Precautions are softer rules that “might increase the chance or severity of a serious adverse reaction” and generally cause the vaccine to be deferred, though a provider can override the precaution if benefit is judged to outweigh risk.⁴ Both categories describe conditions under which the product is expected to injure a subset of recipients.

The general contraindications, applied across all vaccines, include a severe allergic reaction to a vaccine component; a severe allergic reaction following a prior dose; severe immunosuppression for live vaccines; a history of intussusception for rotavirus; and the pertussis encephalopathy rule quoted above.⁵ The precautions list adds Guillain-Barré syndrome within six weeks of a previous tetanus toxoid-containing or influenza dose; a history of thrombocytopenia or thrombocytopenic purpura for MMR; recent receipt of antibody-containing blood products for MMR and varicella; Arthus-type hypersensitivity reactions after diphtheria or tetanus toxoid; and progressive neurologic disorders including infantile spasms, uncontrolled epilepsy, or progressive encephalopathy for DTaP and Tdap.⁶

Each individual disease chapter carries its own contraindications and precautions box. The boxes repeat the general framework and add product-specific entries: yeast hypersensitivity for hepatitis B and HPV, latex allergy for the RV1 rotavirus applicator, family history of congenital or hereditary immunodeficiency for MMR and varicella.⁷ ⁸ ⁹ ¹⁰

The lists were compiled by people whose professional purpose is to promote the products. That is what makes them evidence.

The Anaphylaxis Rule

One contraindication appears in every product chapter of the Pink Book. The CDC’s phrasing varies slightly between chapters but the substance is identical: a severe allergic reaction, defined as anaphylaxis, to any component of a vaccine or following a prior dose of that vaccine, is a contraindication to further doses of that vaccine.

Anaphylaxis is not a minor reaction. The Pink Book describes it as involving “two or more organ systems (dermatologic, cardiovascular, respiratory, and/or gastrointestinal) simultaneously” with symptoms including generalized hives, swelling of the mouth and throat, difficulty breathing, wheezing, hypotension, and shock.¹¹ It requires emergency medical attention. It can kill.

The CDC lists specific components known to cause anaphylactic reactions to the products on the schedule. Egg protein, from vaccines cultured in embryonated chicken eggs. Gelatin, present in MMR and other formulations. Neomycin, an antibiotic added to several products. Yeast, from the recombinant hepatitis B and HPV vaccines. Latex, present in the rubber components of certain vial closures and in the RV1 rotavirus applicator.¹² ¹³

The universal contraindication concedes a specific fact about the products. They contain substances capable of producing life-threatening allergic reactions in a fraction of recipients. The fraction is small enough to be tolerated as a schedule-wide risk and large enough that the CDC teaches its workforce to screen every patient before every dose. The screening is not optional. It is what the Pink Book calls “the key to preventing serious adverse reactions after vaccination.”¹⁴

The rule reveals a second concession. Anaphylaxis on the first dose predicts anaphylaxis on subsequent doses. This is the CDC’s own logic in issuing the contraindication. The product produces a class of injury that repeats on rechallenge.

The Pertussis Rule

The encephalopathy contraindication for pertussis is older than the acellular DTaP formulation. It comes forward from the era of whole-cell DTP, when the association between pertussis vaccination and post-vaccinal brain injury was documented sufficiently to force the CDC to write a screening rule.

The Pink Book keeps the rule for DTaP. Chapter 7 lists it: encephalopathy not attributable to another identifiable cause, occurring within seven days of a prior dose, is a contraindication to further doses of DTaP or Tdap.¹⁵ The DT and Td formulations, which contain diphtheria and tetanus toxoids without the pertussis component, are the alternatives for a child who has met the contraindication. The child continues to receive the schedule; the pertussis piece is removed.

The Pink Book’s precautions list adds three related entries for DTaP and Tdap: progressive or unstable neurologic disorder, uncontrolled seizures, and progressive encephalopathy. Each is a condition in which the pertussis component is deferred. The CDC’s rationale is that pertussis-containing vaccines can trigger or worsen the neurological process.¹⁶

The contraindication is narrow in a specific way. It applies to the child who has already been injured once. It does not identify, in advance, the child who will be injured for the first time. A first-dose encephalopathy is not preventable through screening because there is no history yet to screen against. The rule protects the child who has been injured from being injured again. The child who is about to be injured for the first time receives the shot.

That is the structure of the whole contraindications framework. Screening prevents rechallenge injury in the identifiable subset. First-exposure injury in the unidentifiable subset is not prevented. The list is what the CDC catches. The rest is the collateral.

The Cluster the Establishment Calls Autoimmune

A group of conditions appears repeatedly across the contraindications and precautions sections of the Pink Book. Each is labeled by the CDC as an allergic, hypersensitivity, or so-called autoimmune phenomenon following a specific product. Read together, they form a cluster that the CDC has coded, chapter by chapter, as a known product-induced pattern.

Guillain-Barré syndrome, a progressive paralysis of the peripheral nerves, is a precaution for tetanus toxoid-containing vaccines when it has occurred within six weeks of a previous tetanus dose.¹⁷ It is also a precaution for influenza vaccines under the same six-week window.¹⁸ The Pink Book acknowledges GBS in the Shingrix chapter as well, noting that the FDA determined an association between Shingrix and GBS in adults 65 and older and required a warning added to the prescribing information.¹⁹

Thrombocytopenic purpura, a bleeding disorder caused by the destruction of platelets, is a precaution for MMR and MMRV vaccine, on the CDC’s stated ground that such persons “may be at increased risk for developing clinically significant thrombocytopenia after MMR or MMRV vaccination.”²⁰

Chronic arthritis is listed on the federal Vaccine Injury Table as a compensable injury following any rubella-containing vaccine, with an onset window of 7 to 42 days.²¹ The CDC’s own compensation program presumes the vaccine caused the arthritis if it appears within that window.

Intussusception, a life-threatening telescoping of the bowel, was documented as a rotavirus vaccine injury sufficient to withdraw the first rotavirus product from the market in 1999. The current products carry a hard contraindication: any prior history of intussusception disqualifies the child from receiving the vaccine.²² The Pink Book acknowledges that “post-marketing studies of the currently licensed vaccines have detected an increased risk for intussusception following rotavirus vaccine administration.”²³

Arthus-type hypersensitivity, a severe inflammatory reaction at the injection site, is a precaution for diphtheria toxoid- and tetanus toxoid-containing vaccines when it has followed a prior dose. The CDC’s rule is that the next dose is deferred until at least ten years have elapsed.²⁴

The hepatitis B chapter contains the most striking passage in the Pink Book on this cluster. In prose describing HepB vaccine safety, the CDC writes: “In rare instances, other illnesses have been reported after HepB vaccination, including Guillain-Barré syndrome, chronic fatigue syndrome, neurologic disorders (e.g., leukoencephalitis, optic neuritis, and transverse myelitis), rheumatoid arthritis, type 1 diabetes, and autoimmune disease.”²⁵ The sentence that follows adds: “However, no causal association between those conditions or any other chronic illness and HepB vaccine has been demonstrated.” The list is the list. The disclaimer that follows it is the CDC declining to affirm what the list already contains.

The pattern across chapters is not confined to one product. It follows the injectable schedule. Different vaccines produce different signatures, but the family resemblance is clear. Charles Richet demonstrated the underlying mechanism in 1902 and won the 1913 Nobel Prize in Physiology or Medicine for the work: injection of a foreign protein sensitizes the body to that protein, and subsequent exposures produce escalating responses that can destroy tissue and kill.²⁶ The specific case survives in the medical curriculum as anaphylaxis. The general principle, that injection is what produces the sensitization, does not. What remains in its place is the vocabulary the establishment reaches for when tissue damage cannot be resolved into another framework. The vocabulary is autoimmune.

The Immunosuppression Rule

The Pink Book contains a category of contraindication that reveals the products’ logic in an unusually clear form. Live vaccines are contraindicated in persons the CDC classifies as severely immunosuppressed. The Pink Book’s stated rationale is that live vaccines can cause “severe or fatal reactions in immunosuppressed persons due to uncontrolled replication of the vaccine virus.”²⁷

The scope of the contraindication is wide. It covers persons with congenital immunodeficiency, leukemia, lymphoma, generalized malignancy, and persons receiving cancer treatment with alkylating agents, antimetabolites, or radiation therapy. It covers persons on large doses of corticosteroids (defined as 20 milligrams or more of prednisone daily, or 2 mg/kg body weight, for 14 days or longer). It covers persons receiving therapeutic monoclonal antibodies, particularly the anti-TNF agents, and persons on lymphocyte-depleting agents such as alemtuzumab and rituximab.²⁸

Appendix A of the Pink Book carries a two-page table titled Vaccination of persons with primary and secondary immunodeficiencies. The table lists contraindicated vaccines against specific immunodeficiency categories: B-lymphocyte deficiencies, T-lymphocyte deficiencies, complement deficiencies, phagocytic function disorders, HIV/AIDS, generalized malignancy and transplantation, asplenia, chronic renal disease.²⁹ Each row identifies the vaccines the CDC has determined this population should not receive.

The contraindication concedes something the CDC’s public messaging does not typically emphasize. The live products depend on the recipient’s body producing the response the vaccine is designed to elicit. When the body cannot produce that response, the product does not become inert. It becomes dangerous. Under the CDC’s own model, what the vaccine introduces replicates in the body without the check the product assumes will be present, and the CDC’s phrase for the outcome is “severe or fatal reactions.”

For the essay’s purposes, what matters is not the mechanism the CDC posits. What matters is that the CDC has drawn a line around a population and instructed its workforce not to inject live vaccines into anyone on the wrong side of that line. The line is the CDC’s admission that the products behave differently, and worse, in bodies that cannot mount the expected response.

The Pregnancy and Family History Rules

Live vaccines are contraindicated in pregnancy. The Pink Book states the rule for MMR, varicella, LAIV, and zoster.³⁰ ³¹ ³² ³³ Inactivated poliovirus vaccine “should not be administered during pregnancy” on theoretical grounds, though the CDC allows an exception if exposure risk is imminent.³⁴ HPV vaccination is deferred until after pregnancy.³⁵ The CDC’s stated basis is the “theoretical risk of virus transmission to the fetus.”

The contraindication is a screening rule against fetal injury. It does not depend on documented fetal harm in any specific dose. It depends on the CDC’s judgment that the risk is real enough, in a population it wants to protect, to justify withholding the product.

The family history contraindication is narrower and stranger. A family history of congenital or hereditary immunodeficiency in first-degree relatives, meaning parents or siblings, is a contraindication to MMR and varicella-containing vaccines, unless testing has confirmed the child does not share the family condition.³⁶ ³⁷ A family history of seizures is a precaution for MMRV vaccination.³⁸

The family history rule concedes that a familial pattern is enough to withhold the product. The child in front of the pediatrician has not manifested the condition. The child’s sibling has, or the child’s parent has, and that is sufficient for the CDC to instruct that MMR and varicella be deferred pending laboratory verification of the child’s status. The rule works because the CDC has determined that the family pattern predicts the injury pattern often enough to matter.

The list of who should not receive the products, taken as a whole, is a portrait of the people the CDC has determined the products injure at rates it considers unacceptable to leave uncorrected by screening. The portrait is the CDC’s own. The features come from the Pink Book, chapter by chapter, in the sections its authors labeled Contraindications and Precautions.

The 1986 Act

The Pink Book contains a second body of admission material, held in Appendix D. Before reading it, the essay pauses to name what makes it possible.

On November 14, 1986, President Reagan signed the National Childhood Vaccine Injury Act into law. The Pink Book’s own account of the Act’s origin, in Appendix D, states that the Vaccine Injury Compensation Program the Act created is “a no-fault alternative to the traditional tort system for resolving vaccine injury claims,” established “after lawsuits against vaccine manufacturers and healthcare providers threatened to cause vaccine shortages and reduce vaccination rates.”³⁹

That sentence names the trade Congress made. In the years before 1986, juries in state courts were finding for plaintiffs alleging vaccine injury. Awards were rising. Manufacturers were exiting the market. The Reagan administration and Congress chose to preserve the industry by removing the industry from the tort system. Injury claims would go to a federal no-fault program funded by an excise tax on doses. Manufacturers would keep making the products. Families of injured children would collect from the fund, if they could clear its procedural bars, rather than from the companies whose products injured them.

In 2011, the Supreme Court closed the remaining aperture. In Bruesewitz v. Wyeth LLC, the Court held that the 1986 Act preempts all state-law design defect claims against vaccine manufacturers. A family cannot argue that a safer alternative design was available and should have been used. The shield is total for design defects; the fund is the exclusive remedy.⁴⁰

The consequence is structural. Every contraindication in the Pink Book, every precaution, every reportable adverse event, every entry on the Vaccine Injury Table, every candid passage in the safety sections of the disease chapters, exists inside a legal architecture in which no admission on any of these documents produces a lawsuit against the manufacturer. Merck, Sanofi, GSK, and Pfizer do not pay for the injuries their products cause. The fund pays. The fund is funded by an excise tax collected on each dose sold. The tax is priced into the product. The final payer is the person who received the injection, or the parent who consented, or the insurer that reimbursed. The manufacturer’s exposure ends at the sale.

That is the frame that makes the second door possible. When a document catalogs a product’s injuries without threatening the product’s maker, the document can be honest. The Vaccine Injury Table is that document.

The Vaccine Injury Table

Appendix D of the Pink Book reproduces the National Vaccine Injury Compensation Program’s Vaccine Injury Table.⁴¹ The Table is the federal government’s official list of injuries and conditions “presumed to be caused by vaccines” when they occur within specified windows after vaccination. The Pink Book’s own explanation notes that if the first symptom appears within the listed window, “it is presumed that the vaccine was the cause of the injury or condition unless another cause is found.”⁴²

Three entries appear across most or all vaccines on the Table: anaphylaxis within four hours (listed for nine of the seventeen vaccine entries), shoulder injury related to administration within 48 hours, and vasovagal syncope within one hour. These are the near-universal compensable injuries.

The vaccine-specific entries reveal what the government has determined each product causes. Brain and nerve injury runs through several products: encephalopathy or encephalitis within 72 hours for pertussis-containing vaccines and 5 to 15 days for MMR, brachial neuritis 2 to 28 days for tetanus toxoid-containing vaccines, and Guillain-Barré syndrome 3 to 42 days for seasonal influenza.

Systemic conditions follow other products. Chronic arthritis 7 to 42 days for rubella-containing vaccines. Thrombocytopenic purpura 7 to 30 days for measles-containing vaccines. Intussusception 1 to 21 days for rotavirus vaccines. Each is a condition the government pays for without requiring the family to prove causation.

A final category compensates injuries produced by the vaccine organism itself: disseminated varicella vaccine-strain viral disease and vaccine-strain viral reactivation, vaccine-strain measles viral infection in an immunodeficient recipient, and paralytic polio following the live oral polio vaccine (no longer used in the United States).⁴³

The Reportable Events Table, reproduced immediately before the Vaccine Injury Table, is the companion document that governs mandatory reporting. Healthcare providers are required by law to report to VAERS any adverse event listed on the Reportable Events Table that occurs within the specified time period after vaccination, and separately, “any adverse event listed by the vaccine manufacturer as a contraindication to subsequent doses of the vaccine.”⁴⁴ Manufacturers are required by federal regulation to report to VAERS “all adverse events made known to them for any vaccine.”⁴⁵

The loop is closed. The package insert lists the contraindications. The Reportable Events Table requires providers to report them when they occur. The Vaccine Injury Table pays for them when they meet its criteria. The manufacturer bears no cost at any stage.

The IOM Passage

Sitting inside the Pink Book’s diphtheria chapter, in the routine vaccine safety subsection, is a passage that does not appear on either the contraindications table or the injury table but describes what surrounds both. The passage reports the findings of the 2011 Institute of Medicine review of vaccine adverse effects. The Pink Book quotes the IOM’s conclusion for diphtheria and tetanus toxoid-containing vaccines:

The IOM “reported in 2011 that the evidence was inadequate to accept or reject a causal relation between receipt of diphtheria toxoid and tetanus toxoid-containing vaccine and encephalitis, encephalopathy, infantile spasms, seizures, ataxia, autism, acute disseminated encephalomyelitis, transverse myelitis, optic neuritis, onset of multiple sclerosis in adults, relapse of multiple sclerosis in adults, relapse of multiple sclerosis in children, Guillain-Barré syndrome, chronic inflammatory disseminated polyneuropathy, opsoclonus myoclonus syndrome, or Bell’s palsy.”⁴⁶

The list is a list of every serious neurological and autoimmune-labeled outcome that has been raised in connection with these vaccines. The IOM’s assessment for each was the same: the evidence was inadequate to say yes and inadequate to say no. The CDC, in publishing this passage in its own textbook, adopts the IOM’s finding as the state of the record. The state of the record is that these outcomes have not been ruled out for the DTaP-Tdap family of products, decades after licensure, hundreds of millions of doses in.

The IOM’s phrasing has a specific meaning. “Inadequate to accept or reject” is the National Academies’ formal category for evidence that permits no conclusion in either direction. The category is populated when the studies necessary to answer the question have not been done, or have been done poorly, or have produced conflicting results. It does not mean the association is disproved. It means the association is neither confirmed nor refuted.

For fifteen specific outcomes, including autism, the CDC’s own textbook records that the IOM could not rule out the causal relation. The autism entry sits inside a passage the CDC has printed unchanged through multiple editions.

The Same List, Both Doors

The contraindications list and the Vaccine Injury Table describe the same population. The contraindications catalog the identifiable subset the CDC screens out in advance. The Injury Table catalogs the subset the government compensates after the fact. The names of the injuries recur across both documents.

Anaphylaxis is a contraindication to further doses in every product chapter of the Pink Book. Anaphylaxis is on the Vaccine Injury Table for nine of the vaccines listed there, each with a 4-hour window. The contraindication protects the child who has already had the reaction. The Injury Table pays the child who was not screened out in time, or who had no prior history to screen against.

Encephalopathy is a contraindication for pertussis-containing vaccines when it occurs within seven days of a dose. The Injury Table’s compensation window is 72 hours for pertussis-containing vaccines and 5 to 15 days for MMR. The pertussis contraindication runs seven days; the pertussis compensation runs three. A child injured on day four is protected from the next dose but not compensated for the first. The contraindication is the CDC’s admission that the injury occurs. The Injury Table is the government’s decision about how much of it to pay for.

Guillain-Barré syndrome within six weeks is a precaution for tetanus toxoid- and influenza-containing vaccines. Guillain-Barré syndrome within 3 to 42 days is on the Injury Table for seasonal influenza vaccines. The CDC does not require an argument to compensate GBS following flu vaccination. The presumption of causation is federal law.

Thrombocytopenic purpura is a precaution for MMR. Thrombocytopenic purpura within 7 to 30 days is on the Injury Table for measles-containing vaccines.

Chronic arthritis is not a contraindication in the Pink Book chapters, but chronic arthritis within 7 to 42 days is on the Injury Table for rubella-containing vaccines. What the chapter does not name, the Table pays for.

Intussusception is a hard contraindication for rotavirus vaccine. Intussusception within 1 to 21 days is on the Injury Table for rotavirus vaccine.

The two documents were written by different offices, for different purposes, under different statutory authorities. They arrive at the same list. The contraindications list is the CDC’s screening tool. The Injury Table is the government’s payout schedule. Both are the same map of who the products hurt, drawn from opposite ends.

Standing outside both doors is the manufacturer, whose product delivered the injury on both sides of the list, and who pays for none of it.

How to Explain It to a Six-Year-Old

Imagine a company makes a candy. When some children eat the candy, they get sick. The company knows which children are most likely to get sick, so they write a list of who should not eat it. The list has the children who got sick from the candy before. The children whose brothers or sisters got sick from it. The children with certain conditions.

The parents ask what happens to the children who get sick anyway. The company says: don’t worry, the government pays. The government has its own list, with the same sicknesses on it. If your child gets sick on the government’s list, the government sends you money.

The parents ask why the company doesn’t pay. The company says: the government made a rule a long time ago. The company doesn’t have to pay anymore. If we had to pay, we might stop making the candy, and the government wants the candy to keep being made.

So the company keeps making it. The company writes the list of who shouldn’t eat it. The government writes the list of who got hurt by it. Nobody can sue the company. And the two lists, when you set them side by side, are almost the same list.

Truth Be Told: I’ve Accepted an Invitation to Speak on The Unvaccinated

On September 17th, I’ll be giving a one-hour presentation titled The Unvaccinated as part of a six-hour livestream called Truth Be Told. This is the first time I have accepted an invitation to an event, and I have been honoured with the opening act. The livestream begins at 12pm EST.

Vaccination is the subject closest to my heart, and this is another opportunity to spread the word. The format will preserve the pen name.

Tickets are here.

The code UNBEKOMING is $5 off and applies automatically at that link. Replay available afterwards. Hope you can make it.

In Print

Seven of my books are now available as paperbacks, printed to order through Lulu and shipped worldwide. The Unvaccinated lays out the completely unvaccinated as a comparison group across twenty chapters and five appendices — as far as I know, the only book of its kind. Medicalized Motherhood follows a woman through 123 documented interventions from teenage pill to postpartum discharge. Drilling for Profit argues that cavities, gum disease, and crooked teeth are a dietary problem the dental profession treats surgically. What Your Vet Can’t Tell You applies the same critique to pets — food, vaccines, and a profession trained by the industries whose products cause the harm. Escape from Psychiatry documents the fabrication of the DSM, the collapse of the serotonin hypothesis, and the specific damage done by every major psychiatric drug class.

Two more take up what the first five leave out — the remedies the first five explain why you need. The DMSO Book covers 100,000 studies, zero deaths, and one approval — the suppressed science of medicine’s most versatile compound. Chlorine Dioxide: The Forbidden Remedy collects the interviews, protocols, and evidence from the doctors and researchers they tried to silence.

A physical book reaches the person a Substack post never will — the sceptical relative, the friend who won’t click a link but might open a book, the visitor whose eye lands on a coffee table. Buy one to keep, and one to give away.

References

1. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hall E, Wodi AP, Hamborsky J, et al., eds. 14th ed. Washington, D.C.: Public Health Foundation; 2021. Chapter 2, p. 15.

2. Ibid., Chapter 2, p. 15.

3. Ibid., front matter and Chapter 1.

4. Ibid., Chapter 2, pp. 15–16.

5. Ibid., Chapter 2, p. 15.

6. Ibid., Chapter 2, p. 16.

7. Ibid., Chapter 10 (Hepatitis B), p. 161.

8. Ibid., Chapter 11 (HPV), p. 174.

9. Ibid., Chapter 19 (Rotavirus), pp. 295–296.

10. Ibid., Chapter 13 (Measles), p. 200; Chapter 22 (Varicella), pp. 341–342.

11. Ibid., Chapter 2, p. 17.

12. Ibid., Chapter 2, pp. 17–18.

13. Ibid., Chapter 19 (Rotavirus), p. 295.

14. Ibid., Chapter 2, p. 23.

15. Ibid., Chapter 7 (Diphtheria), p. 107; Chapter 21 (Tetanus), p. 325; Chapter 16 (Pertussis), p. 250.

16. Ibid., Chapter 7 (Diphtheria), pp. 107–108.

17. Ibid., Chapter 2, p. 16; Chapter 21 (Tetanus), p. 325.

18. Ibid., Chapter 12 (Influenza), p. 187.

19. Ibid., Chapter 23 (Zoster), pp. 354–355.

20. Ibid., Chapter 13 (Measles), p. 200.

21. National Vaccine Injury Compensation Program. Vaccine Injury Table. Reproduced in Pink Book, Appendix D, pp. D-11 to D-13.

22. Pink Book, Chapter 19 (Rotavirus), pp. 295–296.

23. Ibid., Chapter 19 (Rotavirus), p. 296.

24. Ibid., Chapter 2, p. 16; Chapter 7 (Diphtheria), pp. 107–108.

25. Ibid., Chapter 10 (Hepatitis B), p. 162.

26. Richet C. Nobel Lecture in Physiology or Medicine: “Anaphylaxis.” Delivered December 11, 1913. Stockholm: Nobel Foundation. Available at nobelprize.org. See also Portier P, Richet C. De l’action anaphylactique de certains venins. Comptes Rendus des Séances de la Société de Biologie. 1902;54:170–172.

27. Pink Book (as cited in ref. 1), Chapter 2, p. 19.

28. Ibid., Chapter 2, pp. 19–20.

29. Ibid., Appendix A, pp. A-24 to A-25.

30. Ibid., Chapter 13 (Measles), pp. 200–201.

31. Ibid., Chapter 22 (Varicella), pp. 341–342.

32. Ibid., Chapter 12 (Influenza), pp. 187–188 and cross-reference to ACIP LAIV recommendations.

33. Ibid., Chapter 23 (Zoster), p. 354.

34. Ibid., Chapter 2, p. 18; Chapter 18 (Poliomyelitis), p. 285.

35. Ibid., Chapter 11 (HPV), p. 174.

36. Ibid., Chapter 2, p. 16; Chapter 13 (Measles), p. 200.

37. Ibid., Chapter 22 (Varicella), p. 342.

38. Ibid., Chapter 2, p. 16.

39. Ibid., Appendix D, p. D-10.

40. Bruesewitz v. Wyeth LLC, 562 U.S. 223 (2011).

41. Pink Book, Appendix D, pp. D-11 to D-13.

42. Ibid., Appendix D, p. D-10.

43. Ibid., Appendix D, pp. D-11 to D-13.

44. Ibid., Appendix D, pp. D-3, D-5 to D-7.

45. Ibid., Appendix D, p. D-7 (footnote to Reportable Events Table).

46. Ibid., Chapter 7 (Diphtheria), pp. 108–109.

Additional Sources

• National Childhood Vaccine Injury Act of 1986, Public Law 99-660.

• Health Resources and Services Administration. National Vaccine Injury Compensation Program: Vaccine Injury Table. Available at https://www.hrsa.gov/vaccine-compensation/vaccine-injury-table.

• Vaccine Adverse Event Reporting System (VAERS). Co-managed by CDC and FDA. https://vaers.hhs.gov/.

• Institute of Medicine. Adverse Effects of Vaccines: Evidence and Causality. Washington, D.C.: National Academies Press; 2011.