You are following a patient with a known heart condition. That patient is due for their first routine immunizations including diptheria-tetanus-acellular pertussis (DTaP) at two months of age. There may be other vaccinations coadministered, but this study will focus on DTaP due to the adverse effects caused by it. The most commonly reported adverse effects of DTaP include tenderness at the injection site, fever, fussiness or irritability, and poor appetite (see table). For each heart condition you will be asked if you would immunize as normal, immunize as normal with special precautions, defer immunization or specify if you would not be consulted for that particular lesion. If you choose to modify the immunization, will you admit to hospital, give prophylactic antipyretics or other (explanation required)?

Table 1. Prevalence of adverse events caused by DTaP vaccine

Adverse Effect



1 in 3 children

Redness, tenderness, swelling at injection site

1 in 4 children

Low grade fever

1 in 4 children

Drowsiness and poor appetite

1 in 10 children


1 in 50 children

High grade fever (above 40.5˚C)

1 in 16,000 children

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