Report #2866402

Received Oct 16, 2025

ER / ED visit

A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex: Male
Age: 4 yrs
State: CA
Recovered: Unknown
Vaccinated: Oct 16, 2025
Onset: Oct 16, 2025
Days to onset: 0
Hospital days: —

Vaccines (3)

Type	Name	Manufacturer	Dose	Lot	Route / Site
DTAPIPV	DTAP + IPV (QUADRACEL)	SANOFI PASTEUR	1	U8383AB	IM / RL
FLU3	INFLUENZA (SEASONAL) (FLUZONE)	SANOFI PASTEUR	1	U8827AA	IM / LL
MMRV	MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)	MERCK & CO. INC.	2	Z008866	SC / RL

Symptoms (4)

CyanosisNasal flaringRespiratory distressUse of accessory respiratory muscles

Symptom narrative

5 min's after receiving vaccines patient developed respiratory distress; cyanotic, retractions, nasal flaring . Patient was treated with two rounds of Epi Jr, Neb Albuterol 1.25mg's, Albuterol Inhaler, Oxygen high flow rate.. Patient was transported to local emergency room for further treatment/observation.

Current illness

Was hospitalized on 10/12/25 for URI and possible aspiration. D/c on 10/13/25

Medical history

Bronchiolitis, G tube fed, Chronic lung disease of prematurity, cerebral palsy, spastic, developmental delay, dysphagia, preterm newborn 25 weeks, s/p ventriculoperitoneal shunt, seizure disorder,

Other medications

unknown

Allergies

NKA

Lab data

Unknown. Patient is currently being treated at local hospital.