covid vaccine lump at injection site covid vaccine lump at injection site

The frequency and severity of systemic reactions was higher after dose 2 than dose 1 (78.1% vs 57.9%). (2022). Severe, life-threatening reactions following vaccinations are rare. bGrade 3: prevents daily activity; Grade 4: emergency room visit or hospitalization for severe pain at the injection site. Injection site redness was more common after Dose 2 (18.7%) than Dose 1 (11.6%). The reactogenicity profile of the vaccines (It is unknown whether reactogenicity of COVID-19 vaccine is increased with coadministration, including with other vaccines known to be more reactogenic, such as adjuvanted vaccines or live vaccines). 8600 Rockville Pike To relieve symptoms, experts recommend taking an . Whether the patient is behind or at risk of becoming behind on recommended vaccines. The overall incidence of unsolicited adverse events up to 28 days after any dose were similar in the vaccine group (49.3%) and the placebo group (48.2%) for participants ages 523 months. The vaccine produces the SARS-CoV-2 spike protein, which the immune system thinks is an infection that needs to be fought. Vaccine recipients reported higher rates of local reactions after dose 2 than dose 1. COVID arm may feel mildly uncomfortable, but the reaction is not dangerous and will clear on its own. All health care professionals who administer vaccines to older children, adolescents, and adults should be aware of the potential for syncope after vaccination and the related risk of injury caused by falls. . No grade 4 local reactions were reported. This site needs JavaScript to work properly. The AstraZeneca vaccine Vaxzevria is a vaccine against COVID-19. Epub 2022 Jul 19. If you catch strep throat or an ear infection, the lymph nodes behind your ears can become swollen and inflamed. New research finds that some people develop a red, itchy, swollen, or even painful rash where they received their COVID-19 vaccine shot. Injection site redness and swelling following either dose were reported less frequently. While less rare than anaphylaxis, this is still pretty uncommon. COVID arm is thought to be an immune system reaction. However, this reaction is rare . (d) Generation of autoreactive lymphocytes and crossreactive antibodies due to molecular mimicry leading to autoimmune reactions, such as vaccineinduced immune thrombocytopenia (VIIT) lupus erythematosus, vasculitis and bullous pemphigoid. a Pain grade 3: any use of prescription pain reliever or prevented daily activity; grade 4: required emergency room visit or hospitalization. One case of Bells palsy in the vaccine group was considered a serious adverse event. We take your privacy seriously. The frequency of local reactions was higher in the older age group (ages 2 to 5 years) than the younger age group (ages 6-23 months) (73.4% vs 54.4% after dose 2). Vaccines available in the United States are administered by 4 routes: When administering a vaccine by injection, choose the correct needle size based on the route, age, patient size, and injection technique. Local reactions were reported by the majority of vaccine recipients and at higher rates than placebo recipients. For this reason, everyone who receives a COVID-19 vaccine is monitored by their vaccination provider for at least 15 minutes. It wont escalate to a life threatening condition or serious allergic reaction and is not associated with anaphylaxis. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. The majority of systemic events were mild or moderate in severity, but there was a higher occurrence of grade 3 or higher reactions in the vaccine group. Occupational Safety and Health Administration (OSHA) regulations typically do not required gloves to be worn when administering vaccines unless the person administering the vaccine is likely to come in contact with potentially infectious body fluids or has open lesions on the hands. The frequency and severity of systemic reactions was higher after dose 2 than dose 1 (86.1% vs 68.5%). It is recommended that future vaccines continue to be given according to the immunisation schedule. HHS Vulnerability Disclosure, Help COVID arm: Very delayed large injection site reactions to mRNA COVID vaccines. Some patients are reporting a lump in their armpit after getting the COVID vaccine. The most commonly reported unsolicited adverse events after any vaccine dose were injection site lymphadenopathy (4.3%) and headache (2.2%). The .gov means its official. COVID arm: Delayed hypersensitivity reactions to SARS-CoV-2 vaccines misdiagnosed as cellulitis. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Some vaccines are approved by the Food and Drug Administration (FDA) for administration by the Pharmajet Stratis needle-free injection system. The most common manifestations of localized injection-site reactions were swelling (44% after the first dose, 68% after the second), erythema (49% and 67%), and pain (35% and 59%). 2021 Jul;85(1):46-55. doi: 10.1016/j.jaad.2021.03.092. Any AEFI should be reported to the vaccine safety service in your state. Gambichler T, et al. No grade 4 local reactions were reported. In this article, well clue you in on the symptoms and treatments of COVID arm. You may want to consider talking with your doctor to learn more about the COVID-19 vaccines benefits and side effects. . But any time you experience skin symptoms, its a good idea to speak with your doctor. The unsolicited adverse event of COVID-19 within 28 days of any dose was more frequently reported in the placebo group (1.0%) than the vaccine group (0.2%). Cookies used to make website functionality more relevant to you. If you havent experienced COVID arm before after getting your first shot, youre even less likely to get it now. Local reactions were reported by the majority of vaccine recipients and at higher rates than placebo recipients. Serious adverse events were defined as any untoward medical occurrence that resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, or resulted in persistent disability or incapacity. (2022). 2022 Dec;36(12):e979-e981. Injection site reactions. If gloves are worn, they should be changed, and hand hygiene should be performed between patients. COVID arm is a relatively rare occurrence, which should not be confused with the early onset arm reactions caused by many vaccines. } ); These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. COVID arm is a delayed hypersensitivity skin reaction that occurs on or around the injection site. There were no grade 4 local reactions reported. Some persons should be observed longer30 minutesafter receiving COVID-19 vaccine. MVEC acknowledges the traditional owners of the lands on which we live, work and educate. We explain how it works and more. All information these cookies collect is aggregated and therefore anonymous. acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), cdc.gov/coronavirus/2019-ncov/vaccines/safety/allergic-reaction.html, fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-emergency-use-novavax-covid-19-vaccine-adjuvanted, dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines, ncbi.nlm.nih.gov/pmc/articles/PMC8656409/, jamanetwork.com/journals/jamadermatology/fullarticle/2779643, journals.sagepub.com/doi/10.1177/21501327211024431?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed, ncbi.nlm.nih.gov/pmc/articles/PMC8056968/, cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html, cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html, cdc.gov/vaccinesafety/research/publications/index.html, ncbi.nlm.nih.gov/pmc/articles/PMC7959672/. Delayed localized hypersensitivity reactions to the Moderna COVID-19 vaccine a case series. The proportions of participants who reported at least one serious adverse event were 1% in the vaccine group and 1% in the placebo group. You should not consider the information in this site to be specific, professional medical advice for your personal health or for your familys personal health. Systemic reactions were reported by the majority of vaccine recipients and at higher rates than placebo recipients. (Table 10, Table 11). If you experience swelling of your lips, eyes, or tongue, that could be an allergic reaction to the vaccine. However, if you do experience a severe allergic reaction, it will usually happen immediately after receiving the injection. What to Do if You Get COVID Arm and Other Side Effects iStock The CDC has warned that vaccine side effects include: Pain Redness Swelling As well as Tiredness Headache Muscle pain Chills Fever Nausea Contact your doctor if you feel you need medical attention. We avoid using tertiary references. If you have questions about receiving a COVID-19 vaccination at a specific location, please contact that location. In conclusion, there are numerous cutaneous reaction patterns that may occur following COVID-19 vaccination, whereby many of these skin findings are of immunological/autoimmunological nature. Serious adverse events were defined as any untoward medical occurrence that resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, or resulted in persistent disability or incapacity. E, et al Nodule at injection site as an adverse event following immunization: case definition and guidelines for data collection, analysis and presentation, Vaccine 2004 (22): 575-585, Silcock, R. et al Subcutaneous nodules following immunization in children; in Victoria, Australia from 2007 to 2016, Vaccine 2020 (38): 3169-3177, Silcock, R. et al Subcutaneous nodules: an important adverse event following immunization, Expert Review of Vaccines 2019 (18): 405-410, Bergfors, E. Lundmark, K. Kronander, U. xhr.send(payload); Prepare each injectable vaccine using a separate syringe. A severe allergic reaction can cause: difficulty breathing or wheezing, a drop in blood pressure, swelling of the tongue or throat, or Miao G, Chen Z, Cao H, Wu W, Chu X, Liu H, Zhang L, Zhu H, Cai H, Lu X, Shi J, Liu Y, Feng T. Biomed Pharmacother. a Fever Grade 3: 39.0 40.0C or 102.1 104.0F; Grade 4: >40.0C or >104.0F Typically, any minor discomfort goes away in one or two days. Local reactions in both groups were mostly grade mild or moderate; however, severe reactions were more frequent in the vaccine group than in the placebo group. The following were higher in the placebo group compared with the vaccine group by at least 1%: upper respiratory tract infection (12.2% vs 10.3%), COVID-19 (4.9% vs 3.5%), and otitis media (3.7% vs 2.6%). Your immune cells respond to the muscle cells that have absorbed the mRNA vaccine. And for more vaccine news to know, find out why If You're Over 65, You Shouldn't Get This New Vaccine, Experts Warn. They help us to know which pages are the most and least popular and see how visitors move around the site. Injecting vaccines rapidly without aspiration, Using tactile stimulation (rubbing/stroking near the injection site before and during injection), Distracting the patient (done by either the parent or clinician), Having the patient seated rather than lying down. After dose 1, the older age group reported pain more frequently than the younger age group (61.4% vs 37.4%); a similar pattern was observed after dose 2 (71.4% vs 46.2%). Pain, swelling, and a. *Based on age. e Chills Grade 3: prevented daily activity and required medical intervention; Grade 4: required emergency room visit or hospitalization. The median age (range) was 55 years (24-80), with . As more and more people get their shots, they're noticing a lump in the armpit of the arm where they got vaccinated. A 2021 case report showed that the Pfizer-BioNTech vaccine might also cause COVID arm but appears less likely to do so. Pain at the injection site was more common post Dose 2 (94.8%) than Dose 1 (93.1%). Grade 4 fever (>40.0C) was reported by one vaccine recipient after dose 2 and one placebo recipient after dose 2. Lindgren AL, et al. All Rights Reserved. The frequency of local reactions was higher in the younger age group (aged 18 to 64 years) than the older age group (aged 65 years) (90.5% vs 83.9% after dose 2). During the study period, there were 322 patients referred for post-COVID-19 vaccine cutaneous reactions. We are committed to honouring Australian Aboriginal and Torres Strait Islander peoples unique cultural and spiritual relationships to the land, waters and seas. A higher frequency of unsolicited adverse events after any dose was reported in the vaccine group (20.5%) compared to the placebo group (15.9%). You will be subject to the destination website's privacy policy when you follow the link. Healthline Media does not provide medical advice, diagnosis, or treatment. 2005-2023 Healthline Media a Red Ventures Company. Because pain can increase with each injection, the order in which vaccines are injected matters. Pain at the injection site was reported more frequently after dose 1 (93.1%) than after dose 2 (92.4%). Among vaccine recipients, the median onset of systemic reactions was 1 to 2 days after either dose, with a median duration of 2 days. Provide supportive care and take appropriate measures to prevent injuries if such symptoms occur. (b) In presence of secondary allergens, increased COVID19 vaccinemediated immune recruitment may manifest as delayed (type IV) allergic reactions, such as COVID arm, maculopapular rashes, erythema multiforme and dermal filler reactions. The majority of reactions occurred within the first 1 to 2 days after each dose and persisted for a median of 2 days. Kelly JD, et al. It resolves on its own within a few days. Vaccine recipients reported higher rates of local reactions after dose 2 than dose 1. COVID arm: A reaction to the Moderna vaccine. Unauthorized use of these marks is strictly prohibited. Pityriasis rosea-like rashes and reactivation of herpes zoster have also been reported after COVID-19 vaccination. Procedural Pain Management the spike-protein sequences used to design the vaccines) and human components and may thus explain some COVID-19 pathologies as well as adverse skin reactions to COVID-19 vaccinations. Its symptoms appear several days to a week after the first or second vaccination. (2021). scientific studies and medical journals. Incidence of severe COVID-19 illness following vaccination and booster with BNT162b2, mRNA-1273, and Ad26.COV2.S vaccines. Reports of lymphadenopathy were imbalanced with 1.1 % of persons in the vaccine group and 0.6% in the placebo group reporting such events; lymphadenopathy is plausibly related to the vaccine. These cookies may also be used for advertising purposes by these third parties. They may also affect other parts of the body. Usually, the symptoms of COVID arm resolve on their own. There were no other systemic grade 4 reactions reported. a mild: 25-50 mm; moderate: 51-100 mm; severe: >100 mm; Grade 4=necrosis or exfoliative dermatitis. Other serious adverse events in the vaccine group included dehydration, metapneumovirus, foreign body respiratory tract infection, mastoiditis, bronchiolitis, pyrexia, rhinovirus, asthma, adenovirus infection, erythema multiforme, croup infectious, viral gastroenteritis, and 1 participant with Type 1 diabetes and diabetic ketoacidosis. The frequency of systemic reactions was higher in the younger age group than the older age group (81.9% vs 71.9% after dose 2). Why does this happen? For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional. The proportions of participants who reported at least one serious adverse event were 0.5% in the vaccine group and 0.2% in the placebo group. Very rarely, a nodule may persist and become symptomatic for the vaccinee (see rare or persisting subcutaneous nodules below). aGrade for fever: grade 3=39-40.0C; grade 4=> 40.0C. Recently, people who have been vaccinated are sharing stories online about feeling lumps in their armpits, which might seem like cause for concern, but is in fact, to be expected. 2023 Feb 6:S0365-0596(23)00008-9. doi: 10.1016/j.abd.2022.04.010. Injection site redness and swelling following either dose were reported less frequently. Anaphylaxis from a COVID vaccine is also very rare, occurring in only 5 cases per one million administered vaccines, which means the vaccines benefit still outweighs the risk. The most common serious adverse events occurring at higher rates in the vaccine group than the placebo group were myocardial infarction (5 cases in vaccine group vs. 3 cases in placebo group), cholecystitis (3 vs. 0), and nephrolithiasis (3 vs. 0). One 2021 case study of people with this condition found that COVID arm symptoms appeared seven days after the first shot and two days after the second. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Paolino G, Di Nicola MR, Rizzo N, Mercuri SR. An Bras Dermatol. Although pain from injections is, to some extent, unavoidable, there are some things that parents and health care providers can do to help prevent distress and decrease fear. Our website services, content, and products are for informational purposes only. e Chills Grade 3: prevented daily activity and required medical intervention; Grade 4: required emergency room visit or hospitalization. There is growing evidence that not only the novel coronavirus disease (COVID-19) but also the COVID-19 vaccines can cause a variety of skin reactions. d Nausea/Vomiting Grade 3: prevented daily activity, required outpatient intravenous hydration; Grade 4: required emergency room visit or hospitalization for hypotensive shock. If you do experience anaphylaxis symptoms or symptoms of myocarditis after getting COVID vaccine, you should seek immediate help. The majority of systemic reactions were mild or moderate in severity, after both doses. aGrade for fever: grade 3=39.6-40.0C; grade 4=> 40.0C. Unlike an immediate allergic reaction, this delayed reaction is not serious and does not mean you should avoid getting a booster shot. Why Monkeypox Messaging Matters To Reduce LGBTQ Stigma, Everything You Ever Wanted to Know About the Rabies Vaccine, Glycemic Index: What It Is and How to Use It, a red or discolored rash that varies in size from quarter-sized to very large, in some instances, the rash may spread to your hands or fingers, hard lump under your skin where the injection took place. c Axillary swelling or tenderness was collected as a solicited local adverse reaction (i.e. Last medically reviewed on November 27, 2022. It is unclear what causes a nodule however, vaccine components (e.g. official website and that any information you provide is encrypted Virus Res 2021; 17: 198454. Ann Clin Lab Sci. These may include a little swelling, tenderness, pain, itching, or redness around the area where the injection was given. Each vaccine has a recommended administration route and site. asevere: > 50 mm; Grade 4: necrosis or exfoliative dermatitis, bsevere: prevents daily activity; Grade 4: emergency room visit or hospitalization, a Grade 3: > 100 mm; Grade 4: necrosis or exfoliative dermatitis. Lump at the injection site Why it happens Duration Treatment Contacting a doctor Summary Most people experience minor side effects following COVID-19 vaccination. Enlarged lymph nodes are common after the Covid-19 vaccine and are your body's normal reaction to the vaccine. COVID arm is a delayed hypersensitivity reaction that occurs mostly from the Moderna vaccine. Overall, the median onset of local reactions in the vaccine group was 1 day after either dose, with a median duration between 2 and 3 days. In the placebo group serious adverse events, 1 participant experienced an abdominal wall abscess and 1 participant with rhinovirus infection and asthma. (a) Immediate (type I), MeSH In the placebo group there was 1 participant with bronchiolitis, rhinovirus and acute respiratory failure. Functional angiopathies (chilblain-like lesions, erythromelalgia) may also be observed. Injection site reactions are areas of skin redness, swelling, and warmth. Considerations for Coadministration of COVID-19 Vaccines and Other Vaccines. Itching, pain, and swelling are the main symptoms. But even before the vaccines were being administered in the States, medical experts were warning Americans to prepare for some noticeable side effects post-shot. However, in a very small number of cases, an allergic . For most vaccines a 15-minute observation period is recommended. Their risk of vaccine-preventable disease (e.g., during an outbreak or occupational exposures). A child with a long-standing, intensely itching subcutaneous nodule on a thigh: an uncommon (?) No serious adverse events were considered by the FDA as related to vaccine. Bookshelf See this image and copyright information in PMC. FOIA This happens with many of the common vaccines that infants receive, such as DTaP, polio, PCV, hepatitis A and B, chickenpox, MCV, and influenza. Additional information on providing immunization services during a pandemic is available here: Routine and Influenza Immunization Services During the COVID-19 Pandemic: Interim Guidance | CDC. This article reviews all you need to, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. As with most vaccines, the COVID-19 injection comes with a few less-than-desirable side effects, per the Centers for Disease Control and Prevention (CDC), like pain or swelling at the. Cazzato G, Ambrogio F, Pisani MC, Colagrande A, Arezzo F, Cascardi E, Dellino M, Macorano E, Trilli I, Parente P, Lettini T, Romita P, Marzullo A, Ingravallo G, Foti C. Vaccines (Basel). This potential side effect hasn't been as widely discussed as others. Recently, people who have been vaccinated are sharing stories online about feeling lumps in their armpits, which might seem like cause for concern, but is in fact, to be expected. b Grade 3: prevents daily activity; Grade 4: emergency room visit or hospitalization for severe pain at the injection site. (c) Mechanism of molecular mimicry caused by genetic similarities of SARSCOV2 spike protein components to endogenous crossreactive human antigens. The Society of Breast Imaging reports that 11.6% of patients who received Moderna's COVID-19 vaccine had swollen lymph nodes after the first dose, and 16% after the second dose. Cutaneous manifestations of COVID-19 and COVID-19 vaccination. (2022). Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. The Rare COVID Vaccine Side Effect Doctors Want You to Prepare For, vaccine side effect that hasn't been as discussed, This COVID Vaccine Side Effect Could Show Up a Week After Your Shot, If You Take These OTC Meds, You Have to Stop Before Getting the Vaccine, If You're Over 65, You Shouldn't Get This New Vaccine, Experts Warn, The CDC Doesn't Recommend This One Type of Face Mask, immunologist with Allergy & Asthma Network, Click here for all 2022 Melbourne Vaccine Education Centre. Pain/tenderness at the injection site was the most frequent and severe reported solicited local reaction among vaccine recipients. You can review and change the way we collect information below. Most of the known reactions have occurred with Moderna. * Grade 4 event reported due to error in eDiary data entry, event was actually grade 0 (100.0F). If you didnt get it before, youre less likely to get it after a booster shot. J Dermatol. Detailed discussion can be found here: Pinkbook: Vaccine Administration | CDC No specific safety concerns were identified among vaccine recipients aged 6 months5 years. Use combination vaccines (e.g., DTaP-IPV-HepB or DTaP-IPV/Hib) to reduce the number of injections, when appropriate. Therapists say it can damage your connection. COVID-19 vaccination significantly lowers your risk of severe illness, hospitalization, and death if you get infected. Millions of people worldwide are getting vaccinated, so even small occurrences of vaccine reactions and side effects are getting lots of attention. Cutaneous reactions after SARS-CoV-2 vaccination: a cross-sectional Spanish nationwide study of 405 cases. The pain associated with injections is a source of distress for children and their parents and/or guardians. ACS Central Sci 2021; 7: 512533. Within each age group, the frequency and severity of systemic reactions was higher after dose 2 than dose 1. Treating COVID arm will not reduce your immune systems response to the vaccine. -, Vasireddy D, Atluri P, Malayala SV, Vanaparthy R, Mohan G. Review of COVID19 Vaccines Approved in the United States of America for Emergency Use. Subcutaneous injections can lead to localised cellulitis, granuloma formation and abscess. } else { Solicited systemic adverse reactions were most common in the vaccine group than the placebo group and after dose 2 compared to dose 1. It happens about one week after the first or second shot of the Moderna vaccine but may also occur after Pfizer. This information is included in the manufacturers package insert for each vaccine. Authorities at the FDA are likely to authorize the use of Johnson & Johnson's new COVID-19 vaccine. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Illustrating possible pathomechanisms of cutaneous findings following COVID19 vaccination. Local reactions were reported by the majority of vaccine recipients and at higher rates than placebo recipients. doi: 10.1111/jdv.18418. Adverse events in the vaccine group were similar in nature and incidence to those in the placebo group, with the exception of higher incidence of injection site erythema in the vaccine group compared to the placebo group (1.3% vs 0.2%) and COVID-19 in the placebo group compared to the vaccine group (5.5% vs 3.1%). If youre worried about COVID arm, keep in mind that the protective benefits of the COVID-19 vaccine far outweigh the risks associated with COVID arm or developing COVID-19 itself. A new survey takes the worst traffic, road conditions, and infrastructure into consideration. A higher frequency of unsolicited adverse events was reported in the vaccine group compared to the placebo group (29.6% vs 25.1%). In a CDC report on the Moderna vaccine, the agency said that the swelling of lymph nodes, also known as lymphadenopathy, can occur in either the arm or the neck. b Swelling grade 3: >100mm/>10cm; grade 4: necrosis/exfoliative dermatitis. We adhere to structured guidelines for sourcing information and linking to other resources, including Doctors and the CDC say this coronavirus. b Headache Grade 3: significant; any use of prescription pain reliever or prevented daily activity; Grade 4: required emergency room visit or hospitalization. We explain the risks of, How the ongoing stigma surrounding the LGBTQ community connects to the HIV/AIDS crisis, how monkeypox is disproportionately affecting the Queer. Although COVID-19 vaccination and booster doses reduce the risk of serious illness, they don't guarantee you will avoid getting infected. The main imbalances between the vaccine and placebo groups were general disorders and administration site conditions, consistent with the known reactogenicity profile of the vaccine. All vaccines can cause immune responses such as arm rashes, swollen lymph nodes, low-grade fever, soreness, and fatigue. CDC and the Advisory Committee on Immunization Practices (ACIP) guidance states COVID-19 vaccines can be given during the same visit with other vaccines, including flu vaccine, if the recipient is eligible for the vaccines. Selected adverse events reported after COVID-19 vaccination. McMahon DE, Amerson E, Rosenbach M, Lipoff JB, Moustafa D, Tyagi A, Desai SR, French LE, Lim HW, Thiers BH, Hruza GJ, Blumenthal KG, Fox LP, Freeman EE. What Does an Alternative Childhood Vaccine Schedule Look Like?