Reasons of Conscience & Vaccine Decisions
Your beliefs, medical history and questions matter. Learn about birth-plan choices, documented risks and the evidence, so you can discuss your wishes and make informed decisions for your family.
Your voice. Your baby. Your decisions.
In most non-emergency situations, parents or legal guardians generally have the final say about their newborn’s care. You can ask what is being proposed, why it is offered, the benefits and risks, and what alternatives exist. You can generally agree to or decline a proposed treatment after that discussion.
Tell the team your choices before delivery and ask them to document your decisions in your baby’s record. The pregnant patient makes decisions about her own care. Specific laws, court orders or emergencies can affect how consent works; newborn screening has its own Texas requirements described below.
Words you can use: “Please talk with me before non-emergency care for my baby. Explain the benefits, risks and alternatives, and record my decision.”
Questions deserve honest answers
Vaccines can cause side effects, and some have rare but serious risks. Those risks vary by vaccine, product, age and health history. A prior serious reaction or certain medical conditions may change the decision.
Make your wishes known
Ask for clear explanations of the potential benefits and harms of each proposed treatment. When circumstances allow, discuss your concerns and record your decisions in a birth plan or notice for your care team.
Preparing your birth plan
A birth plan helps you tell your care team about your wishes before labor begins. Talk with your doctor or midwife about what is possible for your situation, record your decisions and share the plan with your chosen support person and the hospital.
Comfort and communication
Consider asking for dim lights, quiet or prayer, a support person, freedom to change positions, and an explanation before examinations or procedures. Discuss pain relief, monitoring, food and drink, and the circumstances that could change the plan.
A capable patient makes decisions about their own care. A support person does not automatically become a medical decision-maker; an appropriate legal document may be needed if the patient cannot make decisions.
Bonding and recovery
You may ask for skin-to-skin contact, rooming-in, breastfeeding support, bedside newborn care, limited visitors and a quiet recovery space. Discuss what happens if you or your baby need urgent care or a cesarean birth.
For sleep, place your baby on their back on a firm, flat, separate sleep surface with no loose bedding. Read about safer infant sleep.
Requesting delayed cord clamping
Waiting before clamping can increase the baby's iron stores. In a randomized trial of 400 healthy full-term infants after low-risk pregnancies, waiting at least three minutes improved iron measures compared with clamping within ten seconds. This was one study, not a guarantee for every birth.
About the blood in the placenta: Delaying clamping can allow more blood to transfer to the newborn. The amount varies with the circumstances of birth; early clamping does not mean every baby has bled or lost one-third of their blood. Blood volume and vitamin K needed for normal clotting are related to different questions.
You can discuss this wording with your team: “If my baby and I are stable, I request delayed cord clamping for three to five minutes or until the cord stops pulsating. Please tell me if an urgent medical concern makes that unsafe.”
ACOG recommends at least 30–60 seconds for most vigorous newborns; WHO recommends no earlier than one minute. Delayed clamping can slightly increase the chance of jaundice requiring light treatment, and care may need to change in an emergency. Ask your team about your circumstances and your baby's jaundice check.
Newborn decisions are separate decisions
Ask for the name and purpose of each proposed treatment or test, its benefits and risks, when it needs to be given, and what may happen if it is declined. Vaccines, vitamin K, eye ointment and newborn screening are different interventions.
Communicating a vaccine refusal
If this reflects your informed decision, you may tell the team: “I decline vaccines for my newborn during this hospital stay. Please document my decision, explain any urgent concerns, and speak with me before treatment.” The downloadable plan includes a newborn vaccine refusal and a separate first-person refusal of postpartum vaccines by the birth parent during the hospital stay. Use it only if both statements reflect your wishes.
Discuss hepatitis B testing before birth. If the birth parent has hepatitis B or their status is unknown, the newborn's protection is time-sensitive: health guidance calls for a hepatitis B vaccine within 12 hours, and an additional immune medicine is used in certain circumstances. Infection can become chronic and damage the liver.
Read the hepatitis B birth guidanceVitamin K and the cord
Vitamin K is not a vaccine. Newborns have low vitamin K stores because only a small amount crosses the placenta during pregnancy and their gut has not yet developed the bacteria that help produce it; breast milk also contains little vitamin K. This is true regardless of when the cord is clamped. Delayed cord clamping increases blood transfer, but has not been shown to replace vitamin K protection or prevent vitamin K deficiency bleeding.
Vitamin K deficiency can cause dangerous internal or brain bleeding, often without warning. In a 2026 observational study of 5.2 million U.S. newborns, infants who did not receive the injection had a higher risk of bleeding. Ask the newborn clinician about the benefits, possible risks and timing; CDC notes that the shot can be given after the first feeding, within six hours, to allow bonding.
Newborn eye ointment: what it does and your choice
What it is: Erythromycin eye ointment is an antibiotic, not a vaccine. It is given to prevent a serious eye infection caused by gonorrhea that can damage sight. Gonorrhea can be passed from an infected cervix around birth, and a person can have the infection without symptoms. The ointment does not reliably prevent chlamydial eye infections; prenatal testing and treatment are important.
Your own situation: A negative gonorrhea test close to delivery and no later exposure reduce the chance of gonococcal infection. Ask when you were tested, whether repeat testing is appropriate, and how the results and delivery circumstances affect your baby’s risk. No test is perfect. CDC recommends the ointment after both vaginal and cesarean births. Temporary blurred vision or mild eye irritation can occur.
In Texas: The law requires birth attendants to provide approved eye-infection prevention. It also addresses a parent’s, managing conservator’s or guardian’s objection: if the attendant cannot apply the prophylaxis because of that objection, the law protects the attendant from liability for not applying it and requires the objection to be entered in the baby’s medical record. If you object, discuss it with the birth team before delivery and ask how the objection will be documented.
Seek care promptly: If a newborn develops red or swollen eyes, or drainage or pus, contact the baby’s clinician immediately. Some infections can damage the eyes quickly and need urgent treatment.
Autism, SIDS and the studies
Families deserve a respectful discussion and access to studies that examined their concerns. Timing alone does not show that an event was caused by a vaccine; good studies compare outcomes across groups and account for other factors.
Autism
Large studies do not show that childhood vaccines cause autism. A Danish cohort study followed 657,461 children and found no increased autism risk after MMR vaccination. The study specifically examined MMR; its results should not be represented as measuring every possible product separately.
Sudden infant death syndrome
Research has not established that vaccines cause SIDS. In one case-control study comparing 307 SIDS cases with 971 controls, researchers found no increased SIDS risk in the 14 days after immunization. The cause of an individual sudden death requires careful investigation.
Read the SIDS case-control studyDownload the forms
Use these forms to prepare for conversations with your medical team. Download a copy to your device, fill in the fields in a PDF reader or print it, and keep completed copies private. No family information is prefilled.
Birth plan: vaccine refusal
This template requests delayed cord clamping and states a refusal of newborn and postpartum vaccines during the hospital stay. Use it only if it reflects your wishes; personal details are blank.
Download birth plan PDFVaccine refusal notice
List the specific vaccines you wish to decline and share the notice with your provider. This is not the Texas school exemption affidavit.
Download refusal notice PDFMedical power of attorney
Use the official blank Texas form to designate a health care agent. Read its instructions for signing with a notary or eligible witnesses.
Download Texas state formFor a school or child-care conscientious exemption, use the separate Texas DSHS affidavit. If a form does not open in your browser, download it and open it in a PDF reader.
Understanding reasons of conscience
People may have deeply held religious, moral or personal concerns about medical interventions, ingredients or how a product was developed. Others may be concerned because of a prior reaction or family experience. These questions deserve respect, careful evidence and an individualized discussion.
Concerns about cell lines
Some vaccines, including the rubella component of MMR, chickenpox and hepatitis A vaccines, are produced using laboratory cell lines originally derived from terminated pregnancies decades ago. New abortions are not needed to maintain those cell lines. The finished vaccines do not contain fetal tissue or intact fetal cells, although tiny fragments of cell DNA or proteins may remain after purification. People may reach different moral conclusions about this history.
Read about cell lines and specific vaccinesAsk about the specific product
Ask your clinician or pharmacist for the manufacturer’s package insert and current vaccine information statement. Discuss ingredients, alternatives, prior reactions, pregnancy, immune conditions and your own values. A medical contraindication and a conscientious exemption are different things.
Browse vaccine information statementsExplore vaccines one by one
Open each vaccine to see a list of possible side effects, notable serious risks, important precautions and links to the sources. The lists are not exhaustive; effects and their frequency can differ by product, dose, age and health history. A reported event is not always proven to be caused by a vaccine. Severe allergic reactions can occur after any vaccine, but are rare. Ask for the information sheet and prescribing information for the exact product.
How to read the labels and ingredients
FDA boxed warning: A boxed warning is a specific warning printed in a box in an FDA prescribing label. Serious warnings may also appear elsewhere in the label. Each card identifies the exact products reviewed; another brand or a later label may differ.
Highlighted ingredient names identify substances relevant to a documented allergy or local sensitivity in some people. They are not proof that an ingredient harms everyone. Gelatin, some antibiotics, yeast, PEG and polysorbate can matter to a person with a particular allergy. Aluminum salts can rarely be associated with persistent itchy nodules. Tell your clinician about allergies and previous reactions.
The lists summarize active ingredients, added ingredients and possible manufacturing residues for the named examples. They do not represent every available brand or every detail in a full label. Some residues may be present rather than present in every dose. An ingredient’s amount and exposure matter: a chemical’s hazard at high exposure does not prove harm at the small amounts present in a vaccine. Use the linked FDA label, especially the contraindications, warnings, adverse reactions and description sections, to check the exact product and formulation being considered.
FDA: common vaccine ingredients · FDA: licensed products and labels · FDA: thimerosal
01DTaP, Tdap & TdDiphtheria, tetanus and pertussis
Possible side effects and important risks
- DTaP — common: Pain, redness or swelling at the injection site; fever, fussiness, tiredness, loss of appetite or vomiting.
- DTaP — less common: High fever over 105°F, nonstop crying for three hours or longer, or seizures; rarely, swelling of the entire arm or leg, especially after the fourth or fifth dose.
- Tdap or Td — possible: Pain, redness or swelling where the shot was given; mild fever, headache, tiredness, nausea, vomiting, diarrhea or stomachache.
- Rare: A severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: Infanrix (DTaP); Boostrix (Tdap); Tenivac (Td). Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- Infanrix (DTaP): Diphtheria and tetanus toxoids; three pertussis proteins; aluminum hydroxide (0.5 mg aluminum); sodium chloride. Residues: formaldehyde and polysorbate 80, each at no more than 100 micrograms per dose. Read FDA label for Infanrix (DTaP).
- Boostrix (Tdap): Diphtheria and tetanus toxoids; three pertussis proteins; aluminum hydroxide (0.3 mg aluminum); sodium chloride. Residues: formaldehyde and polysorbate 80, each at no more than 100 micrograms per dose. Read FDA label for Boostrix (Tdap).
- Tenivac (Td): Tetanus and diphtheria toxoids; aluminum phosphate (0.33 mg aluminum); sodium chloride; water. Residual formaldehyde: no more than 5 micrograms per dose. The tip cap of a prefilled syringe may contain natural rubber latex; this is packaging, not a vaccine ingredient. Read FDA label for Tenivac (Td).
What to discuss: Aluminum may rarely be associated with persistent itchy nodules at the injection site. Polysorbate can be relevant to a rare allergy. Tell the clinician about prior severe reactions and latex allergy.
Other considerations: Tell the clinician about a severe prior reaction. Encephalopathy without another identifiable cause within seven days after a pertussis-containing vaccine is a contraindication to further pertussis-containing doses.
About the illnesses: Tetanus can cause painful muscle spasms; diphtheria can damage the heart and breathing; pertussis (whooping cough) can be especially dangerous for infants.
02Polio (IPV)Inactivated poliovirus vaccine
Possible side effects and important risks
- Possible: A sore spot, redness, swelling or pain where the inactivated polio vaccine (IPV) is injected.
- Other: Fainting can occur after an injection.
- Rare: A severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: Ipol. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- Ipol: Inactivated poliovirus types 1, 2 and 3; M-199 culture medium; 2-phenoxyethanol; formaldehyde. Trace residues can include neomycin, streptomycin and polymyxin B, and bovine serum albumin. Read FDA label for Ipol.
What to discuss: The named antibiotics can matter to someone with a severe allergy to one of them. The exact amount of a residue is very small; the full label gives limits.
Other considerations: The inactivated polio vaccine used in the U.S. cannot cause polio. A different, live oral polio vaccine can rarely lead to vaccine-associated or vaccine-derived polio; it has not been used in the U.S. since 2000.
About the illness: Polio can cause permanent paralysis and, in severe cases, death.
03MMR & MMRVMeasles, mumps, rubella, and combination chickenpox vaccine
Possible side effects and important risks
- MMR or MMRV — possible: Soreness or redness where the shot is given, fever, mild rash, swollen glands, or temporary joint pain and stiffness.
- Rare: A fever-related seizure, temporary low platelets that can cause unusual bruising or bleeding, or a severe allergic reaction.
- MMRV first dose: In children 12–23 months old, MMRV was associated with approximately one additional fever-related seizure per 2,300 doses compared with separate MMR and varicella shots at the same visit; the increase occurred about 7–10 days later.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: M-M-R II (MMR); ProQuad, refrigerated formulation (MMRV). Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- M-M-R II (MMR): Live weakened measles, mumps and rubella viruses; sorbitol; sucrose; hydrolyzed gelatin; recombinant human albumin; fetal bovine serum; neomycin; and other buffers and culture-medium ingredients. Read FDA label for M-M-R II (MMR).
- ProQuad, refrigerated formulation (MMRV): Live weakened measles, mumps, rubella and varicella viruses; sucrose; sorbitol; hydrolyzed gelatin; urea; sodium chloride; sodium phosphate; monosodium L-glutamate; recombinant human albumin; sodium bicarbonate; potassium phosphate; potassium chloride. Residues include MRC-5 cell DNA and protein, neomycin, bovine calf serum, and other medium and buffer ingredients. Read FDA label for ProQuad, refrigerated formulation (MMRV).
What to discuss: Gelatin and neomycin can cause serious allergic reactions in susceptible people. The live vaccines have additional precautions for pregnancy and certain immune conditions; see the product labels.
Other considerations: MMR and MMRV are live vaccines and are contraindicated during pregnancy and in people with certain serious immune deficiencies; serious infection can occur in severely immunocompromised recipients. Ask which product is appropriate.
These live vaccines are contraindicated during pregnancy and for people with certain serious immune deficiencies. They help prevent diseases that can cause pneumonia, brain inflammation, birth defects or death.
04VaricellaChickenpox vaccine
Possible side effects and important risks
- Possible: Soreness or redness where the shot is given, a mild rash, or fever.
- Very rare: Pneumonia, infection involving the brain or its covering, a seizure often associated with fever, or a severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: Varivax, frozen formulation. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- Varivax, frozen formulation: Live weakened varicella virus; sucrose; gelatin; sodium chloride; monosodium glutamate; dibasic sodium phosphate; monobasic potassium phosphate; potassium chloride. Residues include MRC-5 cell DNA and protein, monobasic sodium phosphate, EDTA, neomycin and fetal bovine serum. Read FDA label for Varivax, frozen formulation.
What to discuss: Gelatin and neomycin can matter to someone with a severe allergy. This live vaccine has additional precautions in pregnancy and certain immune conditions.
Other considerations: This is a live vaccine and is contraindicated during pregnancy and for people with certain serious immune deficiencies. Ask what to do if a rash appears afterward, especially around a vulnerable person.
About the illness: Chickenpox can cause skin infections, pneumonia or brain complications, including in otherwise healthy people.
05Hepatitis AHepatitis A vaccine
Possible side effects and important risks
- Possible: Soreness or redness where the shot is given, fever, headache, tiredness or loss of appetite.
- Rare: A severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: Havrix. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- Havrix: Inactivated hepatitis A virus; aluminum hydroxide (0.25 mg aluminum in the pediatric dose or 0.5 mg in the adult dose); amino acids; phosphate-buffered saline; polysorbate 20. Residues include MRC-5 cell proteins, formalin and neomycin. Read FDA label for Havrix.
What to discuss: Neomycin can matter to a person with a severe allergy. Aluminum may rarely be associated with persistent itchy nodules at the injection site.
Other considerations: Discuss allergies and any previous serious reaction with your clinician.
About the illness: Hepatitis A is a contagious liver infection. Outbreaks still occur; serious illness can be more likely in older adults and people with liver disease.
06Hepatitis BHepatitis B vaccine
Possible side effects and important risks
- Possible: Soreness where the shot is given, fever, headache or fatigue.
- Rare: A severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: Engerix-B. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- Engerix-B: Recombinant hepatitis B surface antigen; aluminum hydroxide (0.25 mg aluminum in the pediatric dose or 0.5 mg in the adult dose); sodium chloride; disodium phosphate dihydrate; sodium dihydrogen phosphate dihydrate; residual yeast protein. Read FDA label for Engerix-B.
What to discuss: A history of severe allergy to yeast is important for this product. Aluminum may rarely be associated with persistent itchy nodules at the injection site.
Other considerations: Discuss prior reactions, ingredients and the reason the dose is offered for your circumstances.
About the illness: Hepatitis B can lead to chronic liver infection, cirrhosis and liver cancer. Infants exposed around birth face a high risk of chronic infection; time-sensitive care after exposure matters.
07HibHaemophilus influenzae type b vaccine
Possible side effects and important risks
- Possible: Redness, warmth or swelling where the shot is given, or fever.
- Rare: A severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: ActHIB. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- ActHIB: Hib polysaccharide joined to tetanus toxoid; sucrose; sodium chloride diluent. Less than 0.5 micrograms of formaldehyde per dose may remain. Casein-derived material is used in manufacturing; the label does not identify milk as an added ingredient. Read FDA label for ActHIB.
What to discuss: Tell the clinician about a severe reaction to a prior dose or a vaccine component, including tetanus toxoid.
Other considerations: Hib can be combined with other vaccines. Ask for the exact product name and its information sheet.
About the illness: Hib is a bacterium that can cause meningitis and other invasive infections, especially in young children. It is not the influenza virus.
08PneumococcalConjugate and polysaccharide vaccines
Possible side effects and important risks
- Conjugate vaccines (PCV): Redness, swelling, pain or tenderness at the injection site; fever, loss of appetite, irritability, tiredness, headache, muscle or joint pain, or chills.
- Polysaccharide vaccine (PPSV23): Redness, swelling, pain or tenderness where the shot is given; tiredness, headache, fever, chills or muscle aches.
- Less common or rare: Fever-related seizures are more likely in young children when PCV and an inactivated flu vaccine are given at the same visit. A severe allergic reaction is rare.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: Prevnar 20 (conjugate vaccine); Pneumovax 23 (polysaccharide vaccine). Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- Prevnar 20 (conjugate vaccine): Twenty pneumococcal polysaccharides joined to a diphtheria-derived carrier protein; aluminum phosphate (125 micrograms aluminum); polysorbate 80; succinate buffer; sodium chloride. Read FDA label for Prevnar 20 (conjugate vaccine).
- Pneumovax 23 (polysaccharide vaccine): Twenty-three pneumococcal polysaccharides; isotonic saline; phenol preservative (0.25%). Read FDA label for Pneumovax 23 (polysaccharide vaccine).
What to discuss: Aluminum may rarely be associated with persistent itchy nodules. Polysorbate can be relevant to a rare allergy. Phenol is listed as a preservative; toxicity at a different dose does not by itself establish harm at the vaccine amount.
Other considerations: Different products are used for different ages and health conditions.
About the illness: Pneumococcal bacteria can cause pneumonia, bloodstream infection and meningitis. Different products are used for different ages and risk groups.
09Meningococcal ACWYMeningitis-causing bacteria: groups A, C, W and Y
Possible side effects and important risks
- Possible: Redness or soreness where the shot is given; some people have muscle pain, headache or tiredness.
- Rare: A severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: MenQuadfi. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- MenQuadfi: Meningococcal A, C, W and Y polysaccharides joined to tetanus toxoid; sodium chloride; sodium acetate. Residual formaldehyde may be present; no preservative is added. Read FDA label for MenQuadfi.
What to discuss: Tell the clinician about a severe reaction to a prior dose or a vaccine component, including tetanus toxoid.
Other considerations: Tell the clinician about prior reactions, allergies and medical conditions.
About the illness: These bacteria can cause meningitis and bloodstream infections that can become life-threatening quickly. ACWY and MenB cover different groups.
10Meningococcal BMeningitis-causing bacteria: group B
Possible side effects and important risks
- Possible: Soreness, redness or swelling where the shot is given; tiredness, headache, muscle or joint pain, fever, chills, nausea or diarrhea. Some occur in more than half of recipients.
- Rare: A severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: Bexsero. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- Bexsero: Meningococcal B proteins NadA, NHBA and fHbp, and outer-membrane vesicles; aluminum hydroxide (0.519 mg aluminum); sodium chloride; histidine; sucrose. The antibiotic kanamycin can remain at less than 0.01 micrograms per dose. Read FDA label for Bexsero.
What to discuss: Kanamycin can matter to a person with a severe allergy to it. Aluminum may rarely be associated with persistent itchy nodules at the injection site.
Other considerations: During pregnancy, discuss individual risk and timing with your clinician.
About the illness: Meningococcal B can cause rapid, severe meningitis or bloodstream infection. Its vaccine is different from the ACWY vaccine.
11HPVHuman papillomavirus vaccine
Possible side effects and important risks
- Possible: Pain, swelling, redness, itching, bruising or a lump where the shot is given; headache, fever, nausea, dizziness, tiredness, diarrhea or stomach pain.
- Fainting: Fainting can follow injections, especially in adolescents. Sitting or lying down and observation for 15 minutes can help prevent injury.
- Rare: A severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: Gardasil 9. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- Gardasil 9: Nine HPV L1 virus-like particles; amorphous aluminum hydroxyphosphate sulfate (500 micrograms aluminum); sodium chloride; L-histidine; polysorbate 80; sodium borate; water. Residual yeast protein is less than 7 micrograms per dose. Read FDA label for Gardasil 9.
What to discuss: A history of severe yeast allergy is important for this product. Polysorbate can be relevant to a rare allergy; aluminum may rarely be associated with persistent itchy nodules.
Other considerations: Ask which HPV product is being used and review its prescribing information.
About the illness: Persistent HPV infection can cause cervical and other cancers; vaccination protects against the HPV types included in the product.
12RotavirusOral vaccine for infants
Possible side effects and important risks
- Possible: Irritability, or mild temporary diarrhea or vomiting.
- Rare but serious: Intussusception, a bowel blockage that may require hospital treatment or surgery. The estimated additional risk is about 1 in 20,000 to 1 in 100,000 vaccinated U.S. infants, usually within a week of the first or second dose.
- Rare: A severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: Rotarix, oral liquid in dosing applicator; RotaTeq. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- Rotarix, oral liquid in dosing applicator: Live weakened human rotavirus; disodium adipate; Dulbecco’s Modified Eagle Medium (a culture medium containing salts, sugars, vitamins and amino acids); sucrose; sterile water. Read FDA label for Rotarix, oral liquid in dosing applicator.
- RotaTeq: Five live human–bovine reassortant rotaviruses; sucrose; sodium citrate; monobasic sodium phosphate monohydrate; sodium hydroxide; polysorbate 80; cell culture media; trace fetal bovine serum. Read FDA label for RotaTeq.
What to discuss: Polysorbate can be relevant to a rare allergy. The rare risk of intussusception listed above is a vaccine safety concern; the label does not identify a specific ingredient as its cause.
Other considerations: A previous intussusception or severe combined immunodeficiency is a reason not to give rotavirus vaccine.
Get prompt medical care for severe crying with abdominal pain, repeated vomiting, blood in the stool or unusual weakness. The vaccine helps prevent severe diarrhea and dehydration from rotavirus.
13InfluenzaSeasonal flu vaccine
Possible side effects and important risks
- Flu shot — possible: Soreness, redness or swelling at the injection site; fever, muscle aches or headache.
- Nasal-spray vaccine — possible: Runny or stuffy nose, wheezing, headache, vomiting, muscle aches, fever, sore throat or cough. The live nasal spray is not suitable for everyone.
- Rare or less common: A small increased risk of Guillain–Barré syndrome (GBS) has been seen after flu vaccination in some seasons, about 1–2 additional cases per million doses. Fever-related seizures can be more likely in young children when the flu shot is given at the same visit as pneumococcal conjugate and/or DTaP vaccine. Severe allergic reactions are rare.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: Fluzone, 2026–27 formulation; FluMist, 2026–27 formulation. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- Fluzone, 2026–27 formulation: Inactivated split influenza viruses; sodium phosphate-buffered sodium chloride. Residues include formaldehyde, octylphenol ethoxylate and possible egg protein. The multidose vial contains thimerosal (25 micrograms of mercury per 0.5 mL dose); the single-dose syringe does not. Read FDA label for Fluzone, 2026–27 formulation.
- FluMist, 2026–27 formulation: Live weakened influenza viruses; monosodium glutamate; hydrolyzed porcine gelatin; arginine; sucrose; dibasic and monobasic potassium phosphate. Residual egg protein may be present; gentamicin and EDTA may remain. Read FDA label for FluMist, 2026–27 formulation.
What to discuss: Gelatin and gentamicin can matter to people with specific severe allergies. Thimerosal can cause local sensitivity. The FluMist label warns against use after a severe allergy to egg; CDC recommends an age-appropriate flu vaccine for people with egg allergy. Discuss the individual history and the exact product with a clinician.
Other considerations: GBS can also follow infections, including flu. Tell a clinician if you developed GBS within six weeks after a previous flu vaccine.
About the illness: Flu can cause hospitalization, complications and death, particularly in higher-risk people. Different flu vaccine products have different precautions.
14COVID-19COVID-19 vaccines
Possible side effects and important risks
- Possible: Pain, swelling or redness where the shot is given; fatigue, fever, chills, headache, muscle or joint pain, nausea, vomiting or swollen lymph nodes.
- Rare but serious: Myocarditis or pericarditis (inflammation of the heart muscle or its lining) has occurred after mRNA vaccines and has also been observed following Novavax. Risk varies by age, sex, product and dose. Severe allergic reactions are rare.
- An example of measured risk: FDA estimated about 8 cases per million doses overall in ages 6 months–64 years, and 27 per million in males ages 12–24, during the first week after the 2023–2024 mRNA formula. These estimates do not necessarily apply to other products or seasons.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: Comirnaty, 2026–27 formulation; Spikevax, 2026–27 formulation; Nuvaxovid. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- Comirnaty, 2026–27 formulation: Modified messenger RNA; lipids ALC-0315, ALC-0159 (a PEG-containing lipid), DSPC and cholesterol; tromethamine; tromethamine hydrochloride; sucrose. Read FDA label for Comirnaty, 2026–27 formulation.
- Spikevax, 2026–27 formulation: Modified messenger RNA; lipids SM-102, PEG2000-DMG, cholesterol and DSPC; tromethamine; tromethamine hydrochloride; acetic acid; sodium acetate trihydrate; sucrose. Read FDA label for Spikevax, 2026–27 formulation.
- Nuvaxovid: Recombinant spike protein; Matrix-M adjuvant (saponins from soapbark, cholesterol and phosphatidylcholine); potassium dihydrogen phosphate; potassium chloride; disodium hydrogen phosphates; sodium dihydrogen phosphate; sodium chloride; polysorbate 80; water. Residues may include baculovirus and Sf9 cell protein and DNA, lentil lectin, methyl-alpha-D-mannopyranoside, simethicone, Pluronic F68, Triton X-100, Tergitol NP-9 and DL-alpha-tocopherol. Read FDA label for Nuvaxovid.
What to discuss: PEG and polysorbate can be relevant to rare allergies. FDA also warns about myocarditis and pericarditis after the mRNA vaccines; that warning does not establish which ingredient causes it.
Other considerations: Tell your clinician about prior myocarditis, pericarditis or a serious reaction and ask about the specific product.
Get medical attention promptly for chest pain, shortness of breath or a racing, fluttering or pounding heart after vaccination. COVID-19 can also cause serious illness; a person's potential benefit depends on age, health, exposure and product.
15RSVRespiratory syncytial virus vaccines
Possible side effects and important risks
- Possible: Pain, redness or swelling where the shot is given; tiredness, fever, headache, nausea, diarrhea, or muscle or joint pain.
- Older adults — safety signal: An FDA observational study suggested an increased risk of Guillain–Barré syndrome (GBS) in the 42 days after Abrysvo or Arexvy in adults 65 and older. It estimated 9 and 7 excess cases per million doses, respectively; FDA said the evidence was insufficient to establish causation.
- Pregnancy — safety signal: In a trial of Abrysvo given at 24–36 weeks, preterm birth occurred in 5.7% of the vaccine group and 4.7% of the placebo group; preeclampsia occurred in 1.8% and 1.4%, respectively. The FDA says the data cannot establish or exclude a causal relationship for preterm birth; the approved pregnancy window is 32–36 weeks.
- Rare: A severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: mRESVIA; Abrysvo; Arexvy. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- mRESVIA: Modified messenger RNA; lipids SM-102, PEG2000-DMG, cholesterol and DSPC; tromethamine; tromethamine hydrochloride; acetic acid; sodium acetate trihydrate; sucrose; water. Read FDA label for mRESVIA.
- Abrysvo: Recombinant RSV preF A and B proteins; tromethamine; hydrochloride; sucrose; mannitol; polysorbate 80; sodium chloride; water. Host-cell proteins and DNA may remain. Read FDA label for Abrysvo.
- Arexvy: Recombinant RSV protein; AS01E adjuvant (MPL, QS-21, DOPC and cholesterol); trehalose; sodium chloride; potassium dihydrogen phosphate; dipotassium phosphate; polysorbate 80; disodium phosphate; water. Host-cell proteins and DNA may remain. Read FDA label for Arexvy.
What to discuss: PEG and polysorbate can be relevant to rare allergies. The Abrysvo and Arexvy labels also include a Guillain-Barré syndrome safety warning; this does not establish a specific ingredient as its cause.
Other considerations: Products and guidance differ by age, health and pregnancy status. Ask which product is being offered.
About the illness: RSV can cause serious lower respiratory illness, especially in older adults and young infants. A preventive antibody product offered to some infants is not a vaccine.
16ShinglesRecombinant zoster vaccine (Shingrix)
Possible side effects and important risks
- Common: Pain, redness or swelling where the shot is given; tiredness, muscle pain, headache, shivering, fever, stomach pain or nausea.
- Rare — older adults: An observational study found about three excess cases of Guillain–Barré syndrome per million doses in adults 65 and older during the 42 days after Shingrix.
- Rare: A severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: Shingrix. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
Ingredients and possible residues
- Shingrix: Recombinant varicella-zoster glycoprotein E; AS01B adjuvant (MPL, QS-21, DOPC and cholesterol); sucrose; sodium chloride; potassium dihydrogen phosphate; sodium dihydrogen phosphate; disodium phosphate; dipotassium phosphate; polysorbate 80; water. Host-cell proteins and DNA may remain. Read FDA label for Shingrix.
What to discuss: Polysorbate can be relevant to a rare allergy. The label also includes a Guillain-Barré syndrome warning; it does not establish a specific ingredient as the cause.
Other considerations: Ask about your health history and the product’s current warning.
About the illness: Shingles can cause a painful rash and sometimes long-lasting nerve pain.
17Mpox / smallpox (JYNNEOS)A vaccine used for specific exposure risks
Possible side effects and important risks
- Possible: Pain, redness, swelling or itching where the shot is given; tiredness, headache or muscle pain.
- Depending on how it is given: Skin discoloration or a firm area can occur and may last weeks or months, especially with an injection into the skin.
- Rare: A severe allergic reaction.
FDA boxed-warning check
No FDA boxed warning appears in the labeling reviewed November 13, 2026, for these specific examples: JYNNEOS, refrigerated formulation. Other warnings and precautions may still be important. See each linked FDA prescribing label below.
A different product has a boxed warning: ACAM2000 is another smallpox/mpox vaccine, not JYNNEOS. Its FDA boxed warning describes serious complications including inflammation of the heart, neurologic problems, severe skin infections, fetal harm and death. The warning is specific to ACAM2000; it should not be attributed to JYNNEOS. Read the ACAM2000 boxed warning.
Ingredients and possible residues
- JYNNEOS, refrigerated formulation: Live, non-replicating modified vaccinia Ankara virus; tromethamine; sodium chloride. Residues may include host-cell DNA and protein, benzonase, gentamicin and ciprofloxacin. The reconstituted presentation also contains dextran 40, sucrose, potassium L-glutamate monohydrate and water. Read FDA label for JYNNEOS, refrigerated formulation.
What to discuss: Gentamicin and ciprofloxacin can matter to someone with a severe allergy to those antibiotics.
Other considerations: JYNNEOS differs from the older ACAM2000 smallpox vaccine, whose risks and precautions are different.
About the illness: JYNNEOS is used to help protect against mpox and smallpox for people with relevant exposure risks.
This guide covers common U.S. vaccines and selected vaccines for particular risks; it does not list every travel, military or occupational vaccine. Product availability and recommendations change. Consult the complete information-statement index and the product label.
Requesting an exemption for reasons of conscience
Texas allows a notarized state affidavit to be submitted for certain immunization requirements at child-care facilities, elementary and secondary schools, and institutions of higher education. The current DSHS instructions and the institution's requirements are the best starting point.
Get the state form
Download the official blank DSHS affidavit, or request it through one of the methods described by DSHS.
Open the DSHS affidavitFill it out and notarize
Follow the form’s directions, identify the immunizations at issue, and have the completed affidavit signed and notarized.
Give it to the institution
Submit the notarized form to the school, child-care facility or qualifying institution. DSHS says it is valid for two years from the notary date.
Before you decide
Questions for your clinician
- What disease does this vaccine address, and what is my or my child’s risk from it?
- What are the common reactions and the serious risks for this product and age group? How often do they occur?
- Do allergies, a prior reaction, pregnancy or an immune condition affect the decision?
- Are there product or timing choices appropriate for this situation? What happens if vaccination is delayed after an exposure?
- Which symptoms need urgent care, and how do I report a concern?
How to read a study
- Check who was studied, which vaccine and dose were used, and when the study was done.
- Look for a comparison group and the absolute risk, not just a percentage increase.
- Consider both vaccine effects and risks from the infection itself.
- A report of an event after vaccination is a signal to investigate; by itself it does not prove the vaccine caused it.
Concerned about a reaction?
Seek medical care for concerning symptoms. You or your clinician can report a health problem that occurred after vaccination to the Vaccine Adverse Event Reporting System, even if you are unsure what caused it. A report alone cannot establish cause.
Report a possible adverse event to VAERS · Learn about federal injury compensation programs
Different programs, covered products and filing deadlines apply. Review the official program information promptly if you are considering a claim.
Studies and primary sources
These sources include studies that identified safety signals or risks, as well as information needed to understand the comparisons and limitations. Individual vaccine links above provide additional details.
- Andersson et al.: Delayed cord clamping and infant iron status (2011)
- Scott et al.: Newborn vitamin K and bleeding (2026; observational)
- Vennemann et al.: Immunization and SIDS (2007)
- Weintraub et al.: Intussusception after rotavirus vaccination (2014)
- Klein et al.: Fever-related seizures after MMRV (2010)
- Kwong et al.: GBS after flu vaccination and flu illness (2013)
- Goud et al.: GBS after recombinant shingles vaccine (2021)
- Oster et al.: Myocarditis reports after mRNA COVID-19 vaccination (2022)
- FDA: RSV vaccine GBS safety warning (2025)
- Hviid et al.: MMR vaccination and autism, nationwide cohort (2019; no increased autism risk found)
- Texas DSHS: Immunization exemptions
Reviewed November 12, 2026. Educational information only; it does not replace individualized medical or legal advice. Contact a licensed clinician about your circumstances, especially after an exposure or a serious reaction.