Kids’ Vaccine Safety, by the Numbers

Emily Oster

11 min Read Emily Oster

Emily Oster

Kids’ Vaccine Safety, by the Numbers

Emily Oster

11 min Read
When COVID vaccines for 5- to 11-year-olds were first approved, it was clear to me that there were three groups of parents. Group 1: people who would kick down the door to be first in line for vaccination. Group 3: people who are not going to vaccinate their children unless it becomes required. And then there is Group 2, somewhere in the middle. Parents who aren’t necessarily opposed to vaccinating in this age group but who wanted to wait, to see the first round of vaccines, to make sure the relatively small initial trials hadn’t missed rare adverse events.

For this “waiting” group, I would suspect the decision about vaccination is starting to feel more urgent. Omicron is more contagious, even if not more serious, and vaccination provides protection for children against COVID infection. This protection means they are less likely to spread the virus to vulnerable relatives. Also, we’re starting to see more restrictions pop up in some states — kids may be restricted from recreation or school as a result of not being vaccinated. All the reasons to vaccinate your kids before (which I talked about here) are now more true.

The good news, then, is that we are now in a much better position to start talking about large-scale safety results. The American Academy of Pediatrics reports that approximately 5 million children ages 5 to 11 have received at least one dose of the COVID-19 vaccine. A subset of these children have had two doses. These sample sizes are getting large enough that even very rare events should start to show up. If there is a complication that arises 1 in a million times, we’d already expect to see at least five of them. And that’s a really, really rare complication.

Public-health officials have emphasized that we aren’t seeing concerning reports of side effects in kids. Which is a great message (and I think a correct one), but as usual it lacks detail. For at least some worried parents, they want to see the actual data behind this statement. What I want to do today, then, is dig into the data that is coming in through the Vaccine Adverse Event Reporting System, or VAERS, about the COVID-19 vaccine in kids.

What is the VAERS? 

Before getting started, let’s review what the VAERS is. It is a CDC reporting system for adverse events associated with vaccinations. The CDC collates reports from individuals (including medical providers, but also patients and caregivers) about incidents possibly linked to vaccines. The agency does this for all vaccines, not just COVID, and you can access the data publicly here.

The VAERS is a valuable data set, since it gives a window into possible issues with vaccines, and it harnesses the power of distributed information to get that information quickly. However, it is often difficult to draw strong causal conclusions from what we observe in the VAERS.

To understand why, consider the following: Imagine that people believed that cutting an infant’s fingernails led to possible illness, and thus there was an adverse-event reporting system for fingernail cutting.

In all likelihood, this system would get all kinds of reports. There would be parents saying that the day after they cut their infant’s fingernails, the baby came down with a terrible fever. Others would say they had a very liquid-looking poop. You’d get reports of children who didn’t sleep well for days after the fingernail cutting, and others about babies crying uncontrollably for hours.

These would all be true things that happened. But they would not be causally linked to the fingernail cutting! Babies have weird poops and they cry a lot. In order to figure out whether there was any real link, you’d need to know the general base rate of these events — how likely people are to report them when there was no fingernail cutting. But that isn’t something we have a reporting system for. There is no website where you can report every time your kid has an unusual poop.

You’d have to try to piece together whether these adverse events really seem more common among babies whose nails are cut than those whose aren’t. This is especially hard for things that happen all the time, like “baby cried.”

In your fingernail-reporting system, you probably would also learn something. You’d get many reports of finger injury — cuts in need of Band-Aids. This is not something that happens all the time, and there is an obvious mechanism for the connection with nail cutting. So you would probably conclude that fingernail cutting is linked to accidental finger cutting, which is true.

This example extends to vaccines. If you tell people to report anything unusual that happens after a vaccine, they will share a lot of incidents. The challenge — which I will try to meet below — is to figure out what to make of them. To try to pull out the signal from the noise.

With that background, let’s dive into the data.

Overview of data

To do this analysis, I downloaded all the VAERS data for 2021. The first file has a full list of incident reports, including the text in the report (there’s a free-entry field), information on hospitalization, and characteristics of the individual like their age and sex. The second file lets you link in vaccine type, and the third has extracted some information on the main concerns so you do not have to parse the text yourself.

I merged these together and limited them to ages 5 to 11 and the COVID-19 vaccine.

When I did this, I found a total sample of 3,198 adverse events. As noted above, about 5 million children have received a first dose of the COVID-19 vaccine. If (say) a third of these children have also received a second shot, that is 6.65 million doses. This adverse-event rate would be, then, about 1 in 2,100.

But what are these events? We can see details!

Parents lying

Of the 3,198 adverse events, 915 are kids (nearly all of them age 11) getting the COVID-19 vaccine before they were eligible. The reason for this is that their parents lied about their age. To give you a flavor, here are a couple of examples in the text…

Patient was booked by his family in system as his 13 year old sister. Information was changed at vaccine site to this patient who was only 11 years 5 months old. This was not caught until after the patient received his shot. We are not aware of any untoward effects. Patient’s mother was informed this would be reported to the DPH and CDC. Patient’s mother indicated she was aware he was not eligible at this time. This was her second attempt to get him vaccinated as he was turned away at a previous clinic.

Father took her to a pharmacy and lied to the pharmacist about her birthday so she could get a COVID vaccine so he could go on vacation. Parents are divorced and mom has sole custody and father is not allowed to make medical decisions without her consent. He also lied to the pharmacist again when they were confirming the birthday and falsified medical documents to make it appear that the patient was eligible for the Pfizer covid vaccine.

These incidents do not have negative vaccine impacts associated with them. The adverse event is the incorrect vaccine.

Removing these, we are down to 2,283 adverse events.

Dosing issues, etc.

Of these remaining 2,283 reports, 295 of the records specifically indicate that there was no adverse event; these are generally issues with incorrect entry of the vaccine record, or some issue with preparation. Another 539 of them are cases of incorrect dosing (child given adult dose; child moves arm so full dose not delivered) or an issue with vaccine preparation. In these 539 cases, there were no additional side effects reported. The event, again, is the dosing.

Removing these, we are down to 1,469 adverse events, or an adverse event rate of about 1 in 4,500.

Most common side effects

Digging into these 1,469 cases, we can start to isolate the most common complaints. The three most common categories are nausea and vomiting (present in 18% of cases), fainting or dizziness (25% of cases; mostly dizziness), and pain (present in 12% of cases, typically at the injection site). These are minor and self-limiting side effects in nearly all cases.

This side-effect profile is consistent with what we see, for example, with the flu vaccine. During the 2019 flu season, looking at adverse-event reports for kids getting the flu vaccine, we see pain (17%), fainting and dizziness (16%), and nausea (7%) among the leading issues. For the flu vaccine, we also commonly see rash and swelling, which doesn’t show up as prominently in the COVID vaccine.

Put simply: Of the 5 million kids who were vaccinated for COVID, there are 1,469 case reports, of which 25% include a symptom of nausea or dizziness. This is a very, very small share of the overall 5 million.

There are other isolated symptoms listed in these reports. Anxiety. Neck pain. Mouth swelling. Malaise. Eye pain. Lip blister. Some of these could be vaccine-related; others are unlikely to be. This is also true if you look at symptom lists after the flu vaccine.

Putting this together, it seems that the overall profile of most of the commonly cited side effects is similar for the COVID vaccine and the flu vaccine, which is a natural comparison.

Serious events

Nearly all of the adverse events reported after the COVID vaccine are mild and self-limiting. This is great. However: it is worth looking at whether there are any serious events.

There are 42 cases in which an adverse event is associated with a hospitalization. In a number of cases, the hospitalization does not seem to be a result of the vaccine. There are five cases of appendicitis. There are four cases of hospitalization with COVID-19 infection. There is one psychiatric hospitalization for depressive thoughts.

In other cases, it’s harder to tell. And if you read about those, they can seem really scary. This is a feature of these reports that is also true for the flu and other vaccines. Sometimes kids get sick and it’s scary. But in many cases, it seems to be clearly unrelated to the vaccine. There isn’t anything in these 42 or so cases that would suggest any particular vaccine-related concerns. It is likely that all of these, or nearly all, are incidental. Remember: this is on a base of perhaps 5 million children, 6.5 million vaccines. It’s really, really small.

Myocarditis

What about myocarditis, the heart inflammation that has been cited as a side effect of the COVID-19 vaccine in male teenagers and young adults? The VAERS system does show a substantial number of reports of myocarditis in this older age group. It’s part of how we know there are risks there, and it’s a good illustration of the value of such data.

For the younger age group, we do not see anything like this. In the hospitalizations, there are two cases in which myocarditis was suspected, both in 10-year-old boys, both recovered.

Again, this is in the context of millions and millions of shots. Even if both of these were confirmed myocarditis cases, we’d be looking at a risk of perhaps 1 in 1.5 million for boys. There are many activities you do each day that carry more than a 1-in-1.5-million risk of a daylong hospitalization.

Bottom line

These safety data are extremely reassuring. If you’re waiting to see good evidence on the real-world safety of these vaccines, this is it.

I know some parents worry about the long term. The fact is, there isn’t any data that will tell you about vaccine side effects in 10 years. Having said that, there is absolutely no reason to think such side effects would crop up. In vaccines, side effects tend to be fast. You could make a similar case that we do not know about the potential long-term side effects of COVID itself.

Kids remain at low risk of serious illness from COVID. The benefits of vaccination are lower case rates, less risk of spread, and, at least in some locations, more freedom from restrictions. These are real benefits, and these data now show they can be achieved safely.

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Updated CDC Guidelines for School and Child Care

NO QUARANTINES!!!

Emily Oster

Instagram

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Just eat your Cheerios and move on.

Just eat your Cheerios and move on. ...

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide
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It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents

It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents
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Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor

Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor
...

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better.  Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough. 

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better. Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough.

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips
...

When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips

When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips
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The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth

The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth
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There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata
...

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships
...

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles
...

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity
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What's in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you.

What`s in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you. ...

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport
...

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way. 

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way.

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes
...