title: Transient bulging fontanelle after vaccination: case report and review of the vaccine adverse event reporting system.
abstract: OBJECTIVE
  To describe the features of transient bulging fontanelle (TBF) after vaccination.
  
  
  METHODS
  We searched the Vaccine Adverse Event Reporting System database for reports describing bulging fontanelle. We defined a definite TBF case as a patient with a bulging fontanelle, normal neuroimaging and cerebrospinal fluid analysis, and absence of a depressed level of consciousness, focal neurologic findings, or identified cause. Follow-up had to reveal normal development. Probable cases lacked either lumbar puncture or neuroimaging or both but met all other criteria.
  
  
  RESULTS
  We identified 18 patients with definite or probable TBF. The median age at presentation was 4.5 months, interval from vaccination to symptom onset was 18 hours, and time to resolution was 3 days. Fifteen children were febrile.
  
  
  CONCLUSIONS
  We cannot conclude that vaccines cause TBF. Further controlled studies are necessary. Even if further research verifies TBF as a rare side effect, immunization benefits would still vastly outweigh this hypothetical risk. However, confirmation of a vaccine association could modify the management of infants who develop TBF after immunizations.
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Freedman
authors.forename: John
authors.initials: J
authors.lastname: Reed
authors.forename: Dale R
authors.initials: DR
authors.lastname: Burwen
authors.forename: Robert P
authors.initials: RP
authors.lastname: Wise
authors.forename: Amy
authors.initials: A
authors.lastname: Weiss
authors.forename: Robert
authors.initials: R
authors.lastname: Ball
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D022242:Pneumococcal Vaccines / Q000009:adverse effects*; D011559:Pseudotumor Cerebri / Q000209:etiology; D012886:Skull / Q000473:pathology*; D014611:Vaccination / Q000009:adverse effects*
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D022242:Pneumococcal Vaccines