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Chickenpox

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Why get vaccinated? Chickenpox vaccine is the best way to prevent chickenpox, therefore protecting children and adults from the severe complications and death associated with the disease. Even with uncomplicated chickenpox cases, lost time from school and work and the cost of medications or treatment that may be needed can result in a significant cost for the family.

What qualifies for Side Effects Lawsuits and Claims? Serious side effects from the Varicella (chickenpox) vaccine include Pneumonia. Other serious problems, including severe brain reactions and low blood count, have been reported after chickenpox vaccination.

Is the vaccine effective in preventing chickenpox all the time? The Chicken Pox vaccine is not 100% effective. If a vaccinated person does get chickenpox, however, it tends to be a mild case with fewer skin lesions, lasting only a few days, with no or low fever, and few other symptoms.

Is there anyone who should not receive the chickenpox vaccine? According to the CDC, you should not get if you ever had a serious allergic reaction to chickenpox vaccine, neomycin, or gelatin (note: chickenpox vaccine does not contain egg), have moderate or serious illness (note: vaccine may be given to persons with a mild fever, cold or diarrhea), are pregnant, are unable to fight serious infections because of any kind of cancer or cancer treatment with x-rays or drugs, (note: if your child has leukemia in remission he/she may be eligible to receive the vaccine, ask your doctor), have a disease that depresses cellular immune function (note: if your child has HIV infection but has normal immune function he/she may receive the vaccine, ask your doctor), have been undergoing treatment with drugs such as long-term steroids, or have gotten blood products (such as immune globulin or a transfusion) during the past five months. If you are not sure, ask your doctor or nurse.

What if you suffer a side effect from the vaccine? You may be eligible to bring a claim under the National Vaccine Injury Compensation Program. Learn more here.

What problems can occur after chickenpox vaccination? A seizure (jerking and staring spell) usually caused by fever may occur in less than 1 in 1000 vaccine recipients.

Have serious reactions ever occurred from the chickenpox vaccine? As with any vaccine, there is a very small chance that serious problems could occur after getting chickenpox vaccine. It is important to note that the risks from the vaccine remain much lower than the risks from the disease.

What should I do if there is a serious reaction after chickenpox vaccination?

• Call a doctor or get the person to a doctor right away.
• Write down what happened and the date and time it happened.
• Ask your doctor, nurse, or health department to file a Vaccine Adverse Event Report form, or you can call (800) 822-7967 (toll-free). For more information on reporting vaccine adverse events visit site:

Do I Qualify for the National Vaccine Compensation Program? PERSONAL INFORMATION
First Name:
Last Name:
E-mail Address:
Address:
City:
State:	-Please Select- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zipcode:
Phone:	() - ext.
INJURED PERSON INFORMATION
Date of Birth:	MM January February March April May June July August September October November December DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902
For whom are you inquiring about?	PLEASE SELECT Minor Self Other
If you are NOT inquiring on your own behalf, what is your relationship?
Is the person deceased?	Yes No
If deceased, the cause of death as stated on the death certificate:
Date of Death:	MM January February March April May June July August September October November December DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902
Was there an autopsy performed?	Yes No
INJURY INFORMATION
Has person had any of the following injuries within 48 hours of recieving the vaccination:
Encephalopathy Stroke Heart Attack Brain Injury Death Seizure Guillian-Barre Syndrome
DRUG INFORMATION
Has person had any of the following vaccinations:
Tetanus Pertussis Measles Mumps Chicken Pox (Varicella) MMR Rubella Polio Hepatitis B Rotavirus (Rotashield) Flu Shot DTaP DPT
Other:
Dates that Vaccine(s) were given?
Did behavior regress after receiving vaccines?	Yes No
If yes, please describe regressive behavior:
Other Information: