respiratory distress; urticaria; severe abdominal pain; emesis; lethargy; Initial serious information received from a literature article on 16-Jul-2019.  This case is linked to cases 2019SA194910 and 2019SA194901.  The following is verbatim from the article:  Introduction: Diphtheria, tetanus, and pertussis vaccination is an integral component of the pediatric immunization schedule with DTaP administered to patients as a primary series at 2, 4 and 6 months of age and booster doses at 15 -18 months and 4-6 years of age. A single Tdap dose is recommended at 11 to 12 years old. Per the CDC, contraindications to DTaP and Tdap vaccination include anaphylaxis after a previous dose or to a vaccine component and encephalopathy within 7 days of administration.1 Anaphylactic reactions to vaccines are rare, occurring at a rate of approximately 1 per one million doses administered.2 At present, there is limited information regarding the outcome of diphtheria-tetanus vaccine in patients with a history of adverse events following prior immunization. We describe three patients who developed symptoms consistent with IgE-mediated reactions after DT or DTaP vaccination.  This case involves an five year old male patient who experienced respiratory distress, urticaria, severe abdominal pain, emesis and lethargy, while he received vaccines MEASLES VACCINE;MUMPS VACCINE;RUBELLA VACCINE and DIPHTHERIA, TETANUS AND ACELLULAR PERTUSSIS VACCINE.  The patient's past vaccination(s) included MMR (Tolerated) and four doses of DIPHTHERIA TETANUS ACELLULAR PERTUSSIS.  The patient's past medical history, medical treatment(s), family history and concomitant medications were not provided.   On an unknown date, the patient received a dose of suspect DIPHTHERIA, TETANUS AND ACELLULAR PERTUSSIS VACCINE produced by unknown manufacturer lot number not reported via unknown route in unknown administration site.  On an unknown date, the patient received a dose of suspect MEASLES VACCINE;MUMPS VACCINE;RUBELLA VACCINE not produced by Sanofi Pasteur lot number not reported via unknown route in unknown administration site.  On an unknown date, the patient developed a serious respiratory distress following the administration of DIPHTHERIA, TETANUS AND ACELLULAR PERTUSSIS VACCINE and MEASLES VACCINE;MUMPS VACCINE;RUBELLA VACCINE. This event was assessed as medically significant.  On an unknown date, the patient developed a non-serious urticarial, abdominal pain, emesis (vomiting) and lethargy following the administration of DIPHTHERIA, TETANUS AND ACELLULAR PERTUSSIS VACCINE and following the administration of MEASLES VACCINE;MUMPS VACCINE;RUBELLA VACCINE.  It was reported that at age 11 years, patient presented for allergy evaluation. SPT results were as follows (wheal/flare): saline 0 mm/0 mm; histamine 5 mm/ 0 mm; 1:10 DTaP, 1:10 TdaP 0 mm/0 mm; full strength DTaP 0 mm/ 0 mm. IDTs to 1:100 DTaP 8mm/not recorded; Tdap 0 mm/0 mm. Patient subsequently tolerated a single dose of Tdap vaccine without adverse reaction.  Final diagnosis was lethargy, emesis, Severe abdominal pain, urticaria and respiratory distress.   The patient was treated with EPINEPHRINE via intramuscular route as a corrective treatment.  The event outcome was reported as Recovered / Resolved within minutes on an unknown date from all the events.  Information on batch number was requested.  Documents held by the sender: none.; Sender's Comments: This literature case involves a five years old patient who presented with lethargy, emesis, Severe abdominal pain, urticaria and respiratory distress after vaccination with DTaP (unknown manufacturer) and MMR vaccine. Time to onset is compatible with the role of vaccine. Allergy testing was done at age of 11 years in which patient tolerated a single dose of Tdap vaccine without adverse reaction. However, further information including patient's medical history, condition at the time of vaccination, concomitant medications and laboratory investigations excluding other etiology would be needed to fully assess this case. Based on available information and involvement of two vaccines, the role of vaccine cannot be individually assessed.