From initial correspondence received on 3/7/03 it was reported that a 4 year old female patient received a Daptacel vaccination on 3/5/03 at 4:30 PM. The next day (3/6/03) at school the patient had a five minute seizure, with staring and eyes fixed and a fever of 102. She was transported to the emergency room; she was checked and sent home. The patient reportedly recovered from this experience. From additional information received on 10/30/03 from a physician, the patient was fine after receiving the vaccination. She did not have a temperature and ate normally. The next day she felt a little warm to her mother. The child went to school and the mother received a phone call later that day that the patient had fallen. When the mother arrived at the school, the personnel had been trying to wake the patient for at least 10 minutes. The patient's face was pale. She had not wet herself. Prior to the episode, the patient ate her breakfast and was helping the teachers set the table. The teacher turned around and the patient was on the floor. She jerked a little and was staring. She did not respond to her name being called. She vomited once and went into a fetal position and then went to sleep. She was in a deep sleep and the mother could not wake her. She had a fever, which was reported as possibly being 101 degrees F. She did not wake up until she was taken outside to the ambulance. Per school personnel, the episode lasted for 15 minutes. There was no clear convulsion reported. In the ambulance, the patient woke and recognized her mother. She could hear and she responded properly to her mother. During the episode, the patient bit her tongue, as she complained about it the next day. There were no complaints of headaches. She was taken to the emergency room and examined. It was noted that she had a fever of 102 degrees F, but the examination was otherwise normal. She was given Tylenol and was discharged home. She had a fever that day and for the next five to six days and had a cold. The highest reported temperature was 102 degrees F. The patient reportedly acted odd on 3/7/03 when the mother took her back to see the doctor. She was looking at her mother in the car and would not answer. She might have been tired and was running a temperature. She was seen by the doctor, who did not find anything. She was seen again on 3/11/03 for the possibility of her tongue getting infected. She was given something for her tongue. The patient returned to school on 3/11/03. On 3/13/03, she was seen by a neurologist and during the physical exam, the patient was interactive, pleasant, asked logical and genuine questions, was interested in writing new words and made a nice picture. She appeared happy, cooperative for her age and was in no apparent distress. No neck stiffness was present. The patient's head circumference was 52cm and she was awake, alert and oriented to place and person. She had good eye contact and printed her name without difficulty. Cranial nerves 2-12 were within normal limits. There was no pathological nystagmus, the pupils were equal, round and reactive to light. Motor examination showed no pronator drift and the patient had normal tone and power. Physician's impression was that there were a few things occurring at the same time - some resemblance to seizure but some to syncope, status post-vaccination but also started intercurrent illness. It was recommended that the patient have an EKG and EEG done as part of the work up and that salt and fluid intake be increased during illness. She was to follow up with the neurologist in one month.