Medical Editor: John P. Cunha, DO, FACOEP
Pentacel (tetanus toxoid conjugate) Diphtheria, Haemophilus Influenzae, Pertussis, Tetanus, and Polio Vaccine is used to prevent these diseases in children ages 6 weeks to 4 years. Common side effects of Pentacel include injection site reations (redness, pain, tenderness, or swelling), fever, fussiness or crying, headache, tiredness, joint pain, body aches, loss of appetite, nausea, diarrhea, or vomiting.Pentacel is given in a series of 4 doses at ages 15 to 18 months, 2, 4, and 6. The first dose can be given to a child as young as 6 weeks old. Pentacel may interact with other drugs. Before your child receives this vaccine tell your doctor if they have received any other vaccines, or if in the past 2 weeks have taken drugs that can weaken their immune system such as steroids, medications to treat autoimmune disorders like psoriasis, or medications used to treat organ transplant rejection. Make sure your child receives all 4 doses of Pentacel. This medication is not indicated for women of child bearing age so should not be taken if you are pregnant or breastfeeding.
Our Pentacel (tetanus toxoid conjugate) Diphtheria, Haemophilus Influenzae, Pertussis, Tetanus, and Polio Vaccine Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Your child should not receive a booster vaccine if he or she had a life-threatening allergic reaction after the first shot.
Keep track of any and all side effects your child has after receiving this vaccine. When the child receives a booster dose, you will need to tell the doctor if the previous shots caused any side effects.
Becoming infected with diphtheria, haemophilus influenzae, pertussis, tetanus, or polio is much more dangerous to your child's health than receiving the vaccine to protect against these diseases. Like any medicine, this vaccine can cause side effects, but the risk of serious side effects is extremely low.
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if the child has any of these serious side effects:
- extreme drowsiness, fainting;
- fussiness, irritability, crying for an hour or longer;
- seizure (black-out or convulsions); or
- high fever.
Less serious side effects may include:
- redness, pain, tenderness, or swelling where the shot was given;
- low fever;
- mild fussiness or crying;
- headache or tiredness;
- joint pain, body aches;
- loss of appetite; or
- mild nausea, diarrhea, or vomiting.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.
Read the entire detailed patient monograph for Pentacel (Tetanus Toxoid Conjugate)
Data From Clinical Studies
Rates of adverse reactions varied by dose number. The most frequent ( > 50% of participants) systemic reactions following any dose were fussiness/irritability and inconsolable crying. The most frequent ( > 30% of participants) injection site reactions following any dose were tenderness and increased circumference of the injected arm.
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared to rates in the clinical trials of another vaccine and may not reflect the rates observed in practice. The adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse events that appear to be related to vaccine use and for approximating rates of those events.
The safety of Pentacel vaccine was evaluated in four clinical studies in which a total of 5,980 participants received at least one dose of Pentacel vaccine. In three of the studies, conducted in the US, a total of 4,198 participants were enrolled to receive four consecutive doses of Pentacel vaccine. In the fourth study, conducted in Canada, 1,782 participants previously vaccinated with three doses of Pentacel vaccine received a fourth dose. The vaccination schedules of Pentacel vaccine, Control vaccines, and concomitantly administered vaccines used in these studies are provided in Table 1.
Across the four studies, 50.8% of participants were female. Among participants in the three US studies, 64.5% were Caucasian, 9.2% were Black, 12.9% were Hispanic, 3.9% were Asian, and 9.5% were of other racial/ethnic groups. In the two controlled studies, the racial/ethnic distribution of participants who received Pentacel and Control vaccines was similar. In the Canadian fourth dose study, 86.0% of participants were Caucasian, 1.9% were Black, 0.8% were Hispanic, 4.3% were Asian, 2.0% were East Indian, 0.5% were Native Indian, and 4.5% were of other racial/ethnic groups.
Table 1: Clinical Safety Studies of Pentacel Vaccine:
|Study||Pentacel||Control Vaccines||Concomitantly Administered Vaccines|
|494-01||2, 4, 6 and 15 months||HCPDT + POLIOVAX + ActHIB at 2, 4, 6, and 15 months||7-valent pneumococcal conjugate vaccine* (PCV7) at 2, 4, and 6 months in a subset of participants†
Hepatitis B vaccine at 2 and 6 months‡
|P3T06||2, 4, 6, and 15-16 months||DAPTACEL + IPOL + ActHIB at 2, 4, and 6 months; and DAPTACEL + ActHIB at 15-16 months||PCV7* at 2, 4, and 6 months
Hepatitis B vaccine at 2 and 6 months‡
|494-03||2, 4, 6, and 15-16 months||None||PCV7* at 2, 4, and 6 months in all participants; and at 15 months in a random subset of participants
Hepatitis B vaccine at 2 and 6 months (if a dose was previously administered)‡ or at 2, 4, and 6 months (if no previous dose)
Measles, mumps, rubella vaccine§ (MMR) and varicella§ vaccine at 12 or 15 months in random subsets of participants
|5A9908||15-18 months **||None||None|
|HCPDT: non-US licensed DTaP vaccine that is identical to
the DTaP component of Pentacel vaccine.
POLIOVAX: US licensed Poliovirus Vaccine Inactivated, Sanofi Pasteur Limited.
IPOL: US licensed Poliovirus Vaccine Inactivated, Sanofi Pasteur SA.
*PCV7 manufactured by Wyeth Laboratories.
†PCV7 was introduced after the study was initiated, and thus, administered concomitantly with Pentacel vaccine in a subset of participants.
‡ The first dose of hepatitis B vaccine (manufacturer not specified) was administered prior to study initiation, from birth to 21 days of age. Subsequent doses were with hepatitis B vaccine manufactured by Merck and Co.
§ MMR and varicella vaccines were both manufactured by Merck and Co.
** Study participants previously had received three doses of Pentacel vaccine by 8 months of age.
Solicited Adverse Reactions
The incidence and severity of selected solicited injection site and systemic adverse reactions that occurred within 3 days following each dose of Pentacel or Control vaccines in Study P3T06 is shown in Table 2. Information on these reactions was recorded daily by parents or guardians on diary cards. In Table 2, injection site reactions are reported for the Pentacel vaccine and DAPTACEL vaccine injection sites.
Table 2: Number (Percentage) of Children with Selected
Solicited Adverse Reactions by Severity Occurring within 0-3 days of Pentacel
Vaccine or Control Vaccines in Study P3T06
|Injection Site Reactions||Pentacel Vaccine||DAPTACEL Vaccine|
N = 465-467
N = 451
N = 438-440
N = 387-396
N = 1,400-1,404
N = 1,358-1,359
N = 1,311-1,312
N = 376-380
|> 5 mm||7. 1||8.4||8.7||17.3||6.2||7.1||9.6||16.4|
|> 25 mm||2. 8||1.8||1.8||9.2||1||0.6||1.9||7.9|
|> 50 mm||0.6||0.2||0||2.3||0.4||0.1||0||2.4|
|> 5 mm||7.5||7.3||5||9.7||4||4||6.5||10.3|
|> 25 mm||3||2||1.6||3.8||1.6||0.7||1.1||4|
|> 50 mm||0.9||0||0||0.8||0.4||0.1||0.1||1.3|
|Moderate or Severe||19.6||10.6||11.6||16.7||20.7||12.2||12.3||15.8|
|Increase in Arm Circumference|
|> 5 mm||-||-||-||33.6||-||-||-||30.6|
|> 20 mm||-||-||-||4.7||-||-||6.9|
|> 40 mm||-||-||-||0.5||-||-||-||0.8|
|Systemic Reactions||Pentacel Vaccine||DAPTACEL + IPOL + ActHIB Vaccines||DAPTACEL + ActHIB Vaccines|
N = 466-467
N = 451-452
N = 435-440
N = 389-398
N = 1,390-1,406
N = 1,346-1,360
N = 1,301-1,312
N = 379-381
|Decreased Activity/Lethargy §|
|Moderate or Severe||22.9||12.4||12.7||9.8||24.3||15.8||12.7||9.2|
|≥ 1 hour||19.7||10.6||13.6||11.8||16.4||16||12.2||10.5|
|> 3 hours||1.9||0.9||1.1||2.3||2.2||3.4||1.4||1.8|
|≥ 1 hour||34.5||27||26.4||23.6||33.3||30.5||26.2||19.4|
|> 3 hours||4.3||4||5||5.3||5.6||5.5||4.3||4.5|
|Any: Mild, Moderate or Severe; Mild: subject whimpers
when site is touched; Moderate: subject cries when site is touched; Severe:
subject cries when leg or arm is moved.
† Fever is based upon actual temperatures recorded with no adjustments to the measurement route.
‡ Following Doses 1-3 combined, the proportion of temperature measurements that were taken by axillary, rectal or other routes, or not recorded were 46.0%, 53.0%, 1.0%, and 0% respectively, for Pentacel vaccine and 44.8%, 54.0%, 1.0%, and 0.1%, respectively, for DAPTACEL + IPOL + ActHIB vaccines. Following Dose 4, the proportion of temperature measurements that were taken by axillary, rectal or other routes, or not recorded were 62.7%, 34.4%, 2.4% and 0.5%, respectively, for Pentacel vaccine, and 61.1%, 36.6%, 1.7% and 0.5%, respectively, for DAPTACEL + ActHIB vaccines.
§ Moderate: interferes with or limits usual daily activity; Severe: disabling, not interested in usual daily activity.
Hypotonic Hyporesponsive Episodes
In Study P3T06, the diary cards included questions pertaining to HHEs. In Studies 494-01, 494-03, and 5A9908, a question about the occurrence of fainting or change in mental status was asked during post-vaccination phone calls. Across these 4 studies, no HHEs, as defined in a report of a US Public Health Service workshop4 were reported among participants who received Pentacel vaccine (N = 5,979), separately administered HCPDT + POLIOVAX + ActHIB vaccines (N = 1,032) or separately administered DAPTACEL + IPOL + ActHIB vaccines (N = 1,455). Hypotonia not fulfilling HHE criteria within 7 days following vaccination was reported in 4 participants after the administration of Pentacel vaccine (1 on the same day as the 1st dose; 3rd on the same day as the 3 dose) and in 1 participant after the administration of DAPTACEL + IPOL + ActHIB vaccines (4 days following the 1st dose).
Across Studies 494-01, 494-03, 5A9908 and P3T06, a total of 8 participants experienced a seizure within 7 days following either Pentacel vaccine (4 participants; N = 4,197 for at least one of Doses 1-3; N = 5,033 for Dose 4), separately administered HCPDT + POLIOVAX + ActHIB vaccines (3 participants; N = 1,032 for at least one of Doses 1-3, N = 739 for Dose 4), separately administered DAPTACEL + IPOL + ActHIB vaccines (1 participant; N = 1,455 for at least one of Doses 1-3), or separately administered DAPTACEL + ActHIB vaccines (0 participants; N = 418 for Dose 4). Among the four participants who experienced a seizure within 7 days following Pentacel vaccine, one participant in Study 494-01 had an afebrile seizure 6 days after the first dose, one participant in Study 494-01 had a possible seizure the same day as the third dose, and two participants in Study 5A9908 had a febrile seizure 2 and 4 days, respectively, after the fourth dose. Among the four participants who experienced a seizure within 7 days following Control vaccines, one participant had an afebrile seizure the same day as the first dose of DAPTACEL + IPOL + ActHIB vaccines, one participant had an afebrile seizure the same day as the second dose of HCPDT + POLIOVAX + ActHIB vaccines, and two participants had a febrile seizure 6 and 7 days, respectively, after the fourth dose of HCPDT + POLIOVAX + ActHIB vaccines.
Serious Adverse Events
In Study P3T06, within 30 days following any of Doses 1-3 of Pentacel or Control vaccines, 19 of 484 (3.9%) participants who received Pentacel vaccine and 50 of 1,455 (3.4%) participants who received DAPTACEL + IPOL + ActHIB vaccines experienced a serious adverse event. Within 30 days following Dose 4 of Pentacel or Control vaccines, 5 of 431 (1.2%) participants who received Pentacel vaccine and 4 of 418 (1.0%) participants who received DAPTACEL + ActHIB vaccines experienced a serious adverse event. In Study 494-01, within 30 days following any of Doses 1-3 of Pentacel or Control vaccines, 23 of 2,506 (0.9%) participants who received Pentacel vaccine and 11 of 1,032 (1.1%) participants who received HCPDT + POLIOVAX + ActHIB vaccines experienced a serious adverse event. Within 30 days following Dose 4 of Pentacel or Control vaccines, 6 of 1,862 (0.3%) participants who received Pentacel vaccine and 2 of 739 (0.3%) participants who received HCPDT + POLIOVAX + ActHIB vaccines experienced a serious adverse event.
Across Studies 494-01, 494-03 and P3T06, within 30 days following any of Doses 1-3 of Pentacel or Control vaccines, overall, the most frequently reported serious adverse events were bronchiolitis, dehydration, pneumonia and gastroenteritis. Across Studies 494-01, 494-03, 5A9908 and P3T06, within 30 days following Dose 4 of Pentacel or Control vaccines, overall, the most frequently reported serious adverse events were dehydration, gastroenteritis, asthma, and pneumonia.
Across Studies 494-01, 494-03, 5A9908 and P3T06, two cases of encephalopathy were reported, both in participants who had received Pentacel vaccine (N = 5,979). One case occurred 30 days post-vaccination and was secondary to cardiac arrest following cardiac surgery. One infant who had onset of neurologic symptoms 8 days post-vaccination was subsequently found to have structural cerebral abnormalities and was diagnosed with congenital encephalopathy.
A total of 5 deaths occurred during Studies 494-01, 494-03, 5A9908 and P3T06: 4 in children who had received Pentacel vaccine (N = 5,979) and one in a participant who had received DAPTACEL + IPOL + ActHIB vaccines (N = 1,455). There were no deaths reported in children who received HCPDT + POLIOVAX + ActHIB vaccines (N = 1,032). Causes of death among children who received Pentacel vaccine were asphyxia due to suffocation, head trauma,
Sudden Infant Death syndrome, and neuroblastoma (8, 23, 52 and 256 days post-vaccination, respectively). One participant with ependymoma died secondary to aspiration 222 days following DAPTACEL + IPOL + ActHIB vaccines.
Data From Post-Marketing Experience
The following additional adverse events have been spontaneously reported during the post-marketing use of Pentacel vaccine worldwide, since 1997. Between 1997 and 2007, Pentacel vaccine was primarily used in Canada. Because these events are reported voluntarily from a population of uncertain size, it may not be possible to reliably estimate their frequency or establish a causal relationship to vaccine exposure.
The following adverse events were included based on one or more of the following factors: severity, frequency of reporting, or strength of evidence for a causal relationship to Pentacel vaccine.
General Disorders and Administration Site Conditions
Injection site reactions (including inflammation, mass, abscess and sterile abscess), extensive swelling of the injected limb (including swelling that involved adjacent joints), vaccination failure/therapeutic response decreased (invasive H influenzae type b disease)
Immune System Disorders
Infections and Infestations
Metabolism and Nutrition Disorders
Nervous System Disorders
Somnolence, HHE, depressed level of consciousness
Respiratory, Thoracic and Mediastinal Disorders
Skin and Subcutaneous Tissue Disorders Erythema, Skin Discoloration
Vascular disorders Pallor
Read the entire FDA prescribing information for Pentacel (Tetanus Toxoid Conjugate)
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