ExCPT Pharmacy Technician Comprehensive Study Guide and Focus Guide

ROLES OF THE PHARMACY TECHNICIAN AND PHARMACIST

Pharmacy Technician Overview: Pharmacy technicians support the pharmacist by performing various tasks throughout the pharmacy and play a critical role on the health care team. The scope of practice relies on a well-trained, certified workforce because the industry is dynamic. National certification (e.g., ExCPT) demonstrates competency to perform duties including obtaining medication histories, filling prescriptions, and compounding.
Standard in Patient Safety: State boards of pharmacy often differentiate between certified and noncertified technicians to maintain the highest standard in patient safety. A certified workforce is critical for well-operated, efficient, and patient-centric pharmacies.
Scope of Practice: This includes tasks pharmacy technicians can legally perform under their license, registration, or certification. These responsibilities do not require clinical judgment, which is the thought process allowing health care providers to arrive at a clinical conclusion.
Technician Interaction Examples: Technicians may be the first contact a patient has. They handle questions not requiring clinical judgment, such as the price of insulin or the number of refills left. They triage clinical questions, such as the safety of taking $Warfarin$ and $Aspirin$ simultaneously or instructions for a missed dose, to the pharmacist.

TECHNICIAN DUTIES IN PRESCRIPTION PROCESSING AND INVENTORY

Processing Prescriptions: Technicians process electronic (most common), written, telephoned, or verbal prescriptions (state-dependent). This includes entering data into databases with high attention to literal detail. They submit refill requests through health care networks, fax, or phone and add authorizations after physician approval.
Preparation Tasks: Technicians prepare prescriptions by counting or pouring medications, labeling containers, performing calculations, reconstituting powders, and both sterile and nonsterile compounding. This includes products like eyedrops, antibiotics, chemotherapy, and total parenteral nutrition ( $TPN$ ). They also repackage bulk medication into unit-dose packaging.
Inventory and Supplies: Technicians keep pharmacies stocked with vials, caps, and bottles. They restock at the end of every shift and document items to be reordered. They receive medications from suppliers, comparing invoices against medications immediately upon arrival. This includes over-the-counter ( $OTC$ ) departments. In inpatient settings, they restock medication dispensing machines, floor stock, and crash carts.
Quarantine and Disposal: Technicians check expiration dates, add or delete inventory based on needs, and remove recalled, discontinued, or overstocked products. They quarantine products to prevent accidental dispensing.
Housekeeping: Maintaining a clean work environment is mandatory. In community settings, counting trays are cleaned with $70\%$ isopropyl alcohol ( $IPA$ ) throughout the day. In hospital settings, laminar flow hoods are cleaned with sterile $70\%$ isopropyl alcohol on a routine schedule.
Administrative and Support Tasks: * Preparing insurance claims for online adjudication. * Helping patients locate $OTC$ medications. * Completing purchase transactions and documenting behind-the-counter ( $BTC$ ) sales of $Pseudoephedrine$ and Schedule $V$ drugs. * Identifying patterns requiring intervention, such as abnormally large quantities of controlled medications. * Performing monthly unit inspections in institutions where medications are stored outside the pharmacy (e.g., nurses' stations). * Medication reconciliation: Documenting patient lists of medications prescribed and taken. * Processing vaccine paperwork; in some states, certified technicians may administer vaccines. * Gathering and ensuring the confidentiality of Protected Health Information (PHI). * Notifying the pharmacist of Drug Utilization Review (DUR) warnings.

PHARMACIST DUTIES AND CLINICAL RESPONSIBILITIES

Clinical Judgment: A licensed pharmacist must perform all tasks requiring clinical judgment. If any question arises regarding the scope of a task, seek pharmacist clarification.
Exclusive Duties: * Receiving oral prescriptions from prescribers or authorized designees for new telephone orders or refill changes. * Consulting with prescribers regarding prescription changes based on $DUR$ , insurance formularies, or patient requests. * Performing and documenting final product verification prior to dispensing. * Consulting with patients about medication use, adherence, and health issues. * Performing Medication Therapy Management (MTM): A service to improve patient outcomes through profile review and education. * Recommending $OTC$ medications based on patient manifestations (symptoms); technicians can only locate products on the shelf. * Overseeing all functions performed by pharmacy technicians.

PHARMACY SECURITY AND HIPAA COMPLIANCE

Access and Security: Only pharmacists, technicians, and cashiers are permitted in the pharmacy. All other access requires pharmacist approval. The pharmacy must be locked when no pharmacist is on duty. Identification badges of law enforcement, state board inspectors, and $FDA$ personnel must be verified before entry.
Access Codes: These must be individualized, changed regularly, and inactivated upon employee termination or resignation.
Controlled Substance Storage: These must be stored in one of two ways: locked in a secure cabinet or spread/dispersed among other medications on the pharmacy shelf (legend drugs).
Digital Security: Electronic health records containing $PHI$ are protected by HIPAA (Health Insurance Portability and Accountability Act of 1996). Pharmacies must conduct risk assessments, use encryption for transmission, and maintain secure systems to prevent data breaches.
Control Measures for Substances: Strict protocols prevent diversion. These include regular audits and reconciliations of controlled substance inventory to detect discrepancies.
Definitions: * Legend Medications: FDA-approved drugs that require a prescription and carry the federal legend: "Federal law prohibits the dispensing of this medication without a prescription." * Board of Pharmacy: State boards that regulate pharmacy practice. * FDA: Federal agency within the Department of Health and Human Services regulating the manufacture and safety of medications.

SPECIALIZED ROLES: MEDICATION RECONCILIATION AND MTM

Medication Reconciliation: Technicians interview patients (primarily in emergency departments or surgical centers) to document lists of prescription drugs, $OTC$ items, and herbal supplements. These lists must specify the medication, dose, frequency, and route of administration. This prep allows the pharmacist to focus on clinical evaluation.
Medication Therapy Management (MTM): * Technician Role: Identifying candidates (those taking multiple meds, having multiple conditions, or needing special monitoring). Technicians explain the service and follow up after the MTM meeting to ensure adherence to therapy changes. * Pharmacist Role: Identifying drug-drug interactions ( $DDI$ ), side effects, and recommending cost-effective options to physicians.
Revenue Impact and Star Ratings: Insurance plans use "Star Ratings" to evaluate pharmacist-led $MTM$ programs. Higher ratings indicate better outcomes and adherence. Lower ratings can lead to payment retreats (direct and indirect remuneration), reduced reimbursement, or loss of contracts, which result in significant revenue loss.

PATIENT ADHERENCE AIDS AND DEVICES

Adherence Definition: When patients take prescribed medication exactly as directed and follow through with labs and appointments.
Automatic Refills: Medications are refilled a few days before the patient runs out. * Exceptions: $Medicare$ and $Medicaid$ plans may have restrictions. $Medicare$ -paid items are often prohibited from automatic refills to prevent fraud.
Reminder Tools: * Weekly Medication Containers: Low-tech, inexpensive planners with daily compartments. * High-Tech Aids: Planners that open automatically at set times, audible/vibrating alarms on watches/smartphones, and smart pill bottles that record opening times and send missed dose reminders. * Packaging Services: Bubble packing or PillPack services that group all medications for a specific time together.

MEDICAL TERMINOLOGY IN PHARMACY

Word Structure: Prefixes (beginning), Roots (middle), Suffixes (end). Example: "Rhinitis" ( $rhin-$ = nose; $-itis$ = inflammation).
Route of Administration Abbreviations (Table 1.1): * $ad$ : right ear; $as$ : left ear; $au$ : both ears. * $od$ : right eye; $os$ : left eye; $ou$ : both eyes. * $bu$ : buccal; $im$ : intramuscular; $it$ : intrathecal. * $po$ : by mouth; $pr$ : rectal; $pv$ : vaginal. * $sc/sq/sub\,q$ : subcutaneous; $sl$ : sublingual.
Frequency Abbreviations (Table 1.2): * $ac$ : before meals; $pc$ : after meals. * $bid$ : twice daily; $tid$ : three times daily; $qid$ : four times daily. * $hs$ : at bedtime; $qh$ : every hour; $prn$ : as needed; $wa$ : while awake.
Other Abbreviations (Table 1.3): * $aaa$ : apply to affected area; $gtts$ : drops; $ha$ : headache; $qs$ : quantity sufficient; $ung$ : ointment.

MEDICATION CLASSES AND CARDIOVASCULAR SYSTEM (TABLE 1.4)

Nitrates: (Prefix: $nitr-$ ) e.g., $Isosorbide\,mononitrate$ . Use: Antianginal.
Calcium Channel Blockers: (Suffix: $-pine$ ) e.g., $Nifedipine$ . Use: Antianginal, Antiarrhythmic, Antihypertensive.
Beta-blockers: (Suffix: $-lol$ ) e.g., $Atenolol$ . Use: Antianginal, Antiarrhythmic, Antihypertensive.
HMG-CoA Reductase Inhibitors: (Suffix: $-statin$ ) e.g., $Atorvastatin$ . Use: Antihyperlipidemic.
Fibric Acid Derivatives: (Suffix: $-fibr$ ) e.g., $Fenofibrate$ . Use: Antihyperlipidemic.
Alpha-blockers: e.g., $Terazosin$ . Use: Antihypertensive.
ACE Inhibitors: (Suffix: $-pril$ ) e.g., $Benazepril$ . Use: Antihypertensive.
Angiotensin Receptor Blockers (ARBs): (Suffix: $-sartan$ ) e.g., $Irbesartan$ . Use: Antihypertensive.
Loop Diuretics: (Suffix: $-mide$ ) e.g., $Furosemide$ . Use: Antihypertensive.
Thiazide Diuretics: (Suffix: $-thiazide$ ) e.g., $Hydrochlorothiazide$ . Use: Antihypertensive.
Potassium-sparing Diuretics: e.g., $Spironolactone$ . Use: Antihypertensive.
Antiplatelets: e.g., $Clopidogrel$ . Use: Thrombus prevention.

GASTROINTESTINAL AND MUSCULOSKELETAL CLASSES (TABLES 1.5, 1.6)

Anticholinergics: e.g., $Dicyclomine$ . Use: Antiemetic.
Antacids: e.g., $Magnesium$ . Use: GERD.
H2 Blockers: (Suffix: $-tidine$ ) e.g., $Famotidine$ . Use: GERD.
Proton Pump Inhibitors (PPIs): (Suffix: $-prazole$ ) e.g., $Esomeprazole$ . Use: GERD.
Osmotic Laxatives: e.g., $Polyethylene\,glycol$ . Use: Constipation.
Stool Softeners: e.g., $Docusate\,sodium$ . Use: Constipation.
DMARDs: (Suffix: $-ine$ ) e.g., $Methotrexate$ . Use: Antirheumatic.
Xanthine Oxidase Inhibitors: (Suffix: $-inol$ ) e.g., $Allopurinol$ . Use: Gout.
NSAIDs: (Suffix: $-ofen$ ) e.g., $Ibuprofen$ . Use: Anti-inflammatory.
COX-2 Inhibitors: (Suffix: $-oxib$ ) e.g., $Celecoxib$ . Use: Pain, Anti-inflammatory.
Bisphosphonates: (Suffix: $-onate$ ) e.g., $Alendronate$ . Use: Osteoporosis.
Muscle Relaxants: (Suffix: $-prine$ ) e.g., $Cyclobenzaprine$ . Use: Muscle relaxation.

NERVOUS AND SYSTEMIC CLASSES (TABLES 1.7 - 1.13)

Benzodiazepines: (Suffixes: $-zepam$ , $-zolam$ ) e.g., $Lorazepam$ . Use: Antianxiety, anticonvulsant.
Tricyclic Antidepressants (TCAs): (Suffix: $-tyline$ ) e.g., $Amitriptyline$ . Use: Antidepressant.
SNRIs: e.g., $Duloxetine$ . Use: Antidepressant.
SSRIs (Selective Serotonin Reuptake Inhibitors): e.g., $Citalopram$ . Use: Antidepressant, Antianxiety.
Atypical Antipsychotics: (Suffix: $-pine$ ) e.g., $Quetiapine$ . Use: Antipsychotic.
Prostaglandin Analogs: (Suffix: $-oprost$ ) e.g., $Latanoprost$ . Use: Glaucoma.
Alpha Agonists: (Suffix: $-ine$ ) e.g., $Brimonidine$ . Use: Glaucoma.
Narcotic Analgesics: e.g., $Morphine$ . Use: Pain.
Phosphodiesterase Inhibitors: (Suffix: $-afil$ ) e.g., $Sildenafil$ . Use: Erectile dysfunction.
Estrogens: (Prefix: $estra-$ ) e.g., $Estradiol$ . Use: Oral contraceptives, Hormone replacement therapy.
Progestins: (Prefix: $progester-$ ) e.g., $Progesterone$ . Use: Oral contraceptives, Hormone replacement therapy.
Anabolic Steroids: (Prefix: $testo-$ ) e.g., $Testosterone$ . Use: Male hypogonadism.
Urogenital Anticholinergics: e.g., $Oxybutynin$ . Use: Incontinence.
Urogenital Alpha-blockers: (Suffix: $-azosin$ ) e.g., $Doxazosin$ . Use: Benign prostatic hyperplasia.
5-alpha Reductase Inhibitors: (Suffix: $-asteride$ ) e.g., $Finasteride$ . Use: Benign prostatic hyperplasia.
Corticosteroids: (Suffix: $-sone$ ) e.g., $Prednisone$ . Use: Anti-inflammatory.
Antibiotics/Antivirals/Antifungals: * Beta-lactam: (Suffix: $-cillin$ ) e.g., $Amoxicillin$ . * Fluoroquinolones: (Suffix: $-floxacin$ ) e.g., $Ciprofloxacin$ . * Antifungals: (Suffix: $-azole$ ) e.g., $Ketoconazole$ , $Fluconazole$ . * Antivirals: (Suffix: $-vir$ ) e.g., $Acyclovir$ , $Oseltamivir$ .
Respiratory: * Antihistamines: (Suffix: $-adine$ ) e.g., $Loratadine$ . * Bronchodilators: (Suffix: $-terol$ ) e.g., $Albuterol$ . * Expectorants: e.g., $Guaifenesin$ (Congestion). * Antitussives: e.g., $Benzonatate$ (Cough).
Endocrine (Diabetes): * Sulfonylureas: e.g., $Glimepiride$ . * SGLT2 Inhibitors: (Suffix: $-gliflozin$ ) e.g., $Canagliflozin$ . * Biguanides: e.g., $Metformin$ . * Thiazolidinediones: (Suffix: $-glitazone$ ) e.g., $Pioglitazone$ . * GLP-1 Agonists: (Suffix: $-glutide$ ) e.g., $Dulaglutide$ .

COMMUNICATION AND PHARMACY WORKFLOW

Internal/External Customers: External (patients, caregivers) and internal (staff, health care professionals).
Clinical Empathy: The ability to share feelings while maintaining professional demeanor. This builds trust.
Cultural Sensitivity: Respect and knowledge of differing cultural beliefs. Essential for sensitive topics like birth control or emergency contraceptives.
Community Pharmacy Layout: 1. Intake Area: (Drop-off/Check-in). Initial impression; prescriptions are scanned here. 2. Processing Area: (Data entry). Environment should be free from distractions. Contains counting equipment, distilled water, and compounding tools. 3. Pharmacist Final Verification Area: Completed prescriptions reside here for pharmacist sign-off. 4. Processed Prescriptions Area: (Will-call). Stored alphabetically by last name. 5. Out Window: Cash registers process payment. Register identifies if a script has not been verified. 6. Consulting Area: Private sub-area for pharmacist counseling.
Institutional Pharmacy Layout: * Main Dispensary: Computer stations for pharmacist intake. * Pullout Shelves/Carousel: Prepackaged medications for technician order fulfillment. * Ward Boxes Area: Storage for medications organized for specific hospital units. * Aseptic Suite: Sterile clean rooms for $IV$ preparation. An anteroom is required for garbing. * Unpacking Area: For incoming products from distributors.
Technician Check Technician (TCT): A practice allowed in some states where certified technicians verify other technicians' work, typically limited to automated dispensing machine refills and unit dose batching.

INVENTORY MANAGEMENT AND DRUG PRICING

Ordering Parameters: * Reorder Points (ROP): Minimum stock level at which a medication should be replenished. * Reorder Quantities (ROQ): Predetermined quantity of medication that needs to be ordered.
Receiving System: To prevent diversion, the person receiving the order should be different from the person who placed it. Shipments must be signed and dated. Priority goes to temperature-sensitive and controlled substances.
Stocking Methods: Use First In, First Out (FIFO) to prioritize earlier expiration dates. Older stock moved to the front; new stock to the back.
Drug Pricing Primer: * Wholesale Acquisition Cost (WAC): Manufacturer's list price before discounts/rebates. * Average Wholesale Price (AWP): Benchmark price wholesalers sell to pharmacies. * Actual Acquisition Cost (AAC): Price actually paid after discounts/rebates. * Maximum Allowable Cost (MAC): Maximum reimbursement set by payers for generic drugs.
Expiration Protocols: Standard policy is to pull medications expiring in $3$ months or less. Expiration dates can change (e.g., $Insulin$ at room temperature lasts only $28$ days; $Famotidine$ injections expire in $6$ months at room temperature).
Recalls (FDA Classification): * Class I: Strong chance of serious adverse effects or death (most serious). * Class II: Temporary or reversible chance of adverse effects. * Class III: Problem not likely to cause adverse effects (least severe).

TEMPERATURES AND MEDICATION STORAGE

Standard Pharmacy Temperatures: * Room Temperature: $20^{\circ}C$ to $25^{\circ}C$ ( $68^{\circ}F$ to $77^{\circ}F$ ). * Refrigerator: $1.7^{\circ}C$ to $7.8^{\circ}C$ ( $35^{\circ}F$ to $46^{\circ}F$ ). * Freezer: $-15^{\circ}C$ ( $5^{\circ}F$ ) or lower.
Temperature Conversion Formulas: * $5F = 9C + 160$ . * $C = \frac{F - 32}{1.8}$ . * $F = (C \times 1.8) + 32$ .
Storage Requirements Examples: $Nitroglycerin$ tablets must be in their original amber glass bottle to protect from light and moisture. $Latanoprost$ , $Insulin$ , and $Etonogestrel$ / $Ethinyl\,estradiol$ rings require refrigeration.

HAZARDOUS WASTE AND CONTROLLED DISPOSAL

Resource Conservation and Recovery Act (RCRA): * P-listed: Acutely hazardous; empty containers are considered hazardous. * D-listed: Toxic, ignitable, corrosive, or reactive. Includes aerosols and silver nitrate. * U-listed: Toxic, such as chemotherapy drugs.
Controlled Substance Disposal: Involves DEA-41 form and a witness by two authorized professionals (e.g., two pharmacists). Drugs must be rendered non-retrievable.
Patient Responsibility: Advise patients to use National Prescription Drug Take Back Days. For home disposal, mix with cat litter/coffee grounds in a bag. Fentanyl patches are an exception: they must be flushed down the toilet due to the high risk of accidental death to children/pets.

PHARMACY REFERENCES AND LAWS

Reference Library: * Orange Book: Therapeutic Equivalence evaluations (Brand vs. Generic). * Purple Book: Biologic and Biosimilar evaluations. * Red Book: Pricing information (AWP/WAC). * Yellow Book: Health information for international travel (CDC). * Safety Data Sheets (SDS): Dangers of hazardous chemicals. * Merck Manual: Diagnosing and treating conditions. * USP-NF: Official standards of the FDA.
Federal Laws: * Pure Food and Drug Act (1906): Prohibited interstate commerce of adulterated food/medicine. * Federal Food, Drug, and Cosmetic Act (1938): Required safety proof and created legend/OTC categories. * Controlled Substances Act (1970): Created five schedules ( $I$ through $V$ ) based on abuse potential. * Poison Prevention Packaging Act (PPPA, 1970): Required child-resistant packaging. Must resist $80\%$ of children under $5$ years but allow $90\%$ of adults to open within $5$ minutes. * Drug Listing Act (1972): Mandated unique National Drug Code (NDC) for all medications. * Omnibus Budget Reconciliation Act (OBRA 90): Mandated patient profiles, drug utilization review ( $DUR$ ), and pharmacist counseling. * Drug Supply Chain Security Act (DSCSA): Tracking and tracing for counterfeit drugs.

CONTROLLED SUBSTANCE SCHEDULES AND DEA VERIFICATION

C-I: High abuse potential, no medical use (Heroin, LSD, Cannabis).
C-II: High abuse potential, medical use. No refills allowed. Maximum $90$ -day supply via three separate prescriptions (Morphine, Fentanyl, Hydrocodone, Oxycodone).
C-III: Lesser abuse than $C$ - $II$ , moderate physical/high psychological dependence (Ketamine, Testosterone, Acetaminophen with Codeine).
C-IV: Low abuse/dependence potential (Benzodiazepines, Zolpidem, Tramadol).
C-V: Low abuse, limited opiate quantity for cough/diarrhea ( $Lomotil$ , $Lyrica$ , Codeine cough syrups).
DEA Number Verification Process: 1. Add $1st, 3rd, 5th$ digits. 2. Add $2nd, 4th, 6th$ digits and multiply by $2$ . 3. Sum the results of steps $1$ and $2$ . 4. The last digit of the final sum must match the $7th$ (check) digit of the DEA number.
DEA Forms: * Form 222: To order $C$ - $II$ medications (triplicate or electronic $CSOS$ ). Valid for $60$ days. * Form 41: For disposal of controlled substances. * Form 106: Used to report loss or theft of controlled substances.

PRESCRIPTION BILLING AND THIRD-PARTY PAYERS

Adjudication: Process of transmitting a prescription electronically for approval and billing.
Card Components: * BIN (Bank Identification Number): 6-digit number for electronic routing. * PCN (Processor Control Number): Secondary identifier for plan differentiation. * Member ID: Unique number assigned to the primary insured. * Person Code: Identifies family members ( $01$ : Primary, $02$ : Spouse, $03$ : Child).
Payment Terms: * Copay: Fixed amount paid out of pocket. * Deductible: Amount paid upfront before insurance coverage begins. * Coordination of Benefits: Ensuring claims aren't paid multiple times between multiple insurances.
Prior Authorization (PA): Insurance requires extra info from the doctor before agreeing to pay.
Durable Medical Equipment (DME): Billed through $Medicare\,Part\,B$ . Requires $DMEPOS$ accreditation. Items include hospital beds, walkers, and testing supplies.

COMPOUNDING AND ASEPTIC TECHNIQUE

USP Chapters: * Nonsterile compounding. * Sterile compounding. * Hazardous medication handling.
Aseptic Handwashing: Minimum of $30\,seconds$ . Wash from fingertips to elbow. Rinse with hands held upright (water flows toward elbow).
Garbing Order: Dirtiest to cleanest. * Booties/Shoe covers \rightarrow Bouffant cap (all hair covered) \rightarrow Beard cover (if needed) \rightarrow Mask \rightarrow Aseptic handwash \rightarrow Gown \rightarrow Sterile gloves.
Primary Engineering Controls (Hoods): Must be ISO Class 5 (formerly Class $100$ : no more than $100$ airborne particles per cubic foot). * Clean the ceiling first, then sides, then the direct compounding area (back to front).
Supplies: * Needle Gauge: Larger number = smaller diameter (e.g., $25\,G$ is smaller than $15\,G$ ). * Tonicity: Isotonic (same as blood), Hypertonic (causes cells to shrink), Hypotonic (causes cells to burst).

PHARMACY CALCULATIONS

Clark's Rule (Pediatric): $\text{Dose} = \frac{\text{Weight in lb}}{150} \times \text{Adult Dose}$ .
Young's Rule (Pediatric): $\text{Dose} = \frac{\text{Age in years}}{\text{Age} + 12} \times \text{Adult Dose}$ .
Days' Supply: $\text{Quantity} \div \text{Total daily dose}$ .
Dilution Formula: $SV \times SP = DV \times DP$
Alligation: Grid method for mixing two strengths to reach a middle strength.
Weight/Volume %: $g \div 100\,mL$ . Example: $D5W = 5\,g$ Dextrose per $100\,mL$ water.

MEDICATION SAFETY AND QUALITY ASSURANCE

The 9 Rights of Medication: 1. Right medication. 2. Right dose. 3. Right time. 4. Right patient. 5. Right route. 6. Right education. 7. Right documentation. 8. Right effects. 9. Right to refuse.
Just Culture: A learning environment differentiating between: * Human Error: Unintentional failure. * At-risk Behavior: Losing perception of risk (e.g., skipping a barcode scan). * Reckless Behavior: Conscious disregard of risk (blameworthy).
Root Cause Analysis: Process of investigating an error to determine the underlying cause.
Continuous Quality Improvement (CQI): Systematic meetings and reviews to prevent future errors.
Reporting Systems: * MedWatch (FDA): For medications, devices, and supplements. * ISMP MERP: Practitioner-based medication error reporting. * VAERS (CDC/FDA): Vaccine Adverse Event Reporting System.