First, I was disappointed by the case report's missing data. Given the child's age, the presence of cold symptoms, the concern for an asthma exacerbation, the lack of effect of albuterol and prednisolone, and the improvement of the child's condition with oxygen therapy, it is unclear why bronchiolitis was not entertained as a diagnosis. Respiratory syncytial virus, influenza, and other viral test results are absent. Since bronchiolitis commonly causes asthma-like respiratory distress and because adverse events with the use of VVR are exceedingly rare, the omission of this information limits one's ability to determine causality. While the distress was reportedly of rapid onset, this was based on a subjective medical history from grandparents who did not follow label instructions.3 This case report must be compared with extensive safety data demonstrating that in the past 5 years > 1 billion units have been sold with fewer than three adverse events reported per million units sold (Procter and Gamble Company; personal communication; January 12, 2009).