The rotavirus vaccine dose given by the intramuscular route is not valid and should be repeated by the oral route as soon as possible. In a review of such rotavirus vaccine administration errors, there usually were not adverse reactions, and those documented were limited to local reactions and general, brief irritability. Please see www.cdc.gov/mmwr/pdf/wk/mm6304.pdf, page 81, for more information.
Please take steps to ensure that such vaccine administration errors are avoided in the future. This event should be reported to the Vaccine Adverse Event Reporting System at https://vaers.hhs.gov even if an adverse reaction does not result from it.
Last reviewed:
June 7, 2023
In the case of an expired live vaccine, the issue is not necessarily the routine minimum interval (three months in the case of varicella and ProQuad vaccines), but the interval that would prevent viral interference if the expired vaccine happened to be still viable. This interval is considered to be four weeks (28 days). The repeat dose should be administered four weeks after the expired dose.
Last reviewed:
July 15, 2023
Yes, however, this issue is not addressed in the 2010 MMRV ACIP recommendations. Although this is off-label use, CDC recommends that when a dose of MMRV is inadvertently given to a patient age 13 years and older, it may be counted towards completion of the MMR and varicella vaccine series and does not need to be repeated.
Last reviewed:
July 15, 2023
The dose should be repeated. If the expired dose is a live virus vaccine, you should wait at least 4 weeks after the previous (expired) dose was given before repeating it. If the expired dose is not a live vaccine, the dose should be repeated as soon as possible. Although simply repeating the dose is preferred, serologic testing to check for immunity after certain vaccinations (e.g., measles, rubella, varicella, hepatitis A) may be accepted.
Last reviewed:
December 28, 2022
Your practice should put procedures in place to ensure that you always give vaccines by the recommended route because data regarding safety and efficacy of alternate routes are limited. If this does inadvertently happen, ACIP and/or CDC recommends that if hepatitis B, rabies, HPV and inactivated influenza vaccines are administered subcutaneously the doses should not be counted as valid and should be repeated.
ACIP states that If PCV13, Hib, and/or DTaP are administered by the subcutaneous route, providers have the discretion to repeat the doses. There is no minimum interval between the invalid dose and the repeat dose. ACIP and/or CDC recommends that if HepA, MenACWY, IPV, PPSV23, COVID-19, and RZV vaccines are administered subcutaneously, the doses can count and do not need to be repeated. ACIP/CDC has no recommendation for Tdap, Td, MenB, Typhim VI, or JE-VC.
Last reviewed:
December 28, 2022
In general, if the error is discovered on the same clinic day, you can administer the other “half” of the dose on that same day. If the error is discovered later, the dose should not be counted, and then the person should be recalled to the office and given a full age-appropriate repeat dose.
There are, however, two exceptions to the general rule: (1) If a patient sneezes after receiving nasal-spray live attenuated influenza vaccine, count the dose as valid. (2) If an infant regurgitates, spits, or vomits during or after receiving oral rotavirus vaccine, count the dose as valid.
If you give more than an age-appropriate dose, count the dose as valid and notify the patient/parent about the error. Using larger than recommended dosages can be hazardous because of excessive local or systemic concentrations of antigens or other vaccine constituents. Avoid such errors by checking the vaccine vial label 3 times.
Last reviewed:
December 28, 2022
Yes. The DTaP in the Pentacel can be counted. Although Pentacel is licensed as a 4-dose series and this may represent a fifth dose of Pentacel (in which case it would be off-label use), the dose of DTaP counts as the fifth dose of DTaP.
Last reviewed:
December 28, 2022
There are no data on the effectiveness of pneumococcal conjugate vaccine given by the intravenous route. The patient has renal disease, so it is important to ensure that the dose they receive is effective. CDC recommends repeating the dose.
Last reviewed:
December 28, 2022
PPSV23 is not effective in children younger than 24 months of age. PPSV23 given at this age should not be considered to be part of the pneumococcal vaccination series. Pneumococcal conjugate vaccine should be administered as soon as the error is discovered. Any time the wrong vaccine is given, the parent/patient should be notified.
Last reviewed:
December 28, 2022
Although PCV and PPSV23 should not be administered at the same visit, CDC does not recommend repeating either vaccine dose should this occur. You should inform the patient of the error and let them know that they will not need to repeat either dose.
Last reviewed:
December 28, 2022
CDC recommends that if a provider mistakenly administers varicella vaccine to a person for whom zoster vaccine is indicated, no specific safety concerns exist, but the dose should not be considered valid. You should administer a dose of Shingrix to the patient during that same visit (same day). If the error is not detected and corrected on the same day, Shingrix should be administered at least 8 weeks after receipt of the varicella vaccine. However, if Shingrix is inadvertently administered less than 8 weeks after the varicella vaccine, CDC experts state that the Shingrix dose does not need to be repeated if given at least 24 days after the varicella vaccine (in other words, 4 weeks minus the 4-day grace period). A second dose of Shingrix should be given 2–6 months after the first dose of Shingrix.
These events should be documented and procedures put in place, such as checking the vial label 3 times to be sure you are administering the product you intend, to prevent this from happening again.
Last reviewed:
December 28, 2022
There is no waiting period. The varicella vaccine dose can be given at any time after the RZV dose.
Last reviewed:
December 28, 2022
A dose less than the full 0.5 mL dose is not valid and should be repeated. If the patient is still in the office the dose can be repeated immediately. If the repeat dose cannot be given on the same day CDC recommends that it should be given 4 weeks after the invalid dose.
Last reviewed:
December 28, 2022
The CDC zoster subject matter experts recommend that in this situation you should wait 4 weeks before giving a repeat dose.
Last reviewed:
December 28, 2022
Any RZV, either antigen or diluent, that is exposed to freezing temperature should not be used. If a dose exposed to freezing temperature is given to a patient the dose should be considered invalid and should be repeated 4 weeks after the invalid dose.
Last reviewed:
December 28, 2022
