Ask The Experts About Vaccines: Administering Vaccines | Vaccine Administration Errors

Administering Vaccines
Vaccine Administration Errors

We received a report of an infant who received rotavirus vaccine intramuscularly rather than orally. Is this dose valid? If not, when should it be repeated?

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 this type of rotavirus vaccine administration error, 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: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

An expired dose of ProQuad (MMRV, Merck) was given to a patient. We assume that the repeat dose should be given in three months because the spacing between doses of a combination vaccine depends on the longest minimum interval of a component (in this case the varicella vaccine component). Is this correct?

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: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

An expired dose of measles-mumps-rubella-and-varicella vaccine, also known as MMRV was given to a patient. We assume that the repeat dose should be given in three months because the spacing between doses of a combination vaccine depends on the longest minimum interval of a component (in this case the varicella vaccine component). Is this correct? [Video]

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Last reviewed: May 23, 2023

Administering Vaccines
Vaccine Administration Errors

MMRV (ProQuad, Merck) was mistakenly given to a 31-year-old instead of MMR. Can this be considered a valid dose?

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 or older, it may be counted towards completion of the MMR and varicella vaccine series and does not need to be repeated.

Last reviewed: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

What should we do if a dose of expired vaccine is given to a patient?

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 at least 4 weeks after certain vaccinations (e.g., measles, rubella, varicella, hepatitis A) may be accepted.

Last reviewed: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

What should we do if we give an injection by the wrong route (subcutaneous [subcut], instead of intramuscular [IM])?

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.

CDC and/or ACIP guidance about vaccination by the wrong route vary depending upon the vaccine and route:

It is not necessary to repeat doses of vaccines that are recommended to be given subcut if they are inadvertently administered IM.
If hepatitis B, rabies, HPV, or inactivated influenza vaccine is administered subcut, the dose should not be counted as valid and should be repeated and administered IM.
CDC’s guidance on what to do following inadvertent subcut administration of RSV vaccine depends upon the recipient: if given to an older adult by the subcutaneous route, the RSV dose should not count and should be repeated IM; if the recipient is pregnant, the RSV dose should count and should not be repeated.
ACIP states that if PCV, Hib, or DTaP is administered subcut, a provider has the discretion to repeat the dose(s) IM because there is no evidence related to immunogenicity of these vaccine administered subcut. There is no minimum interval between the invalid dose and the repeat dose.
If HepA, MenACWY, IPV, PPSV23, COVID-19, or RZV (Shingrix) vaccines are administered subcutaneously, the doses can count and do not need to be repeated.
ACIP and CDC have no recommendation for Tdap, Td, MenB, Typhim VI (injectable typhoid), or Japanese Encephalitis-VC.

Last reviewed: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

One of our staff gave a dose of pediatric hepatitis A vaccine to an adult patient by mistake. How do we remedy this error?

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 cannot be corrected on the same day, 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 (e.g., an adult HepA vaccine to a child), count the dose as valid and notify the patient/parent about the error. Using larger-than-recommended dosages can be more likely to result in side effects 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: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

A dose of Kinrix (DTaP-IPV; GSK) should have been administered to a 4-year-old, but Pentacel (DTaP-IPV-Hib; Sanofi) was administered instead. Does the dose of DTaP count?

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: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

A dose of pneumococcal conjugate vaccine was administered into my patient’s dialysis port. Does this dose count?

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: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

A 2-month-old was mistakenly given PPSV23. What should be done?

Pneumococcal polysaccharide vaccine (PPSV23, Pneumovax, Merck) is not licensed or assumed to be effective in children younger than 24 months of age. PPSV23 given at this age should not be counted as 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: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

We inadvertently gave both pneumococcal conjugate (PCV) and pneumococcal polysaccharide (PPSV) vaccines to a high-risk adult patient at the same visit. We are looking for guidance.

Although PCV15 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: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

A 60-year-old patient was inadvertently given varicella vaccine instead of recombinant zoster vaccine, Shingrix. Should the patient still be given Shingrix? If so, how long an interval should occur between the 2 doses?

CDC recommends that if a provider mistakenly administers varicella vaccine to a person for whom recombinant zoster vaccine (RZV, Shingrix, GSK) 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 4 weeks (28 days) after the varicella vaccine. A second dose of Shingrix should be given 2–6 months after the first dose of Shingrix to complete the series.

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: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

If RZV (Shingrix) is erroneously given to a child for prevention of varicella, the dose is invalid, but is there a waiting period before a valid dose of varicella vaccine can be given? Is it OK to give a dose of varicella vaccine as soon as the error is discovered?

There is no waiting period. The varicella vaccine dose can be given at any time after the RZV dose.

Last reviewed: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

While giving a dose of RZV (Shingrix) the syringe came loose from the needle and part of the dose was lost. Will the patient be protected with this partial dose or does it need to be repeated?

A dose less than the full 0.5 mL dose is generally not valid and should be repeated. If the patient is still in the office the full 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: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

My medical assistant inadvertently administered a 0.5 mL dose of the RZV (Shingrix) diluent only. The dose did not contain any antigen. When can we administer a properly reconstituted dose?

The CDC zoster vaccine subject matter experts recommend that in this situation you should wait 4 weeks before giving a repeat dose because the diluent contains the ASO1 adjuvant and repeating the dose with a shorter interval could increase the side effects of the dose.

Last reviewed: February 27, 2025

Administering Vaccines
Vaccine Administration Errors

Several doses (antigen and diluent) of RZV (Shingrix) were mistakenly stored in our office freezer. One of these doses was administered to a patient. Is this dose valid and if not, when can it be repeated?

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: February 27, 2025

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Ask the Experts: Administering Vaccines: Vaccine Administration Errors

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We received a report of an infant who received rotavirus vaccine intramuscularly rather than orally. Is this dose valid? If not, when should it be repeated?

MMRV (ProQuad, Merck) was mistakenly given to a 31-year-old instead of MMR. Can this be considered a valid dose?

What should we do if a dose of expired vaccine is given to a patient?

What should we do if we give an injection by the wrong route (subcutaneous [subcut], instead of intramuscular [IM])?

One of our staff gave a dose of pediatric hepatitis A vaccine to an adult patient by mistake. How do we remedy this error?

A dose of Kinrix (DTaP-IPV; GSK) should have been administered to a 4-year-old, but Pentacel (DTaP-IPV-Hib; Sanofi) was administered instead. Does the dose of DTaP count?

A dose of pneumococcal conjugate vaccine was administered into my patient’s dialysis port. Does this dose count?

A 2-month-old was mistakenly given PPSV23. What should be done?

We inadvertently gave both pneumococcal conjugate (PCV) and pneumococcal polysaccharide (PPSV) vaccines to a high-risk adult patient at the same visit. We are looking for guidance.

A 60-year-old patient was inadvertently given varicella vaccine instead of recombinant zoster vaccine, Shingrix. Should the patient still be given Shingrix? If so, how long an interval should occur between the 2 doses?

If RZV (Shingrix) is erroneously given to a child for prevention of varicella, the dose is invalid, but is there a waiting period before a valid dose of varicella vaccine can be given? Is it OK to give a dose of varicella vaccine as soon as the error is discovered?

While giving a dose of RZV (Shingrix) the syringe came loose from the needle and part of the dose was lost. Will the patient be protected with this partial dose or does it need to be repeated?

My medical assistant inadvertently administered a 0.5 mL dose of the RZV (Shingrix) diluent only. The dose did not contain any antigen. When can we administer a properly reconstituted dose?

Several doses (antigen and diluent) of RZV (Shingrix) were mistakenly stored in our office freezer. One of these doses was administered to a patient. Is this dose valid and if not, when can it be repeated?

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