Vaccine Administration - · PDF fileBest Practices Checklist: Vaccine Administration. ... Why delay when an older child will ... Don't use expired diluent or

Proper vaccine preparation, site and route selection, needle length, and injection techniques are essential to the appropriate administration of vaccines. Being ready to handle rare reactions is essential.

Overview of this section: Best Practices Checklist: Vaccine Administration

Five "Rights" to Avoid Medication Wrongs

Don't Hesitate to Vaccinate

Preparing the Shot

Giving the Shot

After the Shot

Key Resources for Vaccine Administration

Improperly administered

injections may result in injuries or

prevent vaccines from providing

optimal protection.

Who to CallCenters for Disease Control and Prevention

800-232-4636

147July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - VACCINE ADMINISTRATION www.health.state.mn.us/immunize

Vaccine AdministrationGuidelines for administering vaccine and handling vaccine reactions

“Five rights” to avoid medication wrongs � Persons who administer vaccines and staff who

manage or support vaccine administration are properly trained and receive ongoing education to avoid medication errors.

Preparing the shot � We check the dose, vial expiration date, the

vial label, and contents prior to drawing up and administering vaccine.

� We check the vaccine label three times: when pulling vaccine from the container, when withdrawing the vaccine, and before replacing it on the shelf or disposing of the empty container.

� We prepare the vaccines for one patient at a time.

� We properly prepare the vaccine.

� We reconstitute vaccine using only the diluent supplied and use it within the proper reconstituted shelf life.

� We label each filled syringe with the date and time it was drawn up, the vaccine type, and the lot number. We do this to identify syringe contents in case the patient changes their mind.

� We follow needle safety and infection control precautions (e.g., washing hands, using gloves, never recapping needles, using sharps containers).

Giving the shot � We use the right size needle when giving

intramuscular (IM) injections to infants/toddlers.

� We use only the muscle site identified for the patient's age group.

� We trained our staff to know the appropriate route (IM or SQ) for each vaccine.

� Our staff are trained to administer multiple vaccinations to patients who are due for multiple vaccinations.

� We prepare patient/parents for what to expect when giving the shot.

After the shot � We have an anaphylaxis protocol which is

clearly posted and reviewed annually.

� We review comfort measures to and after care instructions with patient/parents, inviting questions.

� We train our staff how to manage vaccine reactions including an anaphylactic episode.

� We have an emergency kit in the area where immunizations are administered.

� We know how to obtain Vaccine Adverse Events Reporting System (VAERS) forms and how to report post-vaccination adverse events as required by the National childhood Injury Act (NCVIA).

Best Practices Checklist: Vaccine AdministrationThe information in this checklist will be covered in more detail throughout this section.

148 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011

Avoid missed opportunitiesDon't be a vaccine-hesitant provider; give all the vaccines that are due. Studies have shown that the primary reason for missing an opportunity to vaccinate is the provider’s reluctance to administer all vaccines that are needed at one visit. This robs the patient of the opportunity to be protected from serious diseases. Here are some important tips to help you avoid missed opportunities:

y Parents are less concerned about the number of injections than providers might predict.

y Most parents will generally accept all the vaccinations recommended at a visit if the provider presents the benefits of doing so:

○ Simultaneous administration of vaccines (i.e., on the same day, not at the same anatomic site) does not result in decreased antibody responses or increased rates of adverse reactions.

○ A minute or two of pain from shots is well worth the benefit of being protected from disease for years to come.

○ Spreading out injections can provoke more fear of needles than giving shots on time. Babies in their first year of life quickly forget the pain of shots if comforted immediately after them. Why delay when an older child will begin to anticipate and struggle against discomfort?

Don't Hesitate to Vaccinate

Remember these five "rights" of medication administration to avoid making medication errors when you vaccinate patients:

1. Right patient – including proper age; check the package insert.2. Right dose – check the package insert for directions.3. Right vaccine/diluent – follow indications and contraindications.4. Right route – use the proper needle length and site (intramuscular, subcuta-

neous, nasal, or oral).5. Right time – check the age indications and minimum intervals between doses.

Following these five "rights" will not only keep you in line with best practices but also will greatly reduce wasted vaccine and adverse events.

Five "Rights" to Avoid

Medication Wrongs


Preparing the Shot

Proper preparation assures the vaccine isn't wasted and the patient is protected. y Open only one multi-dose vial of a specific vaccine at a time. y Never combine vaccines in a syringe unless it is specifically recommended in

the package insert. y Check the vaccine label three times: when pulling vaccine from the container,

when withdrawing the vaccine, and before replacing it on the shelf or disposing of the empty container.

y Check the label three times; when you remove the vaccine from storage, when you draw it up, and when you dispose of the syringe or place the vial back into storage.

y Be familiar with each vaccine's storage and handling information provided in the package insert; see Guide to Receiving, Storing, and Handling Vaccines on pages 19-25.

Don't pre-fill syringes: Too much can go wrong y The practice of pre-filling syringes for more than one patient at a time is a

quality control and patient safety issue. y Pre-filling syringes is a violation of medication administration practice

standards, which state that you should only administer vaccine you have personally prepared and drawn up.

y You cannot be sure of the composition and sterility of the dose you are administering if you haven't prepared it.

y Bacteria can contaminate and grow in syringes pre-filled from single-dose vials, because these vials do not contain bacteriostatic agents.

y Once vaccine is inside the syringe, it is difficult to tell which vaccine is which; this may lead to administration errors.

y Bulk plastic syringes, as opposed to manufactured pre-filled glass syringes, are designed for immediate administration and not for vaccine storage.

y No stability data are available for vaccines stored in plastic syringes. Vaccine components may interact with the plastic over time and affect vaccine potency.

y Pre-filling may lead to wasting vaccine, because you will have to discard any vaccine you are unable to use within the reconstituted shelf life or work day.

Reconstitute vaccines correctlyTo ensure adequate potency and safety of a vaccine that requires reconstitution (combining vaccine with diluent): y Only use the diluent provided by the manufacturer, because it is the only

approved diluent, and in some cases, the diluent also contains an antigen for the vaccine (e.g., Pentacel, Menveo).

y Check the expiration dates on both the diluent and the vaccine. Don't use expired diluent or vaccine.

y Reconstitute the vaccine immediately before administering it. y Use the reconstituted vaccine within its recommended shelf life; see the table

Reconstituted Vaccine: Diluents and Shelf Life on page 151. y Follow proper disposal procedures for discarding reconstituted vaccine that

wasn't administered within the recommended shelf life; see Disposing of Vaccine on page 27.

Multi-dose vials of vaccine contain a bacteriostatic agent and once opened, can be used until the expiration date on the vial, unless contaminated.

For information on how to properly dispose of unused, spoiled, or expired

vaccine, see Disposing of Vaccine on page 27.


Reconstituted Vaccine: Diluents and Shelf LifeVaccine Diluent* Reconstituted shelf lifeActHIB (Hib) sanofi pasteur 0.4% saline 24 hours when stored in

refrigeratorHiberix (Hib) GSK 0.9% saline 24 hours when stored in

refrigeratorImovax (Rabies)

sanofi pasteur distilledsterile water 30 minutes

M-M-R II(Measles, mumps, rubella) Merck sterile water 8 hours when protected from

light and stored in refrigerator

MenHIbrix(Meningococcal C/Y-Hib) GSK 0.9% saline 30 minutes

Menomune (Meningococcal)

Single-dose vials - sanofi pasteur distilled sterile water 30 minutes for single-dose vial

Multi-dose vials - sanofi pasteur distilled sterile water with thimerosal

35 days when stored in multi-dose vial in refrigerator

Menveo(Meningococcal) MenCWY conjugate

8 hours at or below room temperature, 68º to 77ºF (20º to 25ºC)

Pentacel(DTaP-IPV-Hib) sanofi pasteur DTaP-IPV 30 minutes

ProQuad (Measles, mumps, rubella, varicella)

Merck sterile water30 minutes when protected from light and stored in refrigerator

RabAvert (Rabies) Novartis sterile water 30 minutes

Rotarix (Rotavirus)

GSK calcium carbonate, sterile water, and xanthane

24 hours when stored in refrigerator

Varivax (Varicella) Merck sterile water 30 minutes when protected

from lightYF-VAX(Yellow fever) sanofi pasteur saline 60 minutes

Zostavax (Zoster) Merck sterile water 30 minutes when protected

from light*Use only the diluent provided by the manufacturer because it is a component of the vaccine.

Most reconstituted vaccines should be

used immediately after reconstitution - within

30 minutes.

TAKE ACTIONTTIf you have drawn up vaccine for a patient who changes their mind:1. Mark the syringe with the date and time it was drawn up, the vaccine type,

and the lot number.2. Use within the same eight-hour work day or within the proper reconstituted

shelf life.3. If the vaccine isn't used within the same eight-hour work day or recon-

stituted shelf life, whichever is shorter, discard it using proper disposal procedures. See Disposing of Vaccine on page 27.


Practice needle safety and infection controlHealth care workers who use needles are at increased risk of exposure to blood- borne pathogens as a result of needle-stick injuries. Take precautions to protect yourself and your patients!

Avoid needle sticks y Never recap used needles. y Dispose of used needles promptly in appropriate sharps disposal containers. y Use needles with safety devices.

Gloving y Use of gloves is not required when administering injections. However, gloves

are recommended if you anticipate coming into contact with potentially infectious body fluids or have open lesions on your hands. Determine your clinic or agency's own policies.

y If you use gloves, change them with each patient. y Hand washing or use of hand sanitizer is recommended before and after each

patient. y Remember, wearing gloves does not protect against needle-stick injuries.

Jet injectors y Currently available single-use jet injectors do not pose a risk of blood-borne

transmission if used properly and can be beneficial in a community setting where a large number of people are receiving the same vaccine.

y Assure that staff are appropriately trained in jet injector use. y Avoid unnecessary bleeding or bruising by applying pressure to the injection

site. y Be certain the jet injector delivers vaccine by the desired route (IM or SQ).

Preparing the Shot


Giving the Shot

Give all vaccines in the same visit: Simultaneous administrationAll vaccines, whether live or inactivated, can be given at the same visit. However, if not administered at the same visit, follow these simple rules (based on ACIP General Recommendations, Table 3 Guidelines for spacing of live and inactivated antigens, page 96):

y Two or more inactivated vaccines can be given at same visit or at any interval between doses.

y Inactivated and live vaccines can be given at the same visit or at any interval between doses.

y Two or more live intranasal or injectable vaccines must be given at least four weeks apart if not given at the same visit.

y Live oral vaccines: Can be given at the same visit or at any interval before or after inactivated or live injectable vaccines.

Live vaccines: y Influenza: LAIV, intranasal y Measles, mumps, rubella y Measles, mumps, rubella, varicella y Rotavirus, oral y Typhoid, oral y Varicella y Yellow fever y Zoster

Inactivated vaccines: y DTaP, DT, Td, TT, Tdap y Haemophilus influenzae type b y Hepatitis A y Hepatitis B y Human papillomavirus y Influenza: TIV, injectable y Japanese encephalitis y Meningococcal, conjugate and polysaccharide y Pneumococcal, conjugate and polysaccharide y Polio, injectable y Rabies y Typhoid, injectable

Selecting the injection site (IM or SQ) y Intramuscular (IM) injections are generally recommended for inactivated

vaccines and vaccines that contain an adjuvant or preservative; see How to Administer IM Injections on page 171.

y Subcutaneous (SQ) injections are generally recommended for live vaccines and other vaccines that may cause fewer local reactions; see How to Administer SQ Injections on page 172.


y When giving injections use only the muscle site identified for the patient's age group, usually the vastus lateralis for infants and toddlers and the deltoid for older children, adolescents, and adults.

y Don’t use the gluteal area (buttocks) to administer vaccine. It is covered by a significant layer of subcutaneous fat that can prevent the needle from reaching the muscle. In young children, an IM injection in the gluteal area has the potential to damage the sciatic nerve.

Vaccine given by the wrong route? y If a vaccine is administered by the wrong route, e.g., SQ rather than IM,

the injection usually does not need to be repeated. Hepatitis B and rabies vaccinations are the exception to this rule. If hepatitis B or rabies vaccine is improperly administered, SQ rather than IM, the dose should be repeated.

y Keep in mind that improperly administered IM vaccines may cause a local reaction (e.g., irritation, redness, swelling, or necrosis). Make sure to advise the patient/parent of possible local reactions.

Administering more than one vaccine at the same siteIf multiple vaccines are being administered at a single visit, try to give each vaccine at a different site. However, if two or more injections are given in a single limb follow these rules:

For infants and younger children: y Use the vastus lateralis muscle y Separate injections by 1 inch or more

For older children and adults: y Use the deltoid muscle y Separate injections by 1 inch or more

For simultaneous administration of a vaccine and an immune globulin (e.g., hepatitis B and hepatitis B immunoglobulin [HBIG]), use different limbs for each injection.

Creating an immunization site mapWhen giving multiple and/or simultaneous injections a site map of which vaccines to give and where can be a helpful tool. A site map takes the guess work out of deciding which vaccine to give at which site. An additional benefit is knowing which vaccine may have caused a local reaction. Create an immunization site map for your clinic by writing the vaccine name or abbreviation next to the appropriate site on the Infant, Toddler, Teen and Adult Immunization Site Maps on pages 173-174.

Immunization Techniques: Best Practices with Infants, Children, and Adults (Video by California Department of Public Health)Brush up on skills and techniques for giving vaccines. Use this video for training and orientation, as well as a refresher for more experienced staff. See page 161 for more information.

Giving the Shot


Giving the Shot

Preparing patients for injections Each age presents its own set of challenges when preparing to give shots. To deliver the shot in the quickest and most comfortable position for the patient, parent, and you, first ask the patient (and parent!) to relax. Also give parents a copy of Be There for Your Child During Shots on page 163.

Age considerations when giving shots Age group Considerations

Infants y Prepare for the parent to be more anxious than the infant and advise them of what to

expect. Ideally, keep infant and parent together. y Prepare for the infant to instinctively pull away from the source of pain.

Toddlers

y Prepare for the toddler to attempt to grab the syringe and to instinctively pull away from the source of pain.

y Toddlers will be anxious about the new environment. Have the toddler sit on the parent's lap; toddlers are usually more cooperative and less anxious there.

y Toddlers are stronger than infants but more easily distracted. Provide distractions such as toys, pictures books, wiggling their toes, or finding an object in the room.

y Reassure the toddler honestly, "It might feel like a sting or pinch but will only last a few seconds."

Children

y Prepare for the child to be anxious; children tend to be most anxious in anticipation of the shot.

y Give choices (when possible) such as which arm to give the shot in. However, be aware that negotiation may have to be sacrificed.

y Provide distractions such as asking them to squeeze mom's hand as hard as they can, wiggle their toes, or find an object in the room.

y Reassure the child honestly: "It might feel like a sting or pinch but will only last a few seconds."

y Tell the child, “It’s okay to cry," and that their main job is to hold still.

Adolescents

y Prepare for possible fainting. To avoid an injury from falling, have the patient sit during and after the injection.

y Observe for 15 minutes for possible fainting. y Instruct them to relax: provide a visual distraction, ask them to take a deep breath and

exhale slowly, or to shake their arms and drop them to their sides, or to pretend to be in a special place. (Adolescents respond well to instructions to relax prior to the injection.)

y Reassure them honestly: "It might feel like a sting or pinch but will only last a few seconds."

Adults

y Evaluate past history of fainting during injections. To avoid an injury from falling, have the patient sit during and after the injection.

y Prepare for adults to tense their arm before shots. Assess for muscle mass remembering that as people age the densest part of the muscle may be slightly lower.

y Advise them to relax: provide a visual distraction, ask them to drop their arms to their sides, to take a deep breath and exhale slowly, or to pretend to be in a special place.


Positioning for injections When positioning an infant, toddler, or young child keep in mind that they will instinctively jerk away from the source of pain. Warn parents about this if they are holding them.

How to position for administering in the thigh y Tuck the child's legs between the parent's

legs and have the parent hold the legs in place. If the child's legs are too short to tuck between the parent’s legs, the shot giver should stabilize the legs with her arms as she gives the injection.

y Have the parent hold the child's arms as if embracing the child and stabilize the arms with their arms as the shot giver gives the injection.

How to position for administering in the arm y Have the child sit facing forward on the

parent's lap. y Tuck one arm behind the parent's back and

have the parent hold the other arm with one hand.

y Tuck the child's legs between the parent's legs and have the parent hold the legs in place.

How to position using an exam table y Place the infant/toddler on an exam table

on their back with their knees at the edge of the table so that their lower legs dangle over the edge of the table. Note: Position an infant on the exam table so you can stabilize their legs/feet by placing them under your arms.

y Press your body against the infant/toddler's knees so the child is stabilized.

y Instruct the parent to lean over the infant/toddler's upper torso, holding the infant/toddler's hands. This position allows the parent to comfort the infant/toddler as well as stabilize the infant/toddler's hands.

Giving the Shot

Positioning for administering in the thigh

Positioning for administering in the arm


After the ShotGuidance following vaccination y Observe the patient for 15 minutes after vaccination. y Advise the parent/patient on the use of a non-aspirin pain reliever. y Give the patient a copy of their immunization record (e.g., MIIC immunization

record, Minnesota “Gold Card”). y Schedule their next immunization appointment before they leave the clinic. y Document immunizations in the medical record. Refer to Documenting

Shots on page 181 for more information on immunization documentation requirements.

y Be familiar with the treatment of vaccine reactions; see Guidelines for Managing Possible Immediate Reactions table on page 158.

y Document any adverse reaction and submit a VAERS report; see pages 175-179.

Managing vaccine reactionsRead this section carefully. Don’t be stuck trying to read information on how to manage a reaction while it is happening! All staff involved with immunizing should familiarize themselves with the material in this section before they have to deal with any sort of reaction to a vaccine. Review your facility's anaphylaxis policy/protocol every year and hold annual staff meetings to review this material. Vaccine reactions can be as mild as local injection-site discomfort or as severe or life-threatening as anaphylaxis. Staff should be prepared to handle all types of reactions. The Guidelines for Managing Possible Immediate Reactions on page 158 describes management of such reactions.

What is anaphylaxis?Anaphylaxis is a potentially life-threatening allergic reaction to a foreign substance. It is extremely rare after immunization. When it occurs, it usually begins within minutes following the injection, although delayed reactions are possible. Early recognition and treatment of anaphylaxis is vital. All staff should feel confident to manage the situation properly. Personnel administering vaccines need to be able to distinguish symptoms of anaphylaxis from vasovagal syncope (fainting).

Prepare in advance for an anaphylactic episode y Have a written policy/protocol in place for medical emergencies and

anaphylaxis. y Know where your policy/protocol is; review, revise, and have your medical

director sign it annually. y Assemble an anaphylaxis kit that contains epinephrine, syringes, needles,

CPR mask or barrier, stethoscope, and a blood pressure cuff. y Know where these emergency materials are located and how to use them. y Have detailed prescriptions for what medications should be given. Typically,

epinephrine and diphenhydramamine (Benadryl) are the medications used. y Periodically conduct practice drills using your policy/protocol (e.g., review how

to draw up medications from ampules, use an EpiPen, start oxygen, and use your CPR barrier mask).

y Check epinephrine expiration dates each quarter as well as the oxygen level of your tank, if you have one.

y Make sure a phone is accessible at immunization clinic sites.


After the Shot

Guidelines for Managing Possible Immediate ReactionsReaction Symptoms ManagementLocalized y Soreness, redness and/or swelling at the

injection site y Apply cold compress to the injection

site.

y Continued bleeding y Apply bandage over the injection site and add direct (hand) pressure.

Psychosomatic y Extreme paleness y Sweating y Coldness of the hands and feet y Nausea y Light-headedness y Visual disturbance

y Have patient sit or lie down until free of symptoms or for 10-15 minutes after injection to prevent fainting or fall-related injuries.

y Loosen any tight clothing.

y Fainting y Protect the patient's head, have them lie flat, and maintain an open airway.

y Fall with loss of consciousness y Maintain an open airway. y Call 911. y Examine patient to determine if injury

is present before attempting to move them.

y Vomiting y If patient is unconscious, roll them onto their side or turn their head to the side and, if necessary, wipe out the mouth with your fingers, preferably gloved and wrapped in cloth.

y Do not pour water over the patient’s face or try to give any liquids unless the patient is fully conscious and upright.

y If patient is alert keep them upright.Anaphylaxis y Anxiety

y Coughing y Generalized itching y “Pins and needles” sensation of the skin y Flushing y Facial edema (swelling of lips, mouth,

throat) y Nausea y Stomach pain y Urticaria (hives) y Respiratory difficulties (wheezing, hoarse

voice, tightness in the chest) y Hypotension - cardiovascular collapse

can occur without respiratory symptoms

y Initiate your facility's anaphylaxis protocol.

y See the TAKE ACTION box on page 159.


After the Shot

TAKE ACTIONIf you suspect anaphylaxis 1. Have someone call for emergency help (911). Make sure emergency

responders know how to get into the building and where to find the room. You may want to have someone meet and escort them.

2. Administer prescribed medication, usually epinephrine, (intramuscularly) for immediate action. Some providers may also include diphenhydramine (Benadryl) for sustained action.

3. Maintain an airway; give oxygen if available. Allow the patient to sit in a chair with a table or desktop to lean on if they find it is easier to breathe that way and their vital signs are stable.

4. Monitor for signs of shock (pallor, low blood pressure, unresponsiveness). If you observe signs of shock, place the patient in a reclining position with lower limbs elevated.

5. Be prepared to give CPR.6. Make sure the patient is seen immediately by a physician for evaluation

and possible follow-up care, even if they are stable when emergency responders arrive.

7. Contact the parent/guardian if they are not present, especially if the patient is a minor.

8. Document the patient’s adverse reaction and the related intervention as soon as possible by entering the reaction in the patient record and submitting a VAERS report.

9. Notify the patient’s clinic or health care provider (if you are not the primary provider) of this episode so that future reactions can be prevented.

Note: Your protocol should include these action steps!


Requirements for Reporting Adverse Events Following VaccinationWho can report to VAERS?

Health care providers and vaccine manufacturers are required to report post-vaccination adverse events outlined in the Reportable Events Table (see page 175); however, anyone can submit a report.

What should be reported?

Use a VAERS report form to report any adverse event, including: y Any clinically significant adverse event that occurs after the administration of any

vaccine--even if you are unsure whether a vaccine caused the event y Any event included in the Reportable Events Table (see page 175) that occurs

within the time period specified (For a current copy of the Reportable Events Table call VAERS at 1-800-822-7967 or download it from vaers.hhs.gov.)

y Any event listed in the manufacturer’s package insert as a contraindication to subsequent doses of the vaccine

How to obtain a report form

• You can obtain pre-addressed postage-paid VAERS report forms by calling VAERS at 1-800-822-7967.

• You may use photocopies of the form to submit reports (see page 178). • You may also download printable copies of the VAERS form as well as other

information about VAERS from vaers.hhs.gov/index. Where to send a completed VAERS report

You can submit completed VAERS report forms any of these three ways: y Online: vaers.hhs.gov/esub/index. y Fax: 877-721-0366 y Mail:

Vaccine Adverse Event Reporting SystemP.O. Box 1100Rockville, MD 20849-1100

Further information on VAERS

y Call VAERS toll-free at 1-800-822-7967. y Visit the VAERS website (vaers.hhs.gov) for information on vaccine safety, links

to vaccine industry news, and summaries of all reports to VAERS.

After the Shot

Report adverse reactions to vaccinesThe federal Vaccine Adverse Events Reporting System (VAERS) is a vaccine safety surveillance program that collects information about adverse events (possible side effects) that occur after the administration of U.S.-licensed vaccines. VAERS is co-managed by the Centers for Disease Control and Prevention and the Food and Drug Administration.

Pregnancy RegistryHealth care providers are encouraged to report any instances of prenatal exposure to a varicella containing vaccine (Varivax, ProQuad, or Zostivax) or human papillomavirus vaccine (Gardasil or Cervarix). Both Merck and GlaxoSmithKline maintain a surveillance registry on pregnancy outcomes and newborn health status outcomes following vaccination with these vaccines.

y Merck vaccines (Varivax, ProQuad, Zostivax, and Gardasil): 800-986 8999 www.merckpregnancyregistries.com/home.html

y GlaxoSmithKline vaccine (Cervarix): 888-452 9622


y Be There For Your Child During Shots (MDH)A brochure for parents to help prepare their child for shots, including what they can do before, during, and after the shots. Brochure can be ordered using the Immunization Materials for Use with the Public order form: www.health.state.mn.us/divs/idepc/immunize/ordermat.html.

y Vaccine Product Summary (MDH)Summary chart showing each vaccine's generic and brand names, manufacturer, licensed age groups, dosing information, and administration route. www.health.state.mn.us/divs/idepc/immunize/hcp/vaxprodsum.pdf

y How to Administer an Intramuscular (IM) or Subcutaneous (SQ) Injections (MDH)Illustrated guide to giving IM and SQ vaccinations for infants, children, and adults. Includes injection site, needle length and size, and angle of needle insertion.www.health.state.mn.us/divs/idepc/immunize/hcp/admim.pdf

y Immunization Site Map (California Department of Public Health, Immunization Branch)Illustrated site maps for giving vaccinations to infants, toddlers, and adults. www.eziz.org/PDF/IMM-718.pdf and www.eziz.org/PDF/IMM-718adult.pdf

y VAERS Table of Reportable Events Following Vaccination Listing of post-vaccination adverse events by vaccine. http://vaers.hhs.gov/resources/VAERS_Table_of_Reportable_Events_Following_Vaccination.pdf

y VAERS Report Form Photocopy-ready, pre-addressed, postage-paid VAERS report form for reporting any adverse event. http://vaers.hhs.gov/esub/index

y Immunization Techniques: Best Practices with Infants, Children, and Adults (Video by the California Department of Public Health)Not included in this section, but a good resource guide to vaccine administration techniques. Focuses on the skills and techniques needed for vaccine administration. Use it for training and orientation, or as a refresher for more experienced staff. Available for purchase on DVD (25 minutes) from the Immunization Action Coalition. Order from www.immunize.org/shop/toolkit_iztechdvd.asp

Key Resources for VaccineAdministration



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e hi

m/

her t

ell y

ou o

ne.

• A

llow

ing

your

chi

ld to

cry

, don

’t fo

rce

him

/her

to b

e br

ave.

• B

e re

ady

to h

old

the

arm

or l

eg s

till

whe

n th

e sh

ot is

giv

en.

Infa

nts–

Com

fort

by:

• H

oldi

ng, c

uddl

ing,

car

essi

ng, a

nd/o

r br

east

feed

ing

• Ta

lkin

g lo

ving

ly a

nd s

ooth

ingl

y.

• A

skin

g yo

ur d

octo

r for

adv

ice

on u

sing

a

non-

aspi

rin p

ain

relie

ver w

hen

you

get h

ome.

Todd

lers

–Als

o try

:

• G

ivin

g pr

aise

s an

d hu

gs o

r a s

urpr

ise.

• R

eass

urin

g yo

ur c

hild

that

eve

ryth

ing

is o

kay.

• M

ake

an a

ppoi

ntm

ent b

efor

e yo

u le

ave

the

clin

ic.

• M

ark

your

cal

enda

r for

you

r nex

t ap-

poin

tmen

t.

• R

evie

w v

acci

ne in

form

atio

n st

atem

ents

fo

r pos

sibl

e re

actio

ns.

• A

cool

wet

clo

th c

an re

duce

redn

ess,

so

rene

ss, a

nd/o

r sw

ellin

g w

here

the

shot

was

giv

en.

• O

bser

ve y

our c

hild

for t

he n

ext f

ew

days

. You

mig

ht s

ee a

sm

all r

ash

or n

o-tic

e a

feve

r. If

you

are

conc

erne

d th

at

som

ethi

ng d

oes

not s

eem

righ

t with

yo

ur b

aby,

or y

ou c

an’t

brin

g th

e fe

ver

dow

n, c

all y

our d

octo

r or c

linic

.

• To

redu

ce p

ain

or fe

ver,

your

doc

tor

may

reco

mm

end

you

give

you

r chi

ld a

no

n-as

pirin

pai

n re

lieve

r.

• A

lso

try g

ivin

g yo

ur c

hild

a s

pong

e ba

th

with

luke

war

m w

ater

to re

duce

feve

r.

• G

ive

your

chi

ld p

lent

y of

fl ui

ds. I

t is

norm

al if

he/

she

eats

less

than

usu

al

for t

he n

ext 2

4 ho

urs.

A p

aren

t’s l

ove

mak

es a

ll the

diff

eren

ce.

Dur

ing

shot

sA

fter

shot

sA

t hom

e

Rep

rinte

d w

ith p

erm

issi

on fr

om th

e C

alifo

rnia

Dep

artm

ent o

f Hea

lth S

ervi

ces,

Imm

uniz

atio

n B

ranc

h

Imm

uniz

atio

n Pr

ogra

m, 1

2/06

P.O

. Box

649

75St

. Pau

l, M

N 5

5164

-097

51-

800-

657-

3970

, 651

-201

-550

3w

ww.

heal

th.st

ate.

mn.

us/im

mun

ize



Vac

cine

Pro

duct

Sum

mar

y

Vacc

ine

Gen

eric

N

ame

Vacc

ine

Bra

nd

Nam

eVa

ccin

e M

ftr*

Age

Gro

up L

icen

sed

to

Rec

eive

Vac

cine

Dos

eA

dm

Rou

teA

dditi

onal

Use

Com

men

ts

Dip

hthe

ria, t

etan

us,

pert

ussi

s(D

TaP)

Dap

tace

lSP

6 w

eeks

thro

ugh

6 ye

ars

0.5

mL

IM•

Can

not b

e us

ed o

n or

afte

r 7th

birt

hday

Infa

nrix

GSK

6 w

eeks

thro

ugh

6 ye

ars

0.5

mL

IM

Dip

hthe

ria, t

etan

us(p

edia

tric)

(DT)

Gen

eric

SP6

wee

ks th

roug

h6

year

s0.

5 m

LIM

•U

sed

if ch

ild h

ad a

reac

tion

to p

ertu

ssis

vac

cine

•

Not

for a

dole

scen

t or a

dult

use

DTa

P–H

epB

–IPV

Pedi

arix

GSK

6 w

eeks

thro

ugh

6ye

ars

0.5

mL

IM•

Can

onl

y be

use

d fo

r the

firs

t 3 d

oses

of D

TaP

and

IPV

DTa

P–IP

VKi

nrix

GSK

4 th

roug

h 6

year

s 0.

5 m

LIM

•C

an b

e us

ed fo

r the

5th

dose

ofD

TaP

•C

an b

e us

ed fo

r the

4th

dos

e of

IPV

serie

s

DTa

P–IP

V–H

ibPe

ntac

elSP

6 w

eeks

thro

ugh

4 ye

ars

0.5

mL

IM•

Mix

DTa

P-IP

V liq

uid

with

Hib

pow

der

Teta

nus,

dip

hthe

ria

(Td)

Dec

avac

SP7

year

s an

d ol

der

0.5

mL

IM•

Not

use

d fo

r per

sons

und

er 7

yea

rs o

f age

TdAk

orn

Teta

nus,

dip

hthe

ria,

pert

ussi

s(T

dap)

Boos

trix

GSK

10ye

ars

and

olde

r0.

5 m

LIM

•Td

ap v

acci

nes

are

licen

sed

as a

one

-tim

e do

se•

Whe

n gi

ving

or c

ompl

etin

g a

3-do

se p

rimar

y se

ries,

one

of

the

dose

s sh

ould

be

Tdap

Adac

elSP

11 th

roug

h 64

year

s0.

5 m

LIM

Hae

mop

hilu

s in

fluen

zae

type

B

(Hib

)

Pedv

axH

IB

(PR

P-O

MP)

MSD

6 w

eeks

thro

ugh

5 ye

ars

0.5

mL

IM•

2-do

se p

rimar

y se

ries

at2

and

4 m

onth

sof

age

, boo

ster

at

12–1

5 m

onth

sof

age

ActH

IB(P

RP-

T)SP

2 th

roug

h 18

mon

ths

0.5

mL

IM•

3-do

se p

rimar

y se

ries

at 2

, 4, a

nd 6

mon

ths

of a

ge,

boos

ter a

t 12–

15 m

onth

sof

age

Hib

erix

(PR

P-T)

GSK

12 m

onth

s th

roug

h 4

year

s 0.

5 m

LIM

•O

nly

use

for f

inal

Hib

dos

e af

ter a

ge 1

2 m

onth

sof

age

•M

ix li

quid

dilu

ent w

ith H

ib p

owde

r and

with

draw

0.5

mL

•M

ust u

se w

ithin

8 h

ours

of re

cons

titut

ion

Hib

–Hep

BC

omva

xM

SD6

wee

ksth

roug

h5

year

s0.

5 m

LIM

•3-

dose

ser

ies

at 2

,4,a

nd 1

2-15

mon

ths

of a

ge

Page

1of

5(1

0/13

)

Imm

uniz

atio

n Pr

ogra

mP.

O. B

ox 6

4975

St. P

aul,

MN

551

64-0

975

651-

201-

5503

, 1-8

00-6

57-3

970

ww

w.h

ealth

.sta

te.m

n.us

/imm

uniz

e

Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/vaxprodsum.pdf


Vac

cine

Pro

duct

Sum

mar

y

Vacc

ine

Gen

eric

N

ame

Vacc

ine

Bra

nd

Nam

eVa

ccin

e M

ftr*

Age

Gro

up L

icen

sed

to

Rec

eive

Vac

cine

Dos

eA

dm

Rou

teA

dditi

onal

Use

Com

men

ts

Hep

atiti

s A

(Hep

A)

Hav

rixG

SKPe

diat

ric: 1

thro

ugh

18 y

ears

0.

5 m

LIM

•2-

dose

ser

ies

at le

ast 6

mon

ths

apar

t•

Do

not g

ive

befo

re 1

st b

irthd

ay

Adul

t: 19

yea

rs a

nd o

lder

1.0

mL

VAQ

TAM

SDPe

diat

ric: 1

thro

ugh

18 y

ears

0.

5 m

LIM

Adul

t: 19

yea

rs a

nd o

lder

1.0

mL

Hep

atiti

s B

(H

epB

)

Enge

rix-B

GSK

Ped

iatri

c: b

irth

thro

ugh

19 y

ears

0.5

mL

IM•

Do

not r

esta

rt th

e se

ries

Adu

lt: 2

0 ye

ars

and

olde

r1.

0m

L

Rec

ombi

vax

HB

MSD

Ped

iatri

c: b

irth

thro

ugh

19 y

ears

0.

5 m

L

IM•

Do

not r

esta

rt th

e se

ries

•W

hen

usin

g al

tern

ativ

e do

sing

for a

dole

scen

ts 1

1 th

roug

h15

yea

rs g

ive

2 do

ses

4–6

mon

ths

apar

tAd

oles

cent

s: 1

1 th

roug

h 15

yea

rs

1.

0m

L

Adu

lt: 2

0 ye

ars

and

olde

r1.

0m

L

Hep

A–H

epB

Twin

rixG

SK18

yea

rs a

nd o

lder

1.0

mL

IM•

Not

ava

ilabl

e th

roug

h M

nVFC

•H

ep A

dos

e in

Tw

inrix

is N

OT

an a

dult

dose

so 3

dos

es

are

requ

ired

Hum

an

papi

llom

aviru

s(H

PV2,

HPV

4)

Gar

dasi

l, H

PV4

(Typ

es 6

, 11,

16,

18)

MSD

9 th

roug

h 26

yea

rs

(fem

ales

and

mal

es)

0.5

mL

IM•

3-do

se s

erie

s at

inte

rval

s of

0, 1

-2, a

nd 6

mon

ths

Cer

varix

HP

V2(T

ypes

16,

18)

GSK

10 th

roug

h 25

yea

rs

(fem

ales

only

)0.

5 m

LIM

Inac

tivat

ed p

olio

(IP

V)Ip

olSP

6 w

eeks

and

old

er0.

5 m

LIM

or

SQ

MD

H, I

mm

uniz

atio

n Pr

ogra

mPa

ge 2

of 5

(10/

13)



Vac

cine

Pro

duct

Sum

mar

y

Vacc

ine

Gen

eric

N

ame

Vacc

ine

Bra

nd

Nam

eVa

ccin

e M

ftr*

Age

Gro

up L

icen

sed

to

Rec

eive

Vac

cine

Dos

eA

dm

Rou

teA

dditi

onal

Use

Com

men

ts

Influ

enza

, in

activ

ated

influ

enza

vacc

ine

(IIV)

Agrif

lu(II

V3)

NO

V18

yea

rs a

nd o

lder

0.5

mL

IM•

Not

cur

rent

ly o

n th

e m

arke

t.

Fluz

one

(IIV3

or I

IV4)

SP6

mon

ths

and

olde

rSe

e no

teIM

•Ag

e 6

mon

ths

thro

ugh

35 m

onth

s: 0

.25

mL

dose

•

Age

3 ye

ars

and

olde

r:0.

5 m

L do

se•

Follo

w A

CIP

’stw

o-do

sere

com

men

datio

n fo

r chi

ldre

n ag

e 6

mon

ths

thro

ugh

8 ye

ars

Fluz

one,

Hig

h-do

se(II

V3)

SP65

yea

rs a

nd o

lder

0.5

mL

IM•

Not

ava

ilabl

e th

roug

h M

nVFC

Fluz

one,

Intra

derm

al(II

V3)

SP18

thro

ugh

64 y

ears

0.1

mL

ID

•Ap

ply

over

del

toid

par

tof a

rm•

Syrin

ge/n

eedl

e is

spe

cific

ally

des

igne

d fo

r adm

inis

terin

g in

to th

e in

trade

rmal

laye

r of s

kin

•N

ot a

vaila

ble

thro

ugh

MnV

FCFl

uviri

n(II

V3)

NO

V4

year

s an

d ol

der

0.5

mL

IM•

Follo

w A

CIP

’stw

o-do

sere

com

men

datio

n fo

r chi

ldre

n ag

e 4

thro

ugh

8 ye

ars

Aflu

ria(II

V3)

CSL

5

year

s an

d ol

der

(See

add

ition

al u

se c

omm

ents

)0.

5 m

LIM

•AC

IP d

oes

not r

ecom

men

d Af

luria

for c

hild

ren

age

5th

roug

h 8

year

sun

less

no o

ther

lice

nsed

age

-app

ropr

iate

va

ccin

e is

ava

ilabl

ean

d th

e ch

ild is

at i

ncre

ased

risk

for

influ

enza

com

plic

atio

ns (i

.e.,

certa

in m

edic

al c

ondi

tions

).•

Aflu

ria m

ay b

e us

ed in

chi

ldre

nag

e 9

year

s an

d ol

der.

•N

ot a

vaila

ble

thro

ugh

MnV

FCFl

uLav

al(II

V3 o

r IIV

4)G

SK3

year

s an

d ol

der

0.5

mL

IM•

Not

ava

ilabl

e th

roug

h M

nVFC

Flua

rix(II

V3 o

r IIV

4)G

SK3

year

s an

d ol

der

0.5

mL

IM•

Follo

w A

CIP

’stw

o-do

se re

com

men

datio

nfo

r chi

ldre

n ag

e 2

thro

ugh

8 ye

ars

•N

ot a

vaila

ble

thro

ugh

MnV

FCIn

fluen

za,

cell

cultu

re

inac

tivat

ed in

fluen

za

vacc

ine

(ccI

IV)

Fluc

elva

x (c

cIIV

3)N

OV

18 y

ears

and

old

er0.

5 m

LIM

•N

ot a

vaila

ble

thro

ugh

MnV

FC

Influ

enza

, re

com

bina

nt

influ

enza

vac

cine

(R

IV)

Flub

lok

(RIV

3)PS

C18

yea

rs th

roug

h 49

yea

rs0.

5 m

LIM

•N

ot a

vaila

ble

thro

ugh

MnV

FC•

Rec

omm

ende

d op

tion

for p

erso

ns w

ith s

igni

fican

t egg

al

lerg

ies

Influ

enza

, liv

e at

tenu

ated

in

fluen

za v

acci

ne

(LA

IV4)

Flum

ist,

quad

rival

ent

(LAI

V4)

MED

I2

thro

ugh

49 y

ears

0.1

mL

in e

ach

nost

rilN

asal

•N

ot a

vaila

ble

in 2

012-

2013

influ

enza

sea

son

MD

H, I

mm

uniz

atio

n Pr

ogra

mPa

ge 3

of 5

(10/

13)



Vac

cine

Pro

duct

Sum

mar

y

Vacc

ine

Gen

eric

N

ame

Vacc

ine

Bra

nd

Nam

eVa

ccin

e M

ftr*

Age

Gro

up L

icen

sed

to

Rec

eive

Vac

cine

Dos

eA

dm

Rou

teA

dditi

onal

Use

Com

men

ts

Japa

nese

En

ceph

aliti

s(J

E)Ix

iaro

NO

V17

yea

rsan

d ol

der

0.5m

L IM

•2

dose

ser

ies

at 0

and

28

days

•C

ompl

ete

the

serie

s at

leas

t 10

days

bef

ore

arriv

al in

en

dem

ic a

reas

•N

ot a

ppro

ved

for c

hild

ren

Mea

sles

, mum

ps,

rube

lla

(MM

R)

M-M

-R II

MSD

1 ye

ar a

nd o

lder

~0.5

mL

SQ

•D

O N

OT

give

befo

re th

e 1s

t birt

hday

•

Giv

eat

the

sam

e tim

e as

var

icel

la a

nd/o

r PPD

or a

ny

othe

r liv

e vi

rus

vacc

ine

(i.e.

, yel

low

feve

r)•

If no

t giv

en a

t the

sam

e tim

e as

var

icel

la a

nd/o

r PPD

wai

t at

leas

t 28

days

•Ad

min

iste

r ent

ire re

cons

titut

ed v

olum

e •

Prot

ect f

rom

ligh

tand

use

with

in 8

hou

rsof

reco

nstit

utio

n

Mea

sles

, mum

ps,

rube

lla, v

aric

ella

(MM

RV)

Proq

uad

MSD

12 m

onth

s th

roug

h 12

yea

rs0.

5 m

LSQ

•M

ust u

se w

ithin

30

min

utes

of r

econ

stitu

tion

Men

ingo

cocc

al C

/Y–

Hib

Men

hibr

ixG

SK6

wee

ks th

roug

h 18

mon

ths

0.5

mL

IM•

Rec

onst

itute

with

sal

ine

dilu

ent (

0.6

mL)

to m

ake

0.5

mL

dose

•N

o AC

IP re

com

men

datio

ns fo

r us

e as

of 7

/201

2

Men

ingo

cocc

alco

njug

ate

(MC

V)

Men

actra

SP9

mon

ths

thro

ugh

55 y

ears

0.5

mL

IM•

Cov

ers

type

s A,

C, Y

, and

W-1

35

Men

veo

NO

V2

mon

ths

thro

ugh

55 y

ears

0.5

mL

IM•

Cov

ers

type

s A,

C, Y

, and

W-1

35•

Mix

liqu

id M

enA

with

pow

der C

, Y, W

-135

•M

ust u

se w

ithin

8 h

ours

of re

cons

titut

ion

Men

ingo

cocc

alpo

lysa

ccha

ride

(MPS

V)M

enom

une

SP2

year

s an

d ol

der

0.5

mL

SQ•

Giv

e to

at r

isk

pers

ons

for w

hom

MC

V4 is

not

lice

nsed

(i.

e., p

erso

ns 5

6 ye

ars

and

olde

r with

risk

fact

ors)

•N

ot a

vaila

ble

thro

ugh

MnV

FC

Pneu

moc

occa

lC

onju

gate

, 13-

vale

nt

(PC

V)Pr

evna

r W

AL6

wee

ks th

roug

h 17

year

s50

yea

rs a

nd o

lder

0.5

mL

IM•

Giv

e a

dose

of P

CV1

3 to

hea

lthy

child

ren

thro

ugh

age

4 ye

ars

and

at ri

sk c

hild

ren

thro

ugh

5 ye

ars

who

alre

ady

com

plet

ed th

e PC

V7 s

erie

s.Pn

eum

ococ

cal,

poly

sacc

harid

e,

23-v

alen

t(P

PSV)

Pneu

mov

ax23

M

SD2

year

s an

d ol

der

0.5

mL

IM or SQ

Rab

ies

Imov

ax

SPN

o de

fined

age

1m

LIM

•N

ot a

vaila

ble

thro

ugh

MnV

FC•

Pre-

expo

sure

•

Post

-exp

osur

eR

abA

vert

NO

V1

mL

IM

MD

H, I

mm

uniz

atio

n Pr

ogra

mPa

ge 4

of 5

(10/

13)



Vac

cine

Pro

duct

Sum

mar

y

Vacc

ine

Gen

eric

N

ame

Vacc

ine

Bra

nd

Nam

eVa

ccin

e M

ftr*

Age

Gro

up L

icen

sed

to

Rec

eive

Vac

cine

Dos

eA

dm

Rou

teA

dditi

onal

Use

Com

men

ts

Rot

aviru

s(R

V1, R

V5)

Rot

arix

(RV1

)G

SK

6 w

eeks

thro

ugh

8 m

onth

s1

mL

PO

•R

otar

ix: m

ix o

ral d

iluen

t int

o po

wde

r and

giv

e im

med

iate

ly af

ter m

ixin

g•

Rot

arix

:2-d

ose

serie

s at

2 a

nd 4

mon

ths

of a

ge•

Rot

ateq

: 3-d

ose

serie

s at

2, 4

, and

6 m

onth

sof

age

•D

O N

OT

begi

n th

e se

ries

afte

r 15

wee

ks o

f age

•D

O N

OT

give

any

dos

es a

fter 8

mon

ths,

0 d

ays

•D

o no

trep

eati

f chi

ld s

pits

out

the

dose

Rot

aTeq

(RV

5)M

SD6

wee

ks th

roug

h 8

mon

ths

2m

LPO

Typh

oid

Typh

im V

iSP

2 ye

ars

and

olde

r0.

5mL

IM•

Giv

e a

sing

le d

ose.

Giv

e a

boos

ter d

ose

ever

y 2

year

s if

pers

on is

at r

isk

•N

ot a

vaila

ble

thro

ugh

MnV

FC

Vivo

tifBe

rna

7 ye

ars

and

olde

rC

apsu

lePO

•G

ive

one

caps

ule

ever

y ot

her d

ayfo

r 4 d

oses

•N

ot a

vaila

ble

thro

ugh

MnV

FC

Varic

ella

(chi

cken

pox)

(VA

R)

Variv

axM

SD1

year

and

olde

r0.

5 m

LSQ

•D

O N

OT

give

bef

ore

the

1st b

irthd

ay•

PPD

Giv

eat

the

sam

e tim

e as

var

icel

la a

nd/o

r PPD

or

any

othe

r liv

e vi

rus

vacc

ine

(i.e.

, yel

low

feve

r)•

If no

t giv

en a

t the

sam

e tim

e as

MM

R a

nd/o

r PP

D w

ait a

t le

ast 2

8 da

ys•

If us

ing

catc

h-up

sch

edul

e, th

e m

inim

um in

terv

al is

3m

onth

s fo

r chi

ldre

n ag

e 1

thro

ugh

12 y

ears

and

4w

eeks

fo

r per

sons

age

13ye

ars

and

olde

r

Yello

w F

ever

YF-V

AXSP

9 m

onth

s an

d ol

der

0.5

mL

SQ•

Mus

t be

a de

sign

ated

by

MD

H a

s a

yello

w fe

ver

vacc

inat

ion

clin

ic

Zost

er(s

hing

les)

(ZO

S)Zo

stav

axM

SD50

yea

rs a

nd o

lder

0.65

mL

SQ

•Ad

min

iste

r ent

ire re

cons

titut

ed v

olum

e •

Mus

t use

with

in 3

0 m

inut

es o

f rec

onst

itutio

n •

Cur

rent

rout

ine

reco

mm

enda

tion

is fo

r per

sons

60

year

s an

d ol

der

* Vac

cine

Man

ufac

ture

r Key

:A

korn

=Ako

rnC

SL=C

SL

Bio

ther

apie

sG

SK=G

laxo

Sm

ithK

line

MED

I=M

edIm

mun

eM

SD=M

erck

NO

V=N

ovar

tisPS

C=P

rote

in S

cien

ces

SP=s

anof

i pas

teur

WA

L=W

yeth

Ada

pted

from

MD

H S

tand

ing

Ord

ers

for R

outin

e Im

mun

izat

ions

and

Glo

ria T

obia

s’ (C

ount

rysi

de P

ublic

Hea

lth) V

acci

ne C

heat

She

et.

MD

H, I

mm

uniz

atio

n Pr

ogra

mPa

ge 5

of 5

(10/

13)




Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/admim.pdf

90º a

ngle

skin

subc

utan

eous

tiss

ue

mus

cle

How

to A

dmin

iste

r IM

(Int

ram

uscu

lar)

Inje

ctio

nsA

dmin

iste

r DTa

P, D

T, T

d, T

dap,

Hib

, hep

A, h

epB

, HP

V, T

IV, M

CV,

PC

V, a

nd ra

bies

vac

cine

s vi

a IM

(int

ram

uscu

lar)

rout

e.

Adm

inis

ter I

PV

and

PP

SV

vac

cine

s ei

ther

via

IM o

r SQ

(sub

cuta

neou

s) ro

ute.

Patie

nt’s

age

Site

(see

illu

stra

tions

)N

eedl

e si

ze*

New

born

/infa

nt

(Birt

h -1

yea

r)

• A

nter

olat

eral

thig

h•

1" n

eedl

e•

5/8"

in p

rem

ies

or n

ewbo

rns

(0-2

8 da

ys o

ld) i

f mus

cle

mas

s in

adeq

uate

¹•

23-2

5 ga

uge

need

leTo

ddle

r(1

-3 y

ears

)•

Ant

erol

ater

al th

igh

pref

erre

d•

Del

toid

whe

n ad

equa

te m

ass

deve

lope

d

• 1"

– 1

¼" n

eedl

e fo

r thi

gh•

5/8"

– 1

" nee

dle

for d

elto

id•

23-2

5 ga

uge

need

leC

hild

ren

(3-1

1 ye

ars)

• D

elto

id•

Ant

erol

ater

al th

igh

• 5/

8" –

1" n

eedl

e fo

r del

toid

• 1"

– 1

¼" n

eedl

e fo

r thi

gh•

23-2

5 ga

uge

need

leA

dole

scen

ts/a

dults

²(1

1 ye

ars

and

olde

r)•

Del

toid

pre

ferr

ed•

Ant

erol

ater

al th

igh

may

be

used

if n

eces

sary

• 1"

– 1

½" n

eedl

e²•

23-2

5 ga

uge

need

le

¹A ⅝

” nee

dle

may

be

used

onl

y if

the

skin

is s

tretc

hed

tight

, the

sub

cuta

neou

s tis

sue

is n

ot b

unch

ed,

an

d in

ject

ion

is m

ade

at a

90°

ang

le.

² A

⅝” n

eedl

e is

suf

fi cie

nt in

adu

lts w

eigh

ing

less

than

130

lbs

(60

kg).

� A

1” n

eedl

e is

suf

fi cie

nt in

adu

lts w

eigh

ing

130–

152

lbs

(60–

70 k

g).

� A

1–1½

” nee

dle

is re

com

men

ded

in w

omen

wei

ghin

g 15

2–20

0 lb

s (7

0–90

kg)

and

men

wei

ghin

g

152–

260

lbs

(70–

118

kg).

� A

1½” n

eedl

e is

reco

mm

ende

d in

wom

en w

eigh

ing

mor

e th

an 2

00 lb

s (9

0 kg

) or m

en w

eigh

ing

mor

e th

an 2

60 lb

s (1

18 k

g).

Nee

dle

inse

rtio

n•

Use

a n

eedl

e lo

ng e

noug

h to

reac

h de

ep in

to

the

mus

cle.

• In

sert

need

le a

t a 9

0º a

ngle

to th

e sk

in w

ith a

qu

ick

thru

st.

• R

etai

n pr

essu

re o

n sk

in a

roun

d in

ject

ion

site

w

ith th

umb

and

inde

x fi n

ger w

hile

nee

dle

is

inse

rted.

• A

spira

tion

befo

re in

ject

ion

is n

ot re

quire

d.*

• M

ultip

le in

ject

ions

giv

en in

the

sam

e ex

trem

ity

shou

ld b

e se

para

ted

as fa

r as

poss

ible

(p

refe

rabl

y at

leas

t 1” a

part)

.

IM s

ite fo

r old

er to

ddle

rs, c

hild

ren,

ado

lesc

ents

, and

adu

lts

Inse

rt n

eedl

e at

90º

ang

le in

to d

ense

st p

ortio

n of

de

ltoid

mus

cle

abov

e ar

mpi

t and

bel

ow a

crom

ion.

elbo

w

IM in

ject

ion

site

are

a

delto

id m

uscl

e(s

hade

d ar

ea)

acro

mio

n

IM s

ite fo

r inf

ants

and

todd

lers

(birt

h to

3 y

ears

of a

ge)

Inse

rt n

eedl

e at

90º

ang

le in

to v

astu

s la

tera

lis m

uscl

e in

an

tero

late

ral a

spec

t of m

iddl

e or

upp

er th

igh.

vast

us la

tera

lis(s

hade

d ar

ea)

IM in

ject

ion

site

are

a

Imm

uniz

atio

n P

rogr

amP.

O. B

ox 6

4975

St.

Pau

l, M

N 5

5164

-097

565

1-20

1-55

03 o

r 1-8

00-6

57-3

970

ww

w.h

ealth

.sta

te.m

n.us

/imm

uniz

e (5

/201

1) IC

# 14

1-23

80

*Red

Boo

k 20

09, A

mer

ican

Aca

dem

y of

Ped

iatri

cs (p

.19)

and

CD

C G

ener

al R

ecom

men

datio

ns o

n Im

mun

izat

ion,

201

1


Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/admim.pdf

Patie

nt’s

age

Site

(see

illu

stra

tions

)N

eedl

e si

ze*

Infa

nts

(Birt

h -1

yea

r)

• Fa

tty a

rea

of th

e th

igh

• 5/

8” n

eedl

e•

23-2

5 ga

uge

Todd

lers

(1

-3 y

ears

)•

Fatty

are

a of

the

thig

h or

ou

ter a

spec

t of u

pper

arm

• 5/

8” n

eedl

e•

23-2

5 ga

uge

Chi

ldre

n (3

-11

year

s)•

Fatty

are

a of

the

thig

h or

ou

ter a

spec

t of u

pper

arm

• 5/

8” n

eedl

e•

23-2

5 ga

uge

Adol

esce

nts/

adul

ts(1

1 ye

ars

and

olde

r)•

Out

er a

spec

t of u

pper

arm

• 5/

8” n

eedl

e•

23-2

5 ga

uge

Nee

dle

inse

rtio

n•

Inse

rt ne

edle

at a

n 45

º ang

le to

the

skin

.•

Pin

ch u

p on

SQ

tiss

ue to

pre

vent

in

ject

ing

into

mus

cle.

• A

spira

tion

befo

re in

ject

ion

is n

ot

requ

ired.

*•

Mul

tiple

inje

ctio

ns g

iven

in th

e sa

me

extre

mity

sho

uld

be s

epar

ated

as

far a

s po

ssib

le (p

refe

rabl

y at

leas

t 1”

apar

t).

45º a

ngle

skin

mus

cle

subc

utan

eous

tiss

ue

Imm

uniz

atio

n P

rogr

amP.

O. B

ox 6

4975

St.

Pau

l, M

N 5

5164

-097

565

1-20

1-55

03 o

r 1-8

00-6

57-3

970

ww

w.h

ealth

.sta

te.m

n.us

/imm

uniz

e (5

/201

1) IC

# 14

1-23

80

How

to A

dmin

iste

r SQ

(Sub

cuta

neou

s) In

ject

ions

Adm

inis

ter M

MR

, MM

RV,

MPS

V, V

AR, a

nd Z

OS

via

SQ (s

ubcu

tane

ous)

rout

e.

Adm

inis

ter I

PV a

nd P

PSV

vacc

ines

eith

er v

ia IM

(int

ram

uscu

lar)

or S

Q ro

ute.

SQ s

ite fo

r inf

ants

and

todd

lers

(birt

h to

3 y

ears

of a

ge)

Inse

rt n

eedl

e at

45º

ang

le in

to fa

tty a

rea

of a

nter

olat

eral

thig

h.

Mak

e su

re y

ou p

inch

up

on S

Q ti

ssue

to p

reve

nt in

ject

ing

into

mus

cle.

SQ in

ject

ions

site

are

a

SQ s

ite fo

r old

er to

ddle

rs, c

hild

ren,

ado

lesc

ents

and

adu

lts

Inse

rt n

eedl

e at

45º

ang

le in

to o

uter

asp

ect o

f upp

er a

rm.

Mak

e su

re y

ou p

inch

up

on S

Q ti

ssue

to p

reve

nt in

ject

ing

into

mus

cle.

elbo

w

SQ in

ject

ions

site

are

a

acro

mio

n

*Red

Boo

k 20

09, A

mer

ican

Aca

dem

y of

Ped

iatri

cs (p

.19)

and

CD

C G

ener

al R

ecom

men

datio

ns o

n Im

mun

izat

ion,

201

1


Sug

gest

ed s

ites

for i

nfan

t im

mun

izat

ions

RA

:

RT:

RT:

Sub

cuta

neou

s tis

sue

on

uppe

r rig

ht a

rm (S

C)

Rig

ht v

astu

s la

tera

lis (I

M) o

r su

bcut

aneo

us ti

ssue

on

right

thig

h (S

C)

Sub

cuta

neou

s tis

sue

on u

pper

le

ft ar

m (S

C)

Left

vast

us la

tera

lis (I

M) o

r su

bcut

atan

eous

tiss

ue o

n le

ft th

igh

(SC

)

LA:

LT:

LT:

Infa

nt Im

mun

izat

ion

Sit

e M

ap

Ada

pted

with

per

mis

sion

from

the

Cal

iforn

ia D

epar

tmen

t of P

ublic

Hea

lth, I

mm

uniz

atio

n B

ranc

h.

Imm

uniz

atio

n P

rogr

amP.

O. B

ox 6

4975

St.

Pau

l, M

N 5

5164

-097

51-

800-

657-

3970

, 651

-201

-550

3w

ww

.hea

lth.s

tate

.mn.

us/im

mun

ize

Cre

ate

an in

fant

imm

uniz

atio

n si

te m

ap fo

r you

r clin

ic b

y in

dica

ting

whi

ch v

acci

nes

shou

ld b

e gi

ven

at

each

site

. Writ

e th

e va

ccin

e na

me

or a

bbre

viat

ion

next

to th

e ap

prop

riate

site

.

Sug

gest

ed s

ites

for t

oddl

er im

mun

izat

ions

:

RD

:

RT:

RT:

Rig

ht d

elto

id (I

M) o

r sub

cuta

neou

s tis

sue

on u

pper

righ

t arm

(SC

)

Rig

ht v

astu

s la

tera

lis (I

M) o

r su

bcut

aneo

us ti

ssue

on

right

th

igh

(SC

)

Left

delto

id (I

M) o

r sub

cuta

neou

s tis

sue

on u

pper

left

arm

(SC

)

Left

vast

us la

tera

lis (I

M) o

r su

bcut

aneo

us ti

ssue

on

left

thig

h (S

C)

LD:

LT:

LT:

Todd

ler

Imm

uniz

atio

n Si

te M

ap

Ada

pted

with

per

mis

sion

from

the

Cal

iforn

ia D

epar

tmen

t of P

ublic

Hea

lth, I

mm

uniz

atio

n B

ranc

h.

Imm

uniz

atio

n P

rogr

amP.

O. B

ox 6

4975

St.

Pau

l, M

N 5

5164

-097

51-

800-

657-

3970

, 651

-201

-550

3w

ww

.hea

lth.s

tate

.mn.

us/im

mun

ize

Cre

ate

a to

ddle

r im

mun

izat

ion

site

map

for y

our c

linic

by

indi

catin

g w

hich

vac

cine

s sh

ould

be

give

n at

ea

ch s

ite. W

rite

the

vacc

ine

nam

e or

abb

revi

atio

n ne

xt to

the

appr

opria

te s

ite.


RD:

RD:

RSC:

RSC:

LD:

LD:

LSC:

LSC:

Right deltoid (IM)

Right upper arm, subcutaneous tissue (SC)

Adapted with permission from the California Department of Public Health, Immunization Branch.

Immunization ProgramP.O. Box 64975St. Paul, MN 55164-09751-800-657-3970, 651-201-5503www.health.state.mn.us/immunize

Teen and Adult Immunization Site Map

Suggested sites for teen and adult immunizations:

Create a teen and adult immunization site map for your clinic by indicating which vaccines should be given at each site. Insert the vaccine name or abbreviation next to the appropriate site.

Left deltoid (IM)

Left upper arm, subcutaneous tissue (SC)


Available on the web at: https://vaers.hhs.gov/resources/VAERS_Table_of_Reportable_Events_Following_Vaccination.pdf

VAERS Table of Reportable Events Following Vaccination*

Vaccine/Toxoid Event and interval from vaccination

Tetanus in any combination; DTaP, DTP, DTP-Hib,

DT, Td, TT, Tdap, DTaP-IPV, DTaP-IPV/Hib, DTaP-

HepB-IPV

A. Anaphylaxis or anaphylactic shock (7 days) B. Brachial neuritis (28 days) C. Any acute complications or sequelae (including death)

of above events (interval - not applicable) D. Events described in manufacturer’s package insert as

contraindications to additional doses of vaccine (interval - see package insert)

Pertussis in any combination; DTaP, DTP, DTP-

Hib, Tdap, P, DTaP-IPV, DTaP-IPV/Hib, DTaP-

HepB-IPV

A. Anaphylaxis or anaphylactic shock (7 days) B. Encephalopathy or encephalitis (7 days) C. Any acute complications or sequelae (including death)



Measles, mumps and rubella in any combination;

MMR, MR, M, MMRV, R

A. Anaphylaxis or anaphylactic shock (7 days) B. Encephalopathy or encephalitis (15 days) C. Any acute complications or sequelae (including death)



Rubella in any combination; MMR, MMRV, MR, R A. Chronic arthritis (42 days) B. Any acute complications or sequelae (including death)

of above event (interval - not applicable) C. Events described in manufacturer’s package insert as


Measles in any combination; MMR, MMRV, MR, M A. Thrombocytopenic purpura (7-30 days) B. Vaccine-strain measles viral infection in an

immunodeficient recipient (6 months) C. Any acute complications or sequelae (including death)



Oral Polio (OPV) A. Paralytic polio

o in a non-immunodeficient recipient (30 days)

o in an immunodeficient recipient (6 months)

o in a vaccine-associated community case (interval - not applicable)

B. Vaccine-strain polio viral infection o in a non-immunodeficient recipient (30 days)

o in an immunodeficient recipient (6 months)




o in a vaccine-associated community case (interval - not applicable)

C. Any acute complication or sequelae (including death) of above events (interval - not applicable)

D. Events described in manufacturer’s package insert as contraindications to additional doses of vaccine (interval - see package insert)

Inactivated Polio -IPV, DTaP-IPV, DTaP-IPV/HIB,

DTaP-HepB-IPV

A. Anaphylaxis or anaphylactic shock (7 days)

B. Any acute complication or sequelae (including death) of the above event (interval - not applicable)

C. Events described in manufacturer’s package insert as contraindications to additional doses of vaccine (interval - see package insert)

Hepatitis B in any combination- HepB, HepA-

HepB, DTaP-HepB-IPV, Hib-HepB

A. Anaphylaxis or anaphylactic shock (7 days)

B. Any acute complications or sequelae (including death) of the above event (interval - not applicable)

C. Events described in manufacturer’s package insert as contraindications to additional doses of vaccine (interval - see package insert)

Hemophilus influenzae type b in any combination

(conjugate)- Hib, Hib-HepB, DTP-Hib, DTaP-

IPV/Hib

Events described in manufacturer’s package insert as contraindications to additional doses of vaccine (interval - see package insert)

Varicella in any combination- VAR, MMRV Events described in manufacturer’s package insert as contraindications to additional doses of vaccine (interval - see package insert)

Rotavirus (monovalent or pentavalent) RV1, RV5 Events described in manufacturer’s package insert as contraindications to additional doses of vaccine (interval - see package insert)

Pneumococcal conjugate (7-valent or 13-valent)

PCV7, PCV13


Hepatitis A in any combination- HepA, HepA-HepBEvents described in manufacturer’s package insert as contraindications to additional doses of vaccine (interval - see package insert)

Influenza--trivalent inactivated influenza , live Events described in manufacturer’s package insert as contraindications to additional doses of vaccine (interval - see package insert)





attenuated influenza‐TIV, LAIV

Meningococcal - MCV4, MPSV4 Events described in manufacturer’s package insert as contraindications to additional doses of vaccine (interval - see package insert)

Human Papillomavirus (Quadrivalent or Bivalent)-

HPV4, HPV2


* Effective date: November 10, 2008. The Reportable Events Table (RET) reflects what is reportable by law (42 USC

300aa-25) to the Vaccine Adverse Event Reporting System (VAERS) including conditions found in the manufacturers

package insert. In addition, healthcare professionals are encouraged to report any clinically significant or unexpected

events (even if you are not certain the vaccine caused the event) for any vaccine, whether or not it is listed on the RET.

Manufacturers are also required by regulation (21CFR 600.80) to report to the VAERS program all adverse events made

known to them for any vaccine.

A list of vaccine abbreviations is attached and is also located at: http://www.cdc.gov/vaccines/recs/acip/vac‐abbrev.htm



Available on the web at: https://vaers.hhs.gov/resources/vaers_form.pdf

WEBSITE: www.vaers.hhs.gov E-MAIL: [email protected] FAX: 1-877-721-0366

Telephone no. (____) ______________________

City State Zip

Address

Last

Telephone no. (____) ______________________

City State Zip

Telephone no. (____) ______________________

City State Zip

VACCINE ADVERSE EVENT REPORTING SYSTEM24 Hour Toll-Free Information 1-800-822-7967

P.O. Box 1100, Rockville, MD 20849-1100PATIENT IDENTITY KEPT CONFIDENTIAL

Patient Name:

First M.I.

Vaccine administered by (Name):

ResponsiblePhysicianFacility Name/Address

For CDC/FDA Use Only

VAERS Number

Date Received

Form completed by (Name):

Relationto PatientAddress (if different from patient or provider)

Vaccine Provider

Manufacturer

Patient/Parent

Other

mm dd yy

mm dd yy

8. Check all appropriate:

Patient died (date )Life threatening illnessRequired emergency room/doctor visitRequired hospitalization (________days)

6. Date form completed5. SexM F

Resulted in prolongation of hospitalizationResulted in permanent disabilityNone of the above

mm dd yy mm dd yy

Date of vaccination10. 11. Adverse event onset

Time ____________ PMAM

Time ____________ PMAM

mm dd yy

4. Patient age3. Date of birth2. County where administered1. State

Describe adverse events(s) (symptoms, signs, time course) and treatment, if any

YES NO UNKNOWN9. Patient recovered

7.

12. Relevant diagnostic tests/laboratory data

13. Enter all vaccines given on date listed in no. 10

Vaccine (type) Manufacturer Lot number Route/SiteNo. Previous

Doses

a.

b.

c.

d.

Vaccine (type) Manufacturer Lot number

14. Any other vaccinations within 4 weeks prior to the date listed in no. 10

Route/SiteNo. Previous

doses

16. Vaccine purchased with:

a.

b.

15. Vaccinated at:Private doctor's office/hospitalPublic health clinic/hospital

Military clinic/hospitalOther/unknown

Private funds Military fundsPublic funds Other/unknown

17. Other medications

Dategiven

19. Pre-existing physician-diagnosed allergies, birth defects, medical conditions (specify)

Only for children 5 and under

22. Birth weight 23. No. of brothers and sisters

Only for reports submitted by manufacturer/immunization project

__________ lb. _________ oz.

24. Mfr./imm. proj. report no. 25. Date received by mfr./imm.proj.

26. 15 day report? 27. Report type

Yes No Initial Follow-Up

20. Have you reportedthis adverse eventpreviously?

No

To doctor

To health department

To manufacturer

AdverseEvent

OnsetAge

TypeVaccine

Dose no.in series

21. Adverse event following prior vaccination (check all applicable, specify)

In patient

In brotheror sister

Health care providers and manufacturers are required by law (42 USC 300aa-25) to report reactions to vaccines listed in the Table of Reportable Events Following Immunization.Reports for reactions to other vaccines are voluntary except when required as a condition of immunization grant awards.

18. Illness at time of vaccination (specify)

Form VAERS-1(FDA)


Available on the web at: https://vaers.hhs.gov/resources/vaers_form.pdf

"Fold in thirds, tape & mail — DO NOT STAPLE FORM"

NO POSTAGE NECESSARY IF MAILED IN THE

UNITED STATES OR APO/FPO

BUSINESS REPLY MAILFIRST-CLASS MAIL PERMIT NO. 1895 ROCKVILLE, MD

POSTAGE WILL BE PAID BY ADDRESSEE

VAERSP.O. Box 1100 Rockville MD 20849-1100

DIRECTIONS FOR COMPLETING FORM

(Additional pages may be attached if more space is needed.)

GENERAL

• Use a separate form for each patient. Complete the form to the best of your abilities. Items 3, 4, 7, 8, 10, 11, and 13 are considered essential and should be completed whenever possible. Parents/Guardians may need to consult the facility where the vaccine was administered for some of the information (such as manufacturer, lot number or laboratory data.)

• Refer to the Reportable Events Table (RET) for events mandated for reporting by law. Reporting for other serious events felt to be related but not on the RET is encouraged.

• Health care providers other than the vaccine administrator (VA) treating a patient for a suspected adverse event should notify the VA and provide the information about the adverse event to allow the VA to complete the form to meet the VA's legal responsibility.

• These data will be used to increase understanding of adverse events following vaccination and will become part of CDC Privacy Act System 09-20-0136, "Epidemiologic Studies and Surveillance of Disease Problems". Information identifying the person who received the vaccine or that person's legal representative will not be made available to the public, but may be available to the vaccinee or legal representative.

• Postage will be paid by addressee. Forms may be photocopied (must be front & back on same sheet).

SPECIFIC INSTRUCTIONSForm Completed By: To be used by parents/guardians, vaccine manufacturers/distributors, vaccine administrators, and/or the person

completing the form on behalf of the patient or the health professional who administered the vaccine. Item 7: Describe the suspected adverse event. Such things as temperature, local and general signs and symptoms, time course,

duration of symptoms, diagnosis, treatment and recovery should be noted. Item 9: Check "YES" if the patient's health condition is the same as it was prior to the vaccine, "NO" if the patient has not returned

to the pre-vaccination state of health, or "UNKNOWN" if the patient's condition is not known. Item 10: Give dates and times as specifically as you can remember. If you do not know the exact time, please and 11: indicate "AM" or "PM" when possible if this information is known. If more than one adverse event, give the onset date and

time for the most serious event. Item 12: Include "negative" or "normal" results of any relevant tests performed as well as abnormal findings. Item 13: List ONLY those vaccines given on the day listed in Item 10. Item 14: List any other vaccines that the patient received within 4 weeks prior to the date listed in Item 10. Item 16: This section refers to how the person who gave the vaccine purchased it, not to the patient's insurance. Item 17: List any prescription or non-prescription medications the patient was taking when the vaccine(s) was given. Item 18: List any short term illnesses the patient had on the date the vaccine(s) was given (i.e., cold, flu, ear infection). Item 19: List any pre-existing physician-diagnosed allergies, birth defects, medical conditions (including developmental and/or

neurologic disorders) for the patient. Item 21: List any suspected adverse events the patient, or the patient's brothers or sisters, may have had to previous vaccinations.

If more than one brother or sister, or if the patient has reacted to more than one prior vaccine, use additional pages to explain completely. For the onset age of a patient, provide the age in months if less than two years old.

Item 26: This space is for manufacturers' use only.


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