Vaccine Administration - · PDF fileBest Practices Checklist: Vaccine Administration. ... Why...
Transcript of Vaccine Administration - · PDF fileBest Practices Checklist: Vaccine Administration. ... Why...
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
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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
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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.
150 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
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.
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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
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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.
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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
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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.
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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
156 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
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.
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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.
158 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
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!
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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
160 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
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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162 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
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t will
onl
y la
st a
few
sec
onds
.”
• N
ever
thre
aten
you
r chi
ld w
ith s
hots
, “If
you
are
not g
ood,
I w
ill h
ave
the
nurs
e gi
ve y
ou a
sho
t.”
• E
ncou
rage
old
er s
iblin
gs to
reas
sure
an
d co
mfo
rt, n
ot to
sca
re y
our
todd
ler.
Infa
nts–
Dis
tract
and
com
fort
by:
• To
uchi
ng s
ooth
ingl
y an
d ta
lkin
g so
ftly.
• M
akin
g ey
e co
ntac
t as
you
smile
at
him
/her
.
Todd
lers
–Als
o try
:
• H
oldi
ng y
our c
hild
sec
urel
y on
you
r la
p.
• Ta
lkin
g to
or s
ingi
ng w
ith y
our c
hild
.
• H
elpi
ng y
our c
hild
take
dee
p br
eath
s an
d sl
owly
blo
w o
ut th
e pa
in.
• U
sing
a h
and
pupp
et.
• P
oint
ing
out p
oste
rs o
r obj
ects
aro
und
the
room
.
• Te
lling
you
r chi
ld a
sto
ry o
r hav
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
163July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - VACCINE ADMINISTRATION www.health.state.mn.us/immunize
164 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
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
165July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - VACCINE ADMINISTRATION www.health.state.mn.us/immunize
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)
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/vaxprodsum.pdf
166 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
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)
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/vaxprodsum.pdf
167July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - VACCINE ADMINISTRATION www.health.state.mn.us/immunize
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)
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/vaxprodsum.pdf
168 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
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/vaxprodsum.pdf
169July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - VACCINE ADMINISTRATION www.health.state.mn.us/immunize
170 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
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
171July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - VACCINE ADMINISTRATION www.health.state.mn.us/immunize
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
172 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
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
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173July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - VACCINE ADMINISTRATION www.health.state.mn.us/immunize
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)
174 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
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)
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)
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)
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)
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
contraindications to additional doses of vaccine (interval - see package insert)
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)
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)
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)
175July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - VACCINE ADMINISTRATION www.health.state.mn.us/immunize
VAERS Table of Reportable Events Following Vaccination*
Vaccine/Toxoid Event and interval from vaccination
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
Events described in manufacturer’s package insert as contraindications to additional doses of vaccine (interval - see package insert)
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)
Available on the web at: https://vaers.hhs.gov/resources/VAERS_Table_of_Reportable_Events_Following_Vaccination.pdf
176 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
VAERS Table of Reportable Events Following Vaccination*
Vaccine/Toxoid Event and interval from vaccination
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
Events described in manufacturer’s package insert as contraindications to additional doses of vaccine (interval - see package insert)
* 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_Table_of_Reportable_Events_Following_Vaccination.pdf
177July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - VACCINE ADMINISTRATION www.health.state.mn.us/immunize
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)
178 www.health.state.mn.us/immunize Got Your Shots? Providers Guide - VACCINE ADMINISTRATION Minnesota Department of Health, July 2011
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.
179July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - VACCINE ADMINISTRATION www.health.state.mn.us/immunize