The patient in this case had no history of vaccine-associated adverse events, so the apparent vaccine-associated adverse event that occurred when Dr. A administered the final set of puppy vaccines would be considered unavoidable and an inherent risk of administering vaccines. Because Dr. A had no knowledge of the patient having an allergy to vaccines, this incident is considered an inherent risk and not due to negligence (avoidable complication). Malpractice insurance policies do not provide financial compensation in situations that are considered inherent risks because they are not below the standard of care.
According to the American Animal Hospital Association’s Vaccination Guidelines for General Practice, the vaccinations administered in this case are consistent with the core vaccination recommendations for a 16-week-old puppy, with the exception of the leptospirosis immunization.
The American College of Veterinary Internal Medicine identifies canines with exposure to water sources shared by wildlife such as lakes, ponds, and streams as well as access to suburban backyards as at risk for infection with leptospirosis and in need of immunization against leptospirosis. Based on the client’s description of the patient’s environment and lifestyle, Dr. A assessed the puppy to be at risk for infection with leptospirosis and deemed the vaccine appropriate.
Canine vaccinations, including those against leptospirosis, are rarely associated with severe adverse events. A 2005 retrospective case review (n=1,226,159) by Moore, et al, documented vaccine-associated adverse events in only 0.038% of canine patients and did not find vaccination for leptospirosis as a factor for increased risk on an adverse event.
In this case, the individual animal had no previous history of reaction to vaccination as documented by the client during the history collection and medical records from previous vaccination appointments. The patient showed evidence of an acute type 1 hypersensitivity reaction with angioedema leading to facial swelling. Dr. A proceeded to provide appropriate treatment, including recommendation for follow-up monitoring by an emergency clinic. Dr. A went on to document the reaction in the patient’s medical record.
Ford, et al 2017 AAHA Vaccination Recommendations for General Practice:. revised 2018, www.aaha.com/aaha-guidelines/vaccination-canine-configuration
Sykes, et al. 2010 ACVIM Small Animal Consensus Statement on Leptospirosis: Diagnosis, Epidemiology, Treatment and Prevention: Journal of American College of Veterinary Internal Medicine 2011; 25: 1-13.
Moore, et al.Adverse events diagnosed within three days of vaccine administration in dogs; Journal of American Veterinary Medical Association Vol. 227; 7:1102-1108.