Recent Grad Administers Vaccine through Incorrect Route, PLIT Coverage Pays $1,200 to Cover Costs of Patient's Follow-Up Care

Dr. A, a recent graduate, was working as an associate veterinarian at a general practice while awaiting licensure by the state. Dr. A was presented an 8-week-old female Labrador Retriever for an initial vaccine visit and examination. At this visit, Dr. A inadvertently administered an intranasal Bordetella bronchiseptica vaccination by the subcutaneous (SQ) route in the left hind limb. After realizing the mistake, Dr. A diluted the area with saline under the skin and sent the patient home with amoxicillin with clavulanic acid 62.5 mg (1 tablet by mouth twice daily for 2 weeks) to provide broad spectrum prophylactic antibiotic coverage for a urinary tract infection also diagnosed at this visit.

Upon arriving home, the patient began to shake, whimper, and had mild ataxia. The owner chose to bring the patient to an emergency veterinary clinic, where the patient vomited on presentation. A physical exam revealed a swollen and very painful left hind limb. The patient was hospitalized overnight on fluids with supportive care. Bloodwork was performed, including a complete blood count (CBC), which revealed leukocytosis and anemia. These findings were consistent with a hypersensitivity reaction.

The patient was discharged the next day on diphenhydramine, gabapentin, and carprofen, with the treating veterinarian’s recommendation to repeat the CBC within the following three weeks to monitor the patient’s elevated white blood cell and reduced red blood cell counts potentially due to the vaccine reaction and concurrent urinary tract infection.


Was Dr. A protected?

At the time of this incident, Dr. A had passed the NAVLE, graduated with their DVM, taken their state examination, and had started their new job, all while awaiting licensure. Dr. A had enrolled in veterinary student professional liability coverage through AVMA PLIT during their final year of veterinary school (This policy remains in force until a new graduate receives their veterinary license or until the end of the calendar year, whichever comes first. Once a new graduate receives their state licensure, they must secure veterinary professional liability insurance to remain protected).

Dr. A filed a claim with their professional liability carrier. Dr. A’s policy responded when the owner of the puppy alleged that the vaccination had been administered incorrectly and demanded financial compensation for the subsequent care at the ER clinic, as well as the repeat bloodwork. After a review, the insurance carrier settled the claim for $1,200, with Dr. A’s consent. The puppy went on to recover with no residual side effects, no swelling or abscess of the left hind leg, no apparent pain, and bloodwork that had returned to within normal limits.


Managing the Error

In a busy clinic setting, errors can occur, and a vaccination intended for a canine patient may be administered through an incorrect route. The ASPCA Animal Poison Control Center provides the following information on adverse effects, complications, and management of incorrect administration:

 The most common adverse effect of inadvertent injection of the intranasal vaccination is local cellulitis, potentially progressing to abscess and local necrosis. Pain, swelling, and warmth may be noted at the site of injection. If the accidental injection is caught within four hours of exposure, diluting an antibiotic in 10-30 mls of sterile saline and then infusing at the site of injection may be helpful. If signs are already present, warm compresses and NSAIDs can be beneficial. Hepatotoxicity is a rare but potentially serious complication of inadvertent subcutaneous or intramuscular injection of Bordetella vaccines. Oral antibiotics, liver protectants, monitoring liver values, and monitoring for clinical signs such as vomiting, diarrhea, lethargy and/or anorexia is advised. Hypersensitivity reactions are rare and would be expected to respond to corticosteroids and antihistamines. Young puppies, toy breeds, old dogs, and debilitated dogs are at increased risk for reactions.


Effective Vaccine Administration

In the prevention of Bordetella bronchiseptica disease in dogs, both intranasal and injectable vaccine options are available. (Only one option is available for cats: an intranasal vaccine.) Click here for additional   information on the efficacy of both intranasal and injectable options in dogs. Zoetis Vanguard B Intranasal (intranasal Bordetella bronchiseptica vaccination for dogs) provides the following directions in their downloadable product insert, found in the Quick Downloads sections here:

  • Rehydrate with the accompanying sterile diluent.
  • Shake well and draw contents back into the syringe.
  • Remove the needle and attach the enclosed applicator tip.
  • Immediately administer 0.5 mL into each nostril.