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
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.