With input from Dr Monica Vasudev

India:

1. April 9: Three elderly women were administered rabies vaccine when they went for a COVID-19 jab in Shamli, western Uttar Pradesh. The incident became known when one of the women felt dizziness and nausea after the vaccination. She went to a private doctor and showed him the slip that was given to her at the community health center. The slip mentioned she was given rabies vaccine. The doubt was confirmed when asked if they were told to submit copies of their Aadhaar cards. The official on duty stated that Aadhaar card was not required in vaccination against dog bite. The affected women are in their late 60s and early 70s. Instead of going to the COVID-19 vaccine OPD, they stood in the line at general OPD, saying ‘tika laga do’ [get us vaccinated]. Prima facie, it appeared to be a lapse on the part of the pharmacist as despite the fact that they stood in the wrong line, the question remains how it was decided to give them rabies vaccine. (The Hindu)
2. 3^rdApril:  A woman in her 50s was administered both doses of COVID-19 vaccine at the same time at a primary health center in Akbarpur area of Kanpur Dehat district. The health worker involved in this incident was reportedly attending a phone call when this happened. (HT) 

Singapore: A staff member of the Singapore National Eye Centre (SNEC) received the equivalent of five doses of the Pfizer/BioNTech COVID-19 vaccine due to human error, but developed no side effects. The incident took place on January 14 during a vaccination exercise. A worker who was in charge of diluting the vaccine was called away during the preparation of the vaccine, while a second staff member mistook the undiluted dose in the vial for the ready for use one. The error was identified within minutes after the vaccination. (India.com)

USA

1. As of March 20, 2021, over 120 million COVID-19 vaccine doses have been administered in the United States.
2. CDC has received over 300 inquiries through the CDC inquiry response services (eg, CDC-INFO, NIP-INFO) asking for guidance for managing mRNA COVID-19 vaccine administration error that had occurred.
3. The most common error type described in the inquiries, representing over a third of them, was administration of a lower dose than authorized. Other frequent errors included administration of vaccine to someone younger than the authorized age (18.5% of inquiries) and administration by a route other than intramuscular (IM) (12.3% of inquiries).
4. COVID-19 Vaccine Administration Error Inquiries Received by CDC between December 14, 2020` and February 28, 2021

 (N = 324)

12. Administration via incorrect route: Subcutaneous administration: 12.3%
13. Administration at incorrect anatomic site: Administration into shoulder bursa/gluteal muscle: 10.2%

• More-than-authorized dose: Administration of undiluted vaccine: 3.4%

35. Lower-than-authorized dose: Dose leaked out of syringe; recipient pulled away and dose leaked out: 35.2%
36. Vaccine administration to someone younger than the authorized age: Administration to person aged < 16 years (Pfizer-BioNTech) or < 18 years (Moderna): 18.5%
37. Administration of a mixed-product series: First and second doses from different manufacturer: 4.9%

• Administration of a second dose earlier than the 4-day grace period: Second dose administered <17 days (Pfizer-BioNTech) or < 24 days (Moderna) after the first dose: 6.5%
• Dose given after improper storage and handling: Temperature excursion; More than allowed time after opening first vial; use after beyond use date: 4.6%

4. Others: Incorrect diluent; incorrect needle length; expired syringe: 4.3%

5. For most errors, CDC recommends against repeating the dose.
6. For dosage errors in which less than half the dose was given, and errors in which only diluent was administered, the agency recommends repeating the dose as soon as possible in the opposite arm.
7. Some vaccine administration errors might diminish vaccine effectiveness.
8. Subcutaneous fat has poor vascularity, causing slow mobilization and antigen processing for some other vaccines given through subcutaneous route.
9. When some vaccines, such as hepatitis B, human papillomavirus, or influenza vaccines, are unintentionally given subcutaneously, the vaccine should be given again by the IM route. However, it is not mandatory to re-administer vaccine doses intended for SC administration (eg, MMR or varicella vaccines) that were accidentally administered by the IM route as this is unlikely to impact the immune response.
10. The safety implications of many COVID-19 vaccine administration errors are not clearly known (such as administration to someone younger than the authorized age or administration of a second dose earlier than the 4-day grace period).
11. Shoulder injury related to vaccine administration (SIRVA) is a known effect of unintentional injection of a vaccine into the tissues and structures lying underneath the deltoid muscle.
12. Errors related to COVID-19 vaccine administration might lead to diminished vaccine effectiveness and safety implications.(Medscape)

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA