Vaccine Administration: After Giving Vaccine

Managing Acute Vaccine Reactions

Although severe, life-threatening reactions following vaccinations are rare, all vaccination providers should be certified in cardiopulmonary resuscitation (CPR) and familiar with their office emergency plan.

Syncope

Health care professionals who administer vaccines to older children, adolescents, and adults should be aware of the potential for syncope after vaccination and the related risk of injury caused by falls. Among all age groups, 80% of reported syncope episodes occur within 15 minutes of vaccine administration (additional information). Providers should take the following measures to prevent injuries if a patient becomes weak or dizzy or loses consciousness.

• Be aware if a patient has a history of syncope after vaccination

• Have the patient seated or laying down for vaccination

• Understand and look out for symptoms that precede fainting (e.g., weakness, dizziness, pallor)

• Observe recipients after vaccination. For most vaccines, a 15-minute observation period is recommended. Some people should be observed longer (30 minutes) after receiving COVID-19 vaccine.

Allergic reactions

Although allergic reactions are a common concern for vaccine providers, these reactions are uncommon and anaphylaxis following vaccines is rare (approximately one per million doses for many vaccines1). Epinephrine and equipment for managing an airway should be available for immediate use2.

Acute allergic reactions following vaccinations might be caused by the vaccine antigen, residual animal protein, antimicrobial agents, preservatives, stabilizers, or other vaccine components3. Components of each vaccine are listed in its respective package insert. The Pink Book (Epidemiology and Prevention of Vaccine-Preventable Diseases) also provides an extensive list of vaccine components and their use, as well as the vaccines that contain each component.

The best practice to prevent allergic reactions is to identify individuals at increased risk by obtaining a history of allergy to previous vaccinations and vaccine components that might indicate an underlying hypersensitivity.

For more in-depth information on preventing acute allergic reactions following vaccinations, see the Preventing and Managing Adverse Reactions section of CDC's General Best Practices for Immunization.

Vaccine and Supply Disposal

Immediately after use, all syringe/needle devices should be placed in biohazard containers that are:

• Closable

• Puncture-resistant

• Leakproof on the sides and bottom

• Labeled or color-coded. This practice helps prevent reuse, and accidental needlestick injury.
  • DO NOT recap, cut, or detach needles from the syringes before disposal.

Medical waste disposal requirements are set by state environmental agencies

• Empty or expired vaccine vials are considered medical waste and should be disposed of according to state regulations.

• Contact your state or local immunization program or state environmental agency for any additional guidance.

Documentation

All vaccines administered should be fully documented in the patient's permanent medical record.

Health care providers who administer vaccines that are covered by the are required by law to ensure the permanent medical record of the recipient indicates:

• Date of administration

• Vaccine manufacturer

• Vaccine lot number

• Name and title of the person who administered the vaccine and the address of the facility where the permanent record will reside

• The edition date of the VIS given and the date it was provided to the patient, parent, or legal representative.

Providers should also update a patient's permanent medical record to reflect any documented adverse events after vaccination and any serologic test results related to vaccine-preventable diseases (e.g., those for rubella screening or antibody to hepatitis B surface antigen). The patient, parent, or legal representative should be provided with a personal immunization record that includes the vaccination(s) and date administered.

Using Immunization Information Systems

Immunization information systems (IISs) are confidential databases that record and consolidate information about all vaccine doses administered by participating providers. Using an IIS to record vaccinations can help keep patient records up to date and give all medical providers that care for a patient access to complete and accurate vaccination history.

• Learn more about immunization information systems

• Find state/territory/city IIS contacts.

Reporting an Adverse Event

In addition to informing the recipient of the vaccine administration error, health care providers are required by law to report certain errors and adverse events following vaccination to the Vaccine Adverse Event Reporting System (VAERS).

Reporting is encouraged for any clinically significant adverse event even if it is uncertain whether the vaccine caused the event. Information on how to submit a report to VAERS is available at or by telephone at 1-800-822-7967.