Sex: M
Vaccine: RAB, UNK
Symptoms: Expired product administered, Inappropriate schedule of product administration, Incomplete course of vaccination, Interchange of vaccine products, No adverse event
Clinical narrative: Second RabAvert vaccine dose with expiration date 23-Apr-2023 given on 24-Apr-2023; The patient received the first dose of RabAvert on day one, and the second dose on day five after the animal exposure, and no additional doses since then; The patient received the first dose of RabAvert on day one, and the second dose on day five after the animal exposure, and no additional doses since then; The patient received two doses of RabAvert and one dose of Imovax; Case reference number US-BN-2023-000743 is a spontaneous case report initially received from a nurse (reference number: USBAV23-0575) on 25-Apr-2023 and concerns a *19-year-old* male patient.  The patient's medical history and concomitant medication details were not provided.  *On 19-Apr-2023*, the patient had contact with a potentially infected *dog*. *It could not be confirmed if the dog had rabies.*  *On 20-Apr-2023, one day after the animal exposure*, the patient was vaccinated with the first dose of RabAvert vaccine (batch number: *ARBA961B211821470354*, also reported as ARBA961B211A2 (to be confirmed); *expiration date: 30-Apr-2024) in an emergency room, at a dose of 1.0 milliliter intramuscularly in the left arm*, for post-exposure rabies prophylaxis *(explicitly coded as 'inappropriate schedule of vaccine administered').*  On 24-Apr-2023, *five days after the animal exposure*, the patient was vaccinated with the second dose of RabAvert vaccine in an emergency room, (batch number: AD01A27C; expiration date: 23-Apr-2023) at a dose of *1.0 milliliter intramuscularly in the right deltoid* (explicitly coded as 'expired vaccine used', *'inappropriate schedule of vaccine administered'* and 'interchange of vaccine products'*).  As reported, the expiration date was in the immunization database, sometimes the expiration dates in the database were entered incorrectly. The emergency room did not have any other rabies vaccine in stock to compare the lot number to and if the patient ever called back the nurse would just go on and re-administer the second dose.  *On 26-Apr-2023, seven days after the animal exposure, the patient was vaccinated with the first dose of co-suspect Imovax (rabies vaccine; batch number: V1B861M; expiration date: 31-May-2024), in the health department, at a dose of 1.0 milliliter, intramuscularly in the right deltoid*, for post-exposure rabies prophylaxis.  *The patient did not receive any additional doses of RabAvert. As reported, the rabies vaccine series was completed using Imovax (explicitly coded as 'incomplete course of vaccination').*  *At the time of this follow-up report, the patient did not experience any adverse event due to RabAvert.*  Additional information received from Bavarian Nordic on 25-Apr-2023 included the local case ID.  Additional information received from the nurse (reference number: USBAV23-0582) on 25-Apr-2023. New information included confirmation of originally reported RabAvert batch number, patient's gender, additional information on RabAvert vaccination, and an additional reference number.  All follow-up information is blended into the case narrative above, with the latest information presented between asterisks (*)  Follow-up information received from the nurse on 12-May-2023: New information included an additional RabAvert dose.  Follow-up information received from the nurse on 01-Jun-2023: New information included date of contact with an animal, RabAvert details, the third dose was Imovax, new events 'interchange of vaccine products', 'inappropriate schedule of vaccine administered' and 'incomplete course of vaccination', and information that the patient did not experience an adverse event.  Non-significant case correction received on 13-Jun-2022 from reporter included confirmation that reporter does not want to be contacted regarding this case.; Reporter's Comments: A 19-year-old male patient was vaccinated with the first dose of RabAvert vaccine one day after the animal exposure, for post-exposure rabies prophylaxis, which is considered as inappropriate schedule of vaccine administered. Five days after the animal exposure patient was vaccinated with the second dose of RabAvert vaccine that expired one day before the vaccine was administered, which is considered as expired vaccine used and inappropriate schedule of vacicne administered. Seven days after the animal exposure the patient was vaccinated with the first dose of Imovax (rabies vaccine) for post-exposure rabies prophylaxis, which is considered as interchange of vaccine products. The patient did not receive any additional doses of RabAvert, reportedly the rabies vaccine series was completed using Imovax, which is considered as incomplete course of vaccination. Expired product administered, inappropriate schedule of vaccine administered, incomplete course of vaccination and interchange of vaccine products are listed per company convention. The patient did not experience any adverse events due to RabAvert vaccine. The patient's medical history and concomitant medication details were not provided. Expired product administered, inappropriate schedule of vaccine administered, incomplete course of vaccination and interchange of vaccine products are not related to suspect product but to human factor. The case is non-serious.; Sender's Comments: A 19-year-old male patient was vaccinated with the first dose of RabAvert vaccine one day after the animal exposure, for post-exposure rabies prophylaxis, which is considered as inappropriate schedule of vaccine administered. Five days after the animal exposure patient was vaccinated with the second dose of RabAvert vaccine that expired one day before the vaccine was administered, which is considered as expired vaccine used and inappropriate schedule of vacicne administered. Seven days after the animal exposure the patient was vaccinated with the first dose of Imovax (rabies vaccine) for post-exposure rabies prophylaxis, which is considered as interchange of vaccine products. The patient did not receive any additional doses of RabAvert, reportedly the rabies vaccine series was completed using Imovax, which is considered as incomplete course of vaccination. Expired product administered, inappropriate schedule of vaccine administered, incomplete course of vaccination and interchange of vaccine products are listed per company convention. The patient did not experience any adverse events due to RabAvert vaccine. The patient's medical history and concomitant medication details were not provided. Expired product administered, inappropriate schedule of vaccine administered, incomplete course of vaccination and interchange of vaccine products are not related to suspect product but to human factor. The case is non-serious.