Age: 44.0
Sex: F
Vaccine: RAB
Symptoms: No adverse effect, Vaccination complication
Clinical narrative: Patient was bit by a bat on 8/8/07 in her left thumb and because the bat was crushed too severely, there was no brain matter available to be tested according to the state lab. Therefore, the recommendation was to proceed with rabies vaccination. She has never received Rabies immunization in the past, so an order was obtained from NP dated 8/9/07 for her to receive Rabies Vaccine on Days 0, 3, 7, 14, and 28 and Rabies Immune Globulin on Day 0 as well (Weight 60.9 kg). The clinic was unable to get a hold of her until 8/10/07 for her to come in for her injections. On 8/10/07 she received her injections at 1130 and was discharged ambulatory with no adverse effects observed or reported. She received 0.5 cc of Rabies Immune Globulin in her left thumb, 4 cc of Rabies Immune Globulin IM in the RUQ of her buttocks, 3.62 cc of Rabies Immune Globulin IM in the LUQ of her buttocks, and 1 cc of Rabies Vaccine IM in her right deltoid. I had a 1 cc syringe of Rabies Immune Globulin drawn up to inject around the bite in her left thumb. When I was injecting this, I was only able to get 0.5 cc of it into her thumb, so I just shot the remaining 0.5 cc of the Immune Globulin that was left in the syringe, into one of the other syringes of Immune Globulin that I injected into her buttocks. After the patient left the clinic, I proceeded to throw my syringes in the sharps container and started to second guess myself that I mixed up my two one cc syringes of Rabies Immune Globulin and Rabies Vaccine. If I did indeed mix up those two syringes, that would mean that I gave 0.5 cc of the Rabies Vaccine in her thumb and then shot the remaining 0.5 cc of Rabies Vaccine into one of the other syringes with the Rabies Immune Globulin (which should never be done!). Since I second guessed myself, I decided to report the incident to the Rabies Hotline, the State Rabies Officer, and the Vaccine Adverse Event Reporting System. Information from the Rabies Hotline was that if I did indeed mix up the vaccine and the immune globulin, that I probably inactivated the vaccine, so I needed to repeat the rabies vaccine today and also re-administer half of the dose of Rabies Immune Globulin again today as well. Patient was contacted, informed of the above situation, and instructed to come back into the clinic again today for more injections, just to be safe. She denied any adverse effects from the injections this morning and verbalized understanding to all. At 1600, she was given Rabies Vaccine in her right thigh and half the dose of Immune Globulin (4 cc.) in her left thigh by the RN. She was discharged ambulatory with instructions to go immediately to the Emergency Room over the weekend if she develops any adverse reactions from the injections. She verbalized understanding to all. Patient has no known drug allergies and she is not on any medications at this time. She does not have any history of reacting to any vaccinations in the past. She returned to the clinic again on 8/13/07 for her Day 3 Rabies injection, which was administered by the RN and still denies nay adverse effects from the injections on 8/10/07.