Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Extra dose administered, No adverse event
Clinical narrative: There were no adverse events when the patient was followed up with on the phone on 2/6/24 at 3:15 p.m.  Patient reported not feeling any differently than normal including not even any arm soreness.  Patient presented to pharmacy to receive COVID vaccine.  She discussed with worker upon filling out paperwork.  Patient told worker that she didn't know how to fill out the paperwork.  Patient was brought to vaccine room at 12:45 p.m. and was educated on current COVID vaccine guidelines and how the 2023-2024 formulation is one dose only.  Patient asked about when she should get her next dose and I explained that it's now an annual dose and compared it to the flu shot.  I encouraged patient to get flu shot and covid shots at same time so it makes it easier to remember.  Patient stated that flu shots give her the flu and I educated her on how the flu shot cannot give her the flu.  Patient stated that she wants to stay up to date on covid vaccines because she hasn't gotten covid yet.  I recapped that to stay up to date she should continue to receive the covid vaccine annually and reviewed potential adverse reactions.  Patient acknowledged.  Patient then stated that her arm usually gets sore from the vaccine.  I told her again that arm soreness was one of the most common effects after vaccination.  I asked if she had any further questions.  Patient stated that she did not.  Vaccine was administered by me intramuscularly into the right deltoid.  No immediate reactions noted. After administration, I went back to the pharmacy management system and was documenting the encounter relating to flu vaccination for the care plan related vaccine hesitancy education and I noticed that patient had received Spikevax on 10/3/23.    I reviewed CDC guidelines, EUA, and prescribing information I called patient on 2/6/24 at 1:18 p.m. and had to leave voicemail  I called Pfizer on 2/6/24 at 2:38 p.m. to request information and data about what the patient may be able to expect.  That information is attached, but ultimately there is no data for a 2nd dose when a prior dose of a different manufacturer was already administered for the same targeted strain. I spoke to patient on 2/6/24 at 3:15 p.m.  Patient stated that she doesn't see a doctor, so she doesn't have any health conditions.  I disclosed that the dose she received today should not have been administered since she received a dose of Spikevax on 10/3/23 and the dose should only be administered annually.  Patient then said that she believes it's been over a year since she's had a covid vaccine.  I re-stated that she received a dose on 10/3/23.  Patient then asked when she needs another dose.  I, again, explained that the dose is annual so she should not receive another dose until the 2024-2025 formulation is available, which is likely to be next fall or winter.  Patient was still confused about the timing of when to receive another dose and I provided further education.  Patient then said, "well I feel fine so far, so am I going to be ok?" I let her know that I've been doing research and called the manufacturer and that there is no data about patients receiving 2 doses of the same annual strain of different manufacturers.  I told her that I would anticipate additional adverse reactions like sore arm, headache, and muscle aches.  Patient re-stated that she felt fine.  I asked her if she had any other questions I could answer at this time or look into for her.  She stated she did not.  I let patient know to call me/the pharmacy at any point if she has any concerns or follow-up questions.  I let the patient know that I will plan to follow-up with her by the end of the week to check on her again and she thanked me. After an in-person and telehealth encounter with patient, I believe her to have cognitive impairment.  I am also going to print off records for the patient to ensure she is able to prevent this to other healthcare providers to help prevent another potential vaccine administration error.