Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Extra dose administered, Fatigue, Pain in extremity
Clinical narrative: The client, was present at a mobile vaccination event on 3/7/2024 conducted by Mobile Vaccine Team in order to receive a 2023/2024 COVID vaccination. The vaccinator, RN, reports that she screened the client for precautions, contraindications, and vaccination history and no concerns were noted. She reports that the client attested that she had received her previous COVID vaccination in August. The vaccinator reports that she reviewed the client?s vaccination history in electronic medical records, but was unable to access immunization database due to connectivity issues in the field. She determined that this vaccination was appropriate based on the information available and the client?s attestation and administered Spikevax (Lot 3031664) 0.5ml to the right deltoid at 12:48.   However, the vaccinator reports that when she was documenting the vaccination in electronic medical record an error message was displayed indicating that ?additional doses should not be given?. She reports that she proceeded to document the vaccination that had already been provided and saw that the section detailing the client?s vaccination history from the Immunization Registry had changed and now showed a previous Comirnaty vaccination on 11/17/2023 in addition to the information under ?Administration History? in which electronic medical record displays previous Pfizer-brand vaccinations on 8/24/2022, 1/11/2022, 3/4/2021, and 2/12/2021 (these are vaccinations that had been directly documented in electronic medical record and whose display wasn?t dependent on connectivity between electronic medical records and Immunization database).  The vaccinator called this writer to explain the situation and then called the on-call provider, who indicated that this client was only 10 days short of being eligible for her booster dose and that this vaccination was not concerning medically. The vaccinator explained the situation to the client, relayed the provider?s response, and outlined the reporting process. The client verbalized understanding.  This writer called the client on 3/8/2024 and left a message, then spoke with her directly on 3/9/2024. The client reported that she had no unusual side effects (beyond a sore arm and some fatigue) and that she was doing well overall. The client stated ?I forgot that I?d had that vaccine, I could?ve sworn it was in August.? but indicated that the recorded site of vaccination for the 11/17/2023 dose is the facility in which she was vaccinated.   After speaking with subject matter experts, it appears likely that electronic medical record had not been fully connected to the internet and/or immunization database due to the site?s poor service when the vaccinator was reviewing the client?s vaccination history, but that, at some point between the review of the data and the documentation process, electronic medical record was able to connect to immunization database and updated its display of the client?s vaccination history. The vaccination team had been using a mobile hotspot at the event.  This writer huddled with the vaccination team to explain the occurrence, the importance of reviewing all available documentation to determine vaccine appropriateness before vaccination, and provided written education to direct the staff to attempt to use alternate connectivity options if the current option being used is insufficient. This writer also demonstrated the process for using a cell phone as a mobile hotspot, connecting it to the computer, and reiterated the use of a VPN when in the field.