PTCB Immunization cheat sheet

Intramuscular injections for adults and older children go into the deltoid; needle length 1 to 1.5 inches (25-38 mm) with gauge 22-25 for most vaccines.

Subcutaneous injections use a 23-25 gauge needle, 5/8 inch long, at a 45-degree angle into fatty tissue such as the upper-outer triceps.

Intradermal injections use a 26-27 gauge needle, 3/8 inch long, at a 5-15 degree angle; a visible wheal confirms correct placement.

Infants and toddlers receive IM vaccines in the vastus lateralis; the deltoid is preferred from about age 3 years and older.

For IM injections, stretch the skin flat (not pinched) in adults; in infants and small children, bunch the tissue before injecting.

Aspiration before injection is not recommended for any vaccine; inject the full dose and withdraw the needle at the same angle.

Separate two injectable vaccines at the same visit by at least 1 inch (2.5 cm) when possible, and use separate syringes and sites.

A 5/8 inch needle is adequate for SC injection; a 1 inch needle may be used for IM in the deltoid of adults weighing under 60 kg.

Refrigerated vaccines are stored at 2 to 8 degrees C (36 to 46 degrees F); frozen vaccines at -50 to -15 degrees C (-58 to +5 degrees F).

Store vaccines in the middle of the refrigerator, away from walls, floor, and cold-air vents, to avoid freezing or heat exposure.

Use a calibrated digital data logger with a buffered probe placed among the vaccines to monitor temperature continuously.

Record minimum and maximum temperatures at least twice each workday, at the start and end of the day.

A temperature excursion requires labeling the affected vaccine DO NOT USE, quarantining it, and contacting the manufacturer or immunization program for viability guidance.

Never store food or specimens in a vaccine refrigerator; keep water bottles in the door to buffer temperature swings, not in the vaccine compartment.

Vaccines must never be stored in a freezer door or on a freezer shelf; place them in the central portion of the freezer unit.

Rotate stock using first-expiry, first-out; check expiration dates monthly and remove expired product from usable inventory.

Screen for contraindications before every dose: severe allergic reaction to a prior dose or vaccine component, and for live vaccines, pregnancy or significant immunocompromise.

Moderate or severe acute illness with or without fever is a precaution to defer vaccination; mild illness is not a reason to defer.

Document the vaccine name, manufacturer, lot number, expiration date, dose volume, route, site, date, and administering clinician.

Report the dose to the state or local immunization information system (IIS) within the timeframe required by jurisdiction.

A patient history of Guillain-Barre syndrome after influenza vaccine, or of thrombocytopenia after MMR, is a precaution requiring risk-benefit discussion.

Egg allergy is not a contraindication to any routinely recommended vaccine; severe allergy to a vaccine component is.

Record the patient's preferred language, consent, and any VIS edition date and date given, as required by federal law.

Syncope precautions: observe patients for 15 minutes after vaccination, seated or lying down, and document the observation period.

The National Childhood Vaccine Injury Act requires providing the current Vaccine Information Statement (VIS) before each dose and recording the VIS edition date and date given.

VAERS accepts reports of any adverse event after vaccination, whether or not causality is established; serious events and errors are reportable.

Pharmacists administer vaccines under state authority; scope, age limits, and prescriptive authority vary by state and must be verified.

Anaphylaxis management: epinephrine 1 mg/mL given IM in the mid-outer thigh at 0.01 mg/kg, max 0.5 mg per dose, repeat every 5-15 minutes as needed.

Emergency equipment must be immediately available at every vaccination site: epinephrine, 1 mL syringes with 1 to 1.5 inch needles, and a means to call emergency services.

Needlestick injuries: wash the site with soap and water, report immediately, and follow post-exposure evaluation for bloodborne pathogens.

Sharps must be disposed of in puncture-resistant, closable containers immediately after use; never recap a needle using two hands.

Live vaccines are contraindicated during pregnancy and in severe immunocompromise; inactivated vaccines are generally preferred in these groups.

The deltoid is the preferred IM site for adults and children 3 years and older; the vastus lateralis is preferred for infants and toddlers.

Needle length for IM depends on weight and gender: 1 inch for adults under 60 kg, 1 to 1.5 inches for adults 60 kg or more.

Subcutaneous injections are given at a 45-degree angle into the upper-outer triceps, using a 23-25 gauge, 5/8 inch needle.

Intradermal injections use a 26-27 gauge, 3/8 inch needle at a 5-15 degree angle, producing a wheal.

Do not aspirate before injecting a vaccine; inject at the same angle used for insertion.

When two injectable vaccines are given at one visit, use separate syringes and separate anatomic sites at least 1 inch apart.

For infants, the anterolateral thigh is preferred; the deltoid may be used starting around age 3 years when muscle mass is adequate.

Refrigerated vaccines: 2 to 8 degrees C (36 to 46 degrees F); frozen vaccines: -50 to -15 degrees C (-58 to +5 degrees F).

Place a calibrated digital data logger with a buffered probe among the vaccines, and record min/max temperatures at least twice daily.

Store vaccines in the middle of the unit, away from walls, floor, and vents; do not store in doors or drawers.

Never store food or specimens in a vaccine refrigerator; water bottles in the door help buffer temperature.

On a temperature excursion, label affected vaccine DO NOT USE, quarantine it, and contact the manufacturer or immunization program.

Rotate stock first-expiry, first-out; check expiration dates monthly and remove expired product from usable inventory.

Keep the refrigerator and freezer plugged into a dedicated outlet; do not use power strips or extension cords, and post a Do Not Unplug sign.

Screen for contraindications before each dose: severe allergic reaction to a prior dose or component; for live vaccines, pregnancy or significant immunocompromise.

Moderate or severe acute illness is a precaution to defer; mild illness is not a reason to defer vaccination.

Document vaccine name, manufacturer, lot number, expiration date, dose volume, route, site, date, and administering clinician.

Report each dose to the state or local immunization information system (IIS) within the jurisdiction's required timeframe.

Provide the current Vaccine Information Statement (VIS) before each dose and document its edition date and the date given.

Observe patients for 15 minutes after vaccination, seated or lying down, and document the observation period.

Egg allergy is not a contraindication to any routinely recommended vaccine; severe allergy to a vaccine component is.

The National Childhood Vaccine Injury Act requires providing the current VIS before each dose and recording the VIS edition date and date given.

VAERS accepts reports of any adverse event after vaccination, whether or not causality is established; serious events and errors are reportable.

Pharmacists administer vaccines under state authority; scope, age limits, and prescriptive authority vary by state and must be verified.

Anaphylaxis management: epinephrine 1 mg/mL IM in the mid-outer thigh at 0.01 mg/kg, max 0.5 mg per dose, repeat every 5-15 minutes as needed.

Emergency equipment must be immediately available at every vaccination site: epinephrine, 1 mL syringes with 1 to 1.5 inch needles, and a way to call emergency services.

Needlestick injuries: wash the site with soap and water, report immediately, and follow post-exposure evaluation for bloodborne pathogens.

Sharps go in puncture-resistant, closable containers immediately after use; never recap a needle using two hands.

The deltoid is the preferred IM site for adults and children 3 years and older; the vastus lateralis is preferred for infants and toddlers.

Needle length for IM depends on weight and gender: 1 inch for adults under 60 kg, 1 to 1.5 inches for adults 60 kg or more.

Subcutaneous injections are given at a 45-degree angle into the upper-outer triceps, using a 23-25 gauge, 5/8 inch needle.

Intradermal injections use a 26-27 gauge, 3/8 inch needle at a 5-15 degree angle, producing a wheal.

Do not aspirate before injecting a vaccine; inject at the same angle used for insertion.

When two injectable vaccines are given at one visit, use separate syringes and separate anatomic sites at least 1 inch apart.

For infants, the anterolateral thigh is preferred; the deltoid may be used starting around age 3 years when muscle mass is adequate.

Refrigerated vaccines: 2 to 8 degrees C (36 to 46 degrees F); frozen vaccines: -50 to -15 degrees C (-58 to +5 degrees F).

Place a calibrated digital data logger with a buffered probe among the vaccines, and record min/max temperatures at least twice daily.

Store vaccines in the middle of the unit, away from walls, floor, and vents; do not store in doors or drawers.

Never store food or specimens in a vaccine refrigerator; water bottles in the door help buffer temperature.

On a temperature excursion, label affected vaccine DO NOT USE, quarantine it, and contact the manufacturer or immunization program.

Rotate stock first-expiry, first-out; check expiration dates monthly and remove expired product from usable inventory.

Keep the refrigerator and freezer plugged into a dedicated outlet; do not use power strips or extension cords, and post a Do Not Unplug sign.

Screen for contraindications before each dose: severe allergic reaction to a prior dose or component; for live vaccines, pregnancy or significant immunocompromise.

Moderate or severe acute illness is a precaution to defer; mild illness is not a reason to defer vaccination.

Document vaccine name, manufacturer, lot number, expiration date, dose volume, route, site, date, and administering clinician.

Report each dose to the state or local immunization information system (IIS) within the jurisdiction's required timeframe.

Provide the current Vaccine Information Statement (VIS) before each dose and document its edition date and the date given.

Observe patients for 15 minutes after vaccination, seated or lying down, and document the observation period.

Egg allergy is not a contraindication to any routinely recommended vaccine; severe allergy to a vaccine component is.

The National Childhood Vaccine Injury Act requires providing the current VIS before each dose and recording the VIS edition date and date given.

VAERS accepts reports of any adverse event after vaccination, whether or not causality is established; serious events and errors are reportable.

Pharmacists administer vaccines under state authority; scope, age limits, and prescriptive authority vary by state and must be verified.

Anaphylaxis management: epinephrine 1 mg/mL IM in the mid-outer thigh at 0.01 mg/kg, max 0.5 mg per dose, repeat every 5-15 minutes as needed.

Emergency equipment must be immediately available at every vaccination site: epinephrine, 1 mL syringes with 1 to 1.5 inch needles, and a way to call emergency services.

Needlestick injuries: wash the site with soap and water, report immediately, and follow post-exposure evaluation for bloodborne pathogens.

Sharps go in puncture-resistant, closable containers immediately after use; never recap a needle using two hands.

The deltoid is the preferred IM site for adults and children 3 years and older; the vastus lateralis is preferred for infants and toddlers.

Needle length for IM depends on weight and gender: 1 inch for adults under 60 kg, 1 to 1.5 inches for adults 60 kg or more.

Subcutaneous injections are given at a 45-degree angle into the upper-outer triceps, using a 23-25 gauge, 5/8 inch needle.

Intradermal injections use a 26-27 gauge, 3/8 inch needle at a 5-15 degree angle, producing a wheal.

Do not aspirate before injecting a vaccine; inject at the same angle used for insertion.

When two injectable vaccines are given at one visit, use separate syringes and separate anatomic sites at least 1 inch apart.

For infants, the anterolateral thigh is preferred; the deltoid may be used starting around age 3 years when muscle mass is adequate.

Refrigerated vaccines: 2 to 8 degrees C (36 to 46 degrees F); frozen vaccines: -50 to -15 degrees C (-58 to +5 degrees F).

Place a calibrated digital data logger with a buffered probe among the vaccines, and record min/max temperatures at least twice daily.

Store vaccines in the middle of the unit, away from walls, floor, and vents; do not store in doors or drawers.

Never store food or specimens in a vaccine refrigerator; water bottles in the door help buffer temperature.

On a temperature excursion, label affected vaccine DO NOT USE, quarantine it, and contact the manufacturer or immunization program.

Rotate stock first-expiry, first-out; check expiration dates monthly and remove expired product from usable inventory.

Keep the refrigerator and freezer plugged into a dedicated outlet; do not use power strips or extension cords, and post a Do Not Unplug sign.

Screen for contraindications before each dose: severe allergic reaction to a prior dose or component; for live vaccines, pregnancy or significant immunocompromise.

Moderate or severe acute illness is a precaution to defer; mild illness is not a reason to defer vaccination.

Document vaccine name, manufacturer, lot number, expiration date, dose volume, route, site, date, and administering clinician.

Report each dose to the state or local immunization information system (IIS) within the jurisdiction's required timeframe.

Provide the current Vaccine Information Statement (VIS) before each dose and document its edition date and the date given.

Observe patients for 15 minutes after vaccination, seated or lying down, and document the observation period.

Egg allergy is not a contraindication to any routinely recommended vaccine; severe allergy to a vaccine component is.

The National Childhood Vaccine Injury Act requires providing the current VIS before each dose and recording the VIS edition date and date given.

VAERS accepts reports of any adverse event after vaccination, whether or not causality is established; serious events and errors are reportable.

Pharmacists administer vaccines under state authority; scope, age limits, and prescriptive authority vary by state and must be verified.

Anaphylaxis management: epinephrine 1 mg/mL IM in the mid-outer thigh at 0.01 mg/kg, max 0.5 mg per dose, repeat every 5-15 minutes as needed.

Emergency equipment must be immediately available at every vaccination site: epinephrine, 1 mL syringes with 1 to 1.5 inch needles, and a way to call emergency services.

Needlestick injuries: wash the site with soap and water, report immediately, and follow post-exposure evaluation for bloodborne pathogens.

Sharps go in puncture-resistant, closable containers immediately after use; never recap a needle using two hands.

The deltoid is the preferred IM site for adults and children 3 years and older; the vastus lateralis is preferred for infants and toddlers.

Needle length for IM depends on weight and gender: 1 inch for adults under 60 kg, 1 to 1.5 inches for adults 60 kg or more.

Subcutaneous injections are given at a 45-degree angle into the upper-outer triceps, using a 23-25 gauge, 5/8 inch needle.

Intradermal injections use a 26-27 gauge, 3/8 inch needle at a 5-15 degree angle, producing a wheal.

Do not aspirate before injecting a vaccine; inject at the same angle used for insertion.

When two injectable vaccines are given at one visit, use separate syringes and separate anatomic sites at least 1 inch apart.

For infants, the anterolateral thigh is preferred; the deltoid may be used starting around age 3 years when muscle mass is adequate.

Refrigerated vaccines: 2 to 8 degrees C (36 to 46 degrees F); frozen vaccines: -50 to -15 degrees C (-58 to +5 degrees F).

Place a calibrated digital data logger with a buffered probe among the vaccines, and record min/max temperatures at least twice daily.

Store vaccines in the middle of the unit, away from walls, floor, and vents; do not store in doors or drawers.

Never store food or specimens in a vaccine refrigerator; water bottles in the door help buffer temperature.

On a temperature excursion, label affected vaccine DO NOT USE, quarantine it, and contact the manufacturer or immunization program.

Rotate stock first-expiry, first-out; check expiration dates monthly and remove expired product from usable inventory.

Keep the refrigerator and freezer plugged into a dedicated outlet; do not use power strips or extension cords, and post a Do Not Unplug sign.

Screen for contraindications before each dose: severe allergic reaction to a prior dose or component; for live vaccines, pregnancy or significant immunocompromise.

Moderate or severe acute illness is a precaution to defer; mild illness is not a reason to defer vaccination.

Document vaccine name, manufacturer, lot number, expiration date, dose volume, route, site, date, and administering clinician.

Report each dose to the state or local immunization information system (IIS) within the jurisdiction's required timeframe.

Provide the current Vaccine Information Statement (VIS) before each dose and document its edition date and the date given.

Observe patients for 15 minutes after vaccination, seated or lying down, and document the observation period.

Egg allergy is not a contraindication to any routinely recommended vaccine; severe allergy to a vaccine component is.

The National Childhood Vaccine Injury Act requires providing the current VIS before each dose and recording the VIS edition date and date given.

VAERS accepts reports of any adverse event after vaccination, whether or not causality is established; serious events and errors are reportable.

Pharmacists administer vaccines under state authority; scope, age limits, and prescriptive authority vary by state and must be verified.

Anaphylaxis management: epinephrine 1 mg/mL IM in the mid-outer thigh at 0.01 mg/kg, max 0.5 mg per dose, repeat every 5-15 minutes as needed.

Emergency equipment must be immediately available at every vaccination site: epinephrine, 1 mL syringes with 1 to 1.5 inch needles, and a way to call emergency services.

Needlestick injuries: wash the site with soap and water, report immediately, and follow post-exposure evaluation for bloodborne pathogens.

Sharps go in puncture-resistant, closable containers immediately after use; never recap a needle using two hands.

The deltoid is the preferred IM site for adults and children 3 years and older; the vastus lateralis is preferred for infants and toddlers.

Needle length for IM depends on weight and gender: 1 inch for adults under 60 kg, 1 to 1.5 inches for adults 60 kg or more.

Subcutaneous injections are given at a 45-degree angle into the upper-outer triceps, using a 23-25 gauge, 5/8 inch needle.

Intradermal injections use a 26-27 gauge, 3/8 inch needle at a 5-15 degree angle, producing a wheal.

Do not aspirate before injecting a vaccine; inject at the same angle used for insertion.

When two injectable vaccines are given at one visit, use separate syringes and separate anatomic sites at least 1 inch apart.

For infants, the anterolateral thigh is preferred; the deltoid may be used starting around age 3 years when muscle mass is adequate.

Refrigerated vaccines: 2 to 8 degrees C (36 to 46 degrees F); frozen vaccines: -50 to -15 degrees C (-58 to +5 degrees F).

Place a calibrated digital data logger with a buffered probe among the vaccines, and record min/max temperatures at least twice daily.

Store vaccines in the middle of the unit, away from walls, floor, and vents; do not store in doors or drawers.

Never store food or specimens in a vaccine refrigerator; water bottles in the door help buffer temperature.

On a temperature excursion, label affected vaccine DO NOT USE, quarantine it, and contact the manufacturer or immunization program.

Rotate stock first-expiry, first-out; check expiration dates monthly and remove expired product from usable inventory.

Keep the refrigerator and freezer plugged into a dedicated outlet; do not use power strips or extension cords, and post a Do Not Unplug sign.

Screen for contraindications before each dose: severe allergic reaction to a prior dose or component; for live vaccines, pregnancy or significant immunocompromise.

Moderate or severe acute illness is a precaution to defer; mild illness is not a reason to defer vaccination.

Document vaccine name, manufacturer, lot number, expiration date, dose volume, route, site, date, and administering clinician.

Report each dose to the state or local immunization information system (IIS) within the jurisdiction's required timeframe.

Provide the current Vaccine Information Statement (VIS) before each dose and document its edition date and the date given.

Observe patients for 15 minutes after vaccination, seated or lying down, and document the observation period.

Egg allergy is not a contraindication to any routinely recommended vaccine; severe allergy to a vaccine component is.

The National Childhood Vaccine Injury Act requires providing the current VIS before each dose and recording the VIS edition date and date given.

VAERS accepts reports of any adverse event after vaccination, whether or not causality is established; serious events and errors are reportable.

Pharmacists administer vaccines under state authority; scope, age limits, and prescriptive authority vary by state and must be verified.

Anaphylaxis management: epinephrine 1 mg/mL IM in the mid-outer thigh at 0.01 mg/kg, max 0.5 mg per dose, repeat every 5-15 minutes as needed.

Emergency equipment must be immediately available at every vaccination site: epinephrine, 1 mL syringes with 1 to 1.5 inch needles, and a way to call emergency services.

Needlestick injuries: wash the site with soap and water, report immediately, and follow post-exposure evaluation for bloodborne pathogens.

Sharps go in puncture-resistant, closable containers immediately after use; never recap a needle using two hands.

The deltoid is the preferred IM site for adults and children 3 years and older; the vastus lateralis is preferred for infants and toddlers.

Needle length for IM depends on weight and gender: 1 inch for adults under 60 kg, 1 to 1.5 inches for adults 60 kg or more.

Subcutaneous injections are given at a 45-degree angle into the upper-outer triceps, using a 23-25 gauge, 5/8 inch needle.

Intradermal injections use a 26-27 gauge, 3/8 inch needle at a 5-15 degree angle, producing a wheal.

Do not aspirate before injecting a vaccine; inject at the same angle used for insertion.

When two injectable vaccines are given at one visit, use separate syringes and separate anatomic sites at least 1 inch apart.

For infants, the anterolateral thigh is preferred; the deltoid may be used starting around age 3 years when muscle mass is adequate.

Refrigerated vaccines: 2 to 8 degrees C (36 to 46 degrees F); frozen vaccines: -50 to -15 degrees C (-58 to +5 degrees F).

Place a calibrated digital data logger with a buffered probe among the vaccines, and record min/max temperatures at least twice daily.

Store vaccines in the middle of the unit, away from walls, floor, and vents; do not store in doors or drawers.

Never store food or specimens in a vaccine refrigerator; water bottles in the door help buffer temperature.

On a temperature excursion, label affected vaccine DO NOT USE, quarantine it, and contact the manufacturer or immunization program.

Rotate stock first-expiry, first-out; check expiration dates monthly and remove expired product from usable inventory.

Keep the refrigerator and freezer plugged into a dedicated outlet; do not use power strips or extension cords, and post a Do Not Unplug sign.

Screen for contraindications before each dose: severe allergic reaction to a prior dose or component; for live vaccines, pregnancy or significant immunocompromise.

Moderate or severe acute illness is a precaution to defer; mild illness is not a reason to defer vaccination.

Document vaccine name, manufacturer, lot number, expiration date, dose volume, route, site, date, and administering clinician.

Report each dose to the state or local immunization information system (IIS) within the jurisdiction's required timeframe.

Provide the current Vaccine Information Statement (VIS) before each dose and document its edition date and the date given.

Observe patients for 15 minutes after vaccination, seated or lying down, and document the observation period.

Egg allergy is not a contraindication to any routinely recommended vaccine; severe allergy to a vaccine component is.

The National Childhood Vaccine Injury Act requires providing the current VIS before each dose and recording the VIS edition date and date given.

VAERS accepts reports of any adverse event after vaccination, whether or not causality is established; serious events and errors are reportable.

Pharmacists administer vaccines under state authority; scope, age limits, and prescriptive authority vary by state and must be verified.

Anaphylaxis management: epinephrine 1 mg/mL IM in the mid-outer thigh at 0.01 mg/kg, max 0.5 mg per dose, repeat every 5-15 minutes as needed.

Emergency equipment must be immediately available at every vaccination site: epinephrine, 1 mL syringes with 1 to 1.5 inch needles, and a way to call emergency services.

Needlestick injuries: wash the site with soap and water, report immediately, and follow post-exposure evaluation for bloodborne pathogens.

Sharps go in puncture-resistant, closable containers immediately after use; never recap a needle using two hands.

The deltoid is the preferred IM site for adults and children 3 years and older; the vastus lateralis is preferred for infants and toddlers.

Needle length for IM depends on weight and gender: 1 inch for adults under 60 kg, 1 to 1.5 inches for adults 60 kg or more.

Subcutaneous injections are given at a 45-degree angle into the upper-outer triceps, using a 23-25 gauge, 5/8 inch needle.

Intradermal injections use a 26-27 gauge, 3/8 inch needle at a 5-15 degree angle, producing a wheal.

Do not aspirate before injecting a vaccine; inject at the same angle used for insertion.

When two injectable vaccines are given at one visit, use separate syringes and separate anatomic sites at least 1 inch apart.

For infants, the anterolateral thigh is preferred; the deltoid may be used starting around age 3 years when muscle mass is adequate.

Refrigerated vaccines: 2 to 8 degrees C (36 to 46 degrees F); frozen vaccines: -50 to -15 degrees C (-58 to +5 degrees F).

Place a calibrated digital data logger with a buffered probe among the vaccines, and record min/max temperatures at least twice daily.

Store vaccines in the middle of the unit, away from walls, floor, and vents; do not store in doors or drawers.

Never store food or specimens in a vaccine refrigerator; water bottles in the door help buffer temperature.

On a temperature excursion, label affected vaccine DO NOT USE, quarantine it, and contact the manufacturer or immunization program.

Rotate stock first-expiry, first-out; check expiration dates monthly and remove expired product from usable inventory.

Keep the refrigerator and freezer plugged into a dedicated outlet; do not use power strips or extension cords, and post a Do Not Unplug sign.

Screen for contraindications before each dose: severe allergic reaction to a prior dose or component; for live vaccines, pregnancy or significant immunocompromise.

Moderate or severe acute illness is a precaution to defer; mild illness is not a reason to defer vaccination.

Document vaccine name, manufacturer, lot number, expiration date, dose volume, route, site, date, and administering clinician.

Report each dose to the state or local immunization information system (IIS) within the jurisdiction's required timeframe.

Provide the current Vaccine Information Statement (VIS) before each dose and document its edition date and the date given.

Observe patients for 15 minutes after vaccination, seated or lying down, and document the observation period.

Egg allergy is not a contraindication to any routinely recommended vaccine; severe allergy to a vaccine component is.

The National Childhood Vaccine Injury Act requires providing the current VIS before each dose and recording the VIS edition date and date given.

VAERS accepts reports of any adverse event after vaccination, whether or not causality is established; serious events and errors are reportable.

Pharmacists administer vaccines under state authority; scope, age limits, and prescriptive authority vary by state and must be verified.

Anaphylaxis management: epinephrine 1 mg/mL IM in the mid-outer thigh at 0.01 mg/kg, max 0.5 mg per dose, repeat every 5-15 minutes as needed.

Emergency equipment must be immediately available at every vaccination site: epinephrine, 1 mL syringes with 1 to 1.5 inch needles, and a way to call emergency services.

Needlestick injuries: wash the site with soap and water, report immediately, and follow post-exposure evaluation for bloodborne pathogens.

Sharps go in puncture-resistant, closable containers immediately after use; never recap a needle using two hands.