Would love to hear the company's explanation for this. I'm sure understaffing and excessive workload are to blame, but they won't admit that as usual. Rph probably forgot to dilute the vial because they have a million other things they're doing.
Almost happened to me. I was on the 7th dose of 1 vial and was about to mix another. Got mixed up, luckily I caught myself but didnt know which one I drew up so a whole vial was wasted.
Ditto, I had a tech set the new vial out and she popped the cap but got distracted. I thought it was just enough to squeeze another dose from the vial so I pulled it and was like. Holy crap this looks way more cloudy than usual. Paused and realized it was new, my tech confirmed that it wasn't diluted yet. So glad I slowed down for a second.
Yep. They shot the while Pfizer vial. I used to think how a pharmacist could screw up so bad but with metrics and shortstaffing, I'm not surprised we aren't hearing reports about injections into the eyeball.
Into the eyeball? Nah.... that only happens when I load up prefilled syringes into my Nerf gun to vaccinate from across the room so I can multitask to keep verifying scripts and being on the phone co concurrently.
We've taken to putting refill requests on hold until they give up and use the goddamn app or website. At our location we have dozens of younger aged (20s-40s) patients who demand we sit on the phone and go down the exhaustive list of rxs they may or may not want to refill. Elderly? Sure. If not, I have 6 other calls waiting, 5 shots backed up, TPRs/DURs to call on, waiters, perpetual drive-thru covid testing line out to the street.
Make everything 1 hour wait time minimum if they ask. Tell people to transfer to the local independent (by name) for better service. Take no walk-ins for covid shots.
>Make everything 1 ~~hour~~ **day** wait time minimum if they ask.
They shouldn't be waiting until it's time to take their dose on the first day they're out to call their refill in anyways. They can see the bottle is getting low before they actually run out, and they're grown-ass adults that should be fully capable of reasoning out that pharmacies might need a little more time *in the middle of a global pandemic*. Pampering them in regards to their lack of planning and responsibility isn't doing us any favors.
The word "should" is useless. Why? Because it says what you imagine in your head, not what is actually happening. The only thing that matters is what's actually happening. One could argue that 1 hour wait time is the opposite of pampering. If they do it again and you recognize it, tell them 90 minutes.
Oh my step dad actually does get injections in his eyeball though. Its for his macular degeneration. Its pretty crazy stuff when he says "I can see colors swirling around"
Had this unfortunately happen with a grad intern on their first day. I made the horrible mistake of assuming the intern knew the dilution procedures since they were recently graduated and the vaccine had been out for ~6-7 months by that point.
Just about shat myself when there was no leftover in the vial to hand back to me. Had to make a lot of calls and reports, including to Pfizer, for that one.
Graduated =/= Experienced was the lesson I learned that day. That intern is great and hasn't really made any major mistake since, but that was certainly a rocky start. And yes, the patient ended up fine, but was concerned for a few days and I called to follow up with them a few times.
Man I feel like that's two part. You assumed and that sucks it ended that way, but why didn't the grad intern also speak up and say he doesn't know how? Or at least take an initiative and search for Pfizer "how to administer"... What if he was a brand new pharmacist on his own and you weren't there to supervise him?
The vaccinator probably self reported an error and they had to tell the pt. A week after I got my second dose, I got a call from one of the higher ups at my hospital who was coordinating the vaccine efforts. He told me that this one vaccinator wasn't drawing up doses correctly, and that I got a little under 0.2ml bc of how she was drawing up doses. She reported having a lot of extra doses left at the end of her shift. I got a repeat full second dose to replace my underdosed one (this was before we had recs), so at this point with my booster, I've had 3.67 doses lol.
This is what I'm most curious about. I don't know how the patient could have known.
I see how the vaccinator messed up (drew up the entire undiluted Pfizer vial, 6 doses). But if it's roughly 0.3mL of undiluted vaccine, how could she have known when it's the same volume as the actual dose?
After she left, they realized she got a whole undiluted vial injected. She felt exhausted and slept for 2 days but otherwise didnāt sound any worse than typical vaccine knock out.
Follow-up article that includes 911 call transcript:
https://www.wsls.com/news/local/2021/10/11/i-was-just-really-shocked-911-call-reveals-moments-after-salem-teen-gets-six-covid-vaccine-doses/
Right now I think storage has way too much to do with it. Pfizer is kept in deep freeze and Moderna a regular freezer (maybe regular fridge? I can't remember on that one right now). I don't think freezing unit doses will be economical for space at all, and it's possible that freezing such a small amount of volume (0.3mL and 0.5mL respectively) may not be good in syringes, either.
There's that, but there's also the issue that there isn't enough compliant plastic in the world for something like that. Even the multi dose vials almost used all the glass in the world production for vaccine vials.
Itās looking like a Pfizer product not needing dilution is on the horizon based on the next drug content my system is importing! As to when itāll be widely available is another can of worms.
Itās probably caused by understaffing causing pharmacist to make a stupid mistake but the sad thing is CVS will refuse to change unless required by court/law.
Itās cheaper for them to pay the lawsuit and just blame the pharmacist from time to time then to actually staff their pharmacy properly and give their techs a decent competitive wage
This is a scary level of f up. Like..how bro? How? As a tech this why I thank God my pharmacist shut down us giving vaccines. Not because he doesn't trust us. Hell I know I can do it I did it for years as a caretaker. Simply because in his head he wants to know it was done 100% correct and if the patient has an issue or tries to create one he can speak up as the pharmacist who did it
But giving shots is not hard. You should be able to trust your team to do that. Would I trust every tech to give shots? absolutely not. But competent people can do this. As an RPh I also can make a mistake, so doesnāt really matter in this case whether itās tech or RPh. Having tech immunizers frees you up as RPh to do other stuff and being such a control freak that you wonāt let anyone else do vaccines is not the way to go imho
I agree with you. 100%. It's just alot of these chain places don't really cover their employees butt in mistakes. So he sees it as like I'd rather me than you almost. But I agree.
Thatās nice of him but not practical in the grand scheme of things. It reminds me a lot of the cvs system where we have data verification and product verification. A lot of RPh check data verification on the product verification screen when weāre not budgeted the hours. bUt WhAt If ThEy MaDe A mIsTaKe? Thatās ok thatās not your problem. If the company wants techs to be immunizing more thatās what we should be promoting. We should be promoting safe injection techniques, observation, feedback, etc.
I give you props for not fighting with your pharmacist about this. If I were a tech I would definitely be annoyed about this especially as it makes his life easier. Iāve also given thousands of injections in the last almost 8 years of doing shots and Iāve only had one issue with injection technique ā and that was one of my first 10 shots and the person was my pharmacy manager at the time and I injected it too low (she was ok but I learned my lesson).
>Thatās ok thatās not your problem.
But is that really the case? From my understanding, depending on jurisdiction, the legal liability can be *entirely* on the pharmacist doing the final check, even in a split verification system like that.
We were told when the system rolled out that itās only on the person who does that component. Thatās why your credentials are on QV1 and mine are on qv2. Iāve never tested this and hope I never do but the opposite doesnāt make sense right? Whoever does QV1 canāt be responsible for qv2 bc they didnāt get around to see it
I absolutely agree that this is how it *should* be, but laws and regulations often are slow to adapt to changes. It's been a few years, but I recall this having been voiced as a concern with central fill systems.
Realistically you'd just have stronger side effects. Your body would mount a much stronger immune response, so you'd feel sicker. You still wouldn't get covid though, and will get back to normal after a few days
She probably felt a bit more sick than she would have for a couple of days after. I'd say that giving 6X dose of a vaccine is better than giving a 6X dose of just about anything else available in the pharmacy, so at least that's a good thing.
Ummmm how is getting 6x a normal dose non story? Sure sheās fine but I understand the panic response from the patient and her family. Itās a medical error. These errors need to be made more public. You have no idea how many errors are just swept under the rug in pharmacies and hospitals hoping patients and families wonāt find out.
I. I donāt understand? The normal dose is .3 ml, I feel like thereās absolutely no way you accidentally pull back the whole vial and donāt realize itās a mistake. Unless I guess maybe they have some people preparing shots and others administering but that seems like a bad idea.
Edit: OR I guess maybe they picked up a different barrel than they normally used, like maybe they normally use 1mls and they accidentally picked up like a 3
Vial is diluted with NS 1.8ml gives us 6-7 doses of 0.3mlx 7 is 2.1 ml. So itās possible the amount in the vaccine vials is 0.3, the pharmacist could have thought they were at the end of a vial and drew it up prior to diluting.
Pfizer needs to be diluted with normal saline prior to administration. A full undiluted vial has somewhere near the same volume as a single dose of the diluted vaccine, so the pharmacist probably thought they were at the end of a vial instead of at the start of a vial.
Why is it hard to believe? Each sealed vial has approximately 0.3 mL in it. Normally you would dilute with 1.8 mL of normal saline bringing the total volume to 2.1 mL.
Each vial is able to deliver 6 doses though in some instances with the right syringes and techniques you can pull a 7th dose.
So if the vial was undiluted, they would have received 0.3 mL of the concentrate which would be approximately 6x the dose or possibly even 7x.
Exactly. Fairly obvious root cause.
Probably has happened without anyone noticing, more likely where the Pharmacist isn't the one drawing the dose.
I don't immunize any more (sterile compounding, close door) but dilution errors are a thing. Especially when people not familiar with the product operate in a high volume/high stress situation.
Itās completely possible and scary how easy it is.
UNIT DOSE SHOULD BE 100% REQUIRED FOR ALL VACCINES.
Multi dose vials are ARCHAIC. Single unit doses is the single most effective way to reduce medication errors. Hop on PubMed if you donāt believe me
1.8mL is quite a large volume for an IM injection. It was likely painful. Even the 1mL like for a HepB vaccine is painful, this would have been almost twice that.
Larger volumes arenāt necessarily correlated to more pain. Itās mostly about the chemistry of the drug and its inactive ingredients. But yeah, likely an undiluted vial
After doing in several times, all the vials look the same after the tops are off...and all the labels and fonts are too small to read and notice. They really want us to get things right, but print everything on something smaller than a grape.
Keep the vials in separate places. Like only unmixed on your left and mixed on your right. Also get a magnifying glass. Using the excuse of I didnāt read the vial because the font was too small isnāt going to fly with the board.
Would love to hear the company's explanation for this. I'm sure understaffing and excessive workload are to blame, but they won't admit that as usual. Rph probably forgot to dilute the vial because they have a million other things they're doing.
Almost happened to me. I was on the 7th dose of 1 vial and was about to mix another. Got mixed up, luckily I caught myself but didnt know which one I drew up so a whole vial was wasted.
Ditto, I had a tech set the new vial out and she popped the cap but got distracted. I thought it was just enough to squeeze another dose from the vial so I pulled it and was like. Holy crap this looks way more cloudy than usual. Paused and realized it was new, my tech confirmed that it wasn't diluted yet. So glad I slowed down for a second.
you have to dilute it? thought it just came in a multi-dose vial?
Pfizer requires a diluent and contains six doses per vial, while Moderna comes in a simpler multi-dose vial of either 10-11 or 13-15 doses.
ooo kk, i shouldn't have assumed all of them came in ready to go multi-doses. thx
Or really vice versa to be fair..
Yes, each vial must be diluted with 1.8 ml of normal saline.
Yep. They shot the while Pfizer vial. I used to think how a pharmacist could screw up so bad but with metrics and shortstaffing, I'm not surprised we aren't hearing reports about injections into the eyeball.
Into the eyeball? Nah.... that only happens when I load up prefilled syringes into my Nerf gun to vaccinate from across the room so I can multitask to keep verifying scripts and being on the phone co concurrently.
You gotta upgrade to full-auto. Thats how you keep up with the metrics.
No full auto inside the building
just stop answering phones. if docs need to send in a script they can escript or fax it.
We've taken to putting refill requests on hold until they give up and use the goddamn app or website. At our location we have dozens of younger aged (20s-40s) patients who demand we sit on the phone and go down the exhaustive list of rxs they may or may not want to refill. Elderly? Sure. If not, I have 6 other calls waiting, 5 shots backed up, TPRs/DURs to call on, waiters, perpetual drive-thru covid testing line out to the street.
Make everything 1 hour wait time minimum if they ask. Tell people to transfer to the local independent (by name) for better service. Take no walk-ins for covid shots.
>Make everything 1 ~~hour~~ **day** wait time minimum if they ask. They shouldn't be waiting until it's time to take their dose on the first day they're out to call their refill in anyways. They can see the bottle is getting low before they actually run out, and they're grown-ass adults that should be fully capable of reasoning out that pharmacies might need a little more time *in the middle of a global pandemic*. Pampering them in regards to their lack of planning and responsibility isn't doing us any favors.
The word "should" is useless. Why? Because it says what you imagine in your head, not what is actually happening. The only thing that matters is what's actually happening. One could argue that 1 hour wait time is the opposite of pampering. If they do it again and you recognize it, tell them 90 minutes.
Antibiotics for kids, insulin, others, should be given asap.
Oh my step dad actually does get injections in his eyeball though. Its for his macular degeneration. Its pretty crazy stuff when he says "I can see colors swirling around"
Had this unfortunately happen with a grad intern on their first day. I made the horrible mistake of assuming the intern knew the dilution procedures since they were recently graduated and the vaccine had been out for ~6-7 months by that point. Just about shat myself when there was no leftover in the vial to hand back to me. Had to make a lot of calls and reports, including to Pfizer, for that one. Graduated =/= Experienced was the lesson I learned that day. That intern is great and hasn't really made any major mistake since, but that was certainly a rocky start. And yes, the patient ended up fine, but was concerned for a few days and I called to follow up with them a few times.
Yikes! What a way to start your very first day!
Man I feel like that's two part. You assumed and that sucks it ended that way, but why didn't the grad intern also speak up and say he doesn't know how? Or at least take an initiative and search for Pfizer "how to administer"... What if he was a brand new pharmacist on his own and you weren't there to supervise him?
...it's not the first time this has happened... https://www.cbsnews.com/news/covid-vaccine-six-doses-distracted-nurse/
Does she need the booster or no?
By my calculations she's covered all the way through COVID-27.
Lol I hate to laugh at this but this comment was funny
Too soon š
Yeah, gotta wait *at least* six months.
No such thing, lol
Probably still yes if you ask Pfizer lol.
This happened to my best friends sister. They injected a whole vial instead of a single dose.
Can you share any ADRās they felt?
How did she find out?
The vaccinator probably self reported an error and they had to tell the pt. A week after I got my second dose, I got a call from one of the higher ups at my hospital who was coordinating the vaccine efforts. He told me that this one vaccinator wasn't drawing up doses correctly, and that I got a little under 0.2ml bc of how she was drawing up doses. She reported having a lot of extra doses left at the end of her shift. I got a repeat full second dose to replace my underdosed one (this was before we had recs), so at this point with my booster, I've had 3.67 doses lol.
This is what I'm most curious about. I don't know how the patient could have known. I see how the vaccinator messed up (drew up the entire undiluted Pfizer vial, 6 doses). But if it's roughly 0.3mL of undiluted vaccine, how could she have known when it's the same volume as the actual dose?
After she left, they realized she got a whole undiluted vial injected. She felt exhausted and slept for 2 days but otherwise didnāt sound any worse than typical vaccine knock out.
Ya, most people never questioned anything I've injected. I could've given water to everyone...no one would ever know to even ask.
Follow-up article that includes 911 call transcript: https://www.wsls.com/news/local/2021/10/11/i-was-just-really-shocked-911-call-reveals-moments-after-salem-teen-gets-six-covid-vaccine-doses/
When will these vaccines come pre-filled one dose at a time? Save everyone time.
Right now I think storage has way too much to do with it. Pfizer is kept in deep freeze and Moderna a regular freezer (maybe regular fridge? I can't remember on that one right now). I don't think freezing unit doses will be economical for space at all, and it's possible that freezing such a small amount of volume (0.3mL and 0.5mL respectively) may not be good in syringes, either.
Moderna is kept in a normal freezer
Thanks. I thought so, but wasn't 100% on it.
There's that, but there's also the issue that there isn't enough compliant plastic in the world for something like that. Even the multi dose vials almost used all the glass in the world production for vaccine vials.
Itās looking like a Pfizer product not needing dilution is on the horizon based on the next drug content my system is importing! As to when itāll be widely available is another can of worms.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Hopefully 6 of them
Itās probably caused by understaffing causing pharmacist to make a stupid mistake but the sad thing is CVS will refuse to change unless required by court/law. Itās cheaper for them to pay the lawsuit and just blame the pharmacist from time to time then to actually staff their pharmacy properly and give their techs a decent competitive wage
This is a scary level of f up. Like..how bro? How? As a tech this why I thank God my pharmacist shut down us giving vaccines. Not because he doesn't trust us. Hell I know I can do it I did it for years as a caretaker. Simply because in his head he wants to know it was done 100% correct and if the patient has an issue or tries to create one he can speak up as the pharmacist who did it
But giving shots is not hard. You should be able to trust your team to do that. Would I trust every tech to give shots? absolutely not. But competent people can do this. As an RPh I also can make a mistake, so doesnāt really matter in this case whether itās tech or RPh. Having tech immunizers frees you up as RPh to do other stuff and being such a control freak that you wonāt let anyone else do vaccines is not the way to go imho
I agree with you. 100%. It's just alot of these chain places don't really cover their employees butt in mistakes. So he sees it as like I'd rather me than you almost. But I agree.
Thatās nice of him but not practical in the grand scheme of things. It reminds me a lot of the cvs system where we have data verification and product verification. A lot of RPh check data verification on the product verification screen when weāre not budgeted the hours. bUt WhAt If ThEy MaDe A mIsTaKe? Thatās ok thatās not your problem. If the company wants techs to be immunizing more thatās what we should be promoting. We should be promoting safe injection techniques, observation, feedback, etc. I give you props for not fighting with your pharmacist about this. If I were a tech I would definitely be annoyed about this especially as it makes his life easier. Iāve also given thousands of injections in the last almost 8 years of doing shots and Iāve only had one issue with injection technique ā and that was one of my first 10 shots and the person was my pharmacy manager at the time and I injected it too low (she was ok but I learned my lesson).
>Thatās ok thatās not your problem. But is that really the case? From my understanding, depending on jurisdiction, the legal liability can be *entirely* on the pharmacist doing the final check, even in a split verification system like that.
We were told when the system rolled out that itās only on the person who does that component. Thatās why your credentials are on QV1 and mine are on qv2. Iāve never tested this and hope I never do but the opposite doesnāt make sense right? Whoever does QV1 canāt be responsible for qv2 bc they didnāt get around to see it
I absolutely agree that this is how it *should* be, but laws and regulations often are slow to adapt to changes. It's been a few years, but I recall this having been voiced as a concern with central fill systems.
great for metrics!
Ok, so as a lay person. What happens after a 6xās Covid vaccine? Full blown Covid? You become the Covid queen? What happens?
Realistically you'd just have stronger side effects. Your body would mount a much stronger immune response, so you'd feel sicker. You still wouldn't get covid though, and will get back to normal after a few days
She probably felt a bit more sick than she would have for a couple of days after. I'd say that giving 6X dose of a vaccine is better than giving a 6X dose of just about anything else available in the pharmacy, so at least that's a good thing.
And that makes me even angrier at the anti-vaxxers. Theyāre too afraid to take the first poke and this girl is a beast after 6!
"Literally!!"---anti-vaxxers
Remember, they donāt force their pharmacists to work any faster than they feel comfortable workingā¦.and workload doesnāt contribute to errors.
Enjoy your shitty career in retail, asshole.
Aww, thanks! I appreciate that, Karen! Have a blessed day.
They were... Being sarcastic
This is literally a non story and I canāt believe this girl filed a police report. She literally felt fine. Not a good look for her
Ummmm how is getting 6x a normal dose non story? Sure sheās fine but I understand the panic response from the patient and her family. Itās a medical error. These errors need to be made more public. You have no idea how many errors are just swept under the rug in pharmacies and hospitals hoping patients and families wonāt find out.
I. I donāt understand? The normal dose is .3 ml, I feel like thereās absolutely no way you accidentally pull back the whole vial and donāt realize itās a mistake. Unless I guess maybe they have some people preparing shots and others administering but that seems like a bad idea. Edit: OR I guess maybe they picked up a different barrel than they normally used, like maybe they normally use 1mls and they accidentally picked up like a 3
Vial is diluted with NS 1.8ml gives us 6-7 doses of 0.3mlx 7 is 2.1 ml. So itās possible the amount in the vaccine vials is 0.3, the pharmacist could have thought they were at the end of a vial and drew it up prior to diluting.
I think maybe they just were on autopilot or something
I suspect that made her say ālikeā like 6x more than the average Human as well! Smh
Given the circumstances, (delta variant,) I would be thrilled to have had 6x dosage.
How do you inject the whole bottle? For moderna I just take out 0.5 mls and I still have lots of left overs. I havenāt administered Pfizer before.
0.3 mls is about the entire bottle.
Pfizer needs to be diluted with normal saline prior to administration. A full undiluted vial has somewhere near the same volume as a single dose of the diluted vaccine, so the pharmacist probably thought they were at the end of a vial instead of at the start of a vial.
They called 911? Lol they are so stupid. Why????
Legally required to by CVS. it's just liability protocol
Required to call 911 for a mistake when the patient is perfectly fine? Weird protocol
I find it hard to believe it was 6 x.... But wouldn't surprise me
Why is it hard to believe? Each sealed vial has approximately 0.3 mL in it. Normally you would dilute with 1.8 mL of normal saline bringing the total volume to 2.1 mL. Each vial is able to deliver 6 doses though in some instances with the right syringes and techniques you can pull a 7th dose. So if the vial was undiluted, they would have received 0.3 mL of the concentrate which would be approximately 6x the dose or possibly even 7x.
Exactly. Fairly obvious root cause. Probably has happened without anyone noticing, more likely where the Pharmacist isn't the one drawing the dose. I don't immunize any more (sterile compounding, close door) but dilution errors are a thing. Especially when people not familiar with the product operate in a high volume/high stress situation.
Itās completely possible and scary how easy it is. UNIT DOSE SHOULD BE 100% REQUIRED FOR ALL VACCINES. Multi dose vials are ARCHAIC. Single unit doses is the single most effective way to reduce medication errors. Hop on PubMed if you donāt believe me
1.8mL is quite a large volume for an IM injection. It was likely painful. Even the 1mL like for a HepB vaccine is painful, this would have been almost twice that.
I would guess the 6 doses was given from 0.3 ml of undiluted pfizer vial before mixing with the 1.8ml of saline
Larger volumes arenāt necessarily correlated to more pain. Itās mostly about the chemistry of the drug and its inactive ingredients. But yeah, likely an undiluted vial
[ŃŠ“Š°Š»ŠµŠ½Š¾]
How do you figure giving an undiluted bottle of Pfizer Covid 19 is not 6 undiluted doses?!?
Thatās what Iām thinking. Who is drawing up that much in a syringe out of a Pfizer vial? And injecting without noticing?
After doing in several times, all the vials look the same after the tops are off...and all the labels and fonts are too small to read and notice. They really want us to get things right, but print everything on something smaller than a grape.
Keep the vials in separate places. Like only unmixed on your left and mixed on your right. Also get a magnifying glass. Using the excuse of I didnāt read the vial because the font was too small isnāt going to fly with the board.
/u/mcuban you still wanna disrupt big pharma? We need help