What To Do If Shingrix Is Accidentally Given SQ Instead Of IM

In our latest question and answer, the pharmacist discusses what to do if Shingrix is given subcutaneously in error.

What To Do If Shingrix Is Accidentally Given SQ Instead Of IM
Jan 17, 2019

Dee asked

Is there any concern if the second shot of Shingrix was given SQ (subcutaneously) versus IM (intramuscularly)?

At a glance

  • Accidental Administration Although a dose of Shingrix isn't recommended to be repeated if it is accidentally given subcutaneously, there, unfortunately, is no data regarding whether or not there will be an increase in the incidence of side effects. Since Shingrix contains an adjuvant (AS01B), it stands to reason that an SQ injection will likely cause more pain and inflammation than if it were given IM.In regard to SQ administration decreasing the overall effectiveness of the vaccine, this isn't entirely known as well. Studies show that there is a definite immune response, however. Per the Immunization Action Coalition 'Ask The Experts":Q: A patient was inadvertently given RZV [Shingrix] by the subcutaneous rather than the intramuscular route. Does the dose need to be repeated?
  • A: RZV has been shown to be immunogenic when given by the subcutaneous route. A dose erroneously given by this route does not need to be repeated.Ask The Experts: Immunization Action Coalition
  • Shingrix should be given intramuscularly (IM). However, if it is accidentally administered SQ (subcutaneously), the dose does not need to be repeated according to the Immunization Action Coalition.


Shingrix Title Imagbe

Shingrix, the recommended vaccine for shingles prevention, is indicated to be given by IM (intramuscular) injection in the deltoid.

However, if there is an administration error, and it is accidentally given SQ (subcutaneously), the CDC (Centers for Disease Control) states that it should be counted as a valid dose. It does not need to be re-administered in the muscle.

Per the CDC:

If you accidentally administered Shingrix subcutaneously, it is recommended to report the error to the Institute for Safe Medication Practices (ISMP), specifically to their Vaccine Error Reporting Program (VERP). This program allows you to report any vaccine error confidentially, and the information collected is used to provide education for future error prevention.

  • Elsevier ClinicalKey: Shingrix (Accessed 1/17/19)
  • CDC Frequently Asked Questions About Shingrix (Accessed 1/17/19)
  • CDC Administering Shingrix (Accessed 1/17/19)
  • Immunize.org Ask The Experts (Accessed 1/17/19)

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