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A vaccine administration error occurs when a vaccine is given in a way that deviates from standard guidelines established by the Centers for Disease Control and Prevention (CDC) and the vaccine manufacturer’s recommendations. Some administration errors must be reported voluntarily to theVaccine Adverse Event Reporting System (VAERS)to help improve vaccine safety and prevent future errors.

(A) Fluzone was administered subcutaneously.✅(Incorrect Route – Error that Should Be Reported)

Fluzone is aninactivated influenza vaccine (IIV)that should be administeredintramuscularly (IM).

Subcutaneous (SQ) administration isnot recommendedand may reduce vaccine efficacy.

According to theCDC and the Immunization Action Coalition (IAC), administering an inactivated influenza vaccine subcutaneously is a vaccine administration error and should be reported.

(B) Boostrix was administered intramuscularly.❌(Correct Route – No Error)

Boostrix is aTdap (Tetanus, Diphtheria, and Acellular Pertussis) vaccineindicated for booster immunization.

It iscorrectly administered intramuscularly (IM)in thedeltoid muscle.

Since the correct administration route was followed, this does not qualify as a vaccine administration error.

(C) Varivax was administered subcutaneously.❌(Correct Route – No Error)

Varivax is alive-attenuated varicella (chickenpox) vaccine.

It iscorrectly administered subcutaneously (SQ), typically in the upper arm or thigh.

Since the correct administration route was followed, this is not a vaccine administration error.

(D) Shingrix was administered intramuscularly.❌(Correct Route – No Error)

Shingrix is arecombinant zoster vaccine (RZV)used for shingles prevention.

It should be administeredintramuscularly (IM).

Since the correct administration route was followed, this is not a vaccine administration error.

TheInstitute for Safe Medication Practices (ISMP)and theCDCrecommend reportingvaccine administration errorsto VAERS, especially if the error could affect the vaccine’s efficacy or patient safety.

Administration of Fluzonevia the incorrect route (subcutaneously instead of intramuscularly)could alter immune response and should be reported.

If a vaccine is given via the incorrect route, the CDC provides guidance on whether the dose needs to be repeated. For inactivated influenza vaccines given subcutaneously, the CDC states that the dose doesnot need to be repeated, but the error should still be documented and reported.

CDC General Best Practices for

Vaccine Adverse Event Reporting System (VAERS):

Immunization Action Coalition (IAC) - Vaccine Administration Guidelines:

Institute for Safe Medication Practices (ISMP) - Vaccine Safety Recommendations:

Analysis of Each Answer Choice:Reporting Vaccine Administration Errors:References for Pharmacy Technicians:

Phenobarbital is abarbiturateused forseizure control, sedation, and epilepsy management. It is commercially available in both:

Oral tablet form(commonly used for long-term seizure control).

Injectable solution form(used in hospital settings for status epilepticus and acute seizure episodes).

B. Paroxetine❌→Available only as oral tablets and oral suspension.

C. Pioglitazone❌→Available only as oral tablets (for diabetes management).

D. Pramipexole❌→Available only as oral tablets (for Parkinson’s disease and restless legs syndrome).

FDA Drug Labeling Database– ListsPhenobarbital as available in oral and injection forms.

American Society of Health-System Pharmacists (ASHP) Drug Database– Confirmsinjectable and oral availability of Phenobarbital.

PTCB PTCE Exam Content Outline– Covers medication dosage forms and routes of administration.

Why Not the Other Options?Key References:

USP compounding standards require maintaining a Master Formulation Record (MFR) and a Compounding Record (CR). The primary purpose is to ensure the compounded preparation can be consistently and identically reproduced with documented components, calculations, equipment, steps, and quality checks. While documentation can incidentally aid billing or inventory, those are not the primary objectives.

References (Pharmacy Technician documents/Study Guides):

• USP <795> Pharmaceutical Compounding—Nonsterile Preparations: requirements for Master Formulation Records and Compounding Records, including content and purpose (consistent, reproducible compounding and quality assurance).

• ASHP guidelines on compounding documentation and quality systems.

• PTCB/ExCPT study guides—compounding documentation, records, and reproducibility.

Amlodipine(10 mg) anddiltiazem(30 mg) are bothcalcium channel blockers (CCBs)used to treat hypertension and angina.

When a patient is prescribed two medications from the same therapeutic class, the pharmacy's prescription processing system may flag this as"therapeutic duplication."

This alert is meant toprevent potential adverse effectssuch as excessive lowering of blood pressure or heart rate.

A. Prior authorization required→ Not applicable unless the insurance requires special approval before covering the drug.

C. NDC not covered→ Would appear if the specific drug product (based on its National Drug Code) is not covered by insurance, but this scenario relates to duplication, not coverage.

D. Refill too soon→ This applies to refilling a medication before the allowed time frame, but the scenario describes a new prescription.

PTCB PTCE Exam Content Outline – Drug Interactions and Therapeutic Duplication

Lexicomp and Micromedex Drug Databases– Reference sources for drug classifications.

ISMP Guidelines on Preventing Therapeutic Duplication Errors

Why Other Answers Are Incorrect?Pharmacy Technician References: