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After completing this case study, the reader should be able to:

  • Develop a plan for administering any needed vaccines when given a patient’s age, immunization history, and medical history.

  • Recognize appropriate precautions and contraindications for vaccination, including inappropriate reasons for deferring vaccination.

  • Explain appropriate administration of vaccines, including timing and spacing of both inactive and live attenuated vaccines.

  • Recognize the differences in vaccines for young adults currently in use in the United States.


Chief Complaint

“I’m here to get my new prescription filled.”


Sandra Williams is a 23-year-old woman who presents to your pharmacy in January with a new prescription for prednisone 40 mg PO BID for 10 days. She has had a moderate asthma exacerbation. She just started her new job as an elementary school teacher. She is a new patient to your pharmacy. She inquires about your “One less” signs which refers to a national HPV vaccination campaign.


  • Moderate persistent asthma

  • Chickenpox at age 5 per patient

  • Splenectomy secondary to car accident 3 months ago


  • One sister—healthy

  • Mother—healthy

  • Father with type 2 diabetes


  • Does not smoke

  • Drinks alcohol socially


  • Albuterol MDI two inhalations PRN

  • Pulmicort DPI two inhalations once daily



Immunization Record

No vaccines since kindergarten except:

  • Meningococcal vaccine before she started her freshman year in college

  • One dose of hepatitis B vaccine before she started her freshman year in college

  • MMR vaccine before she started her freshman year in college, Td 10 years ago at her adolescent well check-up


WDWN African-American woman in NAD


BP 120/72 mm Hg (left arm, large cuff, seated), P 76 bpm; Wt 54 kg, Ht 5′5″

Physical Examination



A 23-year-old woman recently treated for a moderate asthma exacerbation. She is in need of immunizations today.


Problem Identification

1.a. Create a list of the patient’s immunization-related problems, including any contraindications or precautions for vaccination.

1.b. Create a list of this patient’s drug-related problems.

Desired Outcome


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