Skip to Main Content

Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email User Services ( for more information.


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 who is healthy; mother is healthy; father has type 2 diabetes.


Does not smoke; drinks alcohol socially; has healthcare coverage through her employer; religious affiliation is Baptist.


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 checkup.


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.


Collect Information

1.a. What subjective and objective information indicates needs, precautions, or contraindications to immunization?


Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.