Hundreds contacted to rebook shots after 6 people given saline instead of COVID-19 vaccine

Niagara Region Public Health says six people received an injection of saline instead of the COVID-19 vaccine at its Port Colborne, Ont., clinic. 

Now, 205 people who had appointments on June 16 will be contacted to book a repeat vaccination — meaning some people will receive a third dose. 

Public health says both the saline diluent and receiving a third dose are safe. A third dose does not provide "significant benefit," it said. 

"We deeply regret this error, and want to reassure the public that immediate corrective measures have been taken," said public health in a media release. 

Dr. Mustafa Hirji, acting medical officer of health for Niagara, said the provincial tool doesn't track individual doses.

The closest public health could get to finding out who received saline was to narrow the possibilities down to a certain time frame and those 205 people. 

Anyone impacted will be scheduled for a repeat vaccination "within the appropriate interval."

Hirji said the calls began today, but he was unable to say whether some people were hesitant to get the shot again. 

"Individuals making the calls are prepared to talk about those issues with people on the phone," he said. 

Public health says only the people who are contacted directly are considered "potentially impacted."

Saline wasn't mixed with vaccine before shots

Saline diluent and the vaccine come in separate vials.They're mixed together in a preparation area before being taken to the nursing stations and administered, according to health officials.

"There are no anticipated health effects from receiving the saline diluent only; however, the saline diluent does not protect individuals against COVID-19," the release says.

It explained that an end-of-day audit at the clinic found six extra doses were administered, but weren't accounted for in the number of vaccine vials prepared for the clinic.

One more vial of saline diluent was used as compared to the vaccine vials, which public health says suggests the diluent was given to some people without it being mixed with the vaccine. 

It said management acted immediately and an in-depth review followed to "investigate, identify, and follow-up with those affected."

Extra doses happen with other vaccines

Hirji said there's a "good track record" for the safety of extra doses with other vaccines. If doctors are unsure about someone's vaccine history, Hirji said, they err on the side of caution. 

For example, Hirji said that people might not have a record of all three Hepatitis B shots. They also might be immigrating to Canada, and their previous healthcare provider may not have a record for measles or tetanus shots. 

"The good news is that while getting an extra dose generally doesn't give you much additional protection, it also doesn't really do much harm either," he said. 

"The biggest risk isn't from the side effects [like a sore arm] from an additional dose. It's from getting COVID-19 because they don't have full protection."

But he also said that people circulating in the community under the impression that they received their shot was "certainly a worry." He noted public health advises people to wait a couple of weeks to get the full benefit of the vaccine. 

"We know people will take some degree of confidence that the vaccine is going to protect them, and I think the vaccine is doing an excellent job protecting people. There is some concern that that might have happened," he said. 

"Obviously we can't change what happened in the past. What we need to do is make sure we get people the protection now."

Changes to prevent errors

On whether this might contribute to vaccine hesitancy, Hirji said the mix up doesn't show the vaccine is unsafe. 

"It's just an error that we made that we deeply regret happened," he said. "Our recommendation remains that everybody should get two doses of a COVID-19 vaccine so that they're fully protected." 

Niagara Region Pubic Health says it "understands the importance" of sharing this information with the community.

It listed some steps it's taken, including:

• Additional checks to catch errors.
• Extra training of staff.
• New documentation to track doses from the freezer to the person receiving their COVID-19 vaccine.