Concepts and Terminology
30%of exam
Vaccine Safety and Administration
50%of exam
Documentation and Product Handling
20%of exam
Quick Facts
- Credential
- Immunization Administration Certificate
- Items
- 60 multiple-choice
- Appointment
- 1 hr 30 min
- Exam time
- 80 minutes
- Pass
- 300 scaled (0-400)
- Fee
- $89 per attempt
- Eligibility
- Active CPhT + training program
- Retakes
- No wait, unlimited
- Renewal
- None; does not expire
- Pass rate
- 82% (2025)
Domain Weights
Concepts 30, Safety 50, Documentation 20
30%: terms, types, schedules50%: prep, route, technique20%: records, storage, reactions
Live vs Inactivated
Live attenuated
- Replicates in host
- Avoid in pregnancy
- Avoid severe immunodeficiency
- Often one dose
Inactivated
- Cannot replicate
- Acceptable in pregnancy
- Acceptable if immunocompromised
- Usually multiple doses
Replicates versus cannot
Technician Role and Scope
- What the certificate proves
- Knowledge, not legal authority
- Who grants authority
- State pharmacy practice act
- Who screens the patient
- Pharmacist or authorized prescriber
- Standing order
- Protocol; no individual prescription
- Collaborative practice agreement
- Signed delegation to pharmacist
- Technician tasks
- Prepare, give VIS, inject, document
- Exam prerequisite
- Active CPhT credential
- Training prerequisite
- PTCB-Recognized training program
Live Vaccine Roll Call
MMR, MMRV, Varicella, LAIV, Rotavirus, Yellow fever
Oral typhoid is live tooShingrix is NOT liveAvoid in pregnancy
Active vs Passive Immunity
Active
- Body makes antibody
- Takes weeks
- Lasts years
Passive
- Antibody given directly
- Protects immediately
- Fades in months
Made versus borrowed
Vaccine Types
- Live attenuated
- Weakened; still replicatesLAV
- Inactivated
- Killed; cannot replicate
- Toxoid
- Inactivated toxin; tetanus, diphtheria
- Subunit
- Purified antigen pieces
- Conjugate
- Polysaccharide linked to protein
- Polysaccharide
- Sugar-coat antigen; PPSV23
- Recombinant
- Engineered protein; Shingrix, RIV
- mRNA
- Cells make the antigen
- Viral vector
- Carrier virus delivers gene
Certificate vs CPhT Certification
Immunization certificate
- One skill area
- No renewal required
- Requires CPhT first
CPhT certification
- Broad credential
- Renew every two years
- Prerequisite for the certificate
Skill versus base credential
Immunity Terms
- Active immunity
- Own immune system responds
- Passive immunity
- Borrowed antibody; temporary
- Herd immunity
- Community protection threshold
- Antigen
- Substance triggering immune response
- Antibody
- Protein that binds antigen
- Adjuvant
- Boosts response; requires IM
- Seroconversion
- Detectable antibody appears
- Titer
- Measured antibody level
- Immunogenicity
- Ability to provoke immunity
Shingrix vs Zostavax
Shingrix (RZV)
- Recombinant, not live
- Two doses, IM
- Current US product
Zostavax (ZVL)
- Live attenuated
- One dose, SC
- US-discontinued in 2020
Recombinant versus live
Live Vaccines to Know
- MMR
- Live; subcutaneous
- MMRV
- Live; adds varicella
- Varicella
- Live; subcutaneous
- LAIV
- Live; intranasal, ages 2-49
- Rotavirus
- Live; oral, infants
- Yellow fever
- Live; travel vaccine
- Oral typhoid
- Live; Ty21a capsules
- Shingrix
- NOT live; recombinantTrap
- Zostavax
- Live; US-discontinued 2020Trap
Adult Schedule Highlights
- Influenza
- One dose annually
- Influenza age 65+
- High-dose, adjuvanted, or recombinant
- LAIV eligibility
- Healthy, non-pregnant, ages 2-49
- Tdap
- Once, then Td every 10yr
- Pregnancy Tdap
- Every pregnancy, 27-36 weeks
- Shingrix doses
- Two, 2-6 months apart
- Shingrix ages
- 50 and older; 19 immunocompromised
- Pneumococcal age
- All adults 50 and older
- Pneumococcal products
- PCV15, PCV20 or PCV21
- After PCV15
- PPSV23 about one year8-week minimum
- After PCV20 or PCV21
- No PPSV23; series complete
- Where to check
- Current CDC ACIP schedules
Key Abbreviations
- IIV
- Inactivated influenza vaccine
- RIV
- Recombinant influenza vaccine
- LAIV
- Live attenuated influenza; intranasal
- RZV
- Recombinant zoster vaccine; Shingrix
- PCV
- Pneumococcal conjugate vaccine
- PPSV23
- Pneumococcal polysaccharide vaccine
- MenACWY
- Meningococcal conjugate vaccine
- Tdap vs Td
- Pertussis included versus not
- VIS
- Vaccine Information Statement
- IIS
- Immunization Information System
- BUD
- Beyond-use date
- MDV
- Multidose vial
- MFS
- Manufacturer-filled syringe
- DDL
- Digital data logger
Adult Needle Ladder
Under 130 one inch; over 200 one-and-a-half
<130 lb: 1 inch130-152 lb: 1 inch152-260 lb: 1-1.5 inchWomen >200, men >260: 1.5
Contraindication vs Precaution
Contraindication
- Do not give
- Severe allergy to component
- Severe reaction to prior dose
Precaution
- Defer and weigh benefit
- Moderate or severe illness
- May still vaccinate
Never versus maybe later
Adult Deltoid Needle Picker
- Under 130 lb→1 inch(5/8 if taut)
- 130-152 lb→1 inch
- Man 152-260 lb→1-1.5 inches
- Woman 152-200 lb→1-1.5 inches
- Man over 260 lb→1.5 inches
- Woman over 200 lb→1.5 inches
- Using the thigh instead→1.5 inches(1 inch if taut)
Screening and Contraindications
- Who decides eligibility
- Pharmacist or authorized prescriber
- Severe allergy to prior dose
- Contraindication; never repeat it
- Severe allergy to a component
- Contraindication for that vaccine
- Moderate or severe acute illness
- Precaution; defer until better
- Mild illness or low-grade fever
- Vaccinate; do not defer
- Pregnancy
- Contraindication for live vaccines
- Severe immunodeficiency
- Contraindication for live vaccines
- Egg allergy
- Give RIV or IIV
- Prior severe influenza-vaccine reaction
- Contraindication to future doses
- Neomycin contact dermatitis
- Not a contraindication
- Thimerosal delayed reaction
- Not a contraindication
- Latex anaphylaxis history
- Avoid natural rubber stoppers
- Penicillin allergy
- No vaccine contains penicillin
Reconstitution Clock
MMR 8 hours; varicella 30 minutes
MMR: dark, 2-8°CVaricella: discard fastManufacturer diluent only
IM vs Subcutaneous
Intramuscular
- 90 degrees
- 22-25 gauge
- Deltoid or thigh
- All adjuvanted vaccines
Subcutaneous
- 45 degrees
- 23-25 gauge, 5/8 inch
- Upper-outer triceps
- MMR, varicella
Muscle versus fatty tissue
Route and Site Picker
- Adult IM vaccine→Deltoid, 90 degrees
- Infant under 12 months→Anterolateral thigh(More muscle)
- Non-live adjuvanted vaccine→Intramuscular only(Avoid granuloma)
- MMR or varicella→Subcutaneous, 45 degrees
- Subcutaneous, 12 months plus→Upper-outer triceps
- LAIV→Intranasal spray(0.1 mL each nostril)
- Rotavirus→Oral applicator
- Two shots, same limb→Space 1 inch apart
- Vaccine with immune globulin→Separate limbs
Adult IM Needle Table
- Under 130 lb (60 kg)
- 1 inch5/8 if taut
- 130-152 lb (60-70 kg)
- 1 inch
- Men 152-260 lb
- 1-1.5 inches
- Women 152-200 lb
- 1-1.5 inches
- Men over 260 lb
- 1.5 inches
- Women over 200 lb
- 1.5 inches
- Anterolateral thigh, any adult
- 1.5 inches1 in if taut
- Gauge, all IM
- 22-25 gauge
- Site
- Deltoid preferred; thigh alternate
Repeat the Dose?
- SC vaccine given IM→Counts; do not repeat
- HepB by non-IM route→Invalid; repeat
- HepB in adult gluteal→Invalid; repeat
- Rabies in gluteal→Invalid; repeat
- HepA given SC→Counts; do not repeat
- MenACWY given SC→Counts; do not repeat
- Dose leaked from syringe→Repeat the dose
- LAIV sneezed out→Do not repeat
- Two live vaccines, 3 weeks apart→Repeat the second(28-day rule)
- Dose 5 days early→Invalid; repeat(4-day grace only)
Child IM Needle Table
- Neonates, first 28 days
- 5/8 inch; thigh
- Infants 1-12 months
- 1 inch; thigh
- Toddlers 1-2 years, thigh
- 1-1.25 inchPreferred
- Toddlers 1-2 years, deltoid
- 5/8-1 inch
- Children 3-10, deltoid
- 5/8-1 inchPreferred
- Children 3-10, thigh
- 1-1.25 inches
- Ages 11-18, deltoid
- 5/8-1 inchPreferred
- Ages 11-18, thigh
- 1-1.5 inches
- 5/8-inch footnote
- Only if skin stretched taut
Routes, Angles, Gauges
- IM angle
- 90 degrees to skin
- IM gauge
- 22-25 gauge
- SC angle
- 45 degrees, tissue pinched
- SC needle
- 5/8 inch, 23-25 gauge
- SC site, 12 months and older
- Upper-outer triceps fat
- SC site, under 12 months
- Anterolateral thigh
- Bunched tissue for IM
- Needs 1 inch minimum
- Intranasal LAIV
- 0.1 mL per nostril
- Aspiration
- Not necessary; adds pain
- Two shots, one limb
- Separate by 1 inch
- Vaccine plus immune globulin
- Use separate limbs
- Gluteal site
- Avoid; fat blunts response
Dose Volumes
- Most injectable vaccines
- 0.5 mL
- HepA, age 19 and older
- 1.0 mL
- HepB, age 20 and older
- 1.0 mL
- LAIV
- 0.2 mL, split nostrils
- High-Dose Fluzone
- 0.7 mL
- Shingrix (RZV)
- 0.5 mL reconstituted
- Leaked partial dose
- Repeat the dose
- Divided doses across visits
- Never valid; revaccinate
Preparation and Vial Rules
- Diluent choice
- Only that product's diluent
- Diluent storage
- Never freeze a diluent
- MMR after reconstitution
- Discard within 8 hours
- Varicella after reconstitution
- Discard within 30 minutes
- Pooling vials
- Never combine partial doses
- Predrawing
- Discouraged; draw at administration
- Predraw limit
- 10 or fewer syringes
- Predrawn leftovers
- Discard by workday end
- Vial access devices
- Not recommended; contamination route
- Changing needle before injecting
- Not required unless contaminated
- Per injection
- New sterile needle, syringe
- Mixing vaccines in a syringe
- Never unless licensed combined
Epinephrine Numbers
Adults 0.3-0.5 mg; children 0.01 mg/kg
1 mg/mL preparationMid-outer thighRepeat every 5-15 minutesStock three doses
VAERS vs VERP
VAERS
- Adverse events
- CDC and FDA
- Some reports mandatory
VERP
- Administration errors
- Run by ISMP
- Entirely voluntary
Reaction versus mistake
Where to Report
- Hives after vaccination→VAERS
- Event on Reportable Events Table→VAERS(Required by law)
- Wrong vaccine administered→ISMP VERP(Voluntary)
- Expired product given→ISMP VERP
- Patient seeks compensation→VICP claim(HRSA, no-fault)
- Routine dose record→State IIS
- Needlestick injury→OSHA sharps log(Employer keeps it)
VIS Requirements
- Timing
- Before the injection
- Multi-dose series
- Before every single dose
- Age
- Required regardless of age
- Legal basis
- NCVIA of 1986
- Record: VIS edition date
- Bottom right of VIS
- Record: date VIS given
- Date of the visit
- Record: date administered
- Date vaccine was given
- Record: manufacturer, lot
- Taken from vial label
- Record: administrator
- Name, title, office address
- Signature
- Not required by NCVIA
- Editing a VIS
- Add practice contact only
- Take-home copy
- Offer it; patient may decline
Cold Chain Numbers
Fridge 2 to 8; freezer -50 to -15
Set fridge at 5°CSet freezer at -20°CUltra-cold: -90 to -60
Expiration vs Beyond-Use Date
Expiration date
- Set by manufacturer
- Printed on the vial
- Valid through that day
Beyond-use date
- Calculated by provider
- Starts at puncture or mixing
- Never later than expiration
Printed versus calculated
Temperature Excursion Steps
- Alarm or out-of-range reading→Notify vaccine coordinator
- Vaccines were exposed→Label DO NOT USE
- Labeled stock→Move to correct storage(Separate container)
- Tempted to throw away→Do not discard
- Documenting the event→Date, time, temperatures, inventory
- Deciding viability→Call immunization program(Or manufacturer)
Storage Temperatures
- Refrigerator
- 2°C to 8°C36-46°F
- Freezer
- -50°C to -15°C-58 to 5°F
- Ultra-cold freezer
- -90°C to -60°C-130 to -76°F
- Refrigerator thermostat
- Set midpoint 5°C
- Freezer thermostat
- Set midpoint -20°C
- mResvia frozen
- -40°C to -15°CNarrower
- Accidentally frozen
- Adjuvanted vaccines lose potency
- Diluent
- With its vaccine; never frozen
Refrigerated vs Frozen
Refrigerated 2-8°C
- Most vaccines
- Never let it freeze
- Adjuvanted lose potency
Frozen -50 to -15°C
- Varicella, MMRV
- Stand-alone freezer
- Never store diluent
Freezing ruins adjuvanted vaccines
Storage Unit Choice
- Best available option→NSF/ANSI 456 unit
- Next best→Purpose-built vaccine unit
- Third best→Pharmaceutical-grade unit
- Only household-grade available→Refrigerator compartment only(Never its freezer)
- Dormitory or bar-style unit→Never use
- Frozen vaccine stocked→Stand-alone freezer
Storage and Monitoring Equipment
- Best unit
- NSF/ANSI Standard 456
- Second best
- Purpose-built vaccine unit
- Third best
- Pharmaceutical-grade unit
- Never use
- Dormitory or bar-style units
- Household-grade unit
- Refrigerator compartment only
- Frozen stock
- Needs stand-alone freezer
- Monitoring device
- Digital data logger (DDL)
- Probe
- Buffered; unit center with vaccines
- Accuracy
- ±0.5°C recommended uncertainty
- Calibration
- Current Certificate of Calibration Testing
- Banned devices
- Alcohol, mercury, bimetal, infrared
- Daily check
- Min/max at workday start
- No min/max display
- Record temperature twice daily
- Avoid placing vaccines
- Doors, drawers, under vents
- Spacing
- 2-3 inches from walls
- Stock rotation
- Weekly; earliest expiration first
Reporting and Registries
- VAERS
- Adverse events after vaccination
- VAERS operators
- CDC and FDA jointly
- VAERS mandatory reports
- Reportable Events Table entries
- VAERS limitation
- Cannot establish causality
- VERP
- ISMP voluntary error program
- VERP scope
- Wrong vaccine, dose, expired product
- IIS
- Jurisdiction-run immunization registry
- IIS uses
- School, camp, clinical records
- VICP
- No-fault injury compensation program
- VICP basis
- The Vaccine Injury Table
Adverse Reactions and Anaphylaxis
- Local reaction
- Most frequent, least severe
- Systemic reaction
- Fever; less frequent
- Anaphylaxis rate
- About 1 per million
- Skin findings
- Absent in 10-20% of cases
- Adult epinephrine
- 0.3-0.5 mg IM1 mg/mL
- Child epinephrine
- 0.01 mg/kg IMMax 0.5 mg
- Epinephrine site
- Mid-outer thigh
- Repeat interval
- Every 5-15 minutes
- Contraindication to epinephrine
- None in anaphylaxis
- Position
- Recumbent, legs elevated
- Doses to stock
- At least three, all ages
- Syncope observation
- 15 minutes, seated
- Syncope timing
- 80% within 15 minutes
- Site requirements
- Epinephrine, airway kit, plan
Common Traps
Certificate is not authority
PTCB certificate proves knowledge ≠ State law grants authority
60 questions, not 90
Exam has 60 items ≠ 90 minutes is the appointment
Shingrix is not live
Shingrix is recombinant ≠ Zostavax was the live one
Gauge is not depth
Gauge sets needle width ≠ Length and angle set depth
Wrong route is not always invalid
SC given IM still counts ≠ HepB given non-IM is invalid
Precaution is not contraindication
Precaution means weigh benefit ≠ Contraindication means never give
VAERS is not VERP
VAERS takes adverse events ≠ VERP takes administration errors
VIS goes before, not after
Hand the VIS before injecting ≠ Afterward violates the NCVIA
Freezing is not safe storage
Frozen adjuvanted vaccines are ruined ≠ Thawing does not restore potency
Do not discard excursion stock
Label it DO NOT USE ≠ Await a viability decision
Aspiration is not required
No large vessels at sites ≠ Aspirating only adds pain
Grace period is not universal
4 days for same vaccine ≠ Never for the 28-day rule
Last Minute
- 1.Concepts 30, Safety 50, Documentation 20
- 2.60 items, 80-minute exam
- 3.Pass = 300 scaled, 0-400
- 4.$89 each attempt, no wait
- 5.Certificate never expires; CPhT does
- 6.IM = 90 degrees; SC = 45
- 7.IM gauge 22-25; SC 23-25
- 8.Adult deltoid: 1 to 1.5 inch
- 9.Infants: thigh, 1 inch
- 10.MMR 8 hours; varicella 30 minutes
- 11.Never pool partial vaccine vials
- 12.Fridge 2-8°C; freezer -50/-15°C
- 13.Never dormitory-style storage units
- 14.VIS before every single dose
- 15.Record 5 items after VIS
- 16.Epinephrine 0.3-0.5 mg IM adults
- 17.Observe 15 minutes for syncope
- 18.VAERS = reactions; VERP = errors
- 19.Never recap a used needle
Same family resources
Explore More PTCB Pharmacy Technician Certifications
Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.
More From This Family
Videos and articles for deeper review.
VideoBest PTCB Study Guides Ranked for 2026 (New Blueprint)VideoExCPT Pass Rate 2026: 62% — How to Beat the OddsVideoExCPT Study Plan 2026: Your 6-Week Guide to PassingVideoExCPT vs PTCE: Which Pharmacy Tech Exam? (2026)ArticleFREE PTCE Study Guide 2026: Pass Your Pharmacy Technician Certification Exam14 min readArticlePTCE 2026 Blueprint Overhaul: DSCSA Added, Compounding Removed & Question Formats Explained14 min readArticleFree ExCPT Practice Test (2026): What to Study to Pass10 min readArticleExCPT Pass Rate 2026: 62% — How to Beat the Odds10 min read