{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T01:14:03Z","timestamp":1776474843799,"version":"3.51.2"},"reference-count":46,"publisher":"American Veterinary Medical Association (AVMA)","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["javma"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether replacing needles after vial septum puncture affects canine response to vaccination and whether injectors can distinguish between replaced and nonreplaced needles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this randomized, double-blinded, controlled crossover trial conducted at the Midwestern University College of Veterinary Medicine vaccine clinics between June and August of 2024, 75 client-owned dogs received both rabies and distemper, hepatitis, parainfluenza, and parvovirus vaccines, one with a replaced needle and one with the original needle used to draw up the vaccine. Heart rate (HR) was recorded continuously, reaction to needle insertion was scored on a 5-point scale by 2 blinded observers, and injectors guessed which syringe had the replaced needle. The outcomes of HR change between baseline and maximum after insertion and mean reaction rating were analyzed with linear mixed-effects models and injector guess with a 1-sample test of proportions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>45 dogs (60%) provided complete HR data. Change in HR for replaced as compared to nonreplaced needles was not different (\u03b2 = \u20130.8; 95% CI, \u201312 to 10). Heart rate was higher for rabies administered second (\u03b2 = 23; 95% CI, 7 to 40). Reaction scores did not differ (\u03b2 = \u20130.05; 95% CI, \u20130.24 to 0.14). Injectors identified replaced needles 46% of the time (95% CI, 34 to 58), which was not better than chance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Needle replacement did not improve patient comfort, and injectors were unable to perceive a difference between replaced and nonreplaced needles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Injecting dogs with the same needle used for drawing up vaccines is clinically acceptable. Replacement provides no measurable patient benefit while adding risk, waste, and cost.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2460\/javma.25.10.0661","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T15:50:09Z","timestamp":1766591409000},"page":"451-457","source":"Crossref","is-referenced-by-count":1,"title":["Needle replacement before subcutaneous vaccination in dogs: a randomized clinical trial finds no clinical benefit"],"prefix":"10.2460","volume":"264","author":[{"given":"Jane","family":"Sagaser","sequence":"first","affiliation":[{"name":"College of Veterinary Medicine, Midwestern University, Glendale, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Jones","sequence":"additional","affiliation":[{"name":"College of Veterinary Medicine, Midwestern University, Glendale, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marissa","family":"Baird","sequence":"additional","affiliation":[{"name":"College of Veterinary Medicine, Midwestern University, Glendale, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debbie","family":"Statton","sequence":"additional","affiliation":[{"name":"College of Veterinary Medicine, Midwestern University, Glendale, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5562-5521","authenticated-orcid":true,"given":"Rachael E.","family":"Kreisler","sequence":"additional","affiliation":[{"name":"College of Veterinary Medicine, Midwestern University, Glendale, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1272","reference":[{"issue":"RR-15","key":"ref1","series-title":"MMWR Recomm Rep","first-page":"1","article-title":"General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"55","author":"Kroger AT","year":"2006","unstructured":"Kroger AT, Atkinson WL, Marcuse EK, Pickering LK; Advisory Committee on Immunization Practices (ACIP) CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55(RR-15):1-48."},{"issue":"6","key":"ref2","series-title":"J Am Vet Med Assoc","first-page":"725","article-title":"Needle sharpness is minimally affected by vaccine vial puncture","volume":"263","author":"Tawil JR","year":"2025","unstructured":"Tawil JR, Vitello EC, Agostini-Walesch GM, Mitchell JC, Kreisler RE. Needle sharpness is minimally affected by vaccine vial puncture. J Am Vet Med Assoc. 2025;263(6):725-731. doi:10.2460\/javma.25.01.0025"},{"issue":"12","key":"ref3","series-title":"Can Vet J","first-page":"1278","article-title":"A survey of needle handling practices and needlestick injuries in veterinary technicians","volume":"50","author":"Weese JS","year":"2009","unstructured":"Weese JS, Faires M. A survey of needle handling practices and needlestick injuries in veterinary technicians. Can Vet J. 2009;50(12):1278-1282."},{"key":"ref4","article-title":"CDC","author":"About rabies","unstructured":"About rabies. CDC. June 24, 2025. Accessed September 2, 2025. https:\/\/www.cdc.gov\/rabies\/about\/index.html"},{"key":"ref5","article-title":"Fear Free Happy Homes","author":"Handout: spectrum of FAS for dogs","unstructured":"Handout: spectrum of FAS for dogs. Fear Free Happy Homes. Accessed September 2, 2025. https:\/\/www.fearfreehappyhomes.com\/topics\/handout-spectrum-of-fas-for-dogs\/"},{"key":"ref6","series-title":"Front Vet Sci","first-page":"1137781","article-title":"The standards of reporting trials in pets (PetSORT): explanation and elaboration","volume":"10","author":"Sargeant JM","year":"2023","unstructured":"Sargeant JM, Ruple A, Selmic LE, O\u2019Connor AM. The standards of reporting trials in pets (PetSORT): explanation and elaboration. Front Vet Sci. 2023;10:1137781. doi:10.3389\/fvets.2023.1137781"},{"issue":"4","key":"ref7","series-title":"J Vet Behav","first-page":"205","article-title":"Validation of a Polar human heart rate monitor for measuring heart rate and heart rate variability in adult dogs under stationary conditions","volume":"7","author":"Jonckheer-Sheehy VSM","year":"2012","unstructured":"Jonckheer-Sheehy VSM, Vinke CM, Ortolani A. Validation of a Polar human heart rate monitor for measuring heart rate and heart rate variability in adult dogs under stationary conditions. J Vet Behav. 2012;7(4):205-212. doi:10.1016\/j.jveb.2011.10.006"},{"key":"ref8","series-title":"Physiol Behav","first-page":"114","article-title":"Validity and reliability of Polar RS800CX heart rate monitor, measuring heart rate in dogs during standing position and at trot on a treadmill","author":"Essner A","year":"2013","unstructured":"Essner A, Sj\u00f6str\u00f6m R, Ahlgren E, Lindmark B. Validity and reliability of Polar RS800CX heart rate monitor, measuring heart rate in dogs during standing position and at trot on a treadmill. Physiol Behav. 2013;114-115:1-5. doi:10.1016\/j.physbeh.2013.03.002"},{"key":"ref9","series-title":"J Vet Behav","first-page":"103","article-title":"The potential beneficial effect of classical music on heart rate variability in dogs used in veterinary training","volume":"30","author":"K\u00f6ster LS","year":"2019","unstructured":"K\u00f6ster LS, Sithole F, Gilbert GE, Artemiou E. The potential beneficial effect of classical music on heart rate variability in dogs used in veterinary training. J Vet Behav. 2019;30:103-109. doi:10.1016\/j.jveb.2018.12.011"},{"key":"ref10","series-title":"Appl Anim Behav Sci","first-page":"105574","article-title":"Heart rate and heart rate variability in school dogs","volume":"248","author":"Bidoli EMY","year":"2022","unstructured":"Bidoli EMY, Erhard MH, D\u00f6ring D. Heart rate and heart rate variability in school dogs. Appl Anim Behav Sci. 2022;248:105574. doi:10.1016\/j.applanim.2022.105574"},{"issue":"1","key":"ref11","series-title":"Pain","first-page":"81","article-title":"Heart rate changes as an autonomic component of the pain response","volume":"43","author":"M\u00f6ltner A","year":"1990","unstructured":"M\u00f6ltner A, H\u00f6lzl R, Strian F. Heart rate changes as an autonomic component of the pain response. Pain. 1990;43(1):81-89. doi:10.1016\/0304-3959(90)90052-F"},{"issue":"11","key":"ref12","series-title":"J Hypertens","first-page":"1635","article-title":"Heart rate as marker of sympathetic activity","volume":"16","author":"Grassi G","year":"1998","unstructured":"Grassi G, Vailati S, Bertinieri G,  Heart rate as marker of sympathetic activity. J Hypertens. 1998;16(11):1635-1639. doi:10.1097\/00004872-199816110-00010"},{"issue":"3","key":"ref13","series-title":"Am J Surg","first-page":"226","article-title":"Testing technical skill via an innovative \u201cbench station\u201d examination","volume":"173","author":"Reznick R","year":"1997","unstructured":"Reznick R, Regehr G, MacRae H, Martin J, McCulloch W. Testing technical skill via an innovative \u201cbench station\u201d examination. Am J Surg. 1997;173(3):226-230. doi:10.1016\/S0002-9610(97)89597-9"},{"issue":"2","key":"ref14","series-title":"Diabetes Res Clin Pract","first-page":"119","article-title":"Using insulin pen needles up to five times does not affect needle tip shape nor increase pain intensity","volume":"67","author":"Puder JJ","year":"2005","unstructured":"Puder JJ, Atar M, Muller B, Pavan M, Keller U. Using insulin pen needles up to five times does not affect needle tip shape nor increase pain intensity. Diabetes Res Clin Pract. 2005;67(2):119-123. doi:10.1016\/j.diabres.2004.06.001"},{"issue":"5","key":"ref15","series-title":"PLoS One","first-page":"e0250883","article-title":"The effect of intramuscular injection technique on injection associated pain; a systematic review and meta-analysis","volume":"16","author":"Ayinde O","year":"2021","unstructured":"Ayinde O, Hayward RS, Ross JDC. The effect of intramuscular injection technique on injection associated pain; a systematic review and meta-analysis. PLoS One. 2021;16(5):e0250883. doi:10.1371\/journal.pone.0250883"},{"issue":"12","key":"ref16","series-title":"J Adv Nurs","first-page":"3346","article-title":"Systematic review and meta-analysis: physical-procedural interventions used to reduce pain during intramuscular injections in adults","volume":"75","author":"\u015eanlialp Zeyrek A","year":"2019","unstructured":"\u015eanlialp Zeyrek A, Takmak \u015e, Kurban NK, Arslan S. Systematic review and meta-analysis: physical-procedural interventions used to reduce pain during intramuscular injections in adults. J Adv Nurs. 2019;75(12):3346-3361. doi:10.1111\/jan.14183"},{"issue":"3","key":"ref17","first-page":"147","article-title":"Does drawing up technique influence patients\u2019 perception of pain at the injection site? Aust N Z J Ment Health Nurs","volume":"9","author":"Rock D","year":"2000","unstructured":"Rock D. Does drawing up technique influence patients\u2019 perception of pain at the injection site? Aust N Z J Ment Health Nurs. 2000;9(3):147-151. doi:10.1046\/j.1440-0979.2000.00176.x"},{"issue":"3","key":"ref18","series-title":"J Adv Nurs","first-page":"563","article-title":"Effect on pain of changing the needle prior to administering medicine intramuscularly: a randomized controlled trial","volume":"67","author":"A\u011fa\u00e7 E","year":"2011","unstructured":"A\u011fa\u00e7 E, G\u00fcne\u015f \u00dcY. Effect on pain of changing the needle prior to administering medicine intramuscularly: a randomized controlled trial. J Adv Nurs. 2011;67(3):563-568. doi:10.1111\/j.1365-2648.2010.05513.x"},{"issue":"5","key":"ref19","first-page":"1063","article-title":"Randomized clinical trial to assess pain and bruising in medicines administered by means of subcutaneous and intramuscular needle injection: is it necessary to have needles changed? Rev Lat Am Enfermagem","volume":"19","author":"Lamblet LCR","year":"2011","unstructured":"Lamblet LCR, Meira ES, Torres S, Ferreira BC, Martucchi SD. Randomized clinical trial to assess pain and bruising in medicines administered by means of subcutaneous and intramuscular needle injection: is it necessary to have needles changed? Rev Lat Am Enfermagem. 2011;19(5):1063-1071. doi:10.1590\/S0104-11692011000500002"},{"issue":"1","key":"ref20","series-title":"Heart Lung","first-page":"70","article-title":"Effects of changing needles prior to administering heparin subcutaneously","volume":"29","author":"Klingman L","year":"2000","unstructured":"Klingman L. Effects of changing needles prior to administering heparin subcutaneously. Heart Lung. 2000;29(1):70-75. doi:10.1016\/S0147-9563(00)90041-4"},{"issue":"7","key":"ref21","series-title":"Am J Dis Child","first-page":"796","article-title":"Evaluation of the two-needle strategy for reducing reactions to DPT vaccination","volume":"141","author":"Salomon ME","year":"1987","unstructured":"Salomon ME, Halperin R, Yee J. Evaluation of the two-needle strategy for reducing reactions to DPT vaccination. Am J Dis Child. 1987;141(7):796-798. doi:10.1001\/archpedi.1987.04460070098034"},{"issue":"4","key":"ref22","series-title":"Am J Dis Child","first-page":"413","article-title":"Changing needles when drawing up vaccines and medications","volume":"142","author":"Asnes RS","year":"1988","unstructured":"Asnes RS. Changing needles when drawing up vaccines and medications. Am J Dis Child. 1988;142(4):413-414. doi:10.1001\/archpedi.1988.02150040063007"},{"issue":"4","key":"ref23","series-title":"Arch Pediatr Adolesc Med","first-page":"414","article-title":"Changing needles when drawing up vaccines and medications: reply","volume":"142","author":"Salomon ME","year":"1988","unstructured":"Salomon ME, Halperin R. Changing needles when drawing up vaccines and medications: reply. Arch Pediatr Adolesc Med. 1988;142(4):414. doi:10.1001\/archpedi.1988.02150040063008"},{"issue":"RR-15","key":"ref1","series-title":"MMWR Recomm Rep","first-page":"1","article-title":"General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"55","author":"Kroger AT","year":"2006","unstructured":"Kroger AT, Atkinson WL, Marcuse EK, Pickering LK; Advisory Committee on Immunization Practices (ACIP) CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55(RR-15):1-48."},{"issue":"6","key":"ref2","series-title":"J Am Vet Med Assoc","first-page":"725","article-title":"Needle sharpness is minimally affected by vaccine vial puncture","volume":"263","author":"Tawil JR","year":"2025","unstructured":"Tawil JR, Vitello EC, Agostini-Walesch GM, Mitchell JC, Kreisler RE. Needle sharpness is minimally affected by vaccine vial puncture. J Am Vet Med Assoc. 2025;263(6):725-731. doi:10.2460\/javma.25.01.0025"},{"issue":"12","key":"ref3","series-title":"Can Vet J","first-page":"1278","article-title":"A survey of needle handling practices and needlestick injuries in veterinary technicians","volume":"50","author":"Weese JS","year":"2009","unstructured":"Weese JS, Faires M. A survey of needle handling practices and needlestick injuries in veterinary technicians. Can Vet J. 2009;50(12):1278-1282."},{"key":"ref4","article-title":"CDC","author":"About rabies","unstructured":"About rabies. CDC. June 24, 2025. Accessed September 2, 2025. https:\/\/www.cdc.gov\/rabies\/about\/index.html"},{"key":"ref5","article-title":"Fear Free Happy Homes","author":"Handout: spectrum of FAS for dogs","unstructured":"Handout: spectrum of FAS for dogs. Fear Free Happy Homes. Accessed September 2, 2025. https:\/\/www.fearfreehappyhomes.com\/topics\/handout-spectrum-of-fas-for-dogs\/"},{"key":"ref6","series-title":"Front Vet Sci","first-page":"1137781","article-title":"The standards of reporting trials in pets (PetSORT): explanation and elaboration","volume":"10","author":"Sargeant JM","year":"2023","unstructured":"Sargeant JM, Ruple A, Selmic LE, O\u2019Connor AM. The standards of reporting trials in pets (PetSORT): explanation and elaboration. Front Vet Sci. 2023;10:1137781. doi:10.3389\/fvets.2023.1137781"},{"issue":"4","key":"ref7","series-title":"J Vet Behav","first-page":"205","article-title":"Validation of a Polar human heart rate monitor for measuring heart rate and heart rate variability in adult dogs under stationary conditions","volume":"7","author":"Jonckheer-Sheehy VSM","year":"2012","unstructured":"Jonckheer-Sheehy VSM, Vinke CM, Ortolani A. Validation of a Polar human heart rate monitor for measuring heart rate and heart rate variability in adult dogs under stationary conditions. J Vet Behav. 2012;7(4):205-212. doi:10.1016\/j.jveb.2011.10.006"},{"key":"ref8","series-title":"Physiol Behav","first-page":"114","article-title":"Validity and reliability of Polar RS800CX heart rate monitor, measuring heart rate in dogs during standing position and at trot on a treadmill","author":"Essner A","year":"2013","unstructured":"Essner A, Sj\u00f6str\u00f6m R, Ahlgren E, Lindmark B. Validity and reliability of Polar RS800CX heart rate monitor, measuring heart rate in dogs during standing position and at trot on a treadmill. Physiol Behav. 2013;114-115:1-5. doi:10.1016\/j.physbeh.2013.03.002"},{"key":"ref9","series-title":"J Vet Behav","first-page":"103","article-title":"The potential beneficial effect of classical music on heart rate variability in dogs used in veterinary training","volume":"30","author":"K\u00f6ster LS","year":"2019","unstructured":"K\u00f6ster LS, Sithole F, Gilbert GE, Artemiou E. The potential beneficial effect of classical music on heart rate variability in dogs used in veterinary training. J Vet Behav. 2019;30:103-109. doi:10.1016\/j.jveb.2018.12.011"},{"key":"ref10","series-title":"Appl Anim Behav Sci","first-page":"105574","article-title":"Heart rate and heart rate variability in school dogs","volume":"248","author":"Bidoli EMY","year":"2022","unstructured":"Bidoli EMY, Erhard MH, D\u00f6ring D. Heart rate and heart rate variability in school dogs. Appl Anim Behav Sci. 2022;248:105574. doi:10.1016\/j.applanim.2022.105574"},{"issue":"1","key":"ref11","series-title":"Pain","first-page":"81","article-title":"Heart rate changes as an autonomic component of the pain response","volume":"43","author":"M\u00f6ltner A","year":"1990","unstructured":"M\u00f6ltner A, H\u00f6lzl R, Strian F. Heart rate changes as an autonomic component of the pain response. Pain. 1990;43(1):81-89. doi:10.1016\/0304-3959(90)90052-F"},{"issue":"11","key":"ref12","series-title":"J Hypertens","first-page":"1635","article-title":"Heart rate as marker of sympathetic activity","volume":"16","author":"Grassi G","year":"1998","unstructured":"Grassi G, Vailati S, Bertinieri G,  Heart rate as marker of sympathetic activity. J Hypertens. 1998;16(11):1635-1639. doi:10.1097\/00004872-199816110-00010"},{"issue":"3","key":"ref13","series-title":"Am J Surg","first-page":"226","article-title":"Testing technical skill via an innovative \u201cbench station\u201d examination","volume":"173","author":"Reznick R","year":"1997","unstructured":"Reznick R, Regehr G, MacRae H, Martin J, McCulloch W. Testing technical skill via an innovative \u201cbench station\u201d examination. Am J Surg. 1997;173(3):226-230. doi:10.1016\/S0002-9610(97)89597-9"},{"issue":"2","key":"ref14","series-title":"Diabetes Res Clin Pract","first-page":"119","article-title":"Using insulin pen needles up to five times does not affect needle tip shape nor increase pain intensity","volume":"67","author":"Puder JJ","year":"2005","unstructured":"Puder JJ, Atar M, Muller B, Pavan M, Keller U. Using insulin pen needles up to five times does not affect needle tip shape nor increase pain intensity. Diabetes Res Clin Pract. 2005;67(2):119-123. doi:10.1016\/j.diabres.2004.06.001"},{"issue":"5","key":"ref15","series-title":"PLoS One","first-page":"e0250883","article-title":"The effect of intramuscular injection technique on injection associated pain; a systematic review and meta-analysis","volume":"16","author":"Ayinde O","year":"2021","unstructured":"Ayinde O, Hayward RS, Ross JDC. The effect of intramuscular injection technique on injection associated pain; a systematic review and meta-analysis. PLoS One. 2021;16(5):e0250883. doi:10.1371\/journal.pone.0250883"},{"issue":"12","key":"ref16","series-title":"J Adv Nurs","first-page":"3346","article-title":"Systematic review and meta-analysis: physical-procedural interventions used to reduce pain during intramuscular injections in adults","volume":"75","author":"\u015eanlialp Zeyrek A","year":"2019","unstructured":"\u015eanlialp Zeyrek A, Takmak \u015e, Kurban NK, Arslan S. Systematic review and meta-analysis: physical-procedural interventions used to reduce pain during intramuscular injections in adults. J Adv Nurs. 2019;75(12):3346-3361. doi:10.1111\/jan.14183"},{"issue":"3","key":"ref17","first-page":"147","article-title":"Does drawing up technique influence patients\u2019 perception of pain at the injection site? Aust N Z J Ment Health Nurs","volume":"9","author":"Rock D","year":"2000","unstructured":"Rock D. Does drawing up technique influence patients\u2019 perception of pain at the injection site? Aust N Z J Ment Health Nurs. 2000;9(3):147-151. doi:10.1046\/j.1440-0979.2000.00176.x"},{"issue":"3","key":"ref18","series-title":"J Adv Nurs","first-page":"563","article-title":"Effect on pain of changing the needle prior to administering medicine intramuscularly: a randomized controlled trial","volume":"67","author":"A\u011fa\u00e7 E","year":"2011","unstructured":"A\u011fa\u00e7 E, G\u00fcne\u015f \u00dcY. Effect on pain of changing the needle prior to administering medicine intramuscularly: a randomized controlled trial. J Adv Nurs. 2011;67(3):563-568. doi:10.1111\/j.1365-2648.2010.05513.x"},{"issue":"5","key":"ref19","first-page":"1063","article-title":"Randomized clinical trial to assess pain and bruising in medicines administered by means of subcutaneous and intramuscular needle injection: is it necessary to have needles changed? Rev Lat Am Enfermagem","volume":"19","author":"Lamblet LCR","year":"2011","unstructured":"Lamblet LCR, Meira ES, Torres S, Ferreira BC, Martucchi SD. Randomized clinical trial to assess pain and bruising in medicines administered by means of subcutaneous and intramuscular needle injection: is it necessary to have needles changed? Rev Lat Am Enfermagem. 2011;19(5):1063-1071. doi:10.1590\/S0104-11692011000500002"},{"issue":"1","key":"ref20","series-title":"Heart Lung","first-page":"70","article-title":"Effects of changing needles prior to administering heparin subcutaneously","volume":"29","author":"Klingman L","year":"2000","unstructured":"Klingman L. Effects of changing needles prior to administering heparin subcutaneously. Heart Lung. 2000;29(1):70-75. doi:10.1016\/S0147-9563(00)90041-4"},{"issue":"7","key":"ref21","series-title":"Am J Dis Child","first-page":"796","article-title":"Evaluation of the two-needle strategy for reducing reactions to DPT vaccination","volume":"141","author":"Salomon ME","year":"1987","unstructured":"Salomon ME, Halperin R, Yee J. Evaluation of the two-needle strategy for reducing reactions to DPT vaccination. Am J Dis Child. 1987;141(7):796-798. doi:10.1001\/archpedi.1987.04460070098034"},{"issue":"4","key":"ref22","series-title":"Am J Dis Child","first-page":"413","article-title":"Changing needles when drawing up vaccines and medications","volume":"142","author":"Asnes RS","year":"1988","unstructured":"Asnes RS. Changing needles when drawing up vaccines and medications. Am J Dis Child. 1988;142(4):413-414. doi:10.1001\/archpedi.1988.02150040063007"},{"issue":"4","key":"ref23","series-title":"Arch Pediatr Adolesc Med","first-page":"414","article-title":"Changing needles when drawing up vaccines and medications: reply","volume":"142","author":"Salomon ME","year":"1988","unstructured":"Salomon ME, Halperin R. Changing needles when drawing up vaccines and medications: reply. 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