What is the recommended course of action for a 27-year-old female patient who presents for her second rabies vaccine dose on day 3 after being scratched by a stray cat and experiencing mild symptoms after the first dose?

Clinical Note for Rabies Post-Exposure Prophylaxis - Day 3 Visit

This patient should receive her second rabies vaccine dose today as scheduled, and the series should be completed with doses on days 7 and 14. 1

Assessment and Plan

Chief Complaint: Follow-up for rabies post-exposure prophylaxis (PEP) - Day 3 of 4-dose series

History of Present Illness:

• 27-year-old female presenting for second rabies vaccine dose on day 3 after stray cat scratch 1
• First dose administered on day 0 with appropriate wound care
• Experienced mild headache and flu-like symptoms after first dose (expected vaccine reaction) 2
• Currently asymptomatic with resolution of post-vaccination symptoms
• No acute concerns today

Assessment:

• Rabies post-exposure prophylaxis in progress - previously unvaccinated individual
• Appropriate 4-dose vaccine schedule (days 0,3,7,14) per ACIP 2010 guidelines 1
• Tolerating vaccine series well with only mild, self-limited adverse effects

Plan:

1. Vaccine Administration Today (Day 3):

   • Administer 1.0 mL rabies vaccine (HDCV or PCECV) intramuscularly in deltoid area 1
   • Document vaccine lot number, manufacturer, and administration site

2. Remaining Vaccine Schedule:

   • Day 7 dose: Schedule appointment in 4 days 1
   • Day 14 dose: Schedule appointment in 11 days 1
   • Emphasize importance of completing full 4-dose series for adequate protection 2, 3

3. Patient Education:

   • Mild systemic symptoms (headache, myalgias, fatigue) are common and self-limited 2
   • If doses are delayed by a few days, simply resume schedule maintaining same intervals between remaining doses 4
   • No routine serologic testing needed after completion in healthy individuals 1
   • Return immediately if wound shows signs of infection or if new symptoms develop

4. Follow-up:

   • Return day 7 for third vaccine dose
   • Return day 14 for final vaccine dose
   • No additional follow-up needed after series completion unless complications arise 1

Note: Patient received appropriate initial management with day 0 vaccine. The 4-dose regimen (days 0,3,7,14) is safe, effective, and provides adequate long-lasting antibody response when administered with proper wound care 1, 2, 5, 3.