The Vaccine Vial Monitor (VVM) on a BCG vial is at Stage 2 (inner square lighter than outer circle). The cold chain box label shows a temperature excursion >25°C recorded. The appropriate action is:

• A Discard the vial immediately as VVM has reached the discard point
• B Return the vial to the cold chain for re-evaluation in 24 hours
• C Use the vial immediately as VVM Stage 2 means the vaccine is still usable ✓
• D Use only if the expiry date has not passed, regardless of VVM stage

Explanation

VVM Stage 2 means the inner square is still lighter than the outer circle—the vaccine has not reached the discard point. The discard point (Stage 3/4) is when the inner square matches or is darker than the outer circle. At Stage 2 the vaccine should be prioritized for immediate use (First Expiry First Out principle applies). Temperature excursion history is already encoded in the VVM. The vaccine remains usable at Stage 2. Discarding at Stage 2 wastes viable vaccines.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.