INTRAMUSCULAR (IM)

Vaccines given intramuscularly (IM):

Intramuscular
• Diphtheria-Tetanus-Pertussis (IM) Needle Size:
• Haemophilus influenzae, type b
90º
23–25 gauge
• Hepatitis A • Hepatitis B • Influenza
Needle Length:
• Meningococcal Conjugate
• Pneumococcal Conjugate 1”

Age: 0–36 months

Infant/Toddler Intramuscular Shot
Intramuscular shots in
infants and toddlers are
usually given in the
Site: anterolateral thigh. The
Vastus Lateralis vastus lateralis muscle is on
the outside of the leg in the
mid- to upper-thigh.
• Example of
two IM sites
Use 23–25 gauge, 1” needle.
Insert entire needle at 90º
angle.

Age: 3 years–Adult
Child/Adult Intramuscular Shot
Intramuscular injections to
children and adults are
usually given in the upper
arm. The deltoid muscle is
found about 3 fingers below
the acromion, above the level
Site:
Deltoid of the armpit.

Use 23–25 gauge, 1” needle.

Insert entire needle at 90º
angle. A 11/2” needle may be
needed for large adults.
• Example of
two IM sites

SUBCUTANEOUS (SC)

Vaccines given subcutaneously (SC):

Subcutaneous
• Inactivated Polio Vaccine* (SC) Needle Size:
• Measles-Mumps-Rubella 45º 25 gauge
• Pneumococcal Polysaccharide* Needle Length:
• Varicella 5/ 8”
*Can also be given IM

Age: 0–36 months

Infant/Toddler Subcutaneous Shot
Subcutaneous shots in
infants and toddlers are
given either in the upper
arm or in the fatty area of
the thigh. The tissue is
“pinched” up between the
Site: • Example of thumb and index finger.
Outer Aspect two SC sites

Use 25 gauge, 5/8” needle.

Insert entire needle at 45º
angle.

Age: 3 years–Adult
Child/Adult Subcutaneous Shot
Given in the upper arm.
The tissue on the back of the
upper arm is “pinched”
up between the thumb and
index finger.

Site: Use 25 gauge, 5/8” needle.

Outer Aspect Insert entire needle at 45º
• Example of angle.
two SC sites

O
S a f e • E f f e c t i v e • C a r i n g
Produced by the Immunization Branch, California Department of Health Services.

Arnold Schwarzenegger, Governor—State of California Medical Illustrations by Lynne Larson, www.biovisuals.com. All rights reserved. This chart is based on extensive review of the scien-
Kimberly Belshé, Secretary—Health and Human Services Agency tific literature including recommendations of the Advisory Committee on Immunization Practices (MMWR 1994; 43RR-1, 1-38) and the
American Academy of Pediatrics (Red Book 2000). The purpose of this chart is to present the most customarily recommended vaccine
Sandra Shewry, Director—Department of Health Services
injection sites and needle sizes. For alternatives or additional information, please refer to the vaccine manufacturer’s package insert
Immunization Branch • 850 Marina Bay Parkway, Building P • Richmond, CA 94804 and the cited references. Devices illustrated are available with engineered sharps injury prevention mechanisms.
IMM-685 (10/05) Produced by the Immunization Branch, California Department of Health Services.