Seven days after being laid low by a second dose of the Moderna COVID-19 vaccine, Mary Ann Ferren got a call from the CVS Pharmacy in Norwich where the shot had been administered.

The dose had expired before she got it, the man on the line said.

"Now what?" thought Ferren, a 60-year-old Salem resident.

Was she in any danger from having received an expired vaccine? How effective might the shot yet be, if at all? Should she get another shot?

Mostly, she wondered, "How could this have happened?"

Examining her vaccination card, Ferren noted it provided the lot number of the batch of vaccine that included her shot, but not the expiration date associated with the lot number. She reported it to Uncas Health District, where she said a nurse told her the inclusion of expiration dates on vaccination cards is considered “a best practice” but not required.

In fact, most sites that administer vaccines do not record expiration dates on vaccination cards. Only registered health care organizations and pharmacies that administer vaccines have access to the U.S. Centers for Disease Control and Prevention database of lot numbers and their expiration dates.

“If it was on my card, I would have checked it before I rolled up my sleeve,” Ferren said. “I wish I had known to ask about it.”

A CVSHealth spokesman responded to questions about the incident this week in an email exchange.

“Some patients who were vaccinated at our pharmacy in Norwich between October 14 to October 21 inadvertently received a COVID-19 vaccine that had gone past its October 13 expiration date,” wrote Mike DeAngelis, senior director, corporate communications, for the Rhode Island-based health care company that owns CVS Pharmacy.

“We contacted all affected patients to apologize,” wrote DeAngelis. “As a matter of precaution, we also offered to revaccinate them at their convenience, as the effectiveness of the vaccine they received cannot be determined. We reported this incident to HHS’s (the U.S. Department of Health and Human Services’) Vaccine Adverse Event Reporting System (VAERS) and have taken steps to help prevent this from occurring again.”

Asked how many patients had received an expired dose, DeAngelis said CVSHealth was not providing that information.

Patrick McCormack, director of health for the Uncas Health District, which serves Norwich and surrounding towns and conducts vaccination clinics, said Ferren’s report of receiving an expired dose of COVID-19 vaccine is the only such report the district has received. The district referred it to the state Department of Public Health, he said.

Mary Day, public health nurse for Ledge Light Health District, which covers southern New London County towns, said her district has not fielded any reports of expired vaccinations being administered.

“Expired vaccine should NEVER be administered,” says the U.S. Centers for Disease Control and Prevention’s website. The CDC further recommends, Day said, that a patient who receives any expired dose of vaccine contact the manufacturer for information about the stability of the vaccine.

“If no expiration date is available, a patient should repeat the dose. No minimum interval is necessary,” she said, reading from CDC guidance.

While an expired dose inadvertently administered likely poses no danger to the patient, uncertainty over its effectiveness can be an issue, Jennifer Ceccarelli, a public health nurse for the Uncas district, said.

“We recommended she (Ferren) get another dose,” she said.

Health officials in New York City gave the same advice in June after it was discovered nearly 900 people got expired COVID-19 vaccine doses over several days at a clinic in Times Square.

Ferren, who got seriously ill from the expired shot she received Oct. 16, spending an entire weekend in bed, has not gotten another shot. She said the CVS Pharmacy employee who called didn’t recommend whether she should or not.

“He said I might or might not be inoculated by the expired shot,” she said. “‘Because you got so sick, it probably worked,’ he said.”

In any event, Ferren pointed out, she is now in possession of a vaccination card that shows she has received two doses of the Moderna vaccine, regardless of the expired shot’s effectiveness.

She, too, reported the incident to VAERS, which is compiling data on vaccine-administration errors.

b.hallenbeck@theday.com