    Common Occurrence Not well understood Not well treated Good data & research is lacking Mycobacterium & Mineral Oil  Clostridium sp, Moraxella bovis & Mineral oil  On average, a patient who has an accidental vaccination will be off work for 8 months and have an average of 6 operations after Gudair injection     General advice is to call your doctor We don’t know what to do! No research has been done on whether early excision is possible or not Treatment is based on a few anecdotes       56 yr old male Sustained an accidental vaccination to R hand Attended GP D1 – Had cortisone injected & a splint applied & arm elevated. D2 GP visit – given antibiotics D4 – saw Specialist. Ice, elevation & anti-inflammatories. Delay of definitive surgery till 3/52    Radical excision – “ cancer operation “ Post op 2/52 – working with a glove No further surgery      39 year old male. Smoker Gudair injection into L hand Saw GP – given antibiotics. D3 – huge swelling. Given anti – inflammatories. 3/52 – wound “lanced” “ yellow custard”       31 yr old dairy farmer Injected Piligard into L index finger Advice from Cooper’s Vet Phone advice from Hand Specialist Antibiotics, oral cortisone & anti - inflammatories 1/52 - developed blisters & sterile pus. Finger debrided    6/52 – limited recovery Amputated finger “ At least it wasn’t Gudair “ Cooper’s Vet!        30 yr old female Using a safety gun – injected Gudair into R thigh D1 – GP drained & irrigated wound Given antibiotics Still draining @ 4/12 Fully excised @ 5/12 Healed completely    Take accidental injections seriously More research & trials are needed Having 1 centre for referrals will build expertize Thank you THANK YOU