In our study, 22/26 patients had at least one symptom following high dose BCG administration. Most of the patients (57.7%) developed a papule. 11.5% developed a pustule, 7.7% developed skin erythema, and 3.8% developed axillary lymphadenopathy. 1/26 children also developed jaundice, but he was lost-to-follow-up. None of the patients developed fever disseminated TB or osteomyelitis. These findings are in consistent with the literature in which the most common symptoms following a high dose BCG vaccine were adverse local events and few systemic complications. A European report by Lotte et al. in 1984 documented most side effects of BCG overdose following immunization were exaggerated local reactions cases of large, deep ulcers, necrotic lesions or abscesses, and sometimes regional suppurative lymphadenitis were observed and only 8% developed systemic complications including fever, headache, and malaise. A study published in 1996 in Manchester, documented 857 cases of infants between July and November 1994 being injected intradermally with a percutaneous BCG preparation which was 5 times the upper limit of the normal dose. 61 (11%) of these infants had adverse local reactions. 48 infants (8.6%) had axillary lymphadenopathy, 6 infants had papules >10 mm, and 6 of the infants had ulcer >10 mm. One infant had an abscess which was aspirated by a needle. One infant presented at 4 months with severe combined immune deficiency (Omenn syndrome) but she did not have disseminated BCG infection.In the present study, it was observed that majority of the superficial local skin reactions occurred in the first 2 weeks of life which can also be seen normally with a routine BCG vaccination after birth. Almost all routine vaccine recipients experience an injection site reaction characterized by a papule which commences 2 or more weeks after immunization and then may progress to become ulcerated healing after 2-5 months leaving a superficial scar.However, severe local abscess and keloid formation or lymphadenitis following BCG vaccination are rarely reported and are only limited to few case reports.Wei et al. conducted a study in Taiwan about an event that occurred in 2012 in which the vial was diluted with 2mL instead of 3mL. That vaccine was then administered to 20 healthy infants. 3 (15%) of these infants developed injection site abscesses that resolved within 6 weeks. They all recovered without significant complications in the 18 month follow up period. A case report on a 13-year-old boy who mistakenly received intramuscular (IM) intravesical BCG reported that he suffered from fever, anemia, pancytopenia, enlarged spleen, hydronephrosis and fluid around the liver. However, a relationship was not established between the symptoms and IM intravesical BCG administration. At 2 months, he developed cellulitis and swollen lymph nodes were present on sonography. The skin biopsy showed poorly formed granulomas and he was treated with isoniazid, ethambutol, and rifampicin for 6 months. In a 60-year-old man 4 vials of intravesical BCG were administered intramuscularly which caused fever, headache, and sweating. He then developed local indurations and hypogastric pain after 3 days and received prophylactic isoniazid and rifampicin course. The babies were followed up to a mean follow-up time of 252 days which corresponds to around 8.4 months. The median duration of ATT given was 90 days. There is no consensus on how to best manage patients with BCG overdose. Puliyel et al. in 1996 mainly managed patients by observation except for 1 patient who received abscess aspiration and 1 patient with Omenn syndrome who received ATT after diagnosis. Miles and Shaw in 1996 also managed patients using observation. In the study by Ashraf, isoniazid and rifampicin were given for 2 months, another case study by Ritz et al. a surgical excision of the lump was done and then was treated with Isoniazid and Rifampicin for 6 weeks, whereas Wei et al. in their study managed the children by only observing and following them.