I think you may be referring to my post when you mention being lethargic.  My endo has instructed us not to ever give the injection unless we call her first.  If she is not available then we are to ask for the endo on call.   I agree that it is important to avoid a crisis wherever possible.  But I can speak from experience with my son that not all vomiting and / or fever situations end up in a crisis.  My son has had his share of both of those situations and has only had the shot once in his 9 years of life.  Our endo has stressed that although we are giving our children why their bodies lack that we can give to much and that it is important that we keep that in mind.  I would never suggest taking a chance (nor does our endo) with a child’s life but what I am referring to is that if (I am speaking of my son here) my son is not lethargic and just vomiting like I would when I get sick then I do not give the shot.  Believe me the time we used it he vomited once and his eyes were rolling in his head instantly.  I had to actually hold his head for him to vomit.  We called the endo and were walked through giving the shot.  We had the endo on the phone immediately (and always have when we call).  If my son has a fever that is high enough to be of concern and he is capable of taking his meds orally then that is how it is administered.  I don’t mean to sound argumentative in any way (sometimes I feel it is hard in this format to make that point)..... but if I understood you correctly you give a shot for a fever.  Why would you not just give it orally if there is no vomiting?