We have had to give the shot due to just a fever.  We try to give all the meds orally first but often our daughter doesn’t respond.  Our bodies have a protective mechanism when we have a virus or stomach bug that may or may not cause vominting.  Anyway, this can stop fast absorption from the stomach and make it impossible for meds to get in the system.  We have had to give shots most often due to fever with no other apparent symptom.  Once we got to know our daughter and how she responds this has proven invaluable to us.  Our endo doesn’t require us to call she knows that we know our daughter best and she trusts us to make the decision.  Julia