Dosing & Uses
Dosage Forms & Strengths
injection, frozen suspension concentrate
- Requires dilution before administration
- Purple cap and label border multiple-dose vial (after dilution yields six [30-mcg] doses/vial)
COVID-19 Disease Prevention
August 23, 2021 (full FDA approval): Indicated for active immunization to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for individuals aged ≥16 years
2-dose primary series: 0.3 mL (30 mcg) IM x2 doses administered 3 weeks apart
3-8 week interval between doses
- 8-week interval may be optimal for some people aged ≥12 years, especially for males aged 12-39 years owing to the small risk of myocarditis associated with mRNA COVID-19 vaccines
- Shorter interval (3 weeks) between dose 1 and 2 remains the recommended interval for people who are moderately or severely immunocompromised, adults aged ≥65 years, and others who need rapid protection owing increased concern about community transmission or risk of severe disease
- CDC COVID-19 vaccine interim immunization schedule February 25, 2022
Third primary dose for severely immunocompromised individuals (EUA)
- August 12, 2021: Emergency Use Authorization (EUA) allows a third primary dose (0.3 mL) administered at least 28 days following the 2-dose regimen of an mRNA vaccine in individuals who have undergone solid organ transplantation or who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise
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Booster doses for immunocompromised patients
- CDC recommends booster dose (4th dose) given 5 months after the third primary dose
- Second booster dose (5th dose) recommended at least 4 months after first booster dose of any authorized/approved COVID-19 vaccine
Homologous booster dose (EUA)
- First booster: 0.3 mL IM recommended at least 5 months after completing primary series with the Pfizer-BioNTech COVID-19 vaccine to individuals aged ≥12 years
- Second booster: Recommended at least 4 months after first booster dose of any authorized/approved COVID-19 vaccine for individuals aged ≥50 years
Heterologous boosters (EUA)
- The EUA allows use of each of the available COVID-19 vaccines as a heterologous (or “mix and match”) booster dose to individuals aged ≥18 years following completion of primary vaccination with a different available COVID-19 vaccine
- 0.3 mL IM may be administered as a heterologous booster dose at least 5 months following completion of primary vaccination with another authorized or approved COVID-19 vaccine
- Second booster: Recommended at least 4 months after first booster dose of any authorized/approved COVID-19 vaccine for individuals aged ≥50 years
- Eligible population(s) and dosing interval are the same as those authorized for a booster dose of the vaccine used for primary vaccination (ie, at least 5 months after mRNA-Moderna vaccine or 2 months after single-dose Janssen [Johnson & Johnson] vaccine)
Dosing Considerations
Limitations of effectiveness: May not protect all vaccine recipients
Dosage Forms & Strengths
injection, frozen suspension concentrate
- Requires dilution before administration
- Aged ≥12 years: Purple cap and label border multiple-dose vial (after dilution yields six [30-mcg] doses/vial)
- Aged 5-12 years: Orange cap and label border multiple-dose vial (after dilution yields ten [10-mcg] doses/vial)
COVID-19 Disease Prevention
August 23, 2021 (full FDA approval): Indicated for active immunization to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals aged ≥16 years
2-dose primary series: 0.3 mL (30 mcg) IM x2 doses administered 3 weeks apart
3-8 week interval between doses
- 8-week interval may be optimal for some people aged ≥12 years, especially for males aged 12-39 years owing to the small risk of myocarditis associated with mRNA COVID-19 vaccines
- Shorter interval (3 weeks) between dose 1 and 2 remains the recommended interval for people who are moderately or severely immunocompromised, adults aged ≥65 years, and others who need rapid protection owing increased concern about community transmission or risk of severe disease
- CDC COVID-19 vaccine interim immunization schedule February 25, 2022
12-15 years (EUA)
- May 10, 2021: Emergency Use Authorization (EUA aged ≥12 years) amended to include prevention of COVID-19 caused by SARS-CoV-2 in adolescents aged 12-15 yr
- 2-dose primary series: 0.3 mL (30 mcg; purple cap and label border vial) IM x2 doses administered 3 weeks apart
-
3-8 week interval between doses
- 8-week interval may be optimal for some people aged ≥12 years, especially for males aged 12-39 years owing to the small risk of myocarditis associated with mRNA COVID-19 vaccines
- Shorter interval (3 weeks) between dose 1 and 2 remains the recommended interval for people who are moderately or severely immunocompromised, adults aged ≥65 years, and others who need rapid protection owing increased concern about community transmission or risk of severe disease
- CDC COVID-19 vaccine interim immunization schedule February 25, 2022
5-11 years (EUA)
- October 29, 2021: EUA (aged 5-11 years) granted for prevention of COVID-19 in children aged 5-11 yr
- 2-dose primary series: 0.2 mL (10 mcg; orange cap and label border vial) IM x2 doses administered 3 weeks apart
Third primary dose for severely immunocompromised individuals (EUA)
- EUA reauthorized and recommends third primary dose administered at least 28 days following the 2-dose regimen of an mRNA vaccine in individuals aged ≥5 yr who have undergone solid organ transplantation or who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise
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5-11 years
- 0.2 mL (10 mcg; orange cap and label border vial) IM
- Single booster dose (4th dose) given 5 months after the third primary dose
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≥12 years
- 0.3 mL (30 mcg; purple cap and label border vial) IM
- CDC recommends booster dose (4th dose) given 5 months after the third primary dose
- Second booster dose (5th dose) recommended at least 4 months after first booster for immunosuppressed patients aged >12 years
Homologous booster dose (EUA)
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5-11 years
- Single booster dose (0.2 mL [10 mcg; orange cap and label border vial]) recommended at least 5 months after completing primary series with Pfizer-BioNTech COVID-19 vaccine
- Second booster dose is NOT recommended, except for severely immunosuppressed patients
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≥12 years
- A single booster dose (0.3 mL [30 mcg; purple cap and label border vial]) recommended at least 5 months after completing primary series with Pfizer-BioNTech COVID-19 vaccine
- Second booster dose is NOT recommended, except for severely immunosuppressed patients aged ≥12 years
Heterologous boosters
- Not part of EUA for patients aged <18 years
Dosing Considerations
No data are available on interchangeability of this vaccine with other COVID-19 vaccines in patients aged <18 years; individuals who have received 1 dose should receive a second dose with the same vaccine to complete vaccination series
Limitations of effectiveness: May not protect all vaccine recipients
Adverse Effects
VAERS Reporting
Mandatory for vaccination providers to report to the vaccine adverse events reporting system (VAERS) all vaccine administration errors, serious adverse events, multisystem inflammatory syndrome in adults and children, and hospitalized or fatal cases of COVID-19 following vaccination
>10%
Aged 5-11 years
-
Dose 1
- Pain at the injection site, mild-severe (0.3-58.9%)
- Fatigue, mild-severe (0.3-22%)
- Headache, mild-severe (0.1-16.5%)
-
Dose 2
- Pain at the injection site, mild-severe (0.3-52.8%)
- Fatigue, mild-severe (0.7-21.4%)
- Headache, mild-severe (0.2-18.7%)
Aged 12-15 years
-
Dose 1
- Pain at the injection site, mild-severe (1-43.7%)
- Fatigue, mild-severe (1.3-34.1%)
- Headache, mild-severe (1-32%)
- Chills, mild-severe (0.4-17.3%)
- New or worsened muscle pain, mild-severe (0.2-12.9%)
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Dose 2
- Pain at the injection site, mild-severe (0.6-42.5%)
- Fatigue, mild-severe (2.4-42.7%)
- Headache, mild-severe (2-35%)
- Chills, mild-severe (1.8-20.1%)
- New or worsened muscle pain, mild-severe (0.5-18%)
Aged 16-55 years
-
Dose 1
- Pain at the injection site, mild-severe (1.3-50.5%)
- Headache, mild-severe (1.1-27.1%)
- Fatigue, mild-severe (1.4-26.2%)
- New or worsened muscle pain, mild-severe (0.5-12.2%)
- Chills, mild-severe (0.5-11.7%)
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Dose 2
- Pain at the injection site, mild-severe (1.5-47.5%)
- Fatigue, mild-severe (2.4-35.4%)
- Headache, mild-severe (3.4-26.1%)
- New or worsened muscle pain, mild-severe (2.3-20.6%)
- Chills, mild-severe (2.6-17.8 %)
- New or worsened joint pain, mild-severe (1-11.9%)
Aged ≥56 years
-
Dose 1
- Pain at the injection site, mild-severe (0.2-55.2%)
- Fatigue, mild-severe (0.1-20.7%)
- Headache, mild-severe (0.1-19%)
- New or worsened muscle pain, mild-severe (1.1-15.5%)
-
Dose 2
- Pain at the injection site, mild-severe (0.5-46.9%)
- Fatigue, mild-severe (0.1-26.7%)
- Headache, mild-severe (0.7-24.9%)
- Chills, mild-severe (1.1-12.3 %)
1-10%
Aged 5-11 years
-
Dose 1
- Injection site redness, mild-severe (5.2-9.5%)
- New or worsened muscle pain, mild-severe (0.1-6.4%)
- Injection site swelling, mild-severe (0.1-5.6%)
- Diarrhea, mild-severe (0.7-5.2%)
- Chills, mild-severe (1.1-3.6%)
- New or worsened joint pain, mild-severe (1.1-2.3%)
- Vomiting, mild-severe (0.5-1.7%)
- Fever (≥38°C) (0.2-1.5%)
-
Dose 2
- Injection site redness, mild-severe (0.2-9.5%)
- Injection site swelling, mild-severe (7.5-7.8%)
- New or worsened muscle pain, mild-severe (0.1-7.7%)
- Chills, mild-severe (0.1-7%)
- Diarrhea, mild-severe (0.5-4.8%)
- New or worsened joint pain, mild-severe (1.4-3.8%)
- Fever (≥38°C) (0.1-3.4%)
- Vomiting, mild-severe (0.1-1.8%)
Aged 12-15 years
-
Dose 1
- Diarrhea, mild-severe (1.2-6.8%)
- Fever (≥38°C) (0.1-6.6%)
- New or worsened joint pain, mild-severe (0.1-5.9%)
- Diarrhea, mild-severe (0.5-5.4%)
- Injection site redness, mild-severe (0.1-3.9%)
- Injection site swelling, mild-severe (2-4.9%)
- Vomiting, mild-severe (0.1-2.7%)
-
Dose 2
- Fever (≥38°C) (2.3-9.8%)
- New or worsened joint pain, mild-severe (0.4-8.3%)
- Injection site swelling, mild-severe (1.6-3.3%)
- Injection site redness, mild-severe (2.4-2.6%)
- Vomiting, mild-severe (0.4-2.3%)
Aged 18-55 years
-
Dose 1
- Diarrhea, mild-severe (0.1-8.7%)
- New or worsened joint pain, mild-severe (0.2-6.9%)
- Injection site swelling, mild-severe (0.2-4.3%)
- Injection site redness, mild-severe (0.2-3.9%)
- Fever (≥38°C) (0.3-3%)
- Vomiting, mild-severe (0.2-1%)
-
Dose 2
- Fever (≥38°C) (1.5-9.5%)
- Diarrhea, mild-severe (0.2-8.2%)
- Injection site swelling, mild-severe (0.3-4.1%)
- Injection site redness, mild-severe (0.4-3.4%)
- Vomiting, mild-severe (0.1-1.6%)
Aged >56 years
-
Dose 1
- New or worsened muscle pain, mild-severe (4.5-9.1%)
- Diarrhea, mild-severe (0.2-6.8%)
- New or worsened joint pain, mild-severe (0.1-5.9%)
- Chills, mild-severe (1.4-5.1 %)
- Injection site swelling, mild-severe (0.1-4.3%)
- Injection site redness, mild-severe (0.2-3.5%)
- Fever (≥38°C) (0.1-1.1%)
- Vomiting, mild-severe (0.4%)
-
Dose 2
- New or worsened joint pain, mild-severe (0.5-9.8%)
- Fever (≥38°C) (0.4-8.5%)
- Diarrhea, mild-severe (0.1-6.7%)
- Injection site swelling, mild-severe (0.2-4.3%)
- Injection site redness, mild-severe (0.5-3.5%)
<1%
Malaise (0.5%)
Lymphadenopathy (0.3%)
>56 years
-
Dose 1
- Vomiting, mild-severe (0.4%)
-
Dose 2
- Vomiting, mild-severe (0.1-0.5%)
Postmarketing Experience
Cardiac disorders: Myocarditis, pericarditis
Gastrointestinal disorders: Diarrhea, vomiting
Immune system disorders: Severe allergic reactions, including anaphylaxis, and other hypersensitivity reactions (eg, rash, pruritus, urticaria, angioedema)
Musculoskeletal and connective tissue disorders: Pain in extremity (arm)
Warnings
Contraindications
Known history of severe allergic reaction (eg, anaphylaxis) to any component in vaccine
Cautions
Appropriate treatment used to manage immediate allergic reactions must be immediately available if an acute anaphylactic reaction occurs following administration
Syncope (fainting) may occur; procedures should be in place to avoid injury from fainting
Immunocompromised persons, including individuals receiving immunosuppressant therapy, may have a diminished immune response
May not protect all vaccine recipients
Myocarditis and pericarditis
- May increase risks of myocarditis and pericarditis, particularly within 7 days following the second dose.
- Males aged 12-17 years were at highest risk
- Available data suggest that majority of symptoms resolved with conservative management
- The CDC has published clinical considerations relevant to myocarditis and pericarditis with mRNA COVID-19 vaccines
Pregnancy & Lactation
Pregnancy
Data are insufficient to inform of vaccine-associated risks in pregnancy
CDC guidelines for vaccination of pregnant or lactating females
Pregnancy registry
- Monitors pregnancy outcomes in women exposed to vaccine during pregnancy
- Encourage females who are vaccinated during pregnancy to enroll in the registry
Lactation
Unknown whether vaccine is excreted in human milk
Data are unavailable to assess the effects on breastfed infants or milk production/excretion
For preventive vaccines, underlying maternal condition is susceptibility to disease prevented by the vaccine
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Nucleoside-modified messenger RNA (modRNA) encoding the viral spike (S) glycoprotein of SARS-CoV-2; formulated in lipid particles, which enable delivery of RNA into host cells to allow expression of the SARS-CoV-2 S antigen
Elicits an immune response to the S antigen, which protects against COVID-19
Administration
IM Preparation
Thaw vials before dilution
- Allow vials to thaw in refrigerator (may take up to 3 hr) or at room temperature for 30 minutes
- Using either thawing method, vials must reach room temperature before dilution and must be diluted within 2 hr
-
Thawed under refrigeration
- Thaw and then store undiluted vials in refrigerator at 2-8ºC (35-46ºF) for up to 1 month
- A carton of 25 vials or 195 vials may take up to 2-3 hr, respectively, to thaw in refrigerator, whereas fewer vials will thaw in less time
-
Thawed at room temperature
- For immediate use, thaw undiluted vials at room temperature up to 25ºC (77ºF) for 30 minutes
- Thawed vials can be handled in room light conditions
Dilution
- Before dilution, invert vial gently 10 times; do NOT shake
- Inspect contents; should appear white to off-white suspension and may contain white to off-white opaque amorphous particles
- Do not use if discolored or if other particles observed
- Gently invert diluted vial contents 10 times to mix; do NOT shake
- Record date and time of dilution on vial label
- Store diluted vial at 2-25ºC (35-77ºF); discard any unused vaccine 6 hr after dilution
-
Aged ≥12 years
- Select vial for aged ≥12 years (purple vial cap and label border)
- Dilute vial contents using 1.8 mL of 0.9% NaCl (do NOT use bacteriostatic 0.9% NaCl or any other diluent); equalize vial pressure before removing the needle from the vial by withdrawing 1.8 mL air into the empty diluent syringe
- After dilution, 1 vial contains 6 doses of 0.3 mL (30 mcg); vial labels and cartons may state vial contains 5 doses, however, the latest EAU information supersedes the number of doses stated on vial labels
-
Aged 5-11 years
- Select vial for aged 5-11 years (orange vial cap and label border)
- Dilute vial contents using 1.3 mL of 0.9% NaCl (do NOT use bacteriostatic 0.9% NaCl or any other diluent); equalize vial pressure before removing the needle from the vial by withdrawing 1.3 mL air into the empty diluent syringe
- After dilution, 1 vial contains 10 doses of 0.2 mL (10 mcg)
IM Administration
For IM injection only
Do not pool excess vaccine from multiple vials
Storage
During storage, minimize exposure to room light, and avoid exposure to direct sunlight and ultraviolet light
Do not refreeze thawed vials
Does not contain preservatives
Vial stoppers are not made with natural rubber latex
Frozen vials prior to use
-
Ultra-low freezer
- Vials arrive in thermal containers with dry ice
- Once received, remove vial cartons immediately from the thermal container and store in an ultra-low-temperature freezer at -90ºC to -60ºC (-130ºF to -76ºF); vials must be kept frozen at this temperature range and protected from light in the original cartons until ready to use
-
Short-term storage in pharmaceutical freezer
- Alternatively, vials may be stored at -25ºC to -15ºC (-13ºF to 5ºF) for up to 2 weeks
- Vials must be kept frozen and protected from light until ready to use
- Vials may be returned 1 time to the recommended storage condition of -90ºC to -60ºC (-130ºF to -76ºF)
- Track total cumulative storage time at -25ºC to -15ºC (-13ºF to 5ºF); do not exceed 2 weeks
- May transport under these conditions, but it counts against the total storage time of 2 weeks at this temperature
-
Ultra-low-temperature freezer unavailable
- If an ultra-low-temperature freezer is unavailable, the thermal container in which the vaccine arrives may be used as temporary storage when consistently refilled to the top of the container with dry ice
- Refer to the re-icing guidelines packed in the original thermal container for instructions regarding the use of the thermal container for temporary storage
- The thermal shipping container maintains a temperature range of -90ºC to -60ºC (-130ºF to -76ºF); storage within this temperature range is not considered an excursion from the recommended storage condition
Thawed vials before dilution
-
Thawed under refrigeration
- Thaw and then store undiluted vials in refrigerator at 2-8ºC (35-46ºF) for up to 1 month
- Carton of 25 vials or 195 vials may take up to 2 or 3 hr, respectively, to thaw in refrigerator; whereas, fewer number of vials will thaw in less time
-
Thawed at room temperature
- For immediate use, thaw undiluted vials at room temperature up to 25ºC (77ºF) for 30 minutes
- Thawed vials can be handled in room light conditions
- Vials must reach room temperature before dilution
- Undiluted vials may be stored at room temperature for no more than 2 hr
Vials after dilution
- After dilution, store vials at 2-25ºC (35-77ºF) and use within 6 hr from time of dilution
- During storage, minimize exposure to room light, and avoid exposure to direct sunlight and ultraviolet light
- Discard any vaccine remaining in vials after 6 hr
- Do not refreeze
Images
Formulary
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