COVID-19 Vaccines

(Last modified July 2023)

The charts below provide dosing, storage, adverse effects, efficacy, and other information for COVID-19 vaccines approved or authorized in the US and Canada. The American Society of Health System Pharmacists has resources related to COVID-19 vaccines at https://www.ashp.org/COVID-19/Vaccines?loginreturnUrl=SSOCheckOnly. See end of the chart for links to the fact sheets and product labeling.

COVID-19 Vaccines Available in the UNITED STATES

VACCINE^e	DOSE	STORAGE/STABILITY	COMMENTS
Pfizer BioNTech Bivalent (original and Omicron BA.4/BA.5) for ages 6 months through 4 years (Pfizer-BioNTech)/ mRNA MAROON cap and label with MAROON border EUA Requires dilution with 2.2 mL NS per vial.²	Each dose is 0.2 mL IM. Number and timing of doses depends on COVID-19 vaccine history and immunocompetence.² No previous COVID-19 vaccine: give three doses (at week 0, at week 3, and ≥8 weeks after the 2^nd dose).² Previously vaccinated with one dose of the monovalent Pfizer-BioNTech vaccine: give two doses (≥3 weeks after receipt of the monovalent vaccine, and ≥8 weeks after the 2^nd dose).² Previously vaccinated with two doses of monovalent Pfizer-BioNTech vaccine: give a single dose ≥8 weeks after receipt of the 2^nd monovalent dose.² Previously vaccinated with three doses of monovalent Pfizer-BioNTech vaccine: give a single dose ≥2 months after receipt of the 3^rd monovalent dose.² Immunocompromised and previously vaccinated with three doses of Pfizer-BioNTech vaccine (monovalent or bivalent): Give a 4^th dose ≥1 month after the most recent dose. Additional doses can be given at provider discretion.²	Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d. Refrigerator (2^oC to 8^oC) (option if vials arrive frozen or refrigerated): 10 weeks (undiluted); 12 hours (diluted).² Room temperature (up to 25^oC): 12 hours undiluted;²⁷ 12 hours once diluted.² Vaccine should not be used after 18 months from date of manufacture.²	Approval based on efficacy data from the monovalent vaccine, immunogenicity data from the bivalent vaccine in children 6 months through 4 years of age, and immunogenicity data from a different bivalent vaccine (original and Omicron BA.1) in individuals ≥55 years of age.² Also see footnote b. See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.
Pfizer-BioNTech Bivalent (original and Omicron BA.4/BA.5) for ages 5 through 11 years (Pfizer-BioNTech)/ mRNA ORANGE cap and label with ORANGE border EUA Requires dilution with 1.3 mL of NS per vial.²	Each dose is 0.2 mL IM. Number and timing of doses depends on COVID-19 vaccine history and immunocompetence.² No previous COVID-19 vaccine: Give a single dose.² Previously vaccinated with ≥1 dose of a monovalent COVID-19 vaccine: give a single dose ≥2 months after receipt of the monovalent vaccine.² Immunocompromised: a single additional dose can be given ≥2 months after the initial bivalent COVID-19 vaccine. Additional doses can be given at the healthcare provider’s discretion.²	See above.	See above.
Pfizer-BioNTech Bivalent (original and Omicron BA.4/BA.5) for ages ≥12 years^a (Pfizer BioNTech)/ mRNA) GRAY cap and label with GRAY border EUA Do NOT dilute.	Each dose is 0.3 mL IM. Number and timing of doses depends on COVID-19 vaccine history and immunocompetence.² Give a single dose. If ≥65 years of age, may give an additional dose ≥4 months later.² Immunocompromised: a single additional dose can be given ≥2 months after the initial bivalent COVID-19 vaccine. Additional doses can be given at the healthcare provider’s discretion.²	Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d. Refrigerator (2^oC to 8^oC) (option if vials arrive frozen or refrigerated): 10 weeks.² Room Temp (up to 25^oC): 12 hours prior to first use; 12 hours after first vial puncture.² Vaccine should not be used after 18 months from date of manufacture.²	See above.
mRNA-1273 Bivalent (original and Omicron BA.4/BA.5) (Moderna)/ mRNA Dark BLUE cap and a label with a GRAY border³ EUA	6 months through 5 years of age:³ Not previously vaccinated with a COVID-19 vaccine: give two doses (0.25 mL each) IM one month apart. One previous dose of monovalent Moderna COVID-19 vaccine: give a single 0.25 mL dose IM, one month after receipt of the monovalent vaccine. 6 years through 11 years of age:³ Give a single 0.25 mL dose IM. Give ≥2 months after monovalent COVID-19, if applicable. ≥12 years of age:³ Give a single 0.5 mL dose IM. If ≥65 years of age, may give an additional dose ≥4 months later. Immunocompromised:³ 6 months through 5 years of age who have received two 0.25 mL IM doses of monovalent or bivalent Moderna vaccine, an additional 0.25 mL IM dose of Moderna bivalent vaccine can be given ≥1 month after the most recent dose. Additional doses can be given at the healthcare provider’s discretion. Also see PINK cap presentation, below. ≥6 years of age: an additional age-appropriate dose of Moderna bivalent may be administered ≥2 months after the initial dose of Moderna bivalent. Additional doses can be given at the healthcare provider’s discretion.	Shipping/long-term storage (freezer): See footnote d. Refrigerator (2^oC to 8^oC): 30 days after thawing (prior to first use).³ In-use vial: 12 hours.³ Pre-drawn syringe: 12 hours after first puncture of source vial.¹⁰ Room temperature (8^oC to 25^oC): 24 hours total. Discard 12 hours after first puncture.³ Pre-drawn syringe: 12 hours after first puncture of source vial.¹⁰	Approval based on efficacy data from the monovalent vaccine, and immunogenicity data from a different bivalent booster (original and Omicron BA.1) in individuals ≥18 years of age.³ Also see footnote b. See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.
mRNA-1273 Bivalent (original and Omicron BA.4/BA.5) for ages 6 months through 5 years (Moderna)/ mRNA Dark PINK cap and a label with a YELLOW box.³ EUA	6 months through 5 years of age: single 0.2 mL IM dose ≥2 months after receipt of Moderna monovalent vaccine.³ Immunocompromised, 6 months through 5 years of age: see Dark BLUE cap and label with GRAY border presentation, above. Pink cap presentation may be used for the additional discretionary doses (0.2 mL).³	Shipping/long-term storage (freezer): See footnote d. Refrigerator (2^oC to 8^oC): 30 days after thawing (prior to first use).³ In-use vial: 8 hours.³ Room temperature (8^oC to 25^oC): 24 hours total. Discard 8 hours after first puncture.³	See above.
NVX-CoV2373 (Novavax)/ Recombinant protein subunit, adjuvanted EUA	Primary series for ≥12 years of age: two 0.5 mL IM doses three weeks apart.¹⁴An eight-week interval may reduce the risk of myocarditis/pericarditis.²⁵ Individuals ≥12 years of age who previously received one or more doses of Novavax COVID-19 vaccine are recommended to receive a bivalent mRNA vaccine ≥8 weeks after the last dose.²⁵ Use as a booster: in individuals ≥18 years of age who completed primary vaccination with any COVID-19 vaccine and have not received any boosters, and an mRNA vaccine is not available or appropriate, or is refused, Novavax COVID-19 vaccine 0.5 mL IM can be given ≥6 months after completion of primary vaccination.^14,25 Immunocompromised: response may be diminished.¹⁴	Refrigerator (2^oC to 8^oC): 6 hours (in-use vial or pre-drawn syringe).^10,14 Room temperature (≤25^oC): 6 hours (in-use vial or pre-drawn syringe).^10,14	Effectiveness estimates unknown for current variants.²⁰

VACCINE^e

DOSE

STORAGE/STABILITY

COMMENTS

Pfizer BioNTech Bivalent (original and Omicron BA.4/BA.5) for ages

6 months through 4 years

(Pfizer-BioNTech)/

mRNA

MAROON cap and label with MAROON border

EUA

Requires dilution with

2.2 mL NS per vial.²

Each dose is 0.2 mL IM. Number and timing of doses depends on COVID-19 vaccine history and immunocompetence.²

No previous COVID-19 vaccine: give three doses (at week 0, at week 3, and ≥8 weeks after the 2^nd dose).²

Previously vaccinated with one dose of the monovalent Pfizer-BioNTech vaccine: give two doses (≥3 weeks after receipt of the monovalent vaccine, and ≥8 weeks after the 2^nd dose).²

Previously vaccinated with two doses of monovalent Pfizer-BioNTech vaccine: give a single dose ≥8 weeks after receipt of the 2^nd monovalent dose.²

Previously vaccinated with three doses of monovalent Pfizer-BioNTech vaccine: give a single dose ≥2 months after receipt of the 3^rd monovalent dose.²

Immunocompromised and previously vaccinated with three doses of Pfizer-BioNTech vaccine (monovalent or bivalent): Give a 4^th dose

≥1 month after the most recent dose. Additional doses can be given at provider discretion.²

Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d.

Refrigerator (2^oC to 8^oC) (option if vials arrive frozen or refrigerated): 10 weeks (undiluted); 12 hours (diluted).²

Room temperature (up to 25^oC): 12 hours undiluted;²⁷ 12 hours once diluted.²

Vaccine should not be used after 18 months from date of manufacture.²

Approval based on efficacy data from the monovalent vaccine, immunogenicity data from the bivalent vaccine in children 6 months through 4 years of age, and immunogenicity data from a different bivalent vaccine (original and Omicron BA.1) in individuals ≥55 years of age.² Also see footnote b.

See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.

Pfizer-BioNTech Bivalent (original and Omicron BA.4/BA.5) for ages 5 through 11 years

(Pfizer-BioNTech)/

mRNA

ORANGE cap and label with ORANGE border

EUA

Requires dilution with

1.3 mL of NS per vial.²

Each dose is 0.2 mL IM. Number and timing of doses depends on COVID-19 vaccine history and immunocompetence.²

No previous COVID-19 vaccine: Give a single dose.²

Previously vaccinated with ≥1 dose of a monovalent COVID-19 vaccine: give a single dose ≥2 months after receipt of the monovalent vaccine.²

Immunocompromised: a single additional dose can be given ≥2 months after the initial bivalent COVID-19 vaccine. Additional doses can be given at the healthcare provider’s discretion.²

See above.

Pfizer-BioNTech Bivalent (original and Omicron BA.4/BA.5) for ages ≥12 years^a

(Pfizer BioNTech)/

mRNA)

GRAY cap and label with GRAY border

EUA

Do NOT dilute.

Each dose is 0.3 mL IM. Number and timing of doses depends on COVID-19 vaccine history and immunocompetence.²

Give a single dose. If ≥65 years of age, may give an additional dose ≥4 months later.²

Immunocompromised: a single additional dose can be given ≥2 months after the initial bivalent COVID-19 vaccine. Additional doses can be given at the healthcare provider’s discretion.²

Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d.

Refrigerator (2^oC to 8^oC) (option if vials arrive frozen or refrigerated): 10 weeks.²

Room Temp (up to 25^oC): 12 hours prior to first use; 12 hours after first vial puncture.²

Vaccine should not be used after 18 months from date of manufacture.²

See above.

mRNA-1273 Bivalent (original and Omicron BA.4/BA.5)

(Moderna)/

mRNA

Dark BLUE cap and a label with a GRAY border³

EUA

6 months through 5 years of age:³

Not previously vaccinated with a COVID-19 vaccine: give two doses (0.25 mL each) IM one month apart.
One previous dose of monovalent Moderna COVID-19 vaccine: give a single 0.25 mL dose IM, one month after receipt of the monovalent vaccine.

6 years through 11 years of age:³

Give a single 0.25 mL dose IM. Give ≥2 months after monovalent COVID-19, if applicable.

≥12 years of age:³

Give a single 0.5 mL dose IM. If ≥65 years of age, may give an additional dose ≥4 months later.

Immunocompromised:³

6 months through 5 years of age who have received two 0.25 mL IM doses of monovalent or bivalent Moderna vaccine, an additional 0.25 mL IM dose of Moderna bivalent vaccine can be given ≥1 month after the most recent dose. Additional doses can be given at the healthcare provider’s discretion. Also see PINK cap presentation, below.
≥6 years of age: an additional age-appropriate dose of Moderna bivalent may be administered ≥2 months after the initial dose of Moderna bivalent. Additional doses can be given at the healthcare provider’s discretion.

Shipping/long-term storage (freezer): See footnote d.

Refrigerator (2^oC to 8^oC): 30 days after thawing (prior to first use).³ In-use vial: 12 hours.³ Pre-drawn syringe: 12 hours after first puncture of source vial.¹⁰

Room temperature (8^oC to 25^oC): 24 hours total. Discard 12 hours after first puncture.³ Pre-drawn syringe: 12 hours after first puncture of source vial.¹⁰

Approval based on efficacy data from the monovalent vaccine, and immunogenicity data from a different bivalent booster (original and Omicron BA.1) in individuals ≥18 years of age.³ Also see footnote b.

See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.

mRNA-1273 Bivalent (original and Omicron BA.4/BA.5) for ages

6 months through 5 years

(Moderna)/

mRNA

Dark PINK cap and a label with a YELLOW box.³

EUA

6 months through 5 years of age: single 0.2 mL IM dose ≥2 months after receipt of Moderna monovalent vaccine.³

Immunocompromised, 6 months through 5 years of age: see Dark BLUE cap and label with GRAY border presentation, above. Pink cap presentation may be used for the additional discretionary doses (0.2 mL).³

Shipping/long-term storage (freezer): See footnote d.

Refrigerator (2^oC to 8^oC): 30 days after thawing (prior to first use).³ In-use vial: 8 hours.³

Room temperature (8^oC to 25^oC): 24 hours total. Discard 8 hours after first puncture.³

See above.

NVX-CoV2373

(Novavax)/

Recombinant protein subunit, adjuvanted

EUA

Primary series for ≥12 years of age: two 0.5 mL IM doses three weeks apart.¹⁴An eight-week interval may reduce the risk of myocarditis/pericarditis.²⁵

Individuals ≥12 years of age who previously received one or more doses of Novavax COVID-19 vaccine are recommended to receive a bivalent mRNA vaccine ≥8 weeks after the last dose.²⁵

Use as a booster: in individuals ≥18 years of age who completed primary vaccination with any COVID-19 vaccine and have not received any boosters, and an mRNA vaccine is not available or appropriate, or is refused, Novavax COVID-19 vaccine 0.5 mL IM can be given ≥6 months after completion of primary vaccination.^14,25

Immunocompromised: response may be diminished.¹⁴

Refrigerator (2^oC to 8^oC): 6 hours (in-use vial or pre-drawn syringe).^10,14

Room temperature (≤25^oC): 6 hours (in-use vial or pre-drawn syringe).^10,14

Effectiveness estimates unknown for current variants.²⁰

--Continue to the next section for the COVID-19 Vaccines Available in Canada chart.--

COVID-19 Vaccines Available in CANADA

VACCINE^e	DOSE (Primary Series)	DOSE (Booster)	STORAGE/STABILITY	COMMENTS
BNT162b2 for ages 6 months through 4 years (Pfizer-BioNTech)/ mRNA (Comirnaty) MAROON cap and label border¹⁸ Requires dilution with 2.2 mL NS per vial.¹⁸	Primary vaccination for 6 months through 4 years of age: three 0.2 mL (3 mcg) IM doses. The first two doses are given three weeks apart (8-week interval preferred), followed by a 3^rd dose ≥8 weeks after the 2^nd dose.^18,20 Immunocompromised^f: As above plus 4^th dose, with 4 to 8 weeks between each of the four doses.²⁰	N/A	Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d. Refrigerator (2^oC to 8^oC) (option if vials arrive frozen or refrigerated): 10 weeks undiluted; 12 hours once diluted (vial).¹⁸ Room Temp (up to 25^oC): 12 hours (undiluted); 12 hours (once diluted [vial]).¹⁸ Stable in pre-drawn syringe for 12 hours at room temperature (up to 30^oC).¹⁰ Vaccine should not be used after 18 months from date of manufacture.¹⁸	Efficacy against symptomatic infection ~2 months after the third dose was >70% (Omicron-predominant period).²⁰ See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.
BNT162b2 for ≥12 years of age^a (Pfizer-BioNTech)/ mRNA (Comirnaty) GRAY cap and label border¹⁸ Do NOT dilute.¹⁸	Primary vaccination for ≥12 years of age: two 0.3 mL (30 mcg) IM doses 3 weeks apart (8-week interval preferred).^18,20 Immunocompromised^f: As above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.^18,20	Bivalent booster preferred.^20,c Booster (≥12 years of age [approved for ≥16 years]):^c one 0.3 mL (30 mcg) IM dose ≥6 months (≥3 months in the event of heightened epidemiologic risk) after the primary series, booster, or infection.^11,18 Immunocompromised^f,h: as above.²⁰	Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d. Refrigerator (2^oC to 8^oC): 10 weeks (unpunctured vial).¹⁸ 12 hours (pre-drawn syringe).¹⁰ Room Temp (up to 25^oC): 12 hours (unpunctured vial or pre-drawn syringe).^10,18 Discard vials 12 hours after first puncture.¹⁸ Vaccine should not be used after 18 months from date of manufacture.¹⁸	Case-control data in adults suggests that three doses were 61% effective against symptomatic infection, and 95% effective against severe outcomes from the Omicron variant circulating in Ontario in December 2021.¹³ See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.
BNT162b2 for ages 5 through 11 years (Pfizer-BioNTech)/ mRNA (Comirnaty) ORANGE cap and label border¹⁸ Requires dilution with 1.3 mL of NS per vial.¹⁸	Primary vaccination for 5 to 11 years of age: two 0.2 mL (10 mcg) IM doses 3 weeks apart. (≥8-week interval preferred).^18,20 Immunocompromised: as above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.^18,20	Booster: one 0.2 mL (10 mcg) IM dose ≥6 months after last primary dose.¹⁸	Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d. Refrigerator (2^oC to 8^oC) (option if vials arrive frozen or refrigerated): 10 weeks undiluted; 12 hours once diluted (vial).¹⁸ Room Temp (up to 25^oC): 12 hours (undiluted); 12 hours (once diluted [vial]).¹⁸ Stable in pre-drawn syringe for 24 hours, with no more than 12 hours at room temperature (up to 30^oC).¹⁰ Vaccine should not be used after 18 months from date of manufacture.¹⁸	Efficacy was 68% against hospitalization about one month after the second dose (Omicron BA.1-predominant period).¹⁷ See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.
Pfizer-BioNTech Bivalent (original and Omicron BA.4/BA.5) for≥12 years of age^a (Pfizer-BioNTech)/ mRNA (Comirnaty) GRAY cap and label border.²⁶ Do NOT dilute.²⁶	Primary vaccination for ≥12 years of age: two 0.3 mL (30 mcg) IM doses 3 weeks apart (≥8-week interval preferred).^16,26 Immunocompromised^f: As above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.¹⁶(Spikevax bivalent may be preferred.¹⁶)	Booster (≥12 years of age): one 0.3 mL IM dose ≥3 to 6 months (≥6 months preferred; ≥3 months in the event of heightened epidemiologic risk) after the primary series, booster, or infection.^11,26	Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d. Refrigerator (2^oC to 8^oC): 10 weeks (unpunctured vial).²⁶ Room Temp (up to 25^oC): 12 hours (unpunctured vial).²⁶ Discard vials 12 hours after first puncture.²⁶ Vaccine should not be used after 18 months from date of manufacture.²⁶	Approval based on immunogenicity data from a different bivalent vaccine (original and Omicron BA.1) in individuals ≥55 years of age.²⁶Also see footnote b. See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.
Pfizer-BioNTech Bivalent (original and Omicron BA.4/BA.5) for 5 through 11 years of age (Pfizer-BioNTech)/ mRNA (Comirnaty) ORANGE cap and label border²⁶ Requires dilution with 1.3 mL of NS per vial.²⁶	Primary vaccination for 5 to 11 years of age: two 0.2 mL (10 mcg) IM doses ≥8-weeks aprt.¹⁶ Immunocompromised: as above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.¹⁶(Spikevax bivalent may be preferred.¹⁶)	Booster (5 through 11 years of age): one 0.2 mL IM dose ≥6 months (≥3 months in the event of heightened epidemiologic risk) after the primary series, booster, or infection.^11,26	Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d. Refrigerator (2^oC to 8^oC): 10 weeks (undiluted). 12 hours once diluted.²⁶ Room Temp (up to 25^oC): 12 hours (undiluted). 12 hours once diluted.²⁶ Vaccine should not be used after 18 months from date of manufacture.²⁶	See above.
mRNA-1273 (Moderna)/ mRNA (Spikevax) RED cap and label with a light blue border (0.2 mg/mL)²²	Primary vaccination for ≥12 years of age: two 0.5 mL (100 mcg) IM doses 1 month (4 weeks) apart (8-week interval preferred).^20,22(Comirnaty preferred if 18 to 29 years of age.²⁰) 6 to 11 years of age: two 0.25 mL (50 mcg) IM doses 4 weeks apart (≥8-week interval preferred).^20,22 Immunocompromised^f: as above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.^20,22	Bivalent booster preferred.^20,c Booster (≥12 years of age): one 0.25 mL (50 mcg) IM dose ≥6 months (≥3 months in the event of heightened epidemiologic risk) after the primary series, booster, or infection.^11,22 Immunocompromised^f: as above.²⁰	Shipping/long-term storage (freezer): See footnote d. Refrigerator (2^oC to 8^oC): 30 days after thawing (prior to first use).²² In-use vial: 24 hours.²²Pre-drawn syringe: 12 hours from first puncture of source vial.¹⁰ Room Temp (8^oC to 25^oC): unpunctured or in-use vial: 24 hours total.²² Pre-drawn syringe: 12 hours from first puncture of source vial.¹⁰	Case-control data in adults suggests that three doses were 61% effective against symptomatic infection, and 95% effective against severe outcomes from the Omicron variant circulating in Ontario in December 2021.¹³ See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis. Delayed-type hypersensitivity reaction (e.g., large, red area near injection site) reported most often about a week after first shot. May be itchy, painful, warm, or swollen, and can also involve fingers, elbow, or palm. Not a contraindication to subsequent vaccination.¹⁵
mRNA-1273 (Moderna)/ mRNA (Spikevax) ROYAL blue cap and a label with a PURPLE border²² (0.1 mg/mL) Approved for primary series (6 months through 11 years) and 50 mcg booster (≥12 years of age)²²	Primary vaccination for 6 months through 5 years of age: two 0.25 mL (25 mcg) IM doses 4 weeks apart (≥8 weeks preferred).^20,22 Primary vaccination for 6 through 11 years of age: two 0.5 mL (50 mcg) IM doses 4 weeks apart (≥8 weeks preferred).^20,22 Immunocompromised: as above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.^20,22	Bivalent booster preferred.^20,c Booster (≥12 years of age): one 0.5 mL (50 mcg) IM dose≥6 months (≥3 months in the event of heightened epidemiologic risk) after the primary series, booster, or infection.^11,22	Shipping/long-term storage (freezer): See footnote d. Refrigerator (2^oC to 8^oC): 30 days after thawing (prior to first use).²² In-use vial: 24 hours.²² Room Temp (8^oC to 25^oC): in-use vial: 24 hours.²²	Efficacy ~60% against symptomatic Omicron infection (ages 3 to 5 years, 2 weeks to 2 months post-vaccination).¹² See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.
mRNA-1273 Bivalent (original and Omicron BA.1) (Moderna)/ mRNA (Spikevax Bivalent original and Omicron BA.1) ROYAL blue cap and label with GREEN border¹	Primary vaccination for 6 months through 11 years of age: two 0.25 mL (25 mcg) IM doses ≥8 weeks apart.¹⁶ Primary vaccination for ≥12 years of age: two 0.5 mL (50 mcg) IM doses 8 weeks apart.¹⁶(Comirnaty bivalent preferred for ages 12 to 29 years.¹⁶) Immunocompromised: as above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.¹⁶	Booster (6 to 11 years of age): one 0.25 mL (25 mcg) IM dose ≥6 months (≥3 months in the event of heightened epidemiologic risk) after the last COVID-19 vaccine dose or infection.^1,11 Booster (≥12 years of age): one 0.5 mL (50 mcg) dose ≥6 months (approved ≥4 months)(≥3 months in the event of heightened epidemiologic risk) after the last COVID-19 vaccine dose or infection.^1,11	Shipping/long-term storage (freezer): See footnote d. Refrigerator (2^oC to 8^oC): 30 days after thawing (prior to first use).¹ In-use vial: 24 hours.¹ Room Temp (8^oC to 25^oC): 24 hours total, in-use or unpunctured.¹	Approval based on immunogenicity data.¹ See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.
mRNA-1273 Bivalent (original and Omicron BA.4/BA.5) (Moderna)/ mRNA (Spikevax Bivalent original and Omicron BA.4/BA.5) ROYAL blue cap and label with GREY border¹⁹	Primary vaccination for 6 months through 11 years of age: two 0.25 mL (25 mcg) IM doses ≥8 weeks apart.¹⁶ Primary vaccination for ≥12 years of age: two 0.5 mL (50 mcg) IM doses 8 weeks apart.¹⁶(Comirnaty bivalent preferred for ages 12 to 29 years.¹⁶) Immunocompromised: as above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.¹⁶	Booster (6 to 11 years of age): one 0.25 mL (25 mcg) IM dose ≥6 months (≥3 months in the event of heightened epidemiologic risk) after the last COVID-19 vaccine dose or infection.^1,11 Booster (≥12 years of age): one 0.5 mL (50 mcg) dose ≥6 months (approved ≥4 months) (≥3 months in the event of heightened epidemiologic risk) after the last COVID-19 vaccine dose or infection.^1,11	Shipping/long-term storage (freezer): See footnote d. Refrigerator (2^oC to 8^oC): 30 days after thawing (prior to first use).¹⁹ In-use vial: 24 hours.¹⁹ Room Temp (8^oC to 25^oC): 24 hours total, in-use or unpunctured.¹⁹	Approval based on immunogenicity data.¹Also see footnote b. See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.
Ad26.COV2.S Janssen (J&J)/ Viral vector (non-replicating) (Jcovden) mRNA vaccine preferred.²⁰	Primary vaccination for ≥18 years of age: one 0.5 mL IM dose.²⁴ Immunocompromised: as above, plus 2^nd dose, (mRNA vaccine)4 to 8 weeks later.²⁰	Bivalent booster preferred.^11,c First Booster (only when all other vaccines are contraindicated): ≥2 months after the first dose.²⁴(As a booster after primary vaccination with an mRNA vaccine, a dosing interval of 3 to 6 months was used in clinical trials.²⁴)	Shipping/long-term storage (freezer): See footnote d. Refrigerator (2^oC to 8^oC): up to 11 months, not to exceed manufacturer expiration date (unpunctured vial).²⁴ In-use vial/pre-drawn syringe: 6 hours.²⁴ Room Temp (9^oC to 25^oC): unpunctured vial: 12 hours.²⁴ In-use vial/pre-drawn syringe: 3 hours.²⁴	Efficacy 54.3% against symptomatic infection two to four months after mRNA booster (Omicron BA.1-predominant period).⁷ See our FAQ, Communicating About COVID-19 Vaccination, for information about thrombosis with thrombocytopenia syndrome (TTS) and other rare side effects of viral vector COVID-19 vaccines.
NVX-CoV2373 (Novavax)/ Recombinant protein subunit, adjuvanted (Nuvaxovid) mRNA vaccine preferred.²⁰	Primary vaccination for ≥12 years of age: two 0.5 mL IM doses three weeks apart (8-week interval preferred).^8,20 Immunocompromised^f: As above, plus 3^rd dose, with 4 to 8 weeks between each of the three doses (mRNA vaccine preferred).²⁰	Bivalent booster preferred.^11,c Booster (≥18 years of age): one 0.5 mL IM dose ≥6 months (≥3 months in the event of heightened epidemiologic risk) after the last COVID-19 vaccine dose or infection.^8,11	Refrigerator (2^oC to 8^oC): 12 hours (in-use vial) or 6 hours (pre-drawn syringe).^8,10 Room Temp (≤25^oC): 6 hours (in-use vial or pre-drawn syringe).^8,10	Effectiveness estimates unknown for current variants.²⁰

VACCINE^e

DOSE (Primary Series)

DOSE (Booster)

STORAGE/STABILITY

COMMENTS

BNT162b2 for ages

6 months through 4 years

(Pfizer-BioNTech)/

mRNA

(Comirnaty)

MAROON cap and label border¹⁸

Requires dilution with

2.2 mL NS per vial.¹⁸

Primary vaccination for 6 months through 4 years of age: three 0.2 mL (3 mcg) IM doses. The first two doses are given three weeks apart (8-week interval preferred), followed by a 3^rd dose ≥8 weeks after the 2^nd dose.^18,20

Immunocompromised^f: As above plus 4^th dose, with 4 to 8 weeks between each of the four doses.²⁰

N/A

Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d.

Refrigerator (2^oC to 8^oC) (option if vials arrive frozen or refrigerated): 10 weeks undiluted; 12 hours once diluted (vial).¹⁸

Room Temp (up to 25^oC):

12 hours (undiluted); 12 hours (once diluted [vial]).¹⁸

Stable in pre-drawn syringe for 12 hours at room temperature (up to 30^oC).¹⁰

Vaccine should not be used after 18 months from date of manufacture.¹⁸

Efficacy against symptomatic infection ~2 months after the third dose was >70% (Omicron-predominant period).²⁰

See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.

BNT162b2 for ≥12 years of age^a

(Pfizer-BioNTech)/

mRNA

(Comirnaty)

GRAY cap and label border¹⁸

Do NOT dilute.¹⁸

Primary vaccination for ≥12 years of age: two 0.3 mL (30 mcg) IM doses 3 weeks apart (8-week interval preferred).^18,20

Immunocompromised^f: As above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.^18,20

Bivalent booster preferred.^20,c

Booster (≥12 years of age [approved for ≥16 years]):^c one 0.3 mL (30 mcg) IM dose ≥6 months (≥3 months in the event of heightened epidemiologic risk) after the primary series, booster, or infection.^11,18

Immunocompromised^f,h: as above.²⁰

Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d.

Refrigerator (2^oC to 8^oC):

10 weeks (unpunctured vial).¹⁸ 12 hours (pre-drawn syringe).¹⁰

Room Temp (up to 25^oC): 12 hours (unpunctured vial or pre-drawn syringe).^10,18 Discard vials 12 hours after first puncture.¹⁸

Vaccine should not be used after 18 months from date of manufacture.¹⁸

Case-control data in adults suggests that three doses were 61% effective against symptomatic infection, and 95% effective against severe outcomes from the Omicron variant circulating in Ontario in December 2021.¹³

See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.

BNT162b2 for ages

5 through 11 years

(Pfizer-BioNTech)/

mRNA

(Comirnaty)

ORANGE cap and label border¹⁸

Requires dilution with

1.3 mL of NS per vial.¹⁸

Primary vaccination for 5 to 11 years of age: two 0.2 mL (10 mcg) IM doses 3 weeks apart. (≥8-week interval preferred).^18,20

Immunocompromised: as above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.^18,20

Booster: one 0.2 mL (10 mcg) IM dose ≥6 months after last primary dose.¹⁸

Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d.

Refrigerator (2^oC to 8^oC) (option if vials arrive frozen or refrigerated): 10 weeks undiluted; 12 hours once diluted (vial).¹⁸

Room Temp (up to 25^oC): 12 hours (undiluted); 12 hours (once diluted [vial]).¹⁸

Stable in pre-drawn syringe for 24 hours, with no more than 12 hours at room temperature (up to 30^oC).¹⁰

Vaccine should not be used after 18 months from date of manufacture.¹⁸

Efficacy was 68% against hospitalization about one month after the second dose (Omicron BA.1-predominant period).¹⁷

See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.

Pfizer-BioNTech Bivalent

(original and Omicron BA.4/BA.5) for≥12 years of age^a

(Pfizer-BioNTech)/

mRNA

(Comirnaty)

GRAY cap and label border.²⁶

Do NOT dilute.²⁶

Primary vaccination for ≥12 years of age: two 0.3 mL (30 mcg) IM doses 3 weeks apart (≥8-week interval preferred).^16,26

Immunocompromised^f: As above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.¹⁶(Spikevax bivalent may be preferred.¹⁶)

Booster (≥12 years of age): one 0.3 mL IM dose ≥3 to 6 months (≥6 months preferred; ≥3 months in the event of heightened epidemiologic risk) after the primary series, booster, or infection.^11,26

Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d.

Refrigerator (2^oC to 8^oC):

10 weeks (unpunctured vial).²⁶

Room Temp (up to 25^oC): 12 hours (unpunctured vial).²⁶

Discard vials 12 hours after first puncture.²⁶

Vaccine should not be used after 18 months from date of manufacture.²⁶

Approval based on immunogenicity data from a different bivalent vaccine (original and Omicron BA.1) in individuals ≥55 years of age.²⁶Also see footnote b.

See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.

Pfizer-BioNTech Bivalent (original and Omicron BA.4/BA.5) for 5 through 11 years of age

(Pfizer-BioNTech)/

mRNA

(Comirnaty)

ORANGE cap and label border²⁶

Requires dilution with

1.3 mL of NS per vial.²⁶

Primary vaccination for 5 to 11 years of age: two 0.2 mL (10 mcg) IM doses ≥8-weeks aprt.¹⁶

Immunocompromised: as above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.¹⁶(Spikevax bivalent may be preferred.¹⁶)

Booster (5 through 11 years of age): one 0.2 mL IM dose ≥6 months (≥3 months in the event of heightened epidemiologic risk) after the primary series, booster, or infection.^11,26

Shipping/long-term storage (ultra-low temp freezer, freezer): See footnote d.

Refrigerator (2^oC to 8^oC):

10 weeks (undiluted). 12 hours once diluted.²⁶

Room Temp (up to 25^oC): 12 hours (undiluted). 12 hours once diluted.²⁶

Vaccine should not be used after 18 months from date of manufacture.²⁶

See above.

mRNA-1273

(Moderna)/

mRNA

(Spikevax)

RED cap and label with a light blue border (0.2 mg/mL)²²

Primary vaccination for ≥12 years of age: two 0.5 mL (100 mcg) IM doses 1 month (4 weeks) apart (8-week interval preferred).^20,22(Comirnaty preferred if 18 to 29 years of age.²⁰)

6 to 11 years of age: two 0.25 mL (50 mcg) IM doses 4 weeks apart (≥8-week interval preferred).^20,22

Immunocompromised^f: as above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.^20,22

Bivalent booster preferred.^20,c

Booster (≥12 years of age): one 0.25 mL (50 mcg) IM dose ≥6 months (≥3 months in the event of heightened epidemiologic risk) after the primary series, booster, or infection.^11,22

Immunocompromised^f: as above.²⁰

Shipping/long-term storage (freezer): See footnote d.

Refrigerator (2^oC to 8^oC): 30 days after thawing (prior to first use).²²

In-use vial: 24 hours.²²Pre-drawn syringe: 12 hours from first puncture of source vial.¹⁰

Room Temp (8^oC to 25^oC): unpunctured or in-use vial: 24 hours total.²² Pre-drawn syringe: 12 hours from first puncture of source vial.¹⁰

See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.

Delayed-type hypersensitivity reaction (e.g., large, red area near injection site) reported most often about a week after first shot. May be itchy, painful, warm, or swollen, and can also involve fingers, elbow, or palm. Not a contraindication to subsequent vaccination.¹⁵

mRNA-1273

(Moderna)/

mRNA

(Spikevax)

ROYAL blue cap and a label with a PURPLE border²²

(0.1 mg/mL)

Approved for primary series (6 months through 11 years) and 50 mcg booster (≥12 years of age)²²

Primary vaccination for 6 months through 5 years of age: two 0.25 mL (25 mcg) IM doses 4 weeks apart (≥8 weeks preferred).^20,22

Primary vaccination for 6 through 11 years of age: two 0.5 mL (50 mcg) IM doses 4 weeks apart (≥8 weeks preferred).^20,22

Immunocompromised: as above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.^20,22

Bivalent booster preferred.^20,c

Booster (≥12 years of age): one 0.5 mL (50 mcg) IM dose≥6 months (≥3 months in the event of heightened epidemiologic risk) after the primary series, booster, or infection.^11,22

Shipping/long-term storage (freezer): See footnote d.

Refrigerator (2^oC to 8^oC): 30 days after thawing (prior to first use).²² In-use vial: 24 hours.²²

Room Temp (8^oC to 25^oC): in-use vial: 24 hours.²²

Efficacy ~60% against symptomatic Omicron infection (ages 3 to 5 years, 2 weeks to 2 months post-vaccination).¹²

See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.

mRNA-1273 Bivalent (original and Omicron BA.1)

(Moderna)/

mRNA

(Spikevax Bivalent original and Omicron BA.1)

ROYAL blue cap and label with GREEN border¹

Primary vaccination for 6 months through 11 years of age: two 0.25 mL (25 mcg) IM doses ≥8 weeks apart.¹⁶

Primary vaccination for ≥12 years of age: two 0.5 mL (50 mcg) IM doses 8 weeks apart.¹⁶(Comirnaty bivalent preferred for ages 12 to 29 years.¹⁶)

Immunocompromised: as above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.¹⁶

Booster (6 to 11 years of age): one 0.25 mL (25 mcg) IM dose ≥6 months (≥3 months in the event of heightened epidemiologic risk) after the last COVID-19 vaccine dose or infection.^1,11

Booster (≥12 years of age): one 0.5 mL (50 mcg) dose ≥6 months (approved ≥4 months)(≥3 months in the event of heightened epidemiologic risk) after the last COVID-19 vaccine dose or infection.^1,11

Shipping/long-term storage (freezer): See footnote d.

Refrigerator (2^oC to 8^oC): 30 days after thawing (prior to first use).¹ In-use vial: 24 hours.¹

Room Temp (8^oC to 25^oC): 24 hours total, in-use or unpunctured.¹

Approval based on immunogenicity data.¹

See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.

mRNA-1273 Bivalent (original and Omicron BA.4/BA.5)

(Moderna)/

mRNA

(Spikevax Bivalent original and Omicron BA.4/BA.5)

ROYAL blue cap and label with GREY border¹⁹

Primary vaccination for 6 months through 11 years of age: two 0.25 mL (25 mcg) IM doses ≥8 weeks apart.¹⁶

Primary vaccination for ≥12 years of age: two 0.5 mL (50 mcg) IM doses 8 weeks apart.¹⁶(Comirnaty bivalent preferred for ages 12 to 29 years.¹⁶)

Immunocompromised: as above plus 3^rd dose, with 4 to 8 weeks between each of the three doses.¹⁶

Booster (6 to 11 years of age): one 0.25 mL (25 mcg) IM dose ≥6 months (≥3 months in the event of heightened epidemiologic risk) after the last COVID-19 vaccine dose or infection.^1,11

Booster (≥12 years of age): one 0.5 mL (50 mcg) dose ≥6 months (approved ≥4 months) (≥3 months in the event of heightened epidemiologic risk) after the last COVID-19 vaccine dose or infection.^1,11

Shipping/long-term storage (freezer): See footnote d.

Refrigerator (2^oC to 8^oC): 30 days after thawing (prior to first use).¹⁹ In-use vial: 24 hours.¹⁹

Room Temp (8^oC to 25^oC): 24 hours total, in-use or unpunctured.¹⁹

Approval based on immunogenicity data.¹Also see footnote b.

See our FAQ, Communicating About COVID-19 Vaccination, for information about myocarditis/pericarditis.

Ad26.COV2.S

Janssen (J&J)/

Viral vector (non-replicating)

(Jcovden)

mRNA vaccine preferred.²⁰

Primary vaccination for ≥18 years of age: one 0.5 mL IM dose.²⁴

Immunocompromised: as above, plus 2^nd dose, (mRNA vaccine)4 to 8 weeks later.²⁰

Bivalent booster preferred.^11,c

First Booster (only when all other vaccines are contraindicated): ≥2 months after the first dose.²⁴(As a booster after primary vaccination with an mRNA vaccine, a dosing interval of 3 to 6 months was used in clinical trials.²⁴)

Shipping/long-term storage (freezer): See footnote d.

Refrigerator (2^oC to 8^oC): up to 11 months, not to exceed manufacturer expiration date (unpunctured vial).²⁴ In-use vial/pre-drawn syringe:

6 hours.²⁴

Room Temp (9^oC to 25^oC): unpunctured vial: 12 hours.²⁴ In-use vial/pre-drawn syringe: 3 hours.²⁴

Efficacy 54.3% against symptomatic infection two to four months after mRNA booster (Omicron BA.1-predominant period).⁷

See our FAQ, Communicating About COVID-19 Vaccination, for information about thrombosis with thrombocytopenia syndrome (TTS) and other rare side effects of viral vector COVID-19 vaccines.

NVX-CoV2373

(Novavax)/

Recombinant protein subunit, adjuvanted

(Nuvaxovid)

mRNA vaccine preferred.²⁰

Primary vaccination for ≥12 years of age: two 0.5 mL IM doses three weeks apart (8-week interval preferred).^8,20

Immunocompromised^f: As above, plus 3^rd dose, with 4 to 8 weeks between each of the three doses (mRNA vaccine preferred).²⁰

Bivalent booster preferred.^11,c

Booster (≥18 years of age): one 0.5 mL IM dose ≥6 months (≥3 months in the event of heightened epidemiologic risk) after the last COVID-19 vaccine dose or infection.^8,11

Refrigerator (2^oC to 8^oC):

12 hours (in-use vial) or 6 hours (pre-drawn syringe).^8,10

Room Temp (≤25^oC): 6 hours (in-use vial or pre-drawn syringe).^8,10

Effectiveness estimates unknown for current variants.²⁰

The adult formulation of the Pfizer-BioNTech vaccine CANNOT be used for children <12 years of age by using a dose-adjusted volume. This is because the resulting volume is too small for an intramuscular injection.⁶
Efficacy: Absolute efficacy of the bivalent booster (Original and Omicron BA.4/BA.5) against hospitalization vs receiving no previous COVID-19 vaccine doses was 84% (95% CI 64% to 93%) in one US cohort.⁴ Absolute efficacy of the bivalent booster against infection vs receiving no previous COVID-19 vaccine doses varied based on age and number of previous monovalent doses and ranged from 19% to 50%.⁵ The bivalent booster was also more effective than previous vaccination with the monovalent booster in regard to preventing infection and hospitalization.^4,5 For the Omicron BA.2-related sublineage XBB.1.5, efficacy of the bivalent booster against symptomatic infection relative to monovalent vaccine alone was 38% to 50% depending on age and time since last dose.⁹ Note that many of the patients in these studies likely had at least some natural immunity, which would reduce relative efficacy of the booster. For the most current CDC-authored vaccine effectiveness studies, see COVID-19 Vaccine Effectiveness Monthly Update at https://covid.cdc.gov/covid-data-tracker/#vaccine-effectiveness.
Bivalent booster (age-appropriate) preferred, regardless of the number of booster doses previously received, and can be offered to all individuals ≥5 years of age, especially those at increased risk.¹¹
See product labeling for storage in ultra-low freezer, freezer, and thawing before use, if applicable.
Tips to minimize vaccine waste include:^10,23

Maintain the cold chain to prevent waste due to inappropriate storage conditions.
Maximize doses drawn from multidose vials using:
- low dead-volume syringes/needles.
- techniques to minimize leakage (e.g., multiple puncture locations in the rubber stopper, instead of the same location over and over [this can create a larger hole]).
Draw up an appropriate number of syringes based on expected vaccination appointments for the day.
- Monitor appointment cancellations and no shows throughout the day. Then draw up afternoon doses based on the revised appointment list.
Use syringes in order of expiration time, starting with the earliest expiration date.
Maintain a waiting list to contact people at the end of the day if there are extra doses available.

US: Immunocompromise = solid organ transplant patients or similar level of immunocompromise. For a full list of CDC-recommended conditions, see https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#immunocompromised.

Canada: See a full list of immunocompromising conditions, see the Canadian Immunization Guide: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-3-vaccination-specific-populations/page-8-immunization-immunocompromised-persons.html.

Abbreviations: EUA = Emergency Use Authorization; IM = intramuscular; NS = normal saline

The CDC has interim recommendations for COVID-19 vaccine administration errors and deviations available at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us-appendix.html#appendix-d.

Fact Sheets and Product Labeling

Pfizer-BioNTech vaccine, bivalent. EUA fact sheet for healthcare professionals (US): https://www.fda.gov/media/167211/download
Pfizer-BioNTech vaccine, bivalent. EUA fact sheet for patients (US): https://www.fda.gov/media/167212/download
Moderna vaccine, bivalent EUA fact sheet for healthcare professionals (US): https://www.fda.gov/media/167208/download
Moderna vaccine, bivalent. EUA fact sheet for patients (US): https://www.fda.gov/media/167209/download
Novavax vaccine EUA fact sheet for healthcare professionals (US): https://www.fda.gov/media/159897/download
Novavax vaccine fact sheet for patients (US): https://www.fda.gov/media/159898/download

Current Canadian product monographs for Covid-19 vaccines available in Canada can be found at Health Canada’s COVID-19 Vaccines and Treatments Portal (https://covid-vaccine.canada.ca/)

References

Product monograph for Spikevax Bivalent (Original and Omicron BA.1). Moderna Therapeutics. Cambridge, MA 02139. February 2023.
FDA. Fact sheet for healthcare providers administering vaccine: emergency use authorization of Pfizer-Biontech COVID-19 vaccine, bivalent (original and Omicron. April 28, 2023. BA.4/BA.5). https://www.fda.gov/media/167211/download. (Accessed May 2, 2023).
FDA. Fact sheet for healthcare providers administering vaccine: emergency use authorization of Moderna COVID-19 vaccine, bivalent (original and omicron BA.4/BA.5). April 17, 2023. https://www.fda.gov/media/167208/download. (Accessed May 2, 2023).
Surie D, DeCuir J, Zhu Y, et al.Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19–Associated Hospitalization Among Immunocompetent Adults Aged ≥65 Years — IVY Network, 18 States, September 8–November 30, 2022. MMWR Morb Mortal Wkly Rep. 2022 Dec 30;71(5152):1625-1630.
Link-Gelles R, Ciesla AA, Fleming-Dutra KE, et al. Effectiveness of Bivalent mRNA Vaccines in Preventing Symptomatic SARS-CoV-2 Infection — Increasing Community Access to Testing Program, United States, September–November 2022. MMWR Morb Mortal Wkly Rep. 2022 Dec 2;71(48):1526-1530.
American Pharmacists Association. Considerations for COVID-19 vaccination in adolescents and children. July 7, 2022. https://www.pharmacist.com/Practice/COVID-19/Know-the-Facts/Considerations-for-COVID-19-vaccination-in-adolescents-and-children. (Accessed May 3, 2023).
Accorsi EK, Britton A, Shang N, et al. Effectiveness of Homologous and Heterologous Covid-19 Boosters against Omicron. N Engl J Med. 2022 Jun 23;386(25):2433-2435.
Product monograph for Nuvaxovid. Novavax. Gaithersburg, MD 20878. March 2023.
Link-Gelles R, Ciesla AA, Roper LE, et al.Early Estimates of Bivalent mRNA Booster Dose Vaccine Effectiveness in Preventing Symptomatic SARS-CoV-2 Infection Attributable to Omicron BA.5- and XBB/XBB.1.5-Related Sublineages Among Immunocompetent Adults - Increasing Community Access to Testing Program, United States, December 2022-January 2023. MMWR Morb Mortal Wkly Rep. 2023 Feb 3;72(5):119-124.
USP. COVID-19 vaccine handling toolkit: operational considerations for healthcare practitioners. Version 6.0. October 2022. https://www.usp.org/covid-19/vaccine-handling-toolkit. (Accessed May 2, 2023).
National Advisory Committee on Immunization (NACI). An Advisory Committee Statement (ACS). Guidance on COVID-19 vaccine booster doses: initial considerations for 2023. January 20, 2023. https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/guidance-covid-19-vaccine-booster-doses-initial-considerations-2023/guidance-covid-19-vaccine-booster-doses-initial-considerations-2023.pdf. (Accessed July 10, 2023).
Fleming-Dutra KE, Ciesla AA, Roper LE, et al. Preliminary Estimates of Effectiveness of Monovalent mRNA Vaccines in Preventing Symptomatic SARS-CoV-2 Infection Among Children Aged 3-5 Years - Increasing Community Access to Testing Program, United States, July 2022-February 2023. MMWR Morb Mortal Wkly Rep. 2023 Feb 17;72(7):177-182.
Buchan SA, Chung H, Brown KA, et al. Estimated Effectiveness of COVID-19 Vaccines Against Omicron or Delta Symptomatic Infection and Severe Outcomes. JAMA Netw Open. 2022 Sep 1;5(9):e2232760.
FDA, Fact sheet for healthcare providers administering vaccine (vaccination providers). Emergency use authorization (EUA) of the Novavax COVID-19 vaccine, adjuvanted to prevent coronavirus disease 2019 (COVID-19). March 28, 2023. https://www.fda.gov/media/159897/download. (Accessed May 2, 2023).
Blumenthal KG, Freeman EE, Saff RR, et al. Delayed large local reactions to mRNA-1273 vaccine against SARS-CoV-2. N Engl J Med 2021;384:1273-1277.
Government of Canada. Interim guidance on the use of bivalent Omicron-containing COVID-19 vaccines for primary series. June 9, 2023. https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/national-advisory-committee-immunization-interim-guidance-use-bivalent-omicron-containing-covid-19-vaccines-primary-series.html. (Accessed July 11, 2023).
Price AM, Olson SM, Newhams MM, et al. BNT162b2 Protection against the Omicron Variant in Children and Adolescents. N Engl J Med. 2022 May 19;386(20):1899-1909.
Product monograph for Comirnaty. Pfizer. Canada. Kirkland, QC H9J 2M5. March 2023.
Product monograph for Spikevax Bivalent. Original/Omicron BA.4/BA.5. Ingmar Strategies. Oakville, ON L6L 0C4.May 2023.
Government of Canada. COVID-19 vaccine: Canadian Immunization Guide. Date modified: June 27, 2023. https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-26-covid-19-vaccine.html#t4. (Accessed July 10, 2023).
Menegale F, Manica M, Zardini A, et al. Evaluation of Waning of SARS-CoV-2 Vaccine-Induced Immunity: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023 May 1;6(5):e2310650.
Product monograph for Spikevax. Moderna Therapeutics. Cambridge, MA 02139. January 2023.
Coppock K. ISMP provides recommendations for avoiding COVID-19 vaccination administration errors. January 15, 2021. https://www.pharmacytimes.com/view/ismp-provides-recommendations-for-avoiding-covid-19-vaccination-administration-errors. (Accessed May 4, 2023).
Product monograph for Janssen COVID-19 vaccine. Janssen. Toronto, ON M3C 1L9. February 2023.
CDC. Use of COVID-19 vaccines in the United States. Interim clinical considerations. Last updated May 12, 2023. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html. (Accessed May 15, 2023).
Product monograph for Comirnaty Original/Omicron BA.4/BA.5. Pfizer Canada. Kirkland, QC H9J 2M5. July 2023.
CDC. Vaccine storage and handling toolkit. January 2023. https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-handling-toolkit.pdf. (Accessed May 22, 2023).

Cite this document as follows: Clinical Resource, COVID-19 Vaccines. Pharmacist’s Letter/Pharmacy Technician’s Letter. July 2023. [390731]

COVID-19 Vaccines

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