About the COVID-19 Vaccines

Pfizer-BioNTech COVID-19 Vaccine Information

The Food and Drug Administration (FDA) authorized the Pfizer-BioNTech COVID-19 Vaccine for use in those 6 months through 15 years old and fully approved the same vaccine (under the name Comirnaty) for those 16 years old and up. The Advisory Committee on Immunization Practices (ACIP) and Western States Scientific Safety Review Workgroup also recommend the vaccine.

Vaccine Summary

The Pfizer-BioNTech COVID-19 Vaccine for those 6 months through 4 years is a three-dose series, the first 2 doses given 21 days apart and the third dose given at least 8 weeks after the second dose.

The Pfizer-BioNTech COVID-19 Vaccine for those 5 and older vaccine is a two-dose series, given 21 days apart, plus:

The clinical trials revealed no major unanticipated adverse events.

Resources

Dry Ice Safety

Moderna COVID-19 Vaccine Information

The Food and Drug Administration (FDA) authorized the Moderna COVID-19 Vaccine for use in those ages 6 months through 17 years old and fully approved the same vaccine (under the name Spikevax) for persons 18 years and older. The Advisory Committee on Immunization Practices (ACIP) and Western States Scientific Safety Review Workgroup also recommend the vaccine.

Vaccine Summary

The Moderna COVID-19 Vaccine for those 6 months through 17 years is a two-dose series, given one month apart. An additional (third) dose is authorized for immunocompromised individuals.

The 18-and-older vaccine is a two-dose series, given 28 days apart, plus:

No serious safety concerns were found.

Resources

Johnson & Johnson – Janssen COVID-19 Vaccine Information

On May 6, 2022 the U.S. Food and Drug Administration limited the authorized use of the Johnson & Johnson (Janssen) COVID-19 vaccine. Everyone 18 and older who received a primary vaccine and booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine at least 4 months ago should receive a second booster dose using an mRNA COVID-19 vaccine.

Read their full statement.

DOH has rescinded standing orders for J&J.

Vaccine Summary

The vaccine is a one-dose series, plus a booster shot for people 18 year and older at least two months after completing the primary series.

In December 2021, the Centers for Disease Control and Prevention (CDC) recommended people choose to get an mRNA COVID-19 vaccine (Pfizer or Moderna) instead of the Johnson & Johnson COVID-19 vaccine due to the rare risk of TTS, a condition in which a low blood platelet level interferes with the formation of blood clots, and Guillain Barré Syndrome, an autoimmune disorder which can result in permanent nerve damage. If patients aren't able or willing to get an mRNA vaccine, they can still get a Johnson & Johnson vaccine.

Resources

Vaccine Requirements

Is the COVID-19 vaccine required?

It will be your choice whether to get the vaccine for COVID-19, but some employers, colleges, and universities may require it.

Can I opt out of the COVID-19 vaccine requirement?

It varies by employer. Talk with your employer or human resources office about their vaccine opt out or accommodation policies.

How do I prove that I got vaccinated?

Talk with your employer or human resources office about what they require for proof of vaccination. You may need to show your vaccine record card. If you lost your card, you can get proof of vaccination for free through MyIRMobile. For language assistance or additional help getting your records, please call 833-VAX-HELP (833-829-4357) or email waiisrecords@doh.wa.gov.

What if I can't or don't want to get the COVID-19 vaccine?

Washington requires health care, long-term care, cabinet-agency state employees and employees in education (public and private K-12 school, childcare, early learning, and higher education) to be fully vaccinated by October 18, 2021, as a condition of employment. If you need an accommodation, talk with your employer or human resources office. You may be able to continue working with additional safety requirements, such as regular COVID-19 testing, masking, or other measures.

Is the COVID-19 vaccine required for my patients?

Most likely not. Washington currently only requires cabinet agency state employees, health care workers, long-term care workers, and employees in education (public and private K-12 school, childcare, early learning, and higher education) to get the COVID-19 vaccine. However, your patient's employer, college, or university could decide to require the vaccine for their staff or students.

It's your patient's choice to get vaccinated, but you can talk to them and encourage them to get the vaccine. Check out the Power of Providers Initiative for resources.

What should I do for patients who can't or don't want to get the COVID-19 vaccine?

You may choose to document the patient's reason for not getting the COVID-19 vaccine in their health record.

If your patient's employer or college/university requires the COVID-19 vaccine, or they are required to have the vaccine per Gov. Jay Inslee's August 9 proclamation, they should check with their employer or college/university to find out how they collect proof of vaccination, if they have an opt-out policy, and what they would need to do to opt out. The Department of Health is not involved in the employer's or college's/university's policy.

Your patients do not need to get an exemption form from the Department of Health (DOH) for the COVID-19 vaccine. DOH does not have exemption forms for the COVID-19 vaccine. The Washington state Certificate of Exemption (COE) is only for parents/guardians who wish to exempt their child from the immunizations required for children in K-12 schools, preschools, or child care. Currently, Washington does not require the COVID-19 vaccine for children to attend school or child care, so it is not included on the COE. Any DOH Certificate of Exemptions including COVID-19 vaccines are fake.

Frequently Asked Questions

Does the COVID-19 vaccine work against variant strains?

The COVID-19 vaccines help slow the spread of the virus and keep variant strains in check. They also protect against hospitalization and death for all known virus variants.

Some vaccinated people may still get infected with a variant strain, but research has shown they tend to experience mild symptoms. It's especially important to get all recommended doses for maximum protection against variants. Visit our pages on the COVID-19 variants and vaccine breakthrough for more information.

Vaccination is the best protection against COVID-19. High vaccination coverage will reduce the spread of the virus and help prevent new virus variants from emerging.

Should I administer extra vaccine doses to my patients?

An additional dose is for patients who completed the initial vaccine series but didn't have a strong enough immune response. A booster dose is for patients when it's likely that their immunity after the initial vaccine series waned over time.

The Centers for Disease Control and Prevention (CDC) and the Western States Scientific Safety Review Workgroup recommend booster doses for everyone 5 years and older.

CDC also recommended an additional dose of mRNA (Pfizer-BioNTech or Moderna) COVID-19 vaccines for certain immunocompromised groups. These patients may also get a booster (fourth) dose after getting the additional (third) dose.

  Who Gets It When to Get It

Additional dose

People who are immunocompromised who got a two-dose mRNA COVID-19 vaccine.*

See the Centers for Disease Control and Prevention's (CDC) interim clinical considerations for a list of immunocompromising conditions.

At least 28 days after your second dose of mRNA COVID-19 vaccine.

Booster dose

People 18 years and older who got the Johnson & Johnson COVID-19 vaccine as their primary series. At least two months after your first dose.

People 5 years and older who got the Pfizer-BioNTech COVID-19 vaccine as their primary series.

At least five months after your second dose.**

For patients who are moderately to severely immunocompromised, at least 3 months after the patient's additional (third) dose.

People 18 years and older who got the Moderna COVID-19 vaccine as their primary series.

At least five months after your second dose.**

For patients who are moderately to severely immunocompromised, at least 3 months after the patient's additional (third) dose.

*Use the same vaccine brand as the patient's initial vaccine series, if possible. If you don't have it available, the other mRNA vaccine brand may be used.

Please do not administer any doses of vaccine beyond the doses recommended by CDC, even if your patient requests it. Also, please do not administer any doses of vaccine to someone outside of the recommended age range for that vaccine.

What is the dosage of a Moderna booster for patients who got a different COVID-19 vaccine for their primary series?

The Food and Drug Administration (FDA) only authorized Moderna boosters for a 0.25mL dose. The dosage is the same, regardless of whether a patient got Moderna for their primary series. See the emergency use authorization fact sheet (PDF) for more information.

Is the Johnson & Johnson vaccine available to use again?

On May 6, 2022 the U.S. Food and Drug Administration limited the authorized use of the Johnson & Johnson (Janssen) COVID-19 vaccine.

Read their full statement.

DOH has rescinded standing orders for J&J.

If you wish to still administer J&J, you must do so under your internal ordering process, which could include your own standing orders.

Is the vaccine effective in all age groups?

Yes, the clinical trials showed similar results in different age groups, including those over 65 years of age.

What types of symptoms are normal after receiving the vaccine?

Like other routine vaccines, the most common side effects are a sore arm, fatigue, headache, and muscle pain. These symptoms are a sign that the vaccine is prompting an immune response. For most people, these side effects occurred within two days of getting the vaccine and lasted about a day. People who were 55 years or older were less likely to report having side effects than younger people. For two-dose series COVID-19 vaccines, side effects were more common after the second dose than the first dose.

In clinical trials, scientists found these effects to occur in approximately:

Pfizer
  • Eighty percent of people reported pain at the injection site
  • Fifty percent of people reported fatigue and headache
  • Thirty percent of people reported muscle pain
Moderna
  • Ninety percent of people reported pain at the injection site
  • Seventy percent of people reported fatigue and headache
  • Sixty percent of people reported muscle pain
Johnson & Johnson
  • Sixty percent of people reported pain at the injection site
  • Forty-five percent of people reported fatigue and headache
  • Forty percent of people reported muscle pain
Are there any restrictions on who can receive the vaccine?

Generally, the COVID-19 vaccines should not be given to anyone who is under the authorized age or has a history of severe allergic reactions to an ingredient or previous dose of the COVID-19 vaccines.

Pfizer-BioNTech

The Pfizer COVID-19 vaccine should not be given to anyone:

  • Under 6 months of age
  • Outside of the appropriate age dose
  • With a history of severe or immediate allergic reactions to an ingredient of the Pfizer-BioNTech vaccine, such as polyethylene glycol or polysorbate
  • Who had a severe or immediate allergic reaction to their first dose of an mRNA COVID-19 vaccine (Pfizer or Moderna)
Moderna

The Moderna COVID-19 vaccine should not be given to anyone:

  • Under 6 months of age
  • Outside of the appropriate age dose
  • With a history of severe or immediate allergic reactions to an ingredient of the Moderna vaccine, such as polyethylene glycol or polysorbate
  • Who had a severe or immediate allergic reaction to their first dose of an mRNA COVID-19 vaccine (Pfizer or Moderna)
Johnson & Johnson – Janssen

See the Advisory Committee on Immunization Practices' (ACIP) interim clinical considerations for COVID-19 vaccines for more information.

Should I administer the vaccine to patients with a history of allergies?

The COVID-19 vaccines should not be given to people with a known history of severe allergic reaction, such as anaphylaxis, to any ingredient or a previous dose of the COVID-19 vaccines.

People who have had a severe allergic reaction to other vaccines or injectable therapies may still be able to receive this vaccine. However, providers should do a risk assessment and counsel them about the potential risks. If the patient decides to get the vaccine, providers should observe them for 30 minutes to monitor for any immediate reactions. People who report having mild or childhood allergic reactions to medications or vaccines may still get the vaccine.

See the Advisory Committee on Immunization Practices (ACIP) interim clinical considerations for COVID-19 vaccines for more information.

How quickly is someone protected from COVID-19 after receiving the vaccine?

It will take about two weeks after someone finishes the initial COVID-19 vaccine series to have maximum protection. Protection may wane over time, so it's important to get any recommended booster doses on time.

What is the recommended dosage and schedule?

Pfizer-BioNTech (Comirnaty):

  • 6 months through 4 years: three 0.2mL (3mcg) doses, the first 2 doses given at least 21 days apart. The third dose given at least 8 weeks after the second dose.
  • 5 through 11 years old: two 0.2 mL (10mcg) doses, given at least 21 days apart.
  • 12 years and older: two 0.3 mL (30mcg) doses, given at least 21 days apart.

Immunocompromised patients should get an additional (third) dose at least 28 days after their second dose to improve their immune response. People 5 years and older are recommended to get a booster dose at least five months after their second dose.

Moderna:

  • 6 months through 5 years old: two 0.25mL (25mcg) doses, given one month apart.
  • 6-11 years old: two 50mL doses given one month apart.
  • 12-17 years old: two 100mL doses given one month apart. 
  • 18 and older: two 0.5 mL (100mcg) doses, given at least 28 days apart. 

Immunocompromised patients should get an additional (third) dose at least 28 days after their second dose to improve their immune response. People 18 years and older are recommended to get a booster (third) dose at least five months after their second dose. A Moderna booster dose is 0.25 mL (50mcg). The booster dosage is still 0.25mL for patients getting a Moderna booster but initially vaccinated with Pfizer-BioNTech or Johnson & Johnson.

Johnson & Johnson - Janssen: The Johnson & Johnson vaccine requires a single 0.5 mL (50 mcg) dose. People 18 years and older should get a booster dose at least two months after their first dose. Patients at risk for rare side effects may consider getting an mRNA vaccine booster instead.

Protection is not immediate. It will take about two weeks after someone finishes the initial COVID-19 vaccine series to have maximum protection. Protection may wane over time, so it's important to get any recommended booster doses on time.

If a patient is late for or misses their second or third dose, do they need to restart the series?

No. Patients do not need to restart the COVID-19 vaccine series, but they should get the second or third dose as soon as possible after the recommended days (21 days/6 months for Pfizer, 28/6 months days for Moderna, 2 months for Johnson & Johnson) have passed since their first/second dose. Patients will still develop a good immune response if they get their second or third dose later than the recommended time.

You can read more about the administration schedule in the Centers for Disease Control and Prevention's interim clinical considerations.

How much of the vaccine is in each multi-dose vial?

Pfizer-BioNTech 5-11 pediatric formula (orange cap): Once diluted, each vial contains 10 doses (0.2 mL) of the vaccine.

Pfizer-BioNTech 6 months-4 years pediatric formula (maroon cap): Once diluted, each vial contains 10 doses (0.2 mL) of the vaccine.

Moderna (Spikevax) adult/adolescent formula (red cap): Each vial contains a maximum of 15 primary series doses (0.5 mL) of the vaccine. Do not puncture the vial more than 20 times. If you are administering booster doses, you may have extra vaccine in the vial that you will need to waste.

Moderna 6-11 pediatric formula (dark blue cap with purple vial label): Each vial contains 5 doses (0.5mL) of the vaccine. 

Moderna pediatric formula 6 months-5 years (dark blue cap with magenta vial label): Each vial contains 10 doses (0.25mL) of the vaccine. 

Johnson & Johnson - Janssen: Each vial contains five doses (0.5 mL) of the vaccine.

Can I use any extra doses in the vaccine vials?

You may find that some vials contain extra doses. Given the public health emergency, you can use every full dose you can get from the Pfizer-BioNTech and Moderna vaccine vials. However, you should be sure to:

  • Maintain the dilution concentration of the Pfizer-BioNTech vaccine. See the Pfizer-BioNTech diluent poster (PDF) for more information.
  • Discard any amount of vaccine remaining in the vial that is less than a full dose. Do not pool liquid from multiple vials to create a dose.

If you administer extra doses, you will need to reconcile your inventory in the Washington State Immunization Information System (WAIIS). We recommend you do this every Tuesday for accurate reporting. If you use an electronic health record (EHR) to input data into the WAIIS, you may need to reconcile more often. Instructions are available in the extra dose reconciliation guide (PDF).

My patient/client is moderately or severely immunocompromised. What is the COVID-19 vaccination recommendation for them?
If you got… Should I get an additional dose? Can I get a booster? Total doses
Pfizer: Two doses administered 21 days apart for ages 5 and older Yes, people age 5+ who are moderately or severely immunocompromised should get an additional dose 28 days after their 2nd shot.

Yes, a Pfizer mRNA booster is recommended 3 months after the last dose to be up to date for those aged 5-11.

A 2nd mRNA booster is not recommended for those aged 5-11.

4

Yes, an mRNA booster is recommended 3 months after the last dose to be up to date for those ages 12 and older.

A 2nd mRNA booster should be received 4 months after the 1st booster for those 12 and older.

5
Pfizer: Three doses administered for children 6 months through 4 years old. The first two doses are to be administered 21 days apart and the third dose 8 weeks after the second dose. No, children 6 months through 4 years old who are moderately or severely immunocompromised should not receive an additional primary dose at this time. No, an mRNA booster is not recommended for children 6 months through 4 years old at this time. 3
Moderna: Two doses administered 28 days apart for ages 6 months and older Yes, people aged 6 months and older who are moderately or severely immunocompromised should get an additional dose 28 days after their 2nd shot.

No, an mRNA booster is not authorized for those 6 months through 17 years old at this time for those who received Moderna as their primary series.

3

Yes, an mRNA booster is recommended 3 months after the last dose to be up to date for those 18 years and older.

A 2nd mRNA booster should be received 4 months after the 1st booster for those 18 and older.

5
Johnson & Johnson: One dose, authorized for ages 18 and older Yes, people age 18+ who are moderately or severely immunocompromised should get an additional dose with mRNA vaccine 28 days after 1st dose of J&J.

Yes, an mRNA booster is recommended at least 2 months after the last dose for those aged 18 and older to be up to date.

If you received a primary and booster dose of J&J, a 2nd booster of mRNA vaccine should be received 4 months after the 1st booster.

4

If your patient has not yet been vaccinated against COVID-19, you should recommend and administer the first dose of vaccine if they accept, then follow the applicable recommendation for following doses. The CDC recommends vaccinating with an mRNA vaccine instead of Johnson & Johnson unless your patient cannot or does not want to take an mRNA vaccine.

As medical providers it is imperative to understand the vaccine recommendation for this high-risk population. Please encourage your immunocompromised patients or clients to get vaccinated and ensure they complete the entire primary series plus booster.

If you have any questions, please refer to the CDC guidelines for immunocompromised people.