About the COVID-19 Vaccines

March 22, 2023 – The Center for Disease Control and Prevention’s (CDC) updated booster dose recommendations are as follows:

  • Children ages 6 months–4 years who previously completed a 3-dose original monovalent Pfizer primary series should receive a bivalent Pfizer booster dose at least 2 months after completion of the monovalent primary series.

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 11 years old and fully approved the same vaccine (under the name Comirnaty) for those 12 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 (monovalent)  given 21 days apart and the third dose (bivalent) 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:

  • An additional (third) dose for immunocompromised patients, given at least 28 days after their second dose to improve their immune response.
  • Anyone 6 months – 4 years old who received a three dose original monovalent Pfizer primary series is eligible for an updated Pfizer booster given at least 2 months after completing the primary series or prior booster dose. Children 5 years old who received Pfizer may only receive an updated Pfizer bivalent booster. People 6 years and older can receive an updated Pfizer or Moderna booster dose, regardless of which brand they received for their primary series or previous booster dose.

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 and older is a two-dose series, given one month apart, plus:

    • An additional (third) dose for immunocompromised patients, given at least 28 days after their second dose to improve their immune response.
    • An updated bivalent booster dose for people 6 months and older, given at least 2 months after the primary series or last monovalent booster dose.
    • Children 6 months – 4 years old should receive an updated bivalent dose that is the same brand as their primary series. People 5 years and older can receive an updated Pfizer or Moderna booster dose, regardless of which brand they received for their primary series or previous booster dose.

    No serious safety concerns were found.

    Resources

    Novavax COVID-19 Vaccine, Adjuvanted

    On July 13, 2022 the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the Novavax COVID-19 Vaccine, Adjuvanted. The Advisory Committee on Immunization Practices (ACIP) and Western States Scientific Safety Review Workgroup also recommend the vaccine.

    Vaccine Summary

    The Novavax COVID-19 Vaccine, Adjuvant for those 12 years old and older is a two-dose primary series. The second dose is given at least three weeks after the first dose. It contains the SARS-CoV-2 spike protein and Matrix-M adjuvant. An adjuvant increases a vaccine’s ability to stimulate the body’s immune system to fight off disease (to improve vaccine effectiveness).

    A bivalent booster dose for people 12 years and older, given at least 2 months after the second dose or last monovalent booster dose. Novavax COVID-19 boosters are available for adults if they have completed primary series vaccination but have not previously received a COVID-19 booster—and if they cannot or will not receive an updated mRNA booster.

    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.

    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.

    • An additional dose for immunocompromised patients, given at least 28 days after their second dose to improve their immune response.
    • A bivalent mRNA booster dose for people 18 years and older, given at least 2 months after the second dose or last monovalent booster dose

    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 can get your digital COVID-19 verification record using WAverify. 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?

    COVID-19 vaccines are working well to prevent severe illness, hospitalization, and death, even against variants. However, public health experts are seeing reduced protection against mild and moderate COVID-19 illness, especially among-high risk populations.

    The updated boosters were created to help boost immunity and provide better protection from the omicron variant. It’s important to get all recommended doses available for best protection.

    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. Visit our pages on the COVID-19 variants and vaccine breakthrough for more information.

    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.

    Please review the CDC guidelines for immunocompromised people or visit our booster dose webpage.

    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.

    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

    Novavax

    • Eighty-two percent of people reported pain at the injection site
    • Sixty-two percent of people reported fatigue 
    • Fifty-four 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

    • The Washington State Department of Health (DOH) and Centers for Disease Control and Prevention (CDC) recommend an mRNA COVID-19 vaccine instead of the J&J vaccine due to the rare risk of blood clots (called thrombosis with thrombocytopenia syndrome, or TTS) and nerve damage (called Guillain-Barré syndrome).
    • The Johnson & Johnson COVID-19 vaccine should not be given to anyone under 18 years of age until further research can be done on the use of the vaccine for children.
    • The Johnson & Johnson COVID-19 vaccine should not be given to anyone with a history of severe allergic reactions to an ingredient of the Johnson & Johnson vaccine, such as polysorbate.
    • Do not give a booster dose of the Johnson & Johnson COVID-19 vaccine to anyone who developed thrombosis with thrombocytopenia syndrome after their first dose of the Johnson & Johnson COVID-19 vaccine.

    Novavax

    • The Novavax vaccine currently should not be given:
    • To anyone under the age of 12 years old until further research can support its use in that age category. 
    • Outside the appropriate age dose.
    • To anyone with a history of myocarditis or pericarditis.

    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.

    Additionally, if people are found to be extremely allergic, making COVID-19 vaccine too risky to give, providers should consider offering EVUSHELD.

    In June of 2022 the U.S. Food and Drug Administration authorized revisions to Evusheld dosing. 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 (monovalent) given at least 21 days apart. The third dose (bivalent) 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 5 years and older should get an additional (third) dose at least 28 days after their second dose to improve their immune response. Anyone 6 months – 4 years old who received a three dose original monovalent Pfizer primary series is eligible for an updated Pfizer booster, given at least 2 months after completing the primary series or prior booster dose. Children 5 years old who received Pfizer may only receive an updated Pfizer bivalent booster. People 6 years and older should receive an updated bivalent Pfizer or Moderna booster regardless of their primary series.

    • mRNA vaccines are preferred, but the Johnson & Johnson COVID-19 Vaccine is still available if you aren’t able or willing to get another vaccine. Novavax COVID-19 boosters are available for adults if they have completed primary series vaccination but have not previously received a COVID-19 booster—and if they cannot or will not receive an updated mRNA booster.

    Moderna

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

    Immunocompromised patients 6 months and older should get an additional (third) dose at least 28 days after their second dose to improve their immune response. People 6 months years and older should receive a bivalent booster dose given at least 2 months after completing the primary series or prior booster dose. Children 6 months – 4 years old should receive an updated bivalent dose that is the same brand as their primary series. People 5 years and older should receive an updated bivalent Pfizer or Moderna booster regardless of their primary series.

    • mRNA vaccines are preferred, but the Johnson & Johnson COVID-19 Vaccine is still available if you aren’t able or willing to get another vaccine. Novavax COVID-19 boosters are available for adults if they have completed primary series vaccination but have not previously received a COVID-19 booster—and if they cannot or will not receive an updated mRNA booster.

    Johnson & Johnson – Janssen

    The Johnson & Johnson vaccine requires a single 0.5 mL (50 mcg) dose. People age 18 years and older who are moderately or severely immunocompromised should get an additional dose with mRNA vaccine 28 days after 1st dose of J&J. People 18 years and older should get a bivalent booster dose at least two months after their primary series or prior booster dose.

    • mRNA vaccines are preferred, but the Johnson & Johnson COVID-19 Vaccine is still available if you aren’t able or willing to get another vaccine. Novavax COVID-19 boosters are available for adults if they have completed primary series vaccination but have not previously received a COVID-19 booster—and if they cannot or will not receive an updated mRNA booster.

    Novavax

    • 12 years and older: two 0.5mL doses given 21 days apart.

    People 12 years and older should receive a bivalent booster dose given at least 2 months after completing the primary series or prior booster dose.

    • mRNA vaccines are preferred, but the Johnson & Johnson COVID-19 Vaccine is still available if you aren’t able or willing to get another vaccine. Novavax COVID-19 boosters are available for adults if they have completed primary series vaccination but have not previously received a COVID-19 booster—and if they cannot or will not receive an updated mRNA booster.

    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 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 12 years + adolescent/adult bivalent booster formula (gray cap): Each vial contains 6 doses (0.3 mL) of the vaccine.

    Pfizer-BioNTech 12 years + adolescent/adult primary series formula (gray cap): Each vial contains 6 doses (0.3 mL) of the vaccine.

    Pfizer-BioNTech 12 years + adolescent/adult primary series formula (purple cap): Once diluted, each vial contains 6 doses (0.3 mL) of the vaccine.

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

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

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

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

    Moderna 12 years+ adult/adolescent bivalent booster formula (blue cap with gray label): Each vial contains 5 doses (0.5mL) of the vaccine.

    Moderna 12 years+adult/adolescent primary series formula (red cap with light blue label): Each vial contains a maximum of 11 primary series doses (0.5 mL) of the vaccine. Do not puncture the vial more than 20 times.

    Moderna 6-11 pediatric bivalent booster formula (blue cap with gray label): Each vial contains 10 doses (0.25mL) of the vaccine.

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

    Moderna 6 months – 5 years pediatric/infant bivalent booster (magenta cap/yellow label): Each vial contains 2 doses (0.2mL) of the vaccine.

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

    Johnson & Johnson – Janssen 18 years + adult primary series formula (blue cap): Each vial contains five doses (0.5 mL) of the vaccine.

    Novavax COVID-19 vaccine, adjuvanted 12 years+ adolescent/adult primary series and adult monovalent booster formula (royal blue cap): Each vial of vaccine contains 10 doses of 0.5mL each.

    Please review the Vaccine Product Characteristics Chart for more information.

    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?

    Please review the CDC guidelines for immunocompromised people or visit our booster dose web page.

    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. Another option is offering Novavax COVID-19 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.