Administering COVID-19 Vaccine in Your Practice

As with all vaccines, it is critical that patients get vaccinated properly and safely with COVID-19 vaccine in order to be protected.

Supplies

A supply check list is available from the CDC. You may want to remind patients to bring their own epinephrine autoinjectors if they have them.

Ancillary supply kits
The United States Government provides an ancillary supply kit to accompany doses of COVID-19 vaccine. The kits include supplies to prepare and administer vaccines. Single dose vials (for Pfizer-BioNTech vaccine, ages 12+ only) will not come with supply kits. See below for a list of specific supplies your office may expect.

Administration Supplies

Needles
- For the pediatric formulation
  - All needles are 25 g 1-inch and retractable – this is based on ACIP recommendations – Needle Gauge and Length Chart
  - The government expects sufficient supply of 1-needles
- For the adolescent/adult formulations
  - 25g 1-inch needles
  - 25g 1.5-inch needles
1 mL syringes
Sterile alcohol wipes
Record cards
Some personal protective equipment for health care personnel

Diluting Supplies (if applicable)

1.5 inch needles (to save the smaller ones for administration)
3 or 5 mL syringes
Sterile alcohol wipes
Diluent

Vaccine Preparation for Pfizer-BioNTech Vaccine

Click here to view and download this information in a table.

Always follow the manufacturer’s instructions for dilution (when necessary) and administration. For the Pfizer-BioNTech vaccine, there are different dilution instructions for the different products. See the table below.

Dosing information for previously unvaccinated individuals is provided below. For more information on dosing for children who have already started their vaccination series and children with moderately to severely immunocompromising conditions, please see the AAP Vaccine Dosing Quick Reference Guide.

Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5) for Ages 6 months – 4 years (maroon cap )

Recipient Age:

6 months – 4 years

Cap Color:

Maroon

Dose:

3 mcg

Injection Volume:

0.2 mL

Diluent:

Sterile 0.9% Sodium Chloride Injection, USP

ONLY use sterile 0.9% Sodium Chloride Injection, USP as the diluent. This diluent is supplied in the ancillary supply kit. Do not use bacteriostatic 0.9% Sodium Chloride Injection or any other diluent.
Regardless of the volume of the diluent vial, it must be used for ONE TIME dilution (after 2.2 mL withdrawal, the remaining diluent must be discarded)

Amount of diluent needed per vial:

2.2 mL - Do not add more than 2.2 mL of diluent.

Dose per vial:

10 doses (0.2 mL) per vial (after dilution)

Low dead-volume syringes and/or needles can be used to extract 10 doses from a single vial. If standard syringes and needs are used, there may not be sufficient volume to extract 10 doses from a single vial. Do not pool excess vaccine from multiple vials.

Dosing Schedule:

3 doses

2^nddose 3-8 weeks after 1st dose with Pfizer-BioNTech COVID-19 vaccine, Bivalent
3rd dose at least 8 weeks (56 days) after 2nd dose with Pfizer-BioNTech COVID-19 vaccine, Bivalent

* Individuals with certain kinds of immunocompromise will need an additional dose 8 weeks after dose 3. Please see pages 3-5 of the AAP Vaccine Dosing Quick Reference Guide for details.

Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5) for Ages 5 – 11 years (orange cap)

Recipient Age:

5 – 11 years

Cap Color:

Orange

Dose:

10 mcg

Injection Volume:

0.2 mL

Diluent:

Sterile 0.9% Sodium Chloride Injection, USP

Regardless of the volume of the diluent vial, it must be used for ONE TIME dilution (after 1.3 mL withdrawal, the remaining diluent must be discarded)

Amount of diluent needed per vial:

1.3 mL - Do not add more than 1.3 mL of diluent.

Dose per vial:

10 doses (0.2 mL) per vial (after dilution)

Do not pool excess vaccine from multiple vials.

Dosing Schedule*:

Single dose

* Individuals with certain kinds of immunocompromise will need several doses. Please see pages 3-5 of the AAP Vaccine Dosing Quick Reference Guide for details.

Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5) for Ages 12+ (Gray Cap)

Recipient Age:

12+ Years

Cap Color:

Gray

Dose:

30 mcg

Injection Volume:

0.3 mL

Diluent:

NO DILUTION

Dose per vial:

6 doses per multi-dose vial** OR

Single-dose vial

**Low dead-volume syringes and/or needles can be used to extract 6 doses from a single vial. If standard syringes and needs are used, there may not be sufficient volume to extract 6 doses from a single vial.

Do not pool excess vaccine from multiple vials.

Dosing Schedule*:

Single dose

*Individuals with certain kinds of immunocompromise will need several doses. Please see pages 3-5 of the AAP Vaccine Dosing Quick Reference Guide for details.

Vaccine Preparation for Moderna Vaccines

Click here to view and download this information in a table.

These vaccines may say “BOOSTER DOSES ONLY” Please disregard this. They are now used for vaccination series and additional doses.

Moderna COVID-19 Vaccine, Bivalent for ages 6 months and older

Recipient Age:

6 months – 5 years
6 – 11 years
12 years and older

Cap Color:

Dark Blue Cap/Label with Gray Border

Dose:

6 months – 11 years: 0.25mcg/0.25mL
12 years and older: 0.5mcg/0.5ml

Diluent:

NO DILUTION

Doses per vial:

10 doses per vial if withdrawing .25mL doses/ 5 doses per vial if withdrawing .50mL doses

Dosing Schedule*:

6 months – 5 years: 2 doses 4-8 weeks apart
6 years and older: single dose

*Individuals with certain kinds of immunocompromise will need several doses. Please see pages 3-5 of the AAP Vaccine Dosing Quick Reference Guide for details.

Moderna COVID-19 Vaccine, Bivalent for ages 6 months – 5 years (Only for individuals who previously received 2 doses of monovalent Moderna COVID-19 vaccine)

Recipient Age:

6 months – 5 years

Cap Color:

Dark Pink Cap/Label with Yellow Box

Dose:

0.2mL (10mcg)

Diluent:

NO DILUTION

Doses per vial:

2 doses per vial

If the amount of vaccine remaining in the vial cannot provide a full dose of 0.2mL, discard the vial and contents. Do not pool excess vaccine from multiple vials.

Dosing Schedule**:

Single dose at least 8 weeks after receipt of last Moderna, monovalent COVID-19 Vaccine dose

**Use of this vaccine product is only indicated in children who have already received at least 2 previous doses of Moderna COVID-19 vaccine (monovalent)

Vaccine Preparation for Novavax Vaccine

Novavax Vaccine for ages 12-17

Recipient Age:

12-17 years 

Cap Color:

Dark Blue

Dose:

0.5mL

Dosing Schedule*:

2 doses + 3rd dose of bivalent mRNA COVID-19 vaccine

Dose two should be given 3 – 8 weeks after the first dose*

Dose three should be bivalent mRNA COVID-19 vaccine (preferred) 2 months after 2nd dose OR in limited situations where mRNA vaccine is contraindicated, unavailable, or declined and a booster dose has not been previously administered, a booster dose of Novavax may be given 6 months after 2nd.

*For individuals who are moderately to severely immunocompromised, dose two should be given 3 weeks (21 days) after the first dose. People aged 12 years and up who are moderately to severely immunocompromised have the option to receive 1 additional dose of a bivalent mRNA vaccine at least 8 weeks following the last recommended bivalent dose. Further additional bivalent dose(s) may be administered, informed by the clinical judgment of the healthcare provider and personal preference and circumstances.

Diluent:

NO DILUTION

Doses per vial:

Do not pool excess vaccine from multiple vials. 

Preparation Best Practices

Prepare vaccines in a designated area away from any space where potentially contaminated items are placed.
Only prepare vaccines when you are ready to administer them.
Always check expiration dates and confirm that you have selected the correct vaccine.

Administration

COVID-19 vaccines are administered via intramuscular (IM) injection. Infants (6 months – 12 months) should receive IM injection in the anterolateral thigh muscle. Children 1 year and older can receive IM injection in either the anterolateral thigh muscle or the deltoid muscle.

When co-administering with other vaccines, it is recommended that a different injection site (at least 1 inch apart) be used. If co-administered with a more reactogenic vaccine, consider using a different limb. See the AAP Vaccine Administration web page for more information.

Documenting COVID-19 Vaccination

COVID-19 vaccination record cards are provided as part of vaccine ancillary kits, and vaccination providers must complete these cards with accurate vaccine information (i.e., vaccine manufacturer, lot number, date of first dose administration, and second [and third if applicable] dose due date), and give them to each patient who receives vaccine to ensure a basic vaccination record is provided. Redundant methods and systems, such as immunization registries, should also be used to document vaccine receipt and remind vaccine recipients about their need for second doses.

FAQs for COVID Vaccine Administration

Visit the COVID-19 Vaccine Practice Implementation FAQs page for more information on

Supplies

Vaccine Preparation for Pfizer-BioNTech Vaccine

Vaccine Preparation for Moderna Vaccines

Vaccine Preparation for Novavax Vaccine

Preparation Best Practices

Administration

Documenting COVID-19 Vaccination

FAQs for COVID Vaccine Administration

Additional Resources

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