309/29/2023 CS321570-AO
6 Months Through 4 Years of Age
Updated (2023–2024 Formula)
Pfizer-BioNTech COVID-19 Vaccine
Standing Orders for Administering Vaccine
Additional Clinical Considerations
2023–24 Pfizer-BioNTech COVID-19 Vaccine may be
simultaneously administered with other routinely
recommended vaccines. There are additional
considerations for simultaneous administration of an
orthopoxvirus vaccine and COVID-19 vaccine.
Persons who have received HCT or CAR-T-cell therapy
○ Revaccinate persons who received doses of COVID-19
vaccine prior to or during HCT or CAR-T-cell therapy,
following the current COVID-19 vaccination schedule.
Revaccination should start at least 3 months (12 weeks) after
transplant or CAR-T-cell therapy.
For additional details and all clinical considerations, see
Interim Clinical Considerations for Use of COVID-19 Vaccines.
Contraindications:
History of a severe allergic reaction (e.g., anaphylaxis) after a
previous dose or to a component of the COVID-19 vaccine
Precautions:
History of:
A diagnosed non-severe allergy to a component of the
COVID-19 vaccine
Non-severe, immediate (onset less than 4 hours) allergic
reaction after administration of a previous dose of one
COVID-19 vaccine type, if receiving the same vaccine type
Moderate to severe acute illness, with or without fever
Multisystem inflammatory syndrome in children (MIS-C) or
adults (MIS-A)
Myocarditis or pericarditis within 3 weeks after a dose of any
COVID-19 vaccine
Administration
Provide all recipients and/or parents/legal guardians with a
copy of the current Fact Sheet for Recipients and Caregivers.
Prepare to administer the vaccine following the manufacturer's
guidance.
Prepare to administer vaccine by IM injection.
○ Needle gauge and length: Use a 22–25 gauge, 1-inch
*
○ For children:
» 6 months through 2 years: Vastus lateralis muscle in the
anterolateral thigh
†
» 2 through 4 years: Deltoid muscle in the upper arm
‡
* A 5/8 inch needle may be used if administering the vaccine in the deltoid muscle AND the skin is stretched tightly and the subcutaneous tissue is not bunched for children ages 1–4
years.
† The deltoid muscle in the upper arm may be used if the muscle mass is adequate for ages 1 through 2 years
‡ The vastus lateralis muscle in the anterolateral thigh may be used as an alternate site.
○ Administer Pfizer-BioNTech COVID-19 Vaccine by
intramuscular (IM) injection using the vial with yellow cap
and yellow label. Administer 0.3 mL/3 μg
.
Document Vaccination
Document each recipient's vaccine administration information:
Medical record: The vaccine and the date it was administered,
manufacturer, lot number, vaccination site and route, name
and title of the person administering the vaccine.
Vaccination record for recipient: Date of vaccination,
product name/manufacturer, lot number, and name/location
of the administering clinic or health care professional.
Immunization information system (IIS): Report the
vaccination to the appropriate state/local IIS.
Be Prepared to Manage Medical Emergencies
Consider observing persons after vaccination to monitor for
allergic reactions and syncope:
30 minutes for persons with:
○ A history of a non-severe, immediate (onset within 4 hours)
allergic reaction after a previous dose of one COVID-19
vaccine type, if receiving the same vaccine type
○ A history of a diagnosed non-severe allergy to a component
of the COVID-19 vaccine, if receiving the same vaccine type
15 minutes: All other persons
Syncope may occur in association with injectable vaccines.
Procedures should be in place to avoid falling injuries and
manage syncopal reactions.
Have a written protocol to manage medical emergencies
following vaccination.
Health care personnel who are trained and qualified to recognize
the signs and symptoms of anaphylaxis as well as administer
intramuscular epinephrine should be available at the vaccination
location at all times.
Report Adverse Events to the Vaccine Adverse Event
Reporting System (VAERS)
Adverse events that occur in a recipient following administration
of any licensed or authorized COVID-19 vaccine should be
reported to VAERS, including:
Vaccine administration errors, whether or not associated with
an adverse event
Serious adverse events, irrespective of attribution to
vaccination