Appendix: Vaccine Administration Errors and Deviations

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At a glance

  • Providers should consult the table on this page for guidance in managing different types of COVID-19 vaccine administration errors and deviations.
  • Resources are provided for proper vaccine administration and error prevention.

Managing vaccine administration errors and deviations

NOTE

The package inserts and U.S. COVID-19 Vaccine Product Information should be referenced for detailed information on storage and handling, dosing and schedule, dose preparation, and administration of COVID-19 vaccines. The information provided below on managing vaccine administration errors should not be interpreted as a recommendation or promotion of unapproved use of the vaccines.

For all vaccine administration errors:

  • Inform the recipient of the vaccine administration error.
  • Consult with the jurisdiction immunization program and/or immunization information system (IIS) to determine how the dose should be entered into the IIS.
  • Determine how the error occurred and implement strategies to prevent it from happening again. A discussion on strategies to prevent errors can be found in Epidemiology and Prevention of Vaccine-Preventable Diseases (Pink Book). Additional resources can be found on CDC's vaccine administration web page, including a job aid for preventing errors.
  • Follow the revaccination guidance in the table below, using an age-appropriate COVID-19 vaccine product. Then continue with the recommended schedule for subsequent dose(s) unless otherwise noted in the table.

Vaccinators should consult Reporting vaccine adverse events for information on reporting to the Vaccine Adverse Event Reporting System (VAERS) after COVID-19 vaccination. To file an electronic report, see the VAERS website.

Table: Interim recommendations for COVID-19 vaccine administration errors and deviations

Type Administration error/deviation Interim recommendation
Site/route
  • Incorrect site (i.e., site other than the deltoid muscle or vastus lateralis muscle)
  • Do not repeat dose.
  • Incorrect route (e.g., subcutaneous)
  • Do not repeat dose.
  • Inform the recipient of the potential for local and systemic adverse events.
Age
  • 2025–2026 mRNA vaccine administered to recipient younger than age 6 months
  • If the first dose is administered 5 or more days before age 6 months, repeat the dose on or after the date the recipient reaches 6 months; space the repeat dose at least 4 weeks after the invalid dose.*
Product and dosage
  • Higher-than-approved dose administered (e.g., incorrect dose volume, incorrect product resulting in higher-than-approved dose)
  • Do not repeat dose.†
  • Lower-than-approved dose administered (e.g., leaked out of the syringe, equipment failure, recipient pulled away, incorrect product resulting in lower-than-approved dose)
  • Repeat dose immediately with correct dose (no minimum interval).‡
  • However, if a half-volume dose of vaccine is administered to a recipient recommended for the full volume, another half-volume dose can be administered on the same clinic day, and the 2 doses can count as 1 full dose.
Storage and handling
  • Dose administered after improper storage and handling (i.e., temperature excursion)
  • Contact the manufacturer for information on the stability of the vaccine.§ If the manufacturer does not have data to support the stability of the vaccine, repeat the dose immediately (no minimum interval).‡
  • Dose administered past the expiration/beyond-use date
  • Repeat the dose immediately (no minimum interval).‡
Intervals
  • Any COVID-19 dose administered prior to the minimum interval
  • Repeat dose. Space the repeat dose after the dose given in error by at least the minimum interval (Table 1 and Table 2).‡
  • mNexspike administered at a 2-month interval instead of the recommended 3-month interval
  • Do not repeat dose.
Interchangeability#
  • One dose of 2025–2026 mRNA vaccine and 1 dose of 2025–2026 Novavax vaccine (in any order) administered to previously unvaccinated moderately or severely immunocompromised recipient age 12 years and older
  • Administer 1 dose of any 2025–2026 vaccine at least 4 weeks after the last dose to complete initial vaccination, followed by 1 dose of any 2025–2026 vaccine 6 months later (Table 2).
*In addition to the minimum age, for children who are not moderately or severely immunocompromised, an 8-week interval between the invalid dose and the repeat dose (i.e., extended interval) might reduce the rare risk of myocarditis and pericarditis associated with COVID-19 vaccines.
†If the administration error resulted in a higher-than-approved vaccine dose, in general a subsequent dose may still be administered at the recommended interval. However, if local or systemic side effects following vaccination are clinically concerning (outside of the expected side effect profile) or are ongoing at the time of the subsequent dose, this dose might be delayed, but this decision should be assessed on a case-by-case basis.
‡For people ages 6 months–64 years who are not moderately or severely immunocompromised, an 8-week interval between the dose given in error and the repeat dose (i.e., extended interval) might reduce the rare risk of myocarditis and pericarditis associated with COVID-19 vaccines.

§As of the date of this update, current manufacturer contact information is:

- Pfizer-BioNTech: 1-877-VAX-CO19 (1-877-829-2619)
- Moderna: 1-866-MODERNA (1-866-663-3762)
- Novavax: 1-844-NOVAVAX (1-844-668-2829)

See the package inserts for the most up-to-date manufacturer information.

Vaccine doses administered up to 4 days before the minimum interval (i.e., grace period) may be counted and do not need to be repeated.
#See Interchangeability of COVID-19 vaccines for circumstances in which a COVID-19 vaccine from a different manufacturer may be administered; a VAERS report is not required in these circumstances.
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Content Source:
National Center for Immunization and Respiratory Diseases; Coronavirus and Other Respiratory Viruses Division