COVID-19 Vaccine FAQs for Healthcare Professionals

Information for Healthcare Providers, Pharmacists, and Other Vaccine Providers

Vaccine Storage and Handling

If the vaccine experienced problems during shipment (for example, damage or temperature excursion), contact:

  • Directly distributed vaccine (Pfizer): 800-666-7248 (option 8) or CVGovernment@Pfizer.com.
  • Centrally distributed vaccine (for example, Moderna): McKesson Specialty Customer Service at (833) 343-2703, Monday–Friday, 8 AM–8 PM Eastern Time.

If the vaccine experienced problems after it was received and placed into storage, contact the vaccine manufacturer for guidance on improper storage and handling.

For temperature excursions (out-of-range temperatures), take immediate action:

  • Label the vaccine “Do Not Use” and store at the recommended temperature range until you receive manufacturer guidance.
  • Document the date and length of time of the excursion, storage unit temperature, room temperature, and inventory affected.
  • Record any other relevant information.
  • Contact the manufacturer for guidance on whether to use affected vaccines and whether patients need to be recalled for revaccination.
  • Document the event and action taken for record-keeping requirements.
  • (Pfizer only) If advised to dispose of the vaccine, properly dispose of the vaccine as biohazard waste. Never return vaccines with thermal shipping containers back to the manufacturer.

An expiration date is a date, usually defined by the manufacturer, after which a product should not be used. In certain circumstances, usually determined by the manufacturer, an expiration date can be extended.

A beyond-use-date (BUD), by contrast, is a date/time that is generated when a product is transitioned between storage states (e.g., ultra-cold, freezer, refrigerator, room-temperature), when a product vial is punctured, or when some other transition occurs.  It is a new deadline after which the product should not be used.  This new deadline replaces but will never extend beyond the expiration date. When moving vaccine from one type of storage to another, puncturing a vial for use, and mixing vaccine with diluent, always label the vial with the BUD and staff initials.

CDC recommends transporting vaccine in vials. However, there may be instances when the only option is to transport predrawn vaccine in a syringe. U.S. Pharmacopeia includes guidance for transporting predrawn vaccine in syringes in the COVID-19 Vaccine Handling Guides: Operational Considerations for Healthcare Practitionersexternal icon.

Vaccine Administration

No. While it is important to try to use every dose of vaccine possible, that should not be at the expense of missing an opportunity to vaccinate every eligible person when they are ready to get vaccinated. Strategies to ensure providers do not miss an opportunity to vaccinate every eligible person and limit wastage can be found here: Identification, Disposal, and Reporting of COVID-19 Vaccine Wastagepdf icon.

No. CDC recommends following these practices:

  • Never combine or “pool” partial doses from two or more vials to obtain one or more doses of vaccine.
  • Withdraw only the number of doses authorizedexternal icon for the specific vaccine.
  • Discard the vaccine vial and remaining vaccine if the amount of vaccine left in the vial is not a full dose.

Although no one wants to waste vaccine, it is crucial for infection control and patient safety to administer vaccine properly. Combining vaccine doses from multiple vials can result in cross-contamination, potentially causing bacterial infection in patients.

No. You should not aspirate before giving any vaccine, including COVID-19 vaccines. Aspiration can increase pain because of the combined effects of a longer needle-dwelling time in the tissues and shearing action (wiggling) of the needle. A discussion of vaccine administration best practices can be found in the Vaccine Administration chapter of Epidemiology and Prevention of Vaccine-Preventable Diseases (Pink Book).

No. These devices or a needle should not be left inserted into a medication vial septum for multiple uses. This provides a direct route for microorganisms to enter the vial and contaminate the fluid in these devices. Learn more about injection safety.

COVID-19 vaccines are administered by intramuscular injection. For all intramuscular injections, the needle should be long enough to reach the muscle mass and prevent vaccine from seeping into subcutaneous tissue. Ensuring the vaccine is given in the muscle is important to optimize immunogenicity and minimize adverse reactions at the injection site. If vaccine is given subcutaneously with the incorrect needle length, patients may experience more pain, irritation, and redness at the injection site.

Needle gauge and length recommendations vary for adolescents based on age, and for adults based on age, gender, and weight. CDC’s needle gauge and length chartpdf icon, included in the ancillary kits, outlines ACIP’s recommendations for needle length. Other vaccine administration and injection resources can be found in CDC’s Vaccine Administration Resource Library.

To reduce the risk of fake or counterfeit vaccines, dispose of vials and packaging as medical waste by placing vials in a sharps container and packaging in a red medical waste bag. If medical waste containers are in short supply, deface or safely crush packaging materials so they cannot be reintroduced or reproduced. After the products are sufficiently defaced or destroyed, dispose with regular waste.

The disposal process for unused COVID-19 vaccine and diluent may be different. For guidance, contact your jurisdiction’s immunization program If advised to dispose of the vaccine, properly dispose of the vaccine as biohazard waste. Never return unused or expired vaccines with the shipping containers back to the manufacturer. Additionally, promptly report any expired or unused vaccine. This helps CDC accurately monitor the amount of vaccine in the field.  Keep in mind that there are no negative consequences for reporting waste, and it will not negatively impact future allocations. CDC recognizes that unused expired vaccine is a normal part of any vaccination program, especially one of this scope and size.

Some interim recommendations for COVID-19 vaccine administration errors differ from ACIP’s General Best Practice Guidelines. Review vaccine administration errors and deviations for COVID-19 vaccines to learn about the interim recommendation for each type of error.

For all vaccine administration errors:

Vaccination Documentation

All vaccine recipients should have received a CDC vaccination card when they were initially vaccinated.

When scheduling appointments, remind patients to bring their COVID-19 vaccination record card. If patients do not bring their card, make every effort to verify vaccination history.

  • If patients bring their vaccination card: Document the dose on their existing card. There are two additional spaces on the card.
  • If patients are unable to locate or do not bring their vaccination card: Provide a new card to record the dose.

Remind all patients to bring their vaccination record card to their appointment, even if they laminated it. If your patient presents a laminated vaccination card at their appointment, you can:

  • Add a label or sticker to the card that fits within the appropriate space
  • Provide a new card, transfer the original information, and destroy the old card

No. Under Emergency Use Authorization, there is no VIS for an authorized vaccine. Instead, providers are legally required to provide the EUA Fact Sheet for Recipients and Caregivers to vaccine recipients or their guardians. There are two Fact Sheets for Pfizer-BioNTech based on age group; one covers ages 5 through 11 years and one covers ages 12 years and older. There is no VIS yet for the FDA-approved COMIRNATY vaccine.  The Fact Sheet for ages 12 years and older covers both the authorized Pfizer-BioNTech COVID-19 Vaccine and the FDA-licensed vaccine, COMIRNATY.

The Fact Sheet for Recipients and Caregivers includes:

  • Basic information on COVID-19, symptoms, and what to discuss with a healthcare provider before vaccination
  • Who should and should not receive the vaccine
  • A statement that recipients have the choice to receive the vaccine
  • Vaccine series information
  • Potential and known risks and benefits of the vaccine, including common side effects
  • Information on reporting side effects to VAERS
  • An explanation of what an EUA is and why it is issued
  • Any approved available alternatives for preventing COVID-19
  • Additional resources

No. Although you are required to provide the vaccine-specific Fact Sheet for Recipients and Caregivers to vaccine recipients or their caregivers, you are not required to document that you did so. To help facilitate such documentation in electronic medical records/immunization information systems for vaccination providers who choose to do so, CDC is leveraging the existing vaccine information statement (VIS) Code Set infrastructure, barcoding, and URLs to provide the information needed for various systems. This is similar to the electronic system and workflow documentation of the VIS. The barcode at the bottom of the last page of the Fact Sheet for Recipients and Caregivers may be scanned to capture in electronic medical records/immunization information systems that the fact sheet was provided to the vaccine recipient or caregiver.

Vaccine Safety and Efficacy

Report adverse events that occur in a recipient following COVID-19 vaccination to the Vaccine Adverse Event Reporting System (VAERS)external icon. Vaccination providers are required by the FDA to report:

  • Vaccine administration errors
  • Serious adverse events
  • Cases of multisystem inflammatory syndrome
  • Cases of COVID-19 that result in hospitalization or death following COVID-19 vaccination

Reporting is encouraged for any other clinically significant adverse event, even if it is uncertain whether the vaccine caused the event. Also, vaccine recipients can report adverse events that occur after vaccination. Information on how to submit a report to VAERS is available at https://vaers.hhs.govexternal icon or by calling 1-800-822-7967. For more information on VAERS, please refer to the VAERS FAQsexternal icon.

The VAERS reporting requirements for COVID-19 vaccines are different from those for routine vaccines licensed in the United States. Healthcare providers are strongly encouraged to report vaccine administration errors involving any licensed vaccine. However, healthcare providers are required to report COVID-19 vaccine administration errors to VAERSexternal icon.

Before vaccination, counsel patients about expected local and systemic side effects.

Common side effects include:

Local reactions:

  • Pain
  • Redness
  • Swelling

Systemic reactions:

  • Tiredness
  • Headache
  • Muscle pain
  • Chills
  • Fever
  • Nausea

If receiving Janssen COVID-19 Vaccine, women ages 18–49 years old should be made aware of the rare but increased risk of blood clots with low platelets following vaccination and the availability of other COVID-19 vaccines where this risk has not been observed. Provide recipients or caregivers (as applicable) the EUA Fact Sheet for Recipients and Caregiversexternal icon.

If receiving an mRNA COVID-19 Vaccine (i.e., Pfizer or Moderna), recipients should be made aware of the rare but elevated risk for myocarditis and/or pericarditis, particularly in males ages 12–29 years.  The Advisory Committee on Immunization Practices concluded that the benefits of COVID-19 vaccination to individual persons and at the population level clearly outweighed the risks of myocarditis after vaccination. Provide recipients or caregivers (as applicable) the Pfizer Vaccine Information Fact Sheetexternal icon or the Moderna EUA Fact Sheetexternal icon for Recipients and Caregivers.

No. There is no evidence that any vaccine, including COVID-19 vaccines, cause fertility problems. People who are trying to become pregnant do not need to avoid pregnancy after COVID-19 vaccination. There is no recommendation for routine pregnancy testing before receipt of a COVID-19 vaccine. For more information, please visit Myths and Facts about COVID-19 Vaccines.

For more information, visit CDC’s When You’ve Been Fully Vaccinated webpage.

Other

All staff supporting COVID-19 vaccination efforts should receive ongoing training as new COVID-19 vaccines become available and recommendations evolve. Review and complete training and core competencies by professional qualification. Additionally, for healthcare professionals new to vaccination, the COVID-19 Vaccination Training Programs and Reference Materials for Healthcare Professionalspdf icon provide a comprehensive list of suggested training and reference materials.

For more immunization training resources, see Resources for Health Care Providers and Immunization Education and Training.

Please contact CDC-INFO for further questions on COVID-19 vaccines.

More Frequently Asked Questions (FAQs)
Talking to Vaccine Recipients about COVID-19 Vaccination

Resources to help you share clear and accurate information about COVID-19 vaccines, raise awareness about the benefits of vaccination, and address common questions and concerns about what to expect when getting vaccinated.

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Page last reviewed: May 18, 2022