COVID-19 vaccine, mRNA-Pfizer (Investigational)

Brand and Other Names:BNT-162b2 (Pfizer)
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injection, frozen suspension concentrate

  • 30 mcg/0.3mL (multiple-dose vial)

COVID-19 Disease Prevention

December 11, 2020: Emergency use authorization (EUA) issued by FDA for active immunization to prevent COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

0.3 mL IM x2 doses administered 3 weeks apart

Dosing Considerations

Limitations of effectiveness: May not protect all vaccine recipients

There are no data available on interchangeability of this vaccine with other COVID-19 vaccines; individuals who have received 1 dose should receive a second dose with the same vaccine to complete vaccination series

EUA in adolescents aged 16-17 years is based on extrapolation of safety and effectiveness from adults aged >18 years

Dosage Forms & Strengths

injection, frozen suspension concentrate

  • 30 mcg/0.3mL (multiple-dose vial)

COVID-19 Disease Prevention

December 11, 2020: Emergency use authorization (EUA) issued by FDA for active immunization to prevent COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals aged ≥12 years

<12 years: Safety and efficacy not established

≥12 years: 0.3 mL IM x2 doses administered 3 weeks apart

Dosing Considerations

Limitations of effectiveness: May not protect all vaccine recipients

There are no data available on interchangeability of this vaccine with other COVID-19 vaccines; individuals who have received 1 dose should receive a second dose with the same vaccine to complete vaccination series

EUA in adolescents aged 16-17 years is based on extrapolation of safety and effectiveness from adults aged >18 years

Next:

Adverse Effects

VAERS Reporting

Mandatory for vaccination providers to report to the vaccine adverse events reporting system (VAERS) all vaccine administration errors, serious adverse events, multisystem inflammatory syndrome in adults and children, and hospitalized or fatal cases of COVID-19 following vaccination

>10%

Aged 12-15 years

  • Dose 1
    • Pain at injection site, moderate (43.7%)
    • Pain at injection site, mild (41.4%)
    • Fatigue, moderate (34.1%)
    • Headache, mild (32%)
    • Fatigue, mild (24.7%)
    • Headache, moderate (22.3%)
    • Muscle pain, moderate (18%)
    • Muscle pain, mild (13.9%)
    • Chills, mild (17.3%)
    • Fever >38C (10.1%)
  • Dose 2
    • Pain at injection site, mild (42.5%)
    • Pain at injection site, moderate (35.8%)
    • Fatigue, moderate (42.7%)
    • Headache, moderate (35%)
    • Headache, mild (27.5%)
    • Fatigue, mild (21.1%)
    • Chills, mild (20.1%)
    • Chills, moderate (19.5%)
    • Fever >38C (19.6%)
    • Muscle pain, moderate (12.9%)
    • Muscle pain, mild (11.1%)

Aged 18-55 years

  • Dose 1
    • Pain at injection site, mild (51.1%)
    • Pain at injection site, moderate (31%)
    • Headache, mild (27.4%)
    • Fatigue, moderate (26.1%)
    • Fatigue, mild (19.9%)
    • Headache, moderate (13.4%)
    • Muscle pain, mild (11.2%)
  • Dose 2
    • Pain at injection site, mild (49.5%)
    • Fatigue, moderate (33.7%)
    • Pain at injection site, moderate (27.1%)
    • Headache, mild (25.6%)
    • Headache, moderate (22.9%)
    • Fatigue, mild (21.1%)
    • Chills, mild (17.1%)
    • Chills, moderate (15.9%)
    • Fever ≥38ºC (15.8%)
    • Muscle pain, mild (15.5%)
    • Joint pain, moderate (11.2%)

Aged ≥56 years

  • Dose 1
    • Pain at injection site, mild (55.9%)
    • Fatigue, mild (20.7%)
    • Headache, mild (19.3%)
    • Pain at injection site, moderate (15%)
    • Fatigue, moderate (13.3%)
  • Dose 2
    • Pain at injection site, mild (47%)
    • Fatigue, moderate (26.6%)
    • Headache, mild (25.4%)
    • Fatigue, mild (21.1%)
    • Pain at injection site, moderate (18%)
    • Muscle pain, moderate (15.6%)
    • Headache, moderate (13%)
    • Muscle pain, mild (12.2%)
    • Chills, mild (12%)
    • Fever ≥38ºC (10.9%)

1-10%

Aged 12-15 years

  • Dose 1
    • Injection site swelling, any grade (6.9%)
    • Joint pain, mild (5.9%)
    • Injection site redness, any grade (5.8%)
    • Joint pain, moderate (3.7%)
    • Vomiting, mild (2.7%)
    • Pain at injection site, severe (1%)
  • Dose 2
    • Chills, moderate (9.8%)
    • Joint pain, mild (8.3%)
    • Joint pain, moderate (7.1%)
    • Injection site swelling, any grade (5%)
    • Injection site redness, any grade (4.9%)
    • Vomiting, mild (2.3%)

Aged 18-55 years

  • Dose 1
    • Chills, mild (10%)
    • Muscle pain, moderate (9.5%)
    • Diarrhea, mild (9%)
    • Joint pain, mild (6.4%)
    • Joint pain, moderate (4.3%)
    • Fever >38C (3.7%)
    • Chills, moderate (3.6%)
    • Injection site redness, any grade (0.3-3.1%)
    • Injection site swelling, any grade (0.2-3.8%)
    • Diarrhea, moderate (2%)
    • Fatigue, severe (1.4%)
    • Vomiting, any grade (1.2%)
    • Injection site pain, severe (1%)
    • Headache, severe (1%)
  • Dose 2
    • Joint pain, mild (9.8%)
    • Diarrhea, mild (8.5%)
    • Fatigue, severe (4.6%)
    • Injection site redness, any grade (0.5-3.5%)
    • Injection site swelling, any grade (0.3-3.8%)
    • Headache, severe (3.2%)
    • Muscle pain, severe (2.2%)
    • Chills, severe (2.1%)
    • Vomiting, any grade (1.9%)
    • Diarrhea (1.7%)
    • Injection site pain, severe (1.2%)
    • Joint pain, severe (1%)

Aged >56 years

  • Dose 1
    • Muscle pain, mild (9.3%)
    • Diarrhea, any grade (0.2-6.5%)
    • Headache, moderate (5.8%)
    • Joint pain, any grade (0.1-5.6%)
    • Chills, mild (4.8%)
    • Muscle pain, moderate (4.6%)
    • Injection site swelling, any grade (0.1-3.9%)
    • Injection site redness, any grade (0.2-3.1%)
    • Fever ≥38ºC (1.4%)
    • Chills, moderate (1.4%)
  • Dose 2
    • Chills, moderate (9.7%)
    • Joint pain, any grade (0.4-9.7%)
    • Diarrhea, any grade (0.1-6.9%)
    • Injection site swelling, any grade (0.2-4.1%)
    • Injection site redness, any grade (0.5-3.6%)
    • Fatigue, severe (2.8%)
    • Chills, severe (1%)
    • Muscle pain, severe (1%)

<1%

Malaise (0.5%)

Lymphadenopathy (0.3%)

Post Authorization Experience

Cardiac disorders: Myocarditis, pericarditis

Gastrointestinal disorders: Diarrhea, vomiting

Immune system disorders: Severe allergic reactions, including anaphylaxis, and other hypersensitivity reactions (eg, rash, pruritus, urticaria, angioedema)

Musculoskeletal and connective tissue disorders: Pain in extremity (arm)

Previous
Next:

Warnings

Contraindications

Known history of severe allergic reaction (eg, anaphylaxis) to any component in vaccine

CDC listed contraindications

  • CDC has listed the following contraindications
  • Severe allergic reaction after previously receiving mRNA COVID-19 vaccine or its components
  • Allergic reaction (of any severity) immediately after receiving mRNA COVID-19 vaccine or its components, including polyethylene glycol (PEG)
  • Immediate allergic reaction (of any severity) to polysorbate (due to potential cross-reactive hypersensitivity with the vaccine ingredient PEG)

Cautions

Immunocompromised persons, including individuals receiving immunosuppressant therapy, may have diminished immune response to the vaccine

Vaccine may not protect all vaccine recipients

Allergic reactions

  • Appropriate medical treatment used to manage immediate allergic reactions must be immediately available following vaccination
  • Do not administer second dose to anyone experiencing a severe reaction (ie, requiring epinephrine or hospitalization) to the first dose
  • Individuals with histories of severe allergic reaction to vaccines should consult their doctors about the COVID-19 vaccine
  • People with severe allergies to food, pets, latex, oral medications, or environmental conditions may be vaccinated according to interim CDC clinical considerations for mRNA COVID-19 vaccines
  • Vaccine Adverse Event Reporting System (VAERS)
    • December 14-23, 2020: 21 cases of anaphylaxis detected after administration of 1,893,360 first doses (11.1 cases per million doses) reported in MMWR
    • 71% of these occurred within 15 minutes of vaccination
    • 17 of 21 anaphylaxis cases occurred in people with a known history of allergies or allergic reactions (eg, medications, foods, insect stings), including 7 with prior anaphylactic reactions

Myocarditis and pericarditis

  • Reports of adverse events following use of mRNA COVID-19 vaccines suggest increased risks of myocarditis and pericarditis, particularly following the second dose
  • Symptom onset is typically within a few days after vaccine administration
  • Instruct patients to seek immediate medical attention if they experience chest pain, shortness of breath, of feelings of a fast-beating, fluttering, or pounding heart after receiving the vaccine
  • Available data from short-term follow-up (as of June 2021) suggest that most individuals have had resolution of symptoms, but information is not yet available about potential long-term sequelae
  • The decision to administer an mRNA vaccine to individuals with history of myocarditis or pericarditis should take into account the individual’s clinical circumstances
  • The CDC has published clinical considerations relevant to myocarditis and pericarditis with mRNA COVID-19 vaccines

Drug interaction overview

  • Data are not available to assess concomitant administration with other vaccines
Previous
Next:

Pregnancy & Lactation

Pregnancy

Data are insufficient to inform of vaccine-associated risks in pregnancy

Clinical study to evaluate use in pregnant women initiated February 2021

A smartphone app, v-safe, is also available to report adverse effects to the CDC following vaccination with a COVID-19 vaccine

CDC guidelines for vaccination of pregnant or lactating women

Lactation

Data are not available to assess effects on breastfed infants or on milk production/excretion

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Previous
Next:

Pharmacology

Mechanism of Action

Nucleoside-modified messenger RNA (modRNA) encoding the viral spike (S) glycoprotein of SARS-CoV-2; formulated in lipid particles, which enable delivery of RNA into host cells to allow expression of the SARS-CoV-2 S antigen

Elicits an immune response to the S antigen, which protects against COVID-19

Previous
Next:

Administration

IM Preparation

Thaw vials vefore dilution

  • Allow vials to thaw in refrigerator (may take up to 3 hr) or at room temperature for 30 minutes
  • Using either thawing method, vials must reach room temperature before dilution and must be diluted within 2 hr
  • Thawed under refrigeration
    • Thaw and then store undiluted vials in refrigerator at 2-8C (35-46F) for up to 1 month
    • A carton of 25 vials or 195 vials may take up to 2-3 hr, respectively, to thaw in refrigerator, whereas fewer vials will thaw in less time
  • Thawed at room temperature
    • For immediate use, thaw undiluted vials at room temperature up to 25C (77F) for 30 minutes
    • Thawed vials can be handled in room light conditions

Dilution

  • Before dilution, invert vial gently 10 times; do NOT shake
  • Inspect contents; should appear white to off-white suspension and may contain white to off-white opaque amorphous particles
  • Do not use if discolored or if other particles observed
  • Dilute vial contents using 1.8 mL of 0.9% NaCl (do NOT use bacteriostatic 0.9% NaCl or any other diluent); equalize vial pressure before removing the needle from the vial by withdrawing 1.8 mL air into the empty diluent syringe
  • Gently invert diluted vial contents 10 times to mix; do NOT shake
  • Record date and time of dilution on vial label
  • Store diluted vial at 2-25ºC (35-77ºF); discard any unused vaccine 6 hr after dilution
  • After dilution, 1 vial contains 6 doses of 0.3 mL; vial labels and cartons may state vial contains 5 doses, however, the latest EAU information supersedes the number of doses stated on vial labels

IM Administration

For IM injection only

Do not pool excess vaccine from multiple vials

Storage

During storage, minimize exposure to room light, and avoid exposure to direct sunlight and ultraviolet light

Do not refreeze thawed vials

Does not contain preservatives

Vial stoppers are not made with natural rubber latex

Frozen vials prior to use

  • Ultra-low freezer
    • Vials arrive in thermal containers with dry ice
    • Once received, remove vial cartons immediately from the thermal container and store in an ultra-low-temperature freezer at -80ºC to -60ºC (-112ºF to -76ºF); vials must be kept frozen at this temperature range and protected from light in the original cartons until ready to use
  • Short-term storage in pharmaceutical freezer
    • Alternatively, vials may be stored at -25ºC to -15ºC (-13ºF to 5ºF) for up to 2 weeks
    • Vials must be kept frozen and protected from light until ready to use
    • Vials may be returned 1 time to the recommended storage condition of -80ºC to -60ºC (-112ºF to -76ºF)
    • Track total cumulative storage time at -25ºC to -15ºC (-13ºF to 5ºF); do not exceed 2 weeks
    • May transport under these conditions, but it counts against the total storage time of 2 weeks at this temperature
  • Ultra-low-temperature freezer unavailable
    • If an ultra-low-temperature freezer is unavailable, the thermal container in which the vaccine arrives may be used as temporary storage when consistently refilled to the top of the container with dry ice
    • Refer to the re-icing guidelines packed in the original thermal container for instructions regarding the use of the thermal container for temporary storage
    • The thermal container maintains a temperature range of -90ºC to -60ºC (-130ºF to -76ºF)
    • Storage within this temperature range is not considered an excursion from the recommended storage condition

Thawed vials before dilution

  • Thawed under refrigeration
    • Thaw and then store undiluted vials in refrigerator at 2-8ºC (35-46ºF) for up to 1 month
    • Carton of 25 vials or 195 vials may take up to 2 or 3 hr, respectively, to thaw in refrigerator; whereas, fewer number of vials will thaw in less time
  • Thawed at room temperature
    • For immediate use, thaw undiluted vials at room temperature up to 25ºC (77ºF) for 30 minutes
    • Thawed vials can be handled in room light conditions
    • Vials must reach room temperature before dilution
    • Undiluted vials may be stored at room temperature for no more than 2 hr

Vials after dilution

  • After dilution, store vials at 2-25ºC (35-77ºF) and use within 6 hr from time of dilution
  • During storage, minimize exposure to room light, and avoid exposure to direct sunlight and ultraviolet light
  • Discard any vaccine remaining in vials after 6 hr
  • Do not refreeze
Previous
Next:

Images

Previous
Next:
Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.