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Take steps to eliminate interruptions and distractions during medication preparation.
The coronavirus disease 2019 (COVID-19) vaccines are for the prevention of COVID-19. The Pfizer-BioNTech, Moderna, and Janssen COVID-19 vaccines are U.S. Food and Drug Administration (FDA)-approvedundefined#ref4">4,5,6 for active immunization for the prevention of COVID-19. The adult formulations of the Pfizer-BioNTech COVID-19 vaccine and the Moderna COVID-19 vaccine are for patients 12 years old and older.4,5 The Janssen COVID-19 vaccine is for patients 18 years old and older.6 Vaccination does not ensure immunity.
Both the Pfizer-BioNTech and the Moderna vaccines contain lipid nanoparticle-formulated, nucleoside-modified messenger ribonucleic acid (mRNA), encoding the spike glycoprotein (S) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The Janssen COVID-19 vaccine contains a recombinant replication-incompetent adenovirus type 26 vector, encoding the viral spike glycoprotein (S) of SARS-CoV-2.
The Pfizer-BioNTech COVID-19 vaccine is administered intramuscularly as a series of two doses (0.3 ml each), three weeks apart.4 The Moderna COVID-19 vaccine is administered intramuscularly as a series of two doses (0.5 ml each), one month apart.5 The Janssen COVID-19 vaccine is administered intramuscularly as a single dose (0.5 ml).6 This vaccination series should be followed by an initial booster dose. The FDA has authorized a second booster dose to be given 4 months after the initial booster of either the Pfizer-BioNTech or the Moderna COVID-19 vaccine for those over age 50, for certain immunocompromised individuals, or for those at higher risk for severe COVID-19.1
The COVID-19 vaccine is contraindicated in patients with a history of a severe allergic reaction to any component of the vaccine, including polyethylene glycol (PEG).2 As with any biologic product, procedures should be in place to manage allergic reactions. Epinephrine (1 mg/ml) injection and other agents used in the treatment of severe anaphylaxis in the event of a serious allergic reaction to the vaccine should be readily available.4
If the patient expresses concern regarding the accuracy of a medication, the medication should not be given. The concern should be explored, the practitioner notified, and the order verified.
Do not use the vial if the liquid is discolored or if other particles are observed.
Minimize exposure of the vaccine to indoor room light and avoid exposure to direct sunlight and ultraviolet light.
Thawed and diluted vaccine must be administered within 30 minutes.5
Rationale: Massaging may force some of the vaccine fluid into the subcutaneous space and alter how effectively it is absorbed.
Rationale: Discarding the uncapped needle helps prevent injury to the patient and health care team members. Recapping needles increases the risk for a needlestick injury.
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