What is the proper way to write a prescription for the COVID-19 vaccine, including the vaccine product (e.g. Pfizer-BioNTech (Comirnaty)), dose, and number of doses?

Prescribing COVID-19 Vaccines

COVID-19 vaccines do not require a traditional prescription but should be documented with specific vaccine product name, dose, and schedule according to CDC guidelines.

Documentation Requirements

When administering COVID-19 vaccines, healthcare providers should document:

• Specific vaccine product (e.g., Pfizer-BioNTech, Moderna, Novavax)
• Vaccine valency (monovalent or bivalent, indicated by "1v" or "2v")
• Vaccine platform (mRNA or acellular protein subunit "aPS")
• Dose volume and route of administration
• Number of doses in the series
• Timing between doses

Current Vaccine Recommendations by Age Group

Adults (≥18 years)

• Primary Series Options:

  • 2-dose Moderna (0,4-8 weeks apart)
  • 2-dose Pfizer-BioNTech (0,3-8 weeks apart)
  • 2-dose Novavax (0,3-8 weeks apart) 1

• For Immunocompromised Adults:

  • 3-dose Moderna (0,4,8 weeks)
  • 3-dose Pfizer-BioNTech (0,3,7 weeks)
  • 2-dose Novavax (0,3 weeks) 1

• Booster Dose:

  • Moderna or Pfizer-BioNTech bivalent booster ≥2 months after last dose
  • Novavax monovalent booster may be used in limited situations for those unable/unwilling to receive mRNA vaccines 1

Children and Adolescents

• Ages 12-17 years: Similar to adult recommendations with age-appropriate formulations
• Ages 6-11 years: 2-dose primary series with Moderna or Pfizer-BioNTech
• Ages 5 years: 2-dose primary series with Moderna or Pfizer-BioNTech
• Ages 6 months-4 years: 2-dose Moderna or 3-dose Pfizer-BioNTech 1

Special Considerations

Timing with Immunomodulatory Therapies

For patients on immunosuppressive medications:

• Most medications (including TNF inhibitors, IL-6 inhibitors) require no modification to vaccination timing
• For methotrexate: Consider withholding for 1 week after each mRNA vaccine dose
• For rituximab: Schedule vaccination ~4 weeks before next rituximab cycle when possible 1

Post-Infection Vaccination

• Patients who recently had SARS-CoV-2 infection may consider delaying vaccination by 3 months from symptom onset or positive test 1

Cancer Patients

• The National Comprehensive Cancer Network recommends COVID-19 vaccination for all persons with cancer or who have been previously treated for cancer
• For HCT recipients, vaccination is recommended 6 months post-transplant, with consideration for early vaccination at 3 months during community outbreaks 1

Documentation Example

For a 45-year-old immunocompetent patient receiving first dose:

COVID-19 vaccine, Pfizer-BioNTech (Comirnaty), 0.3 mL, IM, right deltoid
Dose 1 of 2-dose primary series
Return in 3-8 weeks for second dose

Common Pitfalls to Avoid

• Not specifying the vaccine product: Always document the specific vaccine manufacturer
• Failing to document dose number: Clearly indicate which dose in the series is being administered
• Overlooking immunocompromised status: These patients require different dosing schedules
• Not considering medication interactions: Some immunomodulatory therapies may require timing adjustments

Remember that COVID-19 vaccines have demonstrated high efficacy (95% for BNT162b2) with generally mild-to-moderate side effects 2. The benefits of vaccination in reducing morbidity and mortality from COVID-19 significantly outweigh the risks of adverse events.