09/29/2023 CS321571-N 1

6 Months Through 4 Years of Age

Updated (2023–2024 Formula) 

Moderna COVID-19 Vaccine

Standing Orders for Administering Vaccine

2023–24 Formula Vaccine Presentation Dose/Injection Amount Route

Single-dose vial with dark blue cap and green label 0.25 mL/25 μg Intramuscular (IM) injection

Purpose

To reduce morbidity and mortality from coronavirus 

disease 2019 (COVID-19) by vaccinating persons who meet 

the criteria established by the Centers for Disease Control 

and Prevention’s Advisory Committee on Immunization 

Practices (ACIP).

Policy

Where authorized under state law, standing orders enable 

eligible nurses and other health care professionals (e.g., 

pharmacists) to assess and vaccinate persons who meet the 

criteria in the "Procedure" section below without the need 

for clinician examination or direct order from the attending 

provider at the time of the interaction.

Procedure 

Assess children 6 months through 4 years of age for vaccination with the 2023–24 Moderna COVID-19 Vaccine based on 

the following criteria:

Children who are NOT moderately or severely immunocompromised*

COVID-19 vaccination history† (regardless of COVID-19 

vaccine formula)

Schedule for administration of 2023-24 Moderna 

COVID-19 Vaccine

Unvaccinated Give a 2-dose initial series. Administer:

 Dose 1 now

 Dose 2 at least 4–8 weeks after Dose 1‡

1 previous dose of any Moderna COVID-19 Vaccine (Dose 1)§ Give Dose 2 at least 4–8 weeks after Dose 1‡

2 or more doses Moderna COVID-19 Vaccine, NOT including 

at least 1 dose of 2023–24 COVID-19 vaccine§¶

Give 1 dose at least 8 weeks (2 months) after the 

previous dose.

2 or more doses Moderna COVID-19 Vaccine, INCLUDING at 

least 1 dose of 2023–24 COVID-19 vaccine§¶

No further doses are indicated.

* Persons with a recent SARS-CoV-2 infection may consider delaying vaccination by 3 months from symptom onset or positive test (if infection was asymptomatic).

† COVID-19 vaccination history refers to previous receipt of dose(s) of Original monovalent mRNA, bivalent mRNA vaccine, Updated (2023–2024 Formula), or a combination of the 

three, unless otherwise specified.

‡ An 8-week interval between the first and second COVID-19 vaccine (Moderna, Novavax, and Pfizer-BioNTech) doses might be optimal for some people as it might reduce the small 

risk of myocarditis and pericarditis associated with these vaccines.

§ People who are recommended to receive a multidose mRNA series for initial vaccination (i.e., children ages 6 months–4 years and people who are moderately or severely 

immunocompromised) should receive all doses from the same manufacturer. However, in the following exceptional situations a different age-appropriate COVID-19 vaccine product 

may be administered: the same vaccine is not available, the person would otherwise not complete the vaccination series, or the person starts but is unable to complete a vaccination 

series with the same vaccine due to a contraindication.

¶ For children who have received 1 Moderna and 1 Pfizer-BioNTech vaccines of any formulation, follow a 3-dose schedule. A third dose of either Moderna vaccine or Pfizer-BioNTech 

vaccine should be administered at least 8 weeks after the second dose.
2

6 Months Through 4 Years of Age

Updated (2023–2024 Formula) 

Moderna COVID-19 Vaccine

Standing Orders for Administering Vaccine

09/29/2023 CS321571-N

Children who ARE moderately or severely immunocompromised 

COVID-19 vaccination history* (regardless of COVID-19 

vaccine formula)

Schedule for administration of 2023-24 Moderna 

COVID-19 Vaccine

Unvaccinated Give a 3-dose initial series. Administer:

 Dose 1 now

 Dose 2 at least 4 weeks after Dose 1

 Dose 3 at least 4 weeks after Dose 2

1 previous dose of any Moderna COVID-19 Vaccine (Dose 1)† Complete series. Administer:

 Dose 2 at least 4 weeks after Dose 1

 Dose 3 at least 4 weeks after Dose 2

2 doses of any Moderna COVID-19 Vaccine (Doses 1 and 2)†‡ Complete series. Administer:

 Dose 3 at least 4 weeks after Dose 2

3 or more doses of Moderna COVID-19 Vaccine, NOT

including at least 1 dose of 2023–24 COVID-19 vaccine†

Give 1 dose at least 8 weeks (2 months) after the 

previous dose.

3 or more doses of Moderna COVID-19 Vaccine, INCLUDING

at least 1 dose of 2023–24 COVID-19 vaccine†

 People who are moderately or severely 

immunocompromised have the option to receive 

1 additional dose at least 8 weeks (2 months) 

following the last recommended dose. 

 Further additional dose(s) may be administered, 

informed by the clinical judgement of a health 

care provider and personal preference and 

circumstances. 

 Any further additional doses should be 

administered at least 8 weeks (2 months) after the 

last COVID-19 vaccine dose.

* COVID-19 vaccination history refers to previous receipt of dose(s) of Original monovalent mRNA, bivalent mRNA vaccine, Updated (2023–2024 Formula), or a combination of the 

three, unless otherwise specified.

† People who are recommended to receive a multidose mRNA series for initial vaccination (i.e., children ages 6 months–4 years and people who are moderately or severely 

immunocompromised) should receive all doses from the same manufacturer. However, in the following exceptional situations a different age-appropriate COVID-19 vaccine product 

may be administered: the same vaccine is not available, the person would otherwise not complete the vaccination series, or the person starts but is unable to complete a vaccination 

series with the same vaccine due to a contraindication.

‡ For children who have received 1 Moderna and 1 Pfizer-BioNTech vaccines of any formulation, follow a 3-dose schedule. A third dose of either Moderna vaccine or Pfizer-BioNTech 

vaccine should be administered at least 8 weeks after the second dose.
3

6 Months Through 4 Years of Age

Updated (2023–2024 Formula) 

Moderna COVID-19 Vaccine

Standing Orders for Administering Vaccine

09/29/2023 CS321571-N

Additional Clinical Considerations

2023–24 Moderna COVID-19 Vaccine may be 

simultaneously administered with other routinely 

recommended vaccines. There are additional 

considerations for simultaneous administration of an 

orthopoxvirus vaccine and COVID-19 vaccine.

 Persons who have received HCT or CAR-T-cell therapy

○ Revaccinate persons who received doses of COVID-19 

vaccine prior to or during HCT or CAR-T-cell therapy, 

following the current COVID-19 vaccination schedule. 

Revaccination should start at least 3 months (12 weeks) 

after transplant or CAR-T-cell therapy.

 For additional details and all clinical considerations, see 

Interim Clinical Considerations for Use of COVID-19 Vaccines.

Contraindications: 

History of a severe allergic reaction (e.g., anaphylaxis) after a 

previous dose or to a component of the COVID-19 vaccine

Precautions:

History of:

 A diagnosed non-severe allergy to a component of the 

COVID-19 vaccine

 Non-severe, immediate (onset less than 4 hours) allergic 

reaction after administration of a previous dose of one 

COVID-19 vaccine type, if receiving the same vaccine type 

 Moderate to severe acute illness, with or without fever

 Multisystem inflammatory syndrome in children (MIS-C) 

or adults (MIS-A)

 Myocarditis or pericarditis within 3 weeks after a dose of 

any COVID-19 vaccine

Administration

Provide all recipients and/or parents/legal guardians 

with a copy of the current Fact Sheet for Recipients and 

Caregivers.

Prepare to administer vaccine by IM injection.

 Needle gauge and length: Use a 22–25 gauge, 1 inch*

* A 5/8 inch needle may be used if administering the vaccine in the deltoid muscle AND the skin is stretched tightly and the subcutaneous tissue is not bunched for children ages 1–4 

years. 

† The deltoid muscle in the upper arm may be used if the muscle mass is adequate for ages 1 through 2 years.

‡ The vastus lateralis muscle in the anterolateral thigh may be used as an alternate site.

 For children: 

○ 6 months through 2 years: Vastus lateralis muscle in the 

anterolateral thigh†

○ 2 through 4 years: Deltoid muscle in the upper arm‡

 Administer Moderna COVID-19 Vaccine by intramuscular 

(IM) injection using the vial with dark blue cap and green 

label. Administer 0.25 mL/25 μg.

Document Vaccination

Document each recipient's vaccine administration information:

 Medical record: The vaccine and the date it was 

administered, manufacturer, lot number, vaccination site 

and route, name and title of the person administering 

the vaccine.

 Vaccination record for recipient: Date of vaccination, 

product name/manufacturer, lot number, and name/location 

of the administering clinic or health care professional.

 Immunization information system (IIS): Report the 

vaccination to the appropriate state/local IIS.

Be prepared to manage medical emergencies

Consider observing persons after vaccination to monitor 

for allergic reactions and syncope:

 30 minutes for persons with:

○ A history of a non-severe, immediate (onset within 4 

hours) allergic reaction after a previous dose of one 

COVID-19 vaccine type, if receiving the same vaccine type

○ A history of a diagnosed non-severe allergy to a 

component of the COVID-19 vaccine, if receiving the 

same vaccine type 

 15 minutes: All other persons

Syncope may occur in association with injectable vaccines. 

Procedures should be in place to avoid falling injuries and 

manage syncopal reactions.

Have a written protocol to manage medical emergencies 

following vaccination. 

Health care personnel who are trained and qualified to 

recognize the signs and symptoms of anaphylaxis as 

well as administer intramuscular epinephrine should be 

available at the vaccination location at all times.
4

6 Months Through 4 Years of Age

Updated (2023–2024 Formula) 

Moderna COVID-19 Vaccine

Standing Orders for Administering Vaccine

09/29/2023 CS321571-N

Report Adverse Events to the Vaccine Adverse 

Event Reporting System (VAERS)

Adverse events that occur in a recipient following 

administration of any licensed or authorized COVID-19 

vaccine should be reported to VAERS, including: 

 Vaccine administration errors, whether or not associated 

with an adverse event

 Serious adverse events, irrespective of attribution to 

vaccination

 Cases of Multisystem Inflammatory Syndrome (MIS) in 

adults and children

 Cases of myocarditis

 Cases of pericarditis

 Cases of COVID-19 that result in hospitalization or death

Reporting is also encouraged for any other clinically 

significant adverse event, even if it is uncertain whether the 

vaccine caused the event. Information on how to submit a 

report to VAERS is available at https://vaers.hhs.gov or by 

calling 1-800-822-7967.

For More Information, Please See:

 Interim Considerations: Preparing for the Potential 

Management of Anaphylaxis after COVID-19 Vaccination

 CDC’s General Best Practice Guidelines for Immunization, 

“Preventing and Managing Adverse Reactions,”

 Medical Management of Vaccine Reactions in Children 

and Teens in a Community Setting

Note: For more information/guidance, please contact the immunization program at your state or local health 

department or the appropriate state body (e.g., state board of medical/nursing/pharmacy practice).

Standing Orders Authorization

This policy and procedure shall remain in effect for all patients of the 

effective until rescinded or until . 

Medical director (or other authorized practitioner)

 / / . 

Adapted with appreciation from the immunize.org standing orders.