09/29/2023 CS321570-AB 1

5 Years of Age and Older

Updated (2023–2024 Formula) 

Pfizer-BioNTech COVID-19 Vaccine

Standing Orders for Administering Vaccine

2023–24 Formula Vaccine Presentation Age Diluent Dose/Injection 

Amount Route

Single-dose vial with blue cap and blue label 5 through 

11 years None 0.3 mL/10 μg

Intramuscular 

(IM) injection

Single-dose vial with gray cap and gray label 12 years 

and older None 0.3 mL/30 μg

Intramuscular 

(IM) injection

Manufacturer-filled syringe 12 years 

and older None 0.3 mL/30 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 5 years of age and older for vaccination with the 2023–24 Pfizer-BioNTech COVID-19 Vaccine based on the 

following criteria:

* 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.

People who are NOT moderately or severely immunocompromised*

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

vaccine formula)

Schedule for administration of 2023-24 PfizerBioNTech COVID-19 Vaccine

Unvaccinated Give 1 dose now.

Any number of previous doses of 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.

Any number of previous doses COVID-19 vaccine, 

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

No further doses are indicated.
09/29/2023 CS321570-AB 2

5 Years of Age and Older

Updated (2023–2024 Formula) 

Pfizer-BioNTech COVID-19 Vaccine

Standing Orders for Administering Vaccine

People who ARE moderately or severely immunocompromised 

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

vaccine formula)

Schedule for administration of 2023-24 PfizerBioNTech COVID-19 Vaccine

Unvaccinated Give a 3-dose initial series. Administer:

 Dose 1 now

 Dose 2 at least 3 weeks after Dose 1

 Dose 3 at least 4 weeks after Dose 2

1 previous dose of any Pfizer-BioNTech COVID-19 Vaccine 

(Dose 1)†

Complete series. Administer:

 Dose 2 at least 3 weeks after Dose 1

 Dose 3 at least 4 weeks after Dose 2

2 doses of any Pfizer-BioNTech COVID-19 Vaccine 

(Doses 1 and 2)†

Complete series. Administer:

 Dose 3 at least 4 weeks after Dose 2

3 or more doses of Pfizer-BioNTech 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 Pfizer-BioNTech 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. 
09/29/2023 CS321570-AB 3

5 Years of Age and Older

Updated (2023–2024 Formula) 

Pfizer-BioNTech COVID-19 Vaccine

Standing Orders for Administering Vaccine

Additional Clinical Considerations

 2023–24 Pfizer-BioNTech 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

* A 5/8-inch needle can be used if the skin is stretched tightly, and subcutaneous tissues are not bunched.

† Alternately, the anterolateral thigh can be used. A 1- or 1.5-inch needle may be used if administering vaccine in this site, depending on the age of the patient.

‡ Some experts recommend a 5/8-inch needle for men and women who weigh less than 130 pounds. If used, skin must be stretched tightly (do not bunch subcutaneous tissue).

 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 appropriate information material:

 For 5 through 11 years of age: Provide all recipients

and/or parents/legal guardians with a copy of the

current Fact Sheet for Recipients and Caregivers.

 For 12 years of age and older: There is currently no VIS.

Once a VIS is available it should be used; but providers

should not delay use of a vaccine because of the absence

of a VIS. See more information on alternative information

materials that can be provided.

 Prepare to administer the vaccine following the

manufacturer's guidance (ages 5–11 and 12 and older).

Choose the correct needle gauge, needle length, and

injection site for persons:

○ 5 through 18 years of age:

» Needle gauge/length: 22–25 gauge, 5/8*-1-inch

» Site: Deltoid muscle of arm†

○ 19 years of age and older: See chart below.

 Administer Pfizer-BioNTech COVID-19 Vaccine by

intramuscular (IM) injection:

○ 5 through 11 years: 0.3 mL/10 μg

○ 12 years and older: 0.3 mL/30 μg

Sex and Weight of Patient Needle Gauge Needle Length Injection Site†

Female or male less than 130 lbs 22–25 5/8‡–1" Deltoid muscle of arm

Female or male 130–152 lbs 22–25 1" Deltoid muscle of arm

Female 152–200 lbs 22–25 1–1.5" Deltoid muscle of arm

Male 152–260 lbs 22–25 1–1.5" Deltoid muscle of arm

Female 200+ lbs 22–25 1.5" Deltoid muscle of arm

Male 260+ lbs 22–25 1.5" Deltoid muscle of arm
09/29/2023 CS321570-AB 4

5 Years of Age and Older

Updated (2023–2024 Formula) 

Pfizer-BioNTech COVID-19 Vaccine

Standing Orders for Administering Vaccine

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.

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

 Medical Management of Vaccine Reactions in Adults 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.