Vaccination FAQ

It is difficult to predict the course of the COVID-19 pandemic. There is always a risk of a future resurgence with a new variant of COVID-19. 

There’s no way to know ahead of time how getting COVID-19 disease could affect you. For example, we still don’t know why some healthy but unvaccinated people become seriously ill or die from COVID-19, while other healthy people only become mildly sick. In addition, people with mild or even asymptomatic disease can also continue suffering from Long COVID. However, once vaccinated, your body will start building immunity to the virus so you are less likely to get infected, less likely to get seriously ill, less likely to transmit COVID-19 to others, and less likely to get Long COVID. Staying up to date with regard to COVID-19 vaccination will reduce your chances of getting COVID-19 disease and will make it more likely that even if you do get the virus, you will have only mild symptoms or none at all. For 2021 and 2020, COVID-19 was the third leading cause of death after heart disease and cancer.

All available COVID-19 vaccines are highly effective, including among children 5 years and older, for preventing serious illness, hospitalization, and death. Based on results of antibody studies, we expect the same to be true for children 6 months to five years old. 

Both older and more recent studies suggest that the risk of developing “Long COVID” after vaccine breakthrough infections is much lower than in unvaccinated people who get COVID-19.

In addition, some people who already had Long COVID after an earlier infection noted an improvement of their symptoms after they received COVID-19 vaccine. The potential benefits of COVID-19 vaccines on Long COVID are now being studied carefully and results will hopefully be available soon. 

More information on Long COVID and other long-term effects of SARS-CoV-2 infection and COVID-19 illness can be found on the CDC webpage.

At the top of all VDH web pages is a Google Translate button that says 'Select Language.' Clicking on this button translates web page content into 100+ different languages immediately. From there, you can go to the main page at: https://www.vdh.virginia.gov/covid-19-vaccine/ where you can learn more about COVID-19 vaccines.

The vdh.virginia.gov website is providing the “Google Translate” option to assist you in reading the vdh.virginia.gov website in languages other than English. Google Translate cannot translate all types of documents, and may not provide an exact translation.

En la parte superior de todas las páginas web de VDH, hay un botón del Traductor de Google que dice 'Select Language.' (Seleccionar idioma). Al hacer clic en este botón, el contenido de la página web se traduce inmediatamente a más de 100 idiomas diferentes. Desde allí, puede ir a la página principal en: https://www.vdh.virginia.gov/covid-19-vaccine/ donde puede obtener más información sobre las vacunas contra COVID-19.

El sitio web vdh.virginia.gov ofrece la opción "Traductor de Google" para ayudarlo a leer el sitio web de vdh.virginia.gov en otros idiomas además de inglés. Google Translate no puede traducir todos los tipos de documentos y es posible que no proporcione una traducción exacta.

في الجزء العلوي من جميع صفحات موقع الويب الخاص بـ VDH، يوجد زر "تحديد اللغة" لترجمة جوجل "Google Translate"، يؤدي النقر على هذا الزر إلى ترجمة محتوى صفحة الويب على الفور إلى أكثر من 100 لغة مختلفة. من هناك، يمكنك الانتقال إلى الصفحة الرئيسية على: /https://www.vdh.virginia.gov/covid-19-vaccine حيث يمكنك معرفة المزيد عن لقاحات COVID-19.

يقدم موقع vdh.virginia.gov خيار ترجمة جوجل أو "Google Translate" لمساعدتكم على تصفح موقع vdh.virginia.gov بلغات أخرى غير الإنجليزية. لا يمكن لـ Google Translate ترجمة جميع أنواع المستندات، وقد لا توفر ترجمة دقيقة.

모든 VDH 웹 페이지의 상단에 '언어 선택(Select Language)'이라는 Google 번역 버튼이 있습니다.' 이 버튼을 클릭하면 즉시 웹 페이지 콘텐츠가 100가지 이상의 다른 언어로 변환됩니다. 거기에서 https://www.vdh.virginia.gov/covid-19-vaccine/의 메인 페이지로 이동합니다. 그곳에서 COVID-19 백신에 대해 자세히 확인하실 수 있습니다.

vdh.virginia.gov 웹사이트가 제공하는 "구글 번역(Google Translate)" 옵션을 통해 vdh.virginia.gov 웹사이트를 영어 이외의 언어로 읽을 수 있는 도움을 받을 수 있습니다. 구글 번역(Google Translate)은 모든 유형의 문서를 번역 할 수 없으며 정확한 번역을 제공하지 않을 수 있습니다.

Sa kabuuan ng lahat ng mga web page ng VDH, may Google Translate button na nagsasabing 'Piliin ang Wika.' Ang pag-click sa button na ito ay nagsasalin ng content ng web page sa 100+ na iba't ibang wika agad. Mula rito, maaari kang magpunta sa main page sa: https://www.vdh.virginia.gov/covid-19-vaccine/ kung saan matututunan mo ang tungkol sa mga bakuna ng COVID-19.

Ang website ngvdh.virginia.gov ay ibinibigay ang “Google Translate” na opsyon para alalayan ka sa pagbabasa sa website ng vdh.virginia.gov sa iba pang wika maliban sa Ingles. Ang Google Translate ay hindi kayang isalin ang lahat ng uri ng mga dokumento, at maaaring hindi makapagbigay ng eksaktong pagsasalin.

在任何 VDH 网页的顶部，都有一个 Google 翻译按钮，上面写着“选择语言”。点击此按钮即可将网页内容翻译成 100 多种不同的语言。您可以从翻译页面转到 COVID-19 疫苗主页：https://www.vdh.virginia.gov/covid-19-vaccine/，进一步了解有关 COVID-19 疫苗的更多信息。

vdh.virginia.gov网站提供"谷歌翻译"选项，以帮助您阅读vdh.virginia.gov网站上非英语语言的内容。Google翻译无法翻译所有类型的文档，也可能无法提供准确的翻译。

The safety of the updated Moderna and Pfizer booster doses was shown using data from human clinical trials using Omicron BA.1 bivalent vaccines. The BA.1 bivalent vaccine side effects were similar to side effects seen after the primary series and original booster doses. No new safety concerns were identified.

The efficacy of the updated Moderna and Pfizer booster doses was shown by meeting pre-specified immunogenicity objectives in terms of serum antibody levels..

Clinical trials are currently underway for the bivalent BA.4/BA.5 Moderna and Pfizer-BioNTech COVID-19 Vaccines. 

Although clinical trial data in humans are not available yet for the COVID-19 BA.4 and BA.5 bivalent vaccine, the FDA authorization and CDC recommendation process is similar to that used for seasonal influenza vaccines. During the evaluation of the new COVID-19 bivalent vaccines, mice were inoculated with the vaccines, and antibody levels were measured. It is common to use animals in vaccine research before proceeding to studies with humans. The bivalent BA.4 and BA.5 vaccine is based on the original formulations and the benefit of the authorization at this time is that it will likely provide superior protection for current forms of the SARS-CoV-2 virus that are spreading.

mRNA stands for messenger ribonucleic acid. 

The COVID-19 vaccines from Pfizer-BioNTech and Moderna use mRNA to cause a two-stage immune response. First, the vaccines’ mRNA teaches your cells to make a specific non-infectious COVID-19 protein. Then this new protein stimulates your immune system to respond against COVID-19. That immune response produces antibodies and other forms of immunity that help keep you from becoming infected if you are later exposed to COVID-19.

The mRNA in the COVID-19 vaccines does NOT get into the nucleus of your cells or put germs into your body. These two mRNA COVID-19 vaccines will not change your DNA or your body’s other genetic material in any way.These mRNA COVID-19 vaccines do not inject spike proteins into your body. 

Additional information about the development of mRNA vaccines is available.

Viral vector COVID-19 vaccines use a modified version of a virus called an adenovirus - but not the SARS-CoV-2 virus that causes COVID-19 - as a way to insert in human cells a SARS-CoV-2 protein called the spike protein. This spike protein antigen triggers production of antibodies against itself and the resulting immune response then targets any viral spike proteins that are around, including those that would be on the outside of the SARS-CoV-2 virus if you get exposed. The Johnson & Johnson (also known as J&J and Janssen Biotech) vaccine uses adenovirus in its viral vector COVID-19 vaccine. However, the FDA has limited the use of the J&J COVID-19 vaccine due to safety issues. The J&J COVID-19 vaccine should only be given to individuals 18 years and older for whom mRNA COVID-19 vaccines are not accessible or clinically appropriate and who would otherwise not receive a vaccine. People who are starting their vaccine series should get either Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines or the new non-mRNA Novavax COVID-19 vaccine. People who are getting a booster dose should get either Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines.

The Novavax COVID-19 vaccine is a standard protein (and non-mRNA) COVID-19 vaccine that has been in development for more than a year. Its primary vaccination series as studied to date has included two 5 mcg doses intended to be given from 3-8 weeks apart to people 12 years and older. Each dose also includes 50 mcg of an “adjuvant,” a substance that amplifies the immune system’s response to the vaccine.

Preliminary Novavax clinical trial data indicate an overall 90% effectiveness in preventing infection with pre-Omicron variants of SARS-CoV-2 (including 79% effectiveness in people 65 years and older) and near 100% overall effectiveness in preventing moderate-to-severe COVID-19 disease, hospitalization, and death.

The Novavax COVID-19 vaccine is an “adjuvanted protein” vaccine. The Novavax vaccine uses a more traditional approach, by injecting the spike proteins of the coronavirus, stimulating the immune system to respond directly to those proteins. The vaccine also contains an adjuvant, a substance that amplifies the responses of the immune system to the spike proteins. Adjuvants have already been in use for many years in a number of U.S. vaccines such as hepatitis A, hepatitis B, and TDaP (tetanus, diphtheria and pertussis / whooping cough). 

An EUA is an “Emergency Use Authorization,” a process in the FDA that allows a vaccine company or drug company to apply for emergency use of a COVID-19 vaccine (or COVID-19 treatment drug or a COVID-19 test) with only a limited amount of effectiveness and safety data. This temporary emergency limit means that the vaccine can become available for use in an emergency like the current COVID-19 pandemic more quickly than the usual approval and licensing process would allow. 

However, before it allows an EUA, the FDA and its outside advisory group must decide that the known and possible benefits of the proposed vaccine outweigh the risks of authorizing its use.

Information describing a COVID-19 vaccine’s path from initial research to an EUA - and eventually to a biological license application (BLA) - can be found on the FDA’s website.

The FDA’s full approval for a vaccine requires the agency’s standard and rigorous process for reviewing medical products, including vaccines, drugs, test kits, and other medical devices. That review process for a vaccine relies upon the manufacturer’s submission of a Biologics License Application (BLA), a comprehensive submission that is submitted to the agency and that must meet very specific requirements. 

For COVID-19 vaccines, a BLA uses the early information that previously supported the EUA, such as preclinical and clinical data, as well as details of the manufacturing process. However, to ensure the safety of vaccines, the BLA generally requires a far longer period of time for observing and examining both vaccine safety and vaccine effectiveness. This BLA review is among the most comprehensive medical product reviews in the world. It involves the FDA and its external advisory committee conducting their own analyses of the information in the BLA. FDA will also again inspect the facilities that are involved in the manufacturing of the product. 

The FDA has now fully approved the Pfizer- BioNTech vaccine which is being marketed as Comirnaty, for use in those at least 16 years old. In addition, the FDA has fully approved the Moderna vaccine, which is being marketed as Spikevax, for use in those at least 18 years old. 

Full approval by the FDA means the vaccine can also be used in non-emergency settings.

Information on the Pfizer-BioNTech COVID-19 Vaccine is available on the CDC website.

A complete list of this vaccine’s ingredients can be found in the fact sheet.

Type of vaccine: mRNA

How given: injections in the muscle of the upper arm

This vaccine does not contain: eggs, preservatives, gelatin, or latex

The Pfizer-BioNTech vaccine is recommended for people aged 6 months and older.

Information on the Moderna COVID-19 Vaccine can be found on the CDC website.

A complete list of this vaccine’s ingredients can be found in the fact sheet. 

Type of vaccine: mRNA

How given: Injection in the muscle of the upper arm

This vaccine does not contain: eggs, preservatives, gelatin, or latex

The Moderna COVID-19 vaccine is recommended for people aged  6 months and older.

Information on the Janssen COVID-19 Vaccine can be found on the CDC website. (Last updated May 5, 2022) 

A complete list of this vaccine’s ingredients can be found in the fact sheet.

Type of vaccine: adenoviral vector for spike protein

How given: Injection in the muscle of the upper arm

This vaccine does not contain: eggs, preservatives, gelatin, or latex

The Johnson & Johnson (also known as Janssen Biotech) COVID-19 vaccine is recommended for people aged 18 years and older.

The FDA has limited the use of the J&J COVID-19 vaccine due to safety issues. The J&J COVID-19 vaccine should only be given to individuals 18 years and older whom mRNA COVID-19 vaccines are not accessible or clinically appropriate and/or who would otherwise not receive a vaccine. Please see the Johnson & Johnson’s Janssen COVID-19 Vaccine Overview and Safety page for more information.

Information on the Novavax COVID-19 vaccine can be found on the CDC website. 

A complete list of this vaccine’s ingredients can be found in the fact sheet.  

Type of vaccine: protein vaccine with adjuvant

The Novavax COVID-19 vaccine does not contain: eggs, preservatives, gelatin, or latex. 

How given: upper arm muscle

Age range: 12 years and older

Yes. COVID-19 vaccines and other vaccines may be administered to all age groups without regard to timing. This includes getting a COVID-19 vaccine and other vaccines on the same day, as well as co-administration within 14 days. This includes the Flu, Pneumococcal, Tdap, and Shingles vaccine. CDC provides considerations for coadministration with orthopoxvirus (monkeypox) vaccination.

Yes. Getting COVID-19 vaccine during pregnancy can protect you and your fetus and infant from severe illness from COVID-19.

Currently and recently pregnant people are more likely than non-pregnant people to get severely ill if they get COVID-19. Pregnant women with some underlying health conditions, such as diabetes or obesity, are at even greater risk. Having COVID-19 disease while pregnant has been associated with stillbirths, preterm birth, low birth weight babies, and other adverse outcomes of pregnancy. A study showed that infants whose mothers received two doses of COVID-19 vaccine during pregnancy were 61% less likely to be hospitalized in their first six months of life compared to infants of unvaccinated mothers. 

The CDC, VDH, the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal Fetal Medicine (SMFM) all recommend that pregnant or breast-feeding women or other women who intend to get pregnant and who otherwise are eligible for COVID-19 vaccination should be COVID-19 vaccinated and then stay up to date with vaccination. The most recently updated ACOG recommendations are available and a joint message about COVID-19 vaccination from ACOG and SMFM is also available.

CDC and the Food and Drug Administration (FDA) have several vaccine safety monitoring systems in place to collect and study information about vaccination during pregnancy and continue to closely monitor that information. Results from CDC’s v-safe voluntary after-vaccination health check system, with public data that is updated weekly, show that a large number of women who received COVID-19 vaccines have had pregnancies, with no vaccine-specific safety issues identified. 

In addition, CDC has established a specific v-safe COVID-19 Vaccine Pregnancy Registry to learn more about these issues and initial data from this registry show similar vaccine side effects for pregnant and non-pregnant individuals. The most up to date numbers are available.

The safety monitoring of COVID-19 vaccines has been described as “the most comprehensive of any vaccine in US history.”

CDC and FDA continuously monitor the safety of vaccines.These agencies use at least five different systems to monitor vaccine safety:

• The Vaccine Adverse Event Reporting System (VAERS): VAERS is an early warning system that helps CDC and FDA identify potential problems following vaccination.  Anyone can and should report possible vaccine side effects to VAERS. However, most of the VAERS monitoring is done by U.S. healthcare providers providing anonymous data from hundreds of millions of patients being vaccinated. This system alerts the CDC and FDA if healthcare systems begin reporting unusual patterns of adverse effect information about events that occur after vaccinations. 

NOTE: every healthcare provider who administers COVID-19 vaccines is required to report all serious health events occurring soon after vaccination to the VAERS system even if it seems clear that the death was not related to the vaccine. VAERS is therefore set up as an early warning system to collect as much data as possible about any and all events that may or may not turn out to be side effects of vaccines. Those data are then examined closely to verify the events and to identify any clusters or groups of unexpected serious or severe post-vaccine events. Because the data submitted to - and made publicly available by - VAERS has not yet been verified, the VAERS system clearly cannot determine whether a vaccine caused any specific side effect. VAERS is NOT - and is NOT INTENDED TO BE - a reliable source of information on vaccine side effects. Therefore, drawing conclusions from these publicly available but unverified VAERS screening data alone without the follow-up investigations is scientifically and ethically inappropriate because it is likely to lead to erroneous conclusions. 

A description of how VAERS works is available. 

• The Vaccine Safety Datalink (VSD): a collaboration between CDC and nine health care organizations around the United States, which allows ongoing monitoring and proactive searches of vaccine-related data.

• The Clinical Immunization Safety Assessment (CISA) Project: a partnership between CDC and several medical centers that conducts clinical research on vaccine-associated health risks.

• V-safe is a cell phone-based CDC system that individual COVID-19 vaccine recipients can use to notify CDC if they develop any side effects. Each vaccinated person should download a v-safe app onto their cell phone as soon as they receive the vaccine. Instructions on how to download and use v-safe will be given out when you get the vaccine. v-safe will also remind you about getting your second vaccine dose.

Additional vaccine safety monitoring systems, such as the use of National Healthcare Safety Network (NHSN) data, and continued monitoring through clinical trials are also utilized to ensure the safety of COVID-19 vaccines.

FDA REQUIRES EVERY VACCINE PROVIDER to report EVERY death that occurs after a COVID-19 vaccination to the VAERS reporting system. These death reports by vaccine providers are REQUIRED even if it seems clear that the death was not related to the vaccine. The details of every death are investigated by CDC and FDA physicians as soon as possible after these are reported.

Given the absolute requirement to report EVERY death in a vaccine recipient, regardless of its apparent cause, reports of deaths and other adverse events to VAERS following vaccination can not be interpreted to mean that a vaccine caused these problems. In fact, drawing ANY conclusions from the numbers of reported but unverified deaths in the VAERS system is scientifically inappropriate.

COVID-19 vaccines are being given to hundreds of millions of people in the United States. Many COVID-19 vaccine recipients have pre-existing illnesses or are elderly and frail and are thus already at higher risk of death whether or not they get vaccinated. Therefore, a small percentage of people receiving COVID-19 vaccine are likely to die from natural causes soon after being vaccinated. As discussed here, “VAERS data must be interpreted with caution due to the inherent limitations of passive surveillance. VAERS is primarily a safety signal detection and hypothesis generating system. Generally, VAERS data cannot be used to determine if a vaccine caused an adverse event. VAERS data interpreted alone or out of context will lead to erroneous conclusions about cause and effect as well as the risk of adverse events occurring following vaccination.”

Every death that occurs after COVID-19 vaccination is investigated. With a single exception, an ongoing review of available clinical information, including death certificates, autopsy, and medical records, has not established any causal link between any of these deaths and COVID-19 vaccines. 

NOTE: The single exception is that reports have indicated a plausible causal relationship between the J&J/Janssen COVID-19 Vaccine and TTS, a rare and serious adverse event—blood clots with low platelets—which has caused less than a dozen deaths. Get the latest safety information on the J&J/Janssen vaccine here. 

Additional information on investigation of deaths reported after COVID-19 vaccination can be found on the CDC website.   

Short term vaccine side effects fall into one of three categories: 

(1) Local reactions, at or near the injection site

(2) Systemic reactions (such as fever, chills, headache, or muscle aches)

(3) Allergic reactions 

This FAQ response addresses the local and systemic side effects. Allergic side effects are addressed in a later question and response. Although COVID-19 vaccination will help protect you from getting COVID-19 disease, you may have some short term local or systemic side effects from the vaccination, which are normal signs that your body is building protection against COVID-19. 

Some vaccinated adults and children have had local reactions such as pain, redness, or tenderness at the injection site. A small number of vaccine recipients have had transient systemic side effects such as fatigue, nausea, chills, fever, headache or other body aches for a few days. These local or systemic side effects do NOT mean that the vaccine has given you a COVID-19 infection. Rather, these expected side effects mean that the vaccine is causing your body’s immune system to react and create antibodies to fight off the virus that causes COVID-19 if you are exposed in the future.

Some  vaccine recipients have experienced swollen glands (lymph nodes). For the two mRNA vaccines, these expected side effects are more common in younger people than older people and are more common after the second dose than after the first dose. 

Less commonly, a few people have reported redness, swelling, and itching around the injection site beginning a few days or in the second week after their first vaccine dose. However, these local reactions are not considered to be allergic reactions and are not a risk for anaphylaxis when getting a second dose. Individuals with such delayed injection site reactions after the first mRNA COVID-19 vaccine dose should get the second dose using the same vaccine product as the first dose and at the recommended interval, and preferably in the opposite arm. More information about these uncommon “COVID arm” reactions are available.

As happens occasionally with other vaccines such as influenza vaccine, fainting soon after injection has also been noted among a small number of COVID-19 vaccine recipients, especially among adolescents and other young adults. This kind of short term reaction after the first injection of a two-dose COVID-19 vaccine series is also not a reason to avoid the second dose or any later booster doses when eligible.

For young children, the side effects seen after vaccination were similar to those seen in older children. 

Finally, even if you or your child experience one or more of these expected short term side effects after the first dose of mRNA COVID-19 vaccine, it is very important that you still receive the second primary series dose a few weeks later for the initial vaccine series to be effective.

Some of the expected side effects could interfere with your - or your child’s - ability to do daily activities, but they should go away in a few days.

Age appropriate medicines such as acetaminophen, ibuprofen, or naproxen or other medicines called “non-steroidal anti-inflammatory drugs” (NSAIDS) can help with the common side effects (for example, arm pain or fever) after those side effects start to occur. However, these drugs should not be taken before your COVID-19 vaccine doses since information on their possible impact on the body's ability to create immunity to COVID-19 infection is not yet available. 

If you or your child have persistent injection site pain, short term fever, or other discomfort, talk to your healthcare provider about taking one of these over-the-counter medicines.

To reduce pain and discomfort where you or your child got the shot: 

• Apply a clean, cool, wet washcloth over the area and use or exercise the arm.

To reduce discomfort from fever, dress lightly, and drink plenty of fluids.

When to call the doctor:

In most cases, discomfort from arm pain or swelling where you or your child got the shot or from fever, headache, fatigue, etc., will not last more than a few days after a COVID-19 vaccine dose. Contact your doctor or healthcare provider:

• If the redness or tenderness where you got the shot increases after 24 hours
• If your side effects are worrying you or do not seem to be going away after a few days

Remember to sign yourself and your vaccinated child up for v-safe, where you can use your smartphone to tell CDC about any side effects after getting the COVID-19 vaccine. You’ll also get reminders from V-Safe about your second vaccine dose.

Side effects or adverse events can be reported to CDC either in v-safe or VAERS. 

Information on possible vaccine adverse events (side effects) continues to be collected and studied by CDC, FDA, and other groups, using multiple systems to collect the data. 

One serious but rare adverse effect that has been identified is a blood clotting problem that has occurred in a very small number of people vaccinated with the Johnson & Johnson (Janssen) vaccine. It occurs at a rate of less than four (4) cases per million Janssen doses and has resulted in a small number of deaths. When that problem was first noted in early April 2021, use of that vaccine was stopped while it was further studied. After deciding that the vaccine’s known and potential benefits outweighed its known and potential risks, the FDA and CDC recommended resuming its use in the United States. 

However, because of a later risk-benefit analysis of post-vaccination blood clotting disorders, the FDA has limited the use of the J&J COVID-19 vaccine. The J&J COVID-19 vaccine should only be given to individuals 18 years and older for whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate and who would otherwise not receive a COVID-19 vaccine. For more information, visit Johnson & Johnson’s Janssen COVID-19 Vaccine Overview and Safety. 

To date, very few blood clotting problems in people who received an mRNA COVID-19 vaccination (Moderna) have been reported to VAERS. Based on available data, this number is not greater than the background rate of this problem and there is not an increased risk after mRNA COVID-19 vaccination. For additional information on this topic, visit the CDC webpage

There have been rare reports of myocarditis or pericarditis among people ages 30 and younger who received COVID-19 vaccine. Most patients responded well to rest and quickly recovered. More information on this topic can be found on CDC’s Myocarditis and Pericarditis After mRNA COVID-19 Vaccination webpage. 

CDC and FDA are monitoring reports of Guillain-Barré Syndrome (GBS) in people who have received the J&J/Janssen COVID-19 Vaccine. GBS is a rare disorder where the body’s immune system damages nerve cells, causing muscle weakness and sometimes paralysis. Most people fully recover from GBS, but some have permanent nerve damage. These cases have largely been reported about 2 weeks after vaccination and mostly in men, many 50 years and older. 

Given the ongoing risk of serious complications, hospitalizations, and even deaths (including deaths of children) from COVID-19 illness, and given the rarity of serious adverse effects, CDC and VDH continue to strongly recommend being up to date on COVID-19 vaccination for anyone six (6) months of age or older.

For additional information, you can also visit the CDC page at Selected Adverse Events Reported after COVID-19 Vaccination

No. Such effects on reproduction have NOT been seen and are unlikely to occur after COVID-19 vaccination. 

Sometimes people who are concerned about vaccines or vaccination raise a wide range of various reproduction and fertility questions as part of their concerns.  

First, there is no genetic material in any of the current COVID-19 vaccines so there is no risk of a COVID-19 vaccine changing the DNA of any vaccine recipient or that person’s children.

Studies have been published about temporary post-vaccination changes in women’s menstrual cycles. However, short-term changes in menstrual cycles can occur associated with almost any stress, infection, weight changes, dietary changes (including a diet high in soy), excess exercise, or sleep problems. A review of the vaccine-menstrual cycle study data and a summary of the overall vaccine-menstrual cycle question are both available. None of these studies suggested any impact on fertility and, not surprisingly, similar reports about changes in duration and flow of menstrual cycles have been noted after COVID-19 illness. 

 Also, people now using hormonal birth control (pills, patch, ring, implant, etc.) can receive any of the current COVID-19 vaccines.

One recent study found no increase in the risk of miscarriages in the pregnancies of fully vaccinated women. 

As noted elsewhere, there is no reason to withhold COVID 19 vaccine from women who are intending to get pregnant, are currently pregnant, are post-partum, and/or are breastfeeding. Getting a COVID-19 vaccine prior to or during pregnancy can protect you, your fetus, and your infant from severe COVID-19 illness. 

In summary, no negative fertility effects have been found for any current U.S. COVID-19 vaccine and there is no biologic reason to suspect that COVID-19 vaccines might have an effect on female or male fertility. 

A review of the safety of COVID-19 vaccines in terms of fertility and sexual function was published in the Scientific American magazine.  

For people who are considering COVID-19 vaccination at the same time they are considering having a baby, additional useful information can be found on CDC’s COVID-19 Vaccines While Pregnant or Breastfeeding webpage.

You will need your smartphone and information about the COVID-19 vaccine that you or your child received. This information can be found on the vaccination record card you received at the time of your vaccination; if you cannot find your vaccination record card, please contact your healthcare provider.

For instructions on how to register for v-safe, please visit the CDC’s V-safe After Vaccination Health Checker webpage.

VDH is asking providers to report all vaccination administrations to the Virginia Immunization Information System (VIIS). These reports are very important for ensuring that there is an established reporting and data feedback loop for the COVID-19 vaccine.

Yes. Healthcare providers who are interested in providing the COVID-19 vaccine may complete a Provider Intent form on the Virginia Electronic Registration for Immunization Programs (VERIP) website. VDH staff will contact providers once they have submitted their intent form to discuss the next steps to enroll as a COVID-19 vaccine provider.

Further information specific to enrollment as a vaccine provider in Virginia and general information from CDC are available.

CDC has self-study web modules for healthcare providers that can be found at Vaccine Courses, Broadcasts, Webcasts and Self Study Training and include a general overview of COVID-19 Immunization Best Practices (15 minutes) and a set of modules on what healthcare providers need to know about each of the current COVID-19 vaccines. Each of these courses includes continuing medical education (CME) credits.

Additional resources include the CDC website “Clinical Considerations for COVID-19 Vaccination,” the CDC “COVID-19 Vaccination” homepage for healthcare professionals, and COVID-19 Vaccine Product Information.

Immunize.org provides FAQs on their “Ask the Experts” page. 

The American College of Obstetricians and Gynecologists provides COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care. 

The American Academy of Pediatrics provides COVID-19 Vaccine Resources and COVID-19 Frequently Asked Questions related to children.

Fact sheets for healthcare providers administering COVID-19 vaccines may be found on the FDA website:

• Pfizer-BioNTech
• Moderna
• Johnson & Johnson (Janssen)
• Novavax

Resources for vaccinating immunocompromised individuals: 

• Best practices for vaccination of people with altered immunocompetence
• CDC Yellow Book, Chapter 5
• 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host.
• What to Tell Immunocompromised Patients about COVID-19 Vaccines
• How Effective are COVID-19 Vaccines in Immunocompromised People

U.S. Healthcare providers or health departments can request a consultation from CDC’s Clinical Immunization Safety Assessment (CISA) COVIDvax project for any complex COVID-19 vaccine safety question that is (1) about an individual patient residing in the United States or vaccine safety issue and (2) not readily addressed by CDC or Advisory Committee on Immunization Practices (ACIP) guidelines.

This request can be made through CDC-INFO by:

• Calling 800-CDC-INFO (800-232-4636), or
• Submitting a request via CDC-INFO webform

For more information, visit the CDC’s Clinical Immunization Safety Assessment (CISA) Project webpage.

CDC provides information on how to address vaccine administration errors. Additional resources can be found on CDC’s vaccine administration web page.

Key points include:

• Inform the recipient of the vaccine administration error.
• Consult with the state immunization program and/or Immunization Information System (IIS) to determine how the dose should be entered into the IIS. The Virginia IIS homepage is available.

Report the error to the Vaccine Adverse Event Reporting System (VAERS). Determine how the error occurred and implement strategies to prevent it from happening again.

No. Individuals can self-attest, or self-report, that they are eligible for an additional primary dose of an mRNA vaccine (with moderate or severe immunocompromising condition). Eligible persons should be able to receive this additional primary dose wherever vaccines are offered in Virginia.

Vaccine providers should ask patients questions to confirm eligibility for vaccination,  including the person’s age and previous COVID-19 vaccination history.

Vase+, VAMS and PrepMod will all have the ability to record additional doses.  Both additional primary doses and first booster doses will be recorded as third doses in these systems. Both second boosters (and first boosters for certain immunocompromised individuals) will be recorded as fourth doses in these systems. Second boosters for certain immunocompromised individuals will be recorded as a fifth dose. Additional boosters, such as the bivalent booster authorized in Fall 2022, will be recorded in the same pattern.

The VDH COVID Vaccine Wastage Form is available for reporting vaccine waste, including vials that are thawed and refrozen (and therefore cannot be used).

LTCFs are recommended to use their regular facility-pharmacy operations to acquire the COVID-19 vaccine for their residents and/or staff. LTCFs should maintain open and constant communication with their contracted pharmacy providers to discuss meeting COVID-19 vaccine needs moving forward, including boosters.

The VDH Pharmacy Team is working to improve access to boosters in LTC settings. The team is working to identify facilities that need assistance in securing COVID-19 bivalent boosters. Facilities that order and offer vaccination by other means should utilize their standard channels. Facilities that otherwise do not have access to COVID-19 bivalent boosters and require assistance with obtaining vaccine may reach out to COVIDPharmacySupport@vdh.virginia.gov. 

The Federal pharmacy partnership program will not be reinstated by CDC for COVID-19  booster assistance. However, CDC has partnered with various pharmacies to ensure LTCFs are able to access the COVID-19 vaccine. For more information, visit the CDC pharmacy partner contact information page. If you require further assistance in coordinating boosters for your facility, please contact your local health district or email COVIDPharmacySupport@vdh.virginia.gov.

• Facilities are encouraged to consider enrolling as a vaccine provider to be able to order and administer vaccines to staff and residents themselves. This will allow facilities to vaccinate residents and staff in a more timely manner. For more information, visit the VDH Provider Enrollment Process Flow & Checklist.
• If enrolling as a vaccine provider is not an option, you can consider identifying a pharmacy to contract with, if your current pharmacy is not able to meet your needs.
• LTCFs may also submit an off-site clinic request with pharmacies who may be able to assist facilities with their vaccination needs. For more information, visit the CDC pharmacy partner contact information page.

Contact your local health department for additional support, if needed. More information can be found on the Toolkit for Long-Term Care Facilities to Sustain COVID-19 Vaccine Access (updated 9/16/22).

LTCFs are able to order and administer vaccines through VaxMaX if the facility is enrolled as a vaccine provider. For more information on how to enroll as a vaccine provider, visit the VDH Provider Enrollment Process Flow & Checklist.

Patient education can be found on the VDH website. These resources can be used to help educate patients and staff who remain vaccine hesitant.

COVID-19 Staff Vaccination toolkit for LTCFs can be found on the VDH LTC taskforce page under Education & Training Resources.

If the adverse event occurs while the pharmacy team is on site, then they will report the adverse event to VAERS.  If it occurs after the pharmacy team has left, then the facility should report the event to VAERS.  Both the pharmacy and the LTCF facility can report adverse events to VAERS; there is no double reporting jeopardy in the VAERS system. Information about how to report to VAERS can be found on their website. FAQs about VAERS reporting are also available.

1. VAERS accepts reports from anyone. Patients, parents, caregivers and healthcare providers (HCP) are encouraged to report adverse events after vaccination to VAERS even if it is not clear that the vaccine caused the adverse event.
2. Healthcare providers are required by law to report to VAERS:
   1. Any adverse event listed in the VAERS Table of Reportable Events Following Vaccination that occurs within the specified time period after vaccination
   2. An adverse event listed by the vaccine manufacturer as a contraindication to further doses of the vaccine
3. Healthcare providers are strongly encouraged to report:
   1. Any adverse event that occurs after the administration of a vaccine licensed in the United States, whether or not it is clear that a vaccine caused the adverse event
   2. Vaccine administration errors
4. Vaccine manufacturers are required to report to VAERS all adverse events that come to their attention.

Facilities should also encourage staff to report their post vaccination symptoms to v-safe. Any adverse event reported to v-safe will trigger a phone call from the VAERS team. The LTCF can also report these symptoms to the pharmacy when they come back for the second or third clinic. The EUA fact sheet shared with vaccinated individuals contains information about post vaccination adverse event reporting.

There are multiple factors to be considered before deciding whether to conduct a vaccine clinic during an active COVID-19 outbreak. 

1. Individuals with active COVID-19 infection are not recommended to receive a vaccination. 
2. If the outbreak is under control and is restricted to one unit/area of the facility, the clinic can be conducted by following the recommendations from CDC infection prevention guidance (under “indoor visitation during an outbreak response”).
3. If the facility’s current outbreak response plan includes expanding routine testing, it is prudent to reschedule the vaccine clinic to a later date.
4. The facility should notify the booster clinic providers about the outbreak situation.