This section summarizes special considerations for COVID-19 vaccination of children and adolescents.
Dosing and formulation
Children should receive the age-appropriate vaccine formulation and follow the schedule based on their age on the day of vaccination, regardless of their size or weight (Table 1). Children ages 5–11 years should receive the 10 µg Pfizer-BioNTech COVID-19 Vaccine (orange cap) formulation and adolescents ages 12 years and older should receive the 30 µg Pfizer-BioNTech COVID-19 Vaccine (purple or gray cap) formulation.
If a child turns 12 years old between their first and second dose, they should receive the age-appropriate 30 µg Pfizer-BioNTech COVID-19 Vaccine (purple or gray cap) formulation for their second dose. However, the FDA authorizationexternal icon allows children who will turn from age 11 years to 12 years between their first and second dose in the primary regimen to receive, for either dose: (1) the Pfizer-BioNTech COVID-19 Vaccine formulation for children ages 5–11 years (each 0.2 mL dose containing 10 µg in an orange cap vial); or (2) the Pfizer-BioNTech COVID-19 Vaccine formulation authorized for use in people ages 12 years and older (each 0.3 mL dose containing 30 µg in a purple cap or gray cap vial). If such dosing occurred, the child has completed their primary series. This is not considered an error and VAERS reporting is not indicated.
Myocarditis is a rare, serious adverse event that has been reported primarily after receipt of the second dose of mRNA COVID-19 vaccines, with the highest risk currently observed in males ages 12–29 years. FDA has authorized and ACIP and CDC have recommended Pfizer-BioNTech vaccines in children ages 5–11 years and adolescents ages 12–17 years based on the determination that the benefits of COVID-19 vaccination outweigh risks in these populations. Extending the interval between the first and second mRNA vaccine dose to 8 weeks might reduce the risk. More information on myocarditis and COVID-19 vaccination can be found here.