A patient requested her COVID-19 vaccine be given in her thigh rather than the deltoid muscle of the arm, due to previous double mastectomy. Can either of the COVID-19 vaccines be given at a site other than the deltoid muscle of the arm?

The Centers for Disease Control (CDC) state that the anterolateral thigh can also be used as an injection site for either the Moderna or the Pfizer-BioNTech COVID-19 vaccines.

References

Centers for Disease Control. Pfizer-BioNTech COVID-19 Vaccine Standing Orders for Administering Vaccine to Persons 16 Years of Age and Older. https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/downloads/standing-orders.pdf. Accessed January 13,2021

Centers for Disease Control. Moderna COVID-19 Vaccine Standing Orders for Administering Vaccine to Persons 18 Years of Age and Older https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/downloads/standing-orders.pdf

• A severe allergic reaction is defined as need for treatment with epinephrine, or need for hospitalization to manage symptoms.
• The CDC defines an immediate reaction as a reaction occurring within 4 hours of getting a COVID-19 vaccine.

For additional information, please go to:

What to Do If You Have an Allergic Reaction after Getting a COVID-19 Vaccine | CDC

• Delta: This variant is associated with increased transmissibility (possibly up to 60% increase), reduction in efficacy of some COVID-19 treatments, and potential reduction in prevention of infection post vaccination. It is important to know the COVID-19 vaccines still offer substantial protection against the delta variant, and the majority of hospitalizations and deaths are in non-vaccinated or partially vaccinated individuals.
• The CDC recently reinstated a recommendation that masks should be worn indoors and in crowded places even by vaccinated individuals.
• Although breakthrough cases of the Delta variant have been reported in vaccinated individuals, the vaccine is still highly effective in preventing hospitalization and death.

The FDA is aware of this issue, and it's working with Pfizer to determine the best path forward and will share additional updates when available. At this time, given the public health emergency, the FDA is advising that it is acceptable to use every full dose obtainable (the sixth, or possibly even a seventh) from each vial, pending resolution of the issue. However, since these are preservative free vials, it is critical to note that any further remaining liquid that does not constitute a full dose should not be pooled from multiple vials to create one.

References

Owermohle S. FDA says Pfizer vaccine vials hold extra doses, expanding supply. https://www.politico.com/news/2020/12/16/pfizer-vaccine-extra-doses-447117

ACOG recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on ACIP-recommended priority groups. COVID-19 vaccines should be offered to lactating individuals similar to non-lactating individuals when they meet criteria for receipt of the vaccine based on prioritization groups outlined by the ACIP. ACOG Clinical Practice Advisory on Vaccinating Pregnant and Lactating Women Against Covid-19.