COVID-19 vaccine
Brand names: Comirnaty, Spikevax, Nuvaxovid
COVID-19 vaccines are immunising agents used to prevent severe disease from SARS-CoV-2 infection, available in several platforms including mRNA and adenoviral-vector formulations.
Adult dose
Paediatric dose
Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.
Contraindications
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 (§4.3, which is the complete text of that section)
- No further dose of the vaccine should be given to those who have experienced anaphylaxis after a prior dose of Comirnaty (§4.4)
- Vaccination should be postponed in individuals suffering from acute severe febrile illness or acute infection; the presence of a minor infection and/or low-grade fever should not delay vaccination (§4.4)
Side effects
- Myocarditis and pericarditis — §4.4 states there is an increased risk following vaccination with Comirnaty. These conditions can develop within just a few days after vaccination and have primarily occurred within 14 days, more often after the second vaccination and more often in younger males. Most cases recover, but some have required intensive care support and fatal cases have been observed
- Anaphylaxis and hypersensitivity events have been reported (§4.4)
- Anxiety-related reactions, including vasovagal reactions (syncope), hyperventilation and stress-related reactions such as dizziness, palpitations, increases in heart rate, alterations in blood pressure, paraesthesia, hypoaesthesia and sweating, may occur in association with the vaccination process itself (§4.4)
- Children 5 to 11 years, after 2 doses of the 10 microgram presentation — injection site pain (> 80%), fatigue (> 50%), headache (> 30%), injection site redness and swelling (>= 20%), myalgia, chills and diarrhoea (> 10%) (§4.8; a different presentation from the one dosed above)
- Children 2 to 4 years, after the 3 microgram primary series — pain at injection site and fatigue (> 40%), injection site redness and fever (> 10%) (§4.8; a different presentation from the one dosed above)
- Infants 6 to 23 months, after the 3 microgram primary series — irritability (> 60%), drowsiness (> 40%), decreased appetite (> 30%), tenderness at the injection site (> 20%), injection site redness and fever (> 10%) (§4.8; a different presentation from the one dosed above)
- NOTE: §4.8 was truncated at the source-fetch limit inside the adolescent 12 to 15 years analysis, before any adult reaction table was reached. The list above is therefore NOT the adverse-reaction profile for the 12-years-and-over 30 microgram presentation dosed on this page — consult the full §4.8 of the SPC
Monitoring
- Close observation for at least 15 minutes is recommended following vaccination; appropriate medical treatment and supervision should always be readily available in case of an anaphylactic reaction (§4.4)
- Instruct vaccinees, and parents or caregivers, to seek immediate medical attention if they develop symptoms indicative of myocarditis or pericarditis — acute and persisting chest pain, shortness of breath, or palpitations — following vaccination (§4.4)
- Record the name and the batch number of the administered product clearly, to improve traceability of biological medicinal products (§4.4)
- Give with caution in individuals receiving anticoagulant therapy, or with thrombocytopenia or any coagulation disorder such as haemophilia, because bleeding or bruising may occur after intramuscular administration (§4.4)
- Ensure precautions are in place to avoid injury from fainting (§4.4)
- Individuals may not be fully protected until 7 days after their vaccination, and vaccination may not protect all recipients (§4.4)
Clinical monograph
How it works
They present the SARS-CoV-2 spike antigen (or instructions to produce it) to the immune system, eliciting neutralising antibody and T-cell responses that provide protection on subsequent exposure.
Prescribing in practice
- Anaphylaxis is rare but recognised, so vaccinate where resuscitation facilities are available and observe individuals with a relevant allergy history after administration.
- The MHRA has identified very rare thrombosis with thrombocytopenia after adenoviral-vector vaccines and rare myocarditis/pericarditis after mRNA vaccines; advise on warning symptoms.
- Eligibility, product choice and timing follow current national immunisation programme advice.
Monitoring
Observe for immediate hypersensitivity after administration and advise reporting of delayed symptoms such as persistent severe headache or chest pain.
Counselling the patient
- Mild arm soreness, tiredness, headache or low-grade fever for a day or two is common and expected.
- Seek urgent care for severe or persistent headache, breathlessness, chest pain or new severe swelling after vaccination.
- Attend for further doses as advised by the national programme.
Evidence & guidelines
Recommendations follow UKHSA/JCVI immunisation guidance and MHRA safety surveillance.
Reference: UK Green Book; Confirm identity and dosing against the manufacturer SPC (eMC) and NICE. Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).
Related
Curated clinical cross-links plus same-class fallbacks.
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023