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HomeMorbidity & Mortality Weekly Reportindex/list_12208_2COVID-19 Vaccine Safety in Children Aged 5–11 Years

COVID-19 Vaccine Safety in Children Aged 5–11 Years

Abstract and Introduction


On October 29, 2021, the Food and Drug Administration (FDA) amended the Emergency Use Authorization (EUA) for Pfizer-BioNTech COVID-19 (BNT162b2) mRNA vaccine to expand its use to children aged 5–11 years, administered as 2 doses (10 μg, 0.2mL each) 3 weeks apart.[1] As of December 19, 2021, only the Pfizer-BioNTech COVID-19 vaccine is authorized for administration to children aged 5–17 years.[2,3] In preauthorization clinical trials, Pfizer-BioNTech COVID-19 vaccine was administered to 3,109 children aged 5–11 years; most adverse events were mild to moderate, and no serious adverse events related to vaccination were reported.[4] To further characterize safety of the vaccine in children aged 5–11 years, CDC reviewed adverse events after receipt of Pfizer-BioNTech COVID-19 vaccine reported to the Vaccine Adverse Event Reporting System (VAERS), a passive vaccine safety surveillance system co-managed by CDC and FDA, and adverse events and health impact assessments reported to v-safe, a voluntary smartphone-based safety surveillance system for adverse events after COVID-19 vaccination,* during November 3–December 19, 2021. Approximately 8.7 million doses of Pfizer-BioNTech COVID-19 vaccine were administered to children aged 5–11 years during this period; VAERS received 4,249 reports of adverse events after vaccination with Pfizer-BioNTech COVID-19 vaccine in this age group, 4,149 (97.6%) of which were not serious. Approximately 42,504 children aged 5–11 years were enrolled in v-safe after vaccination with Pfizer-BioNTech COVID-19 vaccine; after dose 2, a total of 17,180 (57.5%) local and 12,223 systemic (40.9%) reactions (including injection-site pain, fatigue, or headache) were reported. The preliminary safety findings are similar to those from preauthorization clinical trials.[4,5] The Advisory Committee on Immunization Practices (ACIP) recommends the Pfizer-BioNTech COVID-19 vaccine for children aged 5–11 years for the prevention of COVID-19.[6] Parents and guardians of children aged 5–11 years vaccinated with Pfizer-BioNTech COVID-19 vaccine should be advised that local and systemic reactions are expected after vaccination. Vaccination is the most effective way to prevent COVID-19. CDC and FDA will continue to monitor vaccine safety and will provide updates as needed to guide COVID-19 vaccination recommendations.

VAERS is a national passive vaccine safety surveillance system, jointly managed by CDC and FDA, that monitors adverse events after vaccination.[7] VAERS accepts reports from anyone, including health care providers,§ vaccine manufacturers, and members of the public. Symptoms, signs, and diagnostic findings in VAERS reports are assigned Medical Dictionary for Regulatory Activities (MedDRA) preferred terms by VAERS staff members. VAERS reports are classified as serious if any of the following are reported: hospitalization, prolongation of hospitalization, life-threatening illness, permanent disability, congenital anomaly or birth defect, or death.** Reports of serious adverse events receive follow-up by VAERS staff members to obtain additional information, including medical records. For reports of death, death certificates and autopsy reports are obtained, if available. CDC physicians reviewed all available information for each decedent to form an impression about cause of death. Reports of myocarditis and pericarditis after receipt of COVID-19 vaccine were identified by a search for selected MedDRA preferred terms;[7] CDC staff members attempted to collect information about clinical course and recovery related to myocarditis and pericarditis from patients and health care providers.

CDC established v-safe,†† a voluntary smartphone-based active safety surveillance system, specifically to monitor adverse events after COVID-19 vaccination. Parents and guardians can enroll children in v-safe after either the first or second vaccine dose. Text message reminders for online health surveys are sent to parents or guardians to complete for a child.§§ Health surveys sent in the first week after vaccination included questions about local injection site and systemic reactions (mild, moderate, or severe)¶¶ and health impacts (i.e., whether the child was unable to perform normal daily activities, missed school, or received care from a medical professional because of new symptoms or conditions). CDC’s v-safe call center contacted a parent or guardian when a report indicated that a child received medical care for new or worsening symptoms; completion of a VAERS report, if indicated, was encouraged.

VAERS and v-safe data collected during November 3–December 19, 2021 among children aged 5–11 years who received Pfizer-BioNTech COVID-19 vaccine were analyzed and described overall and by sex, age group, and race/ethnicity. Among 5,277 VAERS reports received for children aged 5–11 years who received Pfizer-BioNTech COVID-19 vaccine, 1,028 (19.5%) were excluded from this analysis because vaccination occurred before authorization for use in this age group or date of vaccination was unknown. SAS software (version 9.4; SAS Institute) was used to conduct all analyses. These activities were reviewed by CDC and conducted consistent with applicable federal law and CDC policy.***

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