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Two Shot Same Day Exception Rules for COVID-19

The Duplicate Shot, Same Day rules do not apply for COVID-19 Vaccine Group

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  • Pfizer COVID-19 vaccine (CVX 208)
  • Moderna COVID-19 vaccine (CVX 207)
  • Janssen COVID-19 vaccine (CVX 212)
  • COVID-19, Unspecified Formulation (CVX 213)

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, due to the fact that the absolute minimum intervals between dose 1 and dose 2 = 0 days in both the Pfizer COVID-19 2-dose Series and Moderna COVID-19 2-dose Series. 

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Table of Contents

COVID-19 Vaccine Group Evaluation and Forecasting Rules

General Rules for COVID-19

The Duplicate Shot, Same Day rules do not apply for COVID-19 Vaccine Group, due to the fact that the absolute minimum intervals between dose 1 and dose 2 = 0 days in both the Pfizer COVID-19 2-dose Series and Moderna COVID-19 2-dose Series. General rules are not series-specific; general rules apply to the entire vaccine group.

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Rules for Recommending at the CVX Code vs. Vaccine Group Level 

  • When recommending in the Pfizer COVID-19 2-dose Series, recommend CVX 208 for the next target dose.
  • RecommendCVXorGroupLevel

    Table of Contents
    Table of Contents

    COVID-19 Vaccine Group Evaluation and Forecasting Rules

    General Rules for COVID-19

    General rules are not series-specific; general rules apply to the entire vaccine group.

    RecommendCVXorGroupLevel
    Rules for Recommending at the CVX Code vs. Vaccine Group Level
     

    • When recommending in the Pfizer COVID-19 2-dose Series, recommend CVX 208 for the next target dose.
    • When recommending in the Moderna COVID-19 2-dose Series, recommend CVX 207 for the next target dose.
    • When recommending in the Janssen COVID-19 1-dose Series, recommend CVX 212 for the next target dose. 
    • If patient has no doses shots on record, 
      • and is > = 12 years old, recommend at the vaccine group level at today's date. 
      • and is < 12 years old, recommend at the vaccine group level at 12 years old.

    COVID-19 Vaccines

    ...

    CVX Code

    ...

    Name

    ...

    Moderna COVID-19 Vaccine

    ...

    208

    ...

    Pfizer COVID-19 Vaccine

    ...

    (*) If a COVID-19 vaccine is administered before the vaccine's minimum age or series' recommended age (12y - 4d for Pfizer; 18y - 4d for Moderna), or below the series' minimum interval, supplemental text is returned to alert the user of this fact even though the may have been evaluated as Valid. See "Series Special Rules" for all series below for more details. (Notethe running distribution must have the output_supplemental_text option enabled for the supplemental text to be returned.)

    (*) See note about exception logic for AstraZeneca below.

    Combination Vaccines that Include COVID-19

    No combination vaccines exist, at this time, that include COVID-19 and count toward completion of the Pfizer COVID-19 2-dose series.

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    CVX Code Specific Rules

    CVX Code Absolute Minimum Age

    • If one of the CVX codes in the table above is administered below the absolute minimum age for that CVX code, then the Evaluation is Invalid and the reason code is BELOW_MINIMUM_AGE_VACCINE

    Rule for CVX 213

    • If the patient receives CVX 213 for:
      • Target Dose 1, evaluate the shot as Valid.
        • Recommend Target Dose 2 at Vaccine Group level
        • Recommended interval = 28 days
        • Recommended age = 18 years
      • Target Dose 2, evaluate the shot as Valid. 
    • If the patient receives CVX 213 for Target Dose 1 and CVX 212 (Janssen COVID-19 Vaccine) is reported for Target Dose 2, the Janssen COVID-19 1-dose Series applies and the series is complete. Therefore,  
      • evaluate Target Dose 2 (CVX 212) as Valid
      • evaluate Target Dose 1 as Accepted and the reason code is VACCINE_NOT_COUNTED_BASED_ON_MOST_RECENT_VACCINE_GIVEN.
    • If the patient receives CVX 213 for Target Dose 1 and CVX 210 (AstraZeneca COVID-19 Vaccine) for Target Dose 2 or CVX 210 (AstraZeneca COVID-19 Vaccine) for Target Dose 1 and CVX 213 for Target Dose 2, then:
      • evaluate both shots as Valid. 
      • No additional doses of COVID-19 vaccine are needed; Recommendation: Not Recommended/ COMPLETE.

    Rule for CVX 210 (AstraZeneca COVID-19 Vaccine)1

  • If the patient has received CVX 210 (AstraZeneca COVID-19 vaccine) for Target Dose 1 and Target Dose 2, then: 
    • Evaluate both shots as Valid. 
    • No additional doses of COVID-19 vaccine are needed; Recommendation: Not Recommended/ COMPLETE.
  • If the patient has received CVX 210 (AstraZeneca COVID-19 vaccine) for Target Dose 1 only, then:Evaluate the shot as Accepted

    Series Completion Special Rule

    • Once a patient completes:
      • either the Pfizer COVID-19 2-dose series or the Moderna COVID-19 2-dose series, the Recommendation is Conditional and the reason code is COMPLETE_HIGH_RISK. 
      • either the Pfizer COVID-19 2-dose series or the Moderna COVID-19 2-dose series AND receives an additional dose1, the Recommendation is Not Recommended and the reason code is COMPLETE.
      • either the 1) Janssen COVID-19 1-dose series, 2) COVID-19 vaccine series not authorized by the FDA, but authorized by the WHO, or a 3) COVID-19 vaccine series not authorized by the FDA or WHO, but is an active COVID-19 vaccine candidate as part of a U.S.-based clinical trial of a COVID-19 vaccine, the Recommendation is Not Recommended/ COMPLETE_HIGH_RISK.

    Rules for an Additional Dose1

    • If a patient completes a COVID-19 vaccine series via the Pfizer 2-dose series or Moderna 2-dose series and receives an additional shot of CVX 208, CVX 207, or CVX 213:
      • at < 28 days - 4 days after series completion, then evaluate the shot as Valid/ SUPPLEMENTAL_TEXT; Descriptive Text: "The timing of the administration of this shot does not follow the guidelines regarding the minimum age and/or minimum interval."
      • at >= 28 days - 4 days after series completion, then evaluate the shot as Valid.
    • If a patient receives a subsequent shot(s) after they have received an additional dose1, then evaluate that shot(s) as Accepted/ EXTRA_DOSE. 


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    Notes

    • 1Additional Dose - Defined by ACIP to be a dose administered when the immune response to a standard primary vaccine series is likely not to be protective. 

    COVID-19 Vaccines

    CVX Code

    Name

    Absolute Minimum AgeCounts towards U.S. Vaccination
    207

    Moderna COVID-19 Vaccine

    0 daysYes

    208

    Pfizer COVID-19 Vaccine

    0 daysYes
    210AstraZeneca COVID-19 Vaccine0 daysYes, only if all recommended doses are administered.
    211Novavax COVID-19 Vaccine0 daysYes, only if all recommended doses are administered.
    212Janssen COVID-19 Vaccine0 daysYes
    213SARS-COV-2 (COVID-19) vaccine, UNSPECIFIED0 daysYes

    500

    COVID-19 Non-US Vaccine, Product Unknown 


    No

    501

    COVID-19 IV Non-US Vaccine (QAZCOVID-IN)


    No

    502

    COVID-19 IV Non-US Vaccine (COVAXIN)


    No

    503

    COVID-19 LAV Non-US Vaccine (COVIVAC)


    No

    504

    COVID-19 VVnr Non-US Vaccine (Sputnik Light)


    No

    505

    COVID-19 VVnr Non-US Vaccine (Sputnik V)


    No

    506

    COVID-19 VVnr Non-US Vaccine (CanSino Biological Inc./Beijing Institute of Biotechnology)


    No

    507

    COVID-19 PS Non-US Vaccine (Anhui Zhifei Longcom Biopharmaceutical + Institute of Microbology Chinese academy of Sciences)


    No

    508

    COVID-19 PS Non-US Vaccine (Jiangsu Province Centers for Disease Control and Prevention)


    No

    509

    COVID-19 PS Non-US Vaccine (EpiVacCorona)


    No

    510

    COVID-19 IV Non-US Vaccine (BIBP, Sinopharm)

    0 daysYes, only if all recommended doses are administered.

    511

    COVID-19 IV Non-US Vaccine (CoronaVac, Sinovac)

    0 daysYes, only if all recommended doses are administered.

    Combination Vaccines that Include COVID-19

    No combination vaccines exist, at this time, that include COVID-19 and count toward completion of the Pfizer COVID-19 2-dose series.


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    CVX Code Specific Rules

    CVX Code Absolute Minimum Age

    • If one of the CVX codes in the table above is administered below the absolute minimum age for that CVX code, then the Evaluation is Invalid and the reason code is BELOW_MINIMUM_AGE_VACCINE

    Rule for CVX 213

    • If the patient receives CVX 213 for:
      • Target Dose 1, evaluate the shot as Valid.
        • Recommend Target Dose 2 at Vaccine Group level
        • Recommended interval = 28 days
        • Recommended age = 18 years
      • Target Dose 2, evaluate the shot as Valid. 
      • If the patient receives CVX 213 for Target Dose 1 and CVX 212 (Janssen COVID-19 Vaccine) is reported for Target Dose 2, the Janssen COVID-19 1-dose Series applies and the series is complete. Therefore,  
        • evaluate Target Dose 2 (CVX 212) as Valid.
        • evaluate Target Dose 1 as Accepted and the reason code is VACCINE_NOT_COUNTED_BASED_ON_MOST_RECENT_VACCINE_GIVEN.
      • If the patient has CVX 213 on their patient record AND receives all recommended doses of a 1) COVID-19 vaccine not authorized by the FDA, but authorized by the WHO or 2) COVID-19 vaccine not authorized by the FDA or WHO, but is an active COVID-19 vaccine candidate as part of a U.S.-based clinical trial of a COVID-19 vaccine, then 
        • evaluate CVX 213 shots given before series completion as Accepted/ VACCINE_NOT_COUNTED_BASED_ON_MOST_RECENT_VACCINE_GIVEN.
          • Example Scenario #1 - Patient receives the following shots (listed in order): CVX 213, CVX 210 (AstraZeneca), CVX 210 (AstraZeneca) 
            • CVX 213 shot is evaluated as Accepted/ VACCINE_NOT_COUNTED_BASED_ON_MOST_RECENT_VACCINE_GIVEN
            • Both CVX 210 shots are evaluated as Valid (series is complete via AstraZeneca 2-dose series)
          • Example Scenario #2 - Patient receives the following shots (listed in order): CVX 210 (AstraZeneca), CVX 213, CVX 210 (AstraZeneca) 
            • CVX 213 shot is evaluated as Accepted/ VACCINE_NOT_COUNTED_BASED_ON_MOST_RECENT_VACCINE_GIVEN
            • Both CVX 210 shots are evaluated as Valid (series is complete via AstraZeneca 2-dose series)
        • evaluate CVX 213 shots given after series completion as Accepted/ EXTRA_DOSE. 
          • Example Scenario #1 - Patient receives the following shots (listed in order): CVX 210 (AstraZeneca), CVX 210 (AstraZeneca), CVX 213 
            • Both CVX 210 shots are evaluated as Valid (series is complete via AstraZeneca 2-dose series)
            • CVX 213 is evaluated as Accepted/ EXTRA_DOSE

    Rules for COVID-19 Vaccines Not Authorized by FDA2

    The following set of rules apply to 1) COVID-19 Vaccines Not Authorized by FDA, but Authorized by WHO and, 2) COVID-19 Vaccines Not Authorized by FDA or WHO, but is an Active COVID-19 Vaccine Candidate as part of a U.S.-based Clinical Trial of a COVID-19 Vaccine. 

    • The list of COVID-19 Vaccines Not Authorized by the FDA, but Authorized by the WHO are:

      • CVX 210 - AstraZeneca COVID-19 Vaccine

      • CVX 510 - BIBP, Sinopharm COVID-19 Vaccine
      • CVX 511 - CoronaVac, Sinovac
    • The list of COVID-19 Vaccines Not Authorized by the FDA or WHO, but is an active COVID-19 vaccine candidate as part of a U.S.-based clinical trial of a COVID-19 vaccine are:

      • CVX 211- Novavax COVID-19 Vaccine

    • If the patient has received all recommended doses of the COVID-19 vaccine, then: 
      • Evaluate the shots as Valid; (Absolute Minimum Interval = 0 days; Absolute Minimum Age = 0 days)
      • No additional doses of COVID-19 vaccine are needed; Recommendation: Not Recommended/ COMPLETE_HIGH_RISK.
    • If the patient has received one or more doses, but has not received all the recommended doses for that COVID-19 vaccine, then:
      • Evaluate the shot(s) as Accepted/ VACCINE_NOT_APPROVED_IN_US. 
      • Recommendation:
        • If one of the above listed COVID-19 vaccine is the last COVID-19 shot administered, then recommend COVID-19 at the vaccine group level at last shot administered + recommended interval (28 days). 
          • Example #1: Patient has 1 shot of CVX 210 (AstraZeneca) on record.
            • Evaluate CVX 210 as Accepted/ VACCINE_NOT_APPROVED_IN_US.
            • Recommend COVID-19 at the vaccine group level for Target Dose 1 at CVX 210 + recommended interval (28 days). 
          • Example #2: Patient has 1 shot of CVX 208 (Pfizer), then 1 shot of CVX 210 (AstraZeneca) on record. 
            • Evaluate CVX 208 as Valid and CVX 210 as Accepted/ VACCINE_NOT_APPROVED_IN_US.
            • Recommend COVID-19 at the vaccine group level for Target Dose 2 at CVX 210 + recommended interval (28 days). 
        • If one of the above listed COVID-19 vaccine is NOT the last COVID-19 shot administered, recommend based on the series that applies for the last COVID-19 shot administered.
          • Example: If CVX 208 (Pfizer) is given after CVX 210 (AstraZeneca), then recommend based on the Pfizer COVID-19 2-dose Series.


    The following set of rules apply to COVID-19 Vaccines Not Authorized by FDA or WHO. 
    • The list of COVID-19 Vaccines Not Authorized by the FDA or WHO are:

      • CVX 500 - COVID-19 Non-US Vaccine, Product Unknown 
      • CVX 501 - COVID-19 IV Non-US Vaccine (QAZCOVID-IN)
      • CVX 502 - COVID-19 IV Non-US Vaccine (COVAXIN)
      • CVX 503 - COVID-19 LAV Non-US Vaccine (COVIVAC) 
      • CVX 504 - COVID-19 VVnr Non-US Vaccine (Sputnik Light) 
      • CVX 505 - COVID-19 VVnr Non-US Vaccine (Sputnik V)
      • CVX 506 - COVID-19 VVnr Non-US Vaccine (CanSino Biological Inc./Beijing Institute of Biotechnology)
      • CVX 507 - COVID-19 PS Non-US Vaccine (Anhui Zhifei Longcom Biopharmaceutical + Institute of Microbology Chinese academy of Sciences)
      • CVX 508 - COVID-19 PS Non-US Vaccine (Jiangsu Province Centers for Disease Control and Prevention)
      • CVX 509 - COVID-19 PS Non-US Vaccine (EpiVacCorona)
    • If the patient has received a COVID-19 vaccine not authorized by the FDA or WHO for all or some or the recommended doses of the COVID-19 vaccine, then: 
      • Evaluate the shot(s) as Invalid/ VACCINE_NOT_APPROVED_IN_US_OR_BY_WHO. (new reason code)
      • Recommendation:
        • If CVX 210 one of the above listed COVID-19 vaccine is the last COVID-19 shot administered, then recommend COVID-19 at the vaccine group level at last shot administered + recommended interval (28 days) or at 12 years old, whichever date is later.  
          • Example #1: Patient has 1 shot of CVX 210 (AstraZeneca) 501 on record.
            • Evaluate CVX 210 501 as AcceptedInvalid/ VACCINE_NOT_APPROVED_IN_US_OR_BY_WHO.
            • Recommend COVID-19 at the vaccine group level for Target Dose 1 at CVX 210 501 + recommended interval (28 days). 
          • Example #2: Patient has 1 shot of CVX 208 (Pfizer), then 1 shot of CVX 210 (AstraZeneca) 501 on record. 
            • Evaluate CVX 208 as Valid and CVX 210 501 as AcceptedInvalid/ VACCINE_NOT_APPROVED_IN_US_OR_BY_WHO.
            • Recommend COVID-19 at the vaccine group level for Target Dose 2 at CVX 210 501 + recommended interval (28 days). 
        • If CVX 210 is not the one of the above listed COVID-19 vaccine is NOT the last COVID-19 shot administered, recommend based on the series that applies for the last COVID-19 shot administered.
          • Example: If CVX 208 (Pfizer) is given after CVX 210 (AstraZeneca)501, then recommend based on the Pfizer COVID-19 2-dose Series.

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    Notes

    1CVX 210 (AstraZeneca COVID-19 Vaccine) has not yet been approved for use in the U.S. by the FDA, but it is approved by the WHO. The "Rule for CVX 210 (AstraZeneca COVID-19 Vaccine)" rules were created to handle AstraZeneca
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    Notes

    Immunization Series and Selection Rules

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    Series Name

    • Pfizer COVID-19 2-dose Series
    • Moderna COVID-19 2-dose Series
    • Janssen COVID-19 1-dose Series

    Series Selection Rules

    There are three series for this vaccine group: the Pfizer COVID-19 2-dose series, Moderna COVID-19 2-dose series, and Janssen COVID-19 1-dose series. The rules for determining which series applies are:

    • If dose 1 is CVX 208, then the Pfizer COVID-19 2-dose series applies.
    • If dose 1 is CVX 207, then the Moderna COVID-19 2-dose series applies. 
    • If dose 1 is CVX 212, then the Janssen COVID-19 1-dose series applies. 
    • If dose 1 is CVX 210, reference the "Rule for CVX 210" rules above. If dose 1 is CVX 213, reference the "Rule for CVX 213" rule above. 
    • If no doses shots are on patient record, reference the "Rules for Recommending at the CVX Code vs. Vaccine Group Level" rules above. 

    Immunization Series: Pfizer COVID-19 2-dose Series

    The Pfizer COVID-19 2dose 2-dose series is complete after 2 doses. 

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    Series Special Rules

    • If the patient receives a shot at < 12 years - 4 days of age and/or < 21 days - 4 days interval between dose 1 and 2, evaluate the shot as Valid, with reason code SUPPLEMENTAL_TEXT; Descriptive Text: "The timing of the administration of this shot does not follow the guidelines of the EUA regarding the minimum age and/or minimum interval."

    Rule for CVX 212 (Janssen COVID-19 Vaccine)

    • If CVX 212 (Janssen COVID-19 Vaccine) is reported for Target Dose 2, the Janssen COVID-19 1-dose Series applies and the series is complete. Therefore,  
      • evaluate Target Dose 2 (CVX 212) as Valid.
      • evaluate Target Dose 1 as Accepted and the reason code is VACCINE_NOT_COUNTED_BASED_ON_MOST_RECENT_VACCINE_GIVEN.

    Immunization Series: Moderna COVID-19 2-dose series

    The Moderna COVID-19 2-dose series is complete after 2 doses. 

    ...

    Dose

    Series Name

    Absolute Minimum
     Age

    Minimum Age

    Routine
    Age

    Latest Recommended Age (less than)

    Valid CVX Code(s) per Dose for this SeriesInvalid CVX Code(s) per Dose for this Series

    1

    Moderna COVID-19 2-dose Series

    0 days

    18 years

    18 years

    N/A207, 213

    N/A


    2

    Moderna COVID-19 2-dose Series

    0 days18 12 years18 12 yearsN/A207, 208, 213

    N/A


    Vaccine Dose Parameters - Minimum and Recommended Intervals

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    Series Special Rules

    • If the patient receives a shot at < 18 years - 4 days of age and/or < 28 days - 4 days interval between dose 1 and 2, evaluate the shot as Valid, with reason code SUPPLEMENTAL_TEXT; Descriptive Text: "The timing of the administration of this shot does not follow the guidelines of the EUA regarding the minimum age and/or minimum interval."

    Rule for CVX 212 (Janssen COVID-19 Vaccine)

    • If CVX 212 (Janssen COVID-19 Vaccine) is reported for Target Dose 2, the Janssen COVID-19 1-dose Series applies and the series is complete. Therefore,  
      • evaluate Target Dose 2 (CVX 212) as Valid.
      • evaluate Target Dose 1 as Accepted and the reason code is VACCINE_NOT_COUNTED_BASED_ON_MOST_RECENT_VACCINE_GIVEN.

    Immunization Series: Janssen COVID-19 1-dose Series

    The Janssen COVID-19 1-dose Series is complete after 1 dose.

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    Series Special Rules

    • If the patient receives a shot at < 18 years - 4 days of age, evaluate the shot as Valid, with reason code SUPPLEMENTAL_TEXT; Descriptive Text: "The timing of the administration of this shot does not follow the guidelines of the EUA regarding the minimum age and/or minimum interval."

    ...