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Minnesota Department of Health
April 16, 2021
Good afternoon,
Here are the COVID-19 vaccine provider updates for 4/9-4/16.
- Minnesota is advising health care providers to follow the April 13 federal recommendation to stop administering Johnson & Johnson COVID-19 vaccine while the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) review information about an extremely rare type of blood clot reported in six of the nearly 7 million people who received the vaccine.
- The Advisory Committee on Immunization Practices (ACIP) met on Wednesday, April 14 to discuss the situation. The committee felt they needed more information and agreed to meet again in seven to 10 days to review the data and make recommendations. Minutes and the meeting recording will be posted at CDC: ACIP Meeting Information.
- Find MDH’s health alert, Minnesota news release, and CDC statement at COVID-19 Vaccine.
What you should do:
- If you have Johnson & Johnson vaccine in your fridge, mark it as DO NOT USE until we know more. Continue to store and handle Johnson & Johnson vaccine properly.
- Health care providers should report adverse events to the Vaccine Adverse Event Reporting System at VAERS: Report an Adverse Event to VAERS.
- We will not place any additional orders for Johnson & Johnson vaccine until there is a resolution.
- If Johnson & Johnson is your only vaccine type, please make your site inactive on the State of Minnesota: Find Vaccine Locations
All people at COVID-19 vaccination sites should feel safe and be treated with respect. Providers play a role in creating a safe and respectful environment at vaccination sites. This means providing reasonable accommodations for those with physical, cognitive, and/or sensory disabilities. Learn more about considerations when working with people with disabilities at Disabilities and Unique Health Needs During the COVID-19 Pandemic.
Providers and staff should also be aware of cultural and religious accommodations that people may need, such as privacy screens or language assistance. Everyone deserves a safe and respectful COVID-19 vaccine experience.
Find the updated guide and appendices at COVID-19 Vaccine Providers.
Key updates to the main guide:
- Vaccine supplies: updated contact information for Pfizer and Moderna/Janssen for questions or problems related to ancillary supply kits (p. 6).
- Vaccine storage and handling: added to refer to specific appendices for each vaccine product (p. 7).
- Guidance on post-vaccination symptoms: updated link to new general workplace guidance, which includes health care (p. 17).
- New section added: security and disposal of vaccine vials (p. 22).
Appendix A/Pfizer BioNTech update: added additional side effects in the adverse reaction section (p. 7).
Appendix B/Moderna updates: adverse reactions (side effects) – added information regarding severe allergic reactions. Do not waste vaccine section – changed six hours to 12 hours for when doses must be administered once the vial is punctured (p. 5).
Now is a good time to check your vaccine expiration dates on your vials, as it has been more than 100 days since the first orders of vaccine shipped. The expiration date should be checked before vaccine preparation and administration. Follow a “first-in/first-out” practice when storing vaccine to be sure older vials are used first (e.g., keep vials expiring the soonest in front in the storage unit).
- When the expiration date has only a month and year, the vaccine/diluent may be used up to and including the last day of that month (unless the vaccine was contaminated or compromised).
- If a day is included with the month and year, the vaccine/diluent may be used only through the end of that day (unless the vaccine was contaminated or compromised).
See example below:
 On the left, the expiration date is Jan. 16, 2020; there are check marks on all days of the calendar until 16. 17 and above are all crossed out. On the right, the expiration date is 01/2020; there are check marks on all days of the Jan. 2020 calendar.
With the COVID-19 vaccines, you may see people with more anxiety, anxiety attacks, dizziness, and syncope. This can be due to the person's anxiety/stress level. The pandemic has caused a lot of stress and mental health-related issues. For some people, the vaccine is a culminating event (the pandemic, restrictions, quarantining, the unknown, difficulty getting an appointment to get vaccinated, and the fear of getting vaccinated versus the fear of not getting vaccinated). They may experience a flood of emotions and adrenaline when they receive the vaccine, which may cause the person to feel anxious. For your awareness:
- CDC is aware of several incidents of vaccine recipients experiencing dizziness, light headedness, feeling faint (vasovagal), rapid breathing, and sweating (anxiety-related) symptoms following COVID-19 vaccines. These types of responses are common and expected following vaccinations in general. Refer to: CDC: Fainting (Syncope) after Vaccination
- CDC conducted lot assessments, which included reviewing VAERS reports or clusters of VAERS reports on fainting and vaccine administration, and has determined there is no evidence to suggest an issue with any lots or vaccine manufacturers.
- Reporting episodes of fainting or other reactions to the Vaccine Adverse Event Reporting System (VAERS) helps to identify patterns in these events.
Use best practices when administering vaccine to avoid potential injury. For people being vaccinated, the main concern is fainting that may result in a head injury. In a study of syncope-related VAERS reports (CDC: MMWR: Syncope After Vaccination --- United States, January 2005--July 2007), 7% of fainting reports were coded as serious (with 12% of these involving head injuries).
Often people have symptoms immediately before they faint, such as becoming pale, sweaty, weak or dizzy.
Ways to prevent fainting and related injuries:
- Have the person sit in a chair or lie down. Do not vaccinate people who are standing or people who are sitting on an exam table.
- Be aware that fainting is more common in adolescents and young adults after vaccination.
- Give people some reassurance about the administration procedure; this has been shown to prevent some fainting. Listen to concerns and answer questions. Be honest and calm.
Use techniques that may lessen pain (and anxiety) during the injection, such as injecting the vaccine rapidly without aspiration. Distraction techniques include tactile stimulation (rubbing the skin) near the injection site before the injection, telling a story or pointing out something interesting in the room, or having them “blow out” the pain by imagining it leaving as they breathe out.
Safety considerations for people administering COVID-19 vaccine
- Set up your workspace to be ergonomically correct: Sit at a comfortable height with your patient and have all supplies within easy reach. Move your chair to the correct side so you are not leaning when you administer the shot.
- Perform hand hygiene (before preparing vaccine, before seeing a new patient, and after vaccine administration).
- Wear appropriate personal protective equipment (PPE). Gloves are optional (if used, change between patients): CDC: Vaccine Administration: COVID-19 Personal Protective Equipment (PDF).
- Ensure all patients wear a cloth face covering or face mask that covers the nose and mouth.
- Use safety syringes; ask if you are not familiar with how they work.
- Dispose of needles/syringes immediately in a readily available sharps container.
- Never recap used needles!
Resources:
- Due to the increased threat of fake or counterfeit vaccines, CDC convened an interagency working group of medical professionals, suppliers, and law enforcement. The working group recommends vaccination sites take appropriate steps to properly dispose of empty vaccine vials and product packaging.
- The following additional recommended actions will further protect empty COVID-19 vaccine vials and packaging from counterfeit efforts:
- Action 1 (preferred method): Treat vials and packaging similarly to medical waste by placing them in a red sharps container.
- Action 2: Deface or safely crush all materials, so they cannot be reintroduced or reproduced. After the products are sufficiently defaced, dispose of with regular waste.
- Vaccines are only available and administered through state-authorized vaccination locations. Nonmedical companies or private people are not authorized to provide, sell, or administer vaccines.
- Any offers related to the sale or use of COVID-19 vaccines that are not from a medical provider should be considered suspicious and reported to the appropriate state or jurisdiction. This may include state or local health departments, the U.S. Department of Health and Human Services, or the Office of the Inspector General: report online or at 1-800-HHS-TIPS. Or submit a tip to the Federal Bureau of Investigation, FBI: Submit a Tip.
As vaccine supply increases, you can expect to receive your Moderna COVID-19 vaccine shipments within two business days of receiving your vaccine order confirmation email from the Minnesota Immunization Information Connection (health.mdhvaccine@state.mn.us). Please note, this is a slight shift from the previous timeline of 24 hours and may result in Moderna vaccine orders arriving a day later than previously expected. MDH staff are doing everything within their control to get vaccine orders out for delivery as soon as possible to Minnesota providers.
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