Should I take COVID-19 vaccines if I have a significant history of allergic reactions?

This section addresses contraindications and precautions to COVID-19 vaccines.

 

Individuals with allergy questions or concerns should consult a health care provider. Disclose any allergies to medical staff prior to vaccination.

 

While rare, anaphylactic reactions have been reported following vaccination with COVID-19 vaccines. Although investigations are ongoing, persons with a history of an immediate allergic reaction (of any severity) to an mRNA COVID-19 vaccine or any of its components might be at greater risk for severe reaction upon taking additional doses. For the purposes of this guidance, an immediate allergic reaction to a vaccine or medication is defined as any hypersensitivity-related signs or symptoms such as hives (urticaria); swelling around the face, lips, and tongue (angioedema); wheezing or other respiratory distress; or anaphylaxis that occur within four hours following getting the vaccine.

 

Recommendations for contraindications and precautions are described below and summarized in the figure from CDC at the end of this question section. The following recommendations may change as further information becomes available.

 

Contraindication to vaccination:

Contraindications are conditions or factors that would be a reason to not get vaccination due to harm. (Individuals with a contraindication should not get the COVID-19 vaccine.)

CDC considers a history of the following to be a contraindication to vaccination with COVID-19 vaccines:

 

Providers should attempt to determine whether reactions reported following vaccination are consistent with immediate allergic reactions versus other types of reactions commonly observed following vaccination, such as passing out (a vasovagal reaction) or post-vaccination side effects—which are not contraindications to receiving the second vaccine dose (see the figure at the bottom of this question section).

The safety and efficacy of the Johnson & Johnson/Janssen COVID-19 vaccine administered after an mRNA COVID-19 vaccine has not been established. However, in limited, exceptional situations where a patient received the first dose of an mRNA COVID-19 vaccine but is unable to complete the series with either the same or different mRNA COVID-19 vaccine (e.g., due to contraindication), a single dose of Janssen COVID-19 vaccine may be considered at a minimum interval of 28 days from the mRNA COVID-19 vaccine dose. Patients who receive Johnson & Johnson/Janssen COVID-19 vaccine after a dose of an mRNA COVID-19 vaccine should be considered to have received a valid, single-dose Janssen vaccination—not a mixed vaccination series.

For the Johnson & Johnson/Janssen vaccine, if a person had had autoimmune heparin induced thrombocytopenia (HIT), they may be offered an mRNA vaccine until 90 days have passed since resolution of HIT, after which any COVID-19 vaccine may be offered.

The following fact sheets contain additional information about who should not receive the vaccine.

Pfizer-BioNTech Fact Sheet for Vaccine Recipients and Caregivers: https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/pfizer-biontech-covid-19-vaccine

 

Moderna Fact Sheet for Vaccine Recipients and Caregivers: https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/moderna-covid-19-vaccine

 

Johnson & Johnson's Janssen Vaccine Fact Sheet for Vaccine Recipients and Caregivers: https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/janssen-covid-19-vaccine

 

For more information about contraindications and precautions on use of the J&J/Janssen COVID-19 vaccine and additional precautions in people with a contraindication to mRNA COVID-19 vaccines: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#Appendix-C

 

The following vaccines ingredients list (next page) is available from: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#Appendix-C

Figure: Ingredients included in COVID-19 vaccines

Precaution to vaccination:

Precautions are conditions or factors that would be a reason to consult with a health care provider before proceeding with vaccination. Vaccine providers should observe these patients for 30 minutes after vaccination to monitor for the development of immediate adverse reactions.

The CDC considers a history of immediate allergic reaction to any other vaccine or injectable therapy (e.g., intramuscular, intravenous, or subcutaneous) as a precaution but not a contraindication to vaccination. These persons may still receive vaccination but should be counseled about unknown risks of developing a severe allergic reaction and balance these risks against the benefits of vaccination. All vaccination sites will have the medication they need, and the trained medical professionals, to respond to an allergic reaction if one occurs. The CDC advises that individuals who are concerned about their history of allergies may prefer to be vaccinated in a setting where more comprehensive medical care is immediately available for anaphylaxis.

People with a contraindication to one type of the currently authorized COVID-19 vaccines (e.g., mRNA) have a precaution to the other (e.g., Johnson & Johnson/Janssen viral vector). For individuals who have a contraindication for one type of COVID-19 vaccine may consider consulting with an allergist-immunologist to help determine whether the patient can safely receive vaccination.

 

No contraindication or precaution:

There are allergies that do not constitute a contraindication or precaution to vaccination, including:

For rare instances when individuals experience immediate allergic reactions, appropriate medical treatments are available (and are mandatory on site) to manage the symptoms. Clinical considerations are available here: https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/anaphylaxis-management.html

(See figure on next page for triage of individuals presenting for COVID-19 vaccination.)

Triage of Individuals Presenting for COVID-19 Vaccination:

The above figure is available at https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#Appendix-C

Full clinical guidance is available here: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/managing-anaphylaxis.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fcovid-19%2Finfo-by-product%2Fpfizer%2Fanaphylaxis-management.html

Are children and adolescents recommended to receive COVID-19 vaccines?

Children/adolescents under age 12.

The Pfizer-BioNTech vaccine is not recommended for children under age 12. The Moderna and Johnson & Johnson/Janssen COVID-19 vaccines are not recommended for children and adolescents under age 18 at this time. In early clinical trials for various COVID-19 vaccines, only adults who were not pregnant participated. Older children (12 and up) were added in later trials. However, clinical trials continue to expand and include other groups, so these recommendations may change in the future.

 

Adolescents age 12 and older.

Individuals aged 12 and older are eligible to receive the Pfizer-BioNTech COVID-19 vaccines (but not the Moderna or Johnson & Johnson/Janssen COVID-19 vaccine at this time). No safety concerns were identified in this group during Pfizer-BioNTech COVID-19 clinical trials. Although vaccine safety and efficacy data in this age group are somewhat limited, there is no medical reason to believe that responses from this group would be different from those who are 18 years of age and older. Individuals aged 12 and older years may be vaccinated with the Pfizer-BioNTech vaccine.

 

Should I take a COVID-19 vaccine if I am pregnant?

Pregnant people may be vaccinated. COVID-19 vaccine safety-related monitoring has not identified any safety concerns for pregnant people who were vaccinated or their babies. Yet, people who are pregnant and become infected with COVID-19 can have an increased risk of severe illness or negative pregnancy outcomes, such as preterm birth. Reputable sources, such as the American College of Obstetricians and Gynecologists, have advised that the benefit of vaccination may outweigh the risk of severe COVID-19 disease. For this reason, a person who is pregnant is part of a group who is recommended to receive a COVID-19 vaccine may choose to be vaccinated. A discussion with a health care provider can help make an informed decision. Although a conversation with a healthcare provider may be helpful, it is not required prior to vaccination.

Should I take the vaccine if I am breastfeeding?

Breastfeeding individuals may be vaccinated. Based on how these vaccines work in the body, COVID-19 vaccines are thought not to be a risk to lactating people or their breastfeeding babies. Therefore, lactating people can receive a COVID-19 vaccine. Recent reports have shown that breastfeeding people who have received COVID-19 mRNA vaccines have antibodies in their breastmilk, which could help protect their babies. More data are needed to determine what protection these antibodies may provide to the baby. A discussion with a health care provider can help to make an informed decision. Although a conversation with a healthcare provider may be helpful, it is not required prior to vaccination.

Are the COVID-19 vaccines safe for people who want to become pregnant?

There is no evidence the COVID-19 vaccine affects fertility. People who are trying to become pregnant or who are pregnant and for whom the vaccine is recommended may choose to be vaccinated. A discussion with a health care provider can help to make an informed decision.

More information from the American Society for Reproductive Medicine is available here:

https://www.asrm.org/news-and-publications/news-and-research/press-releases-and-bulletins/asrm-issues-statement-on-covid-19-vaccines-joins-other-obgyn-groups-on-community-wide-statement/

 

If I have dermal fillers (e.g., face/lip enhancements), are there other possible side effects from COVID-19 vaccination?

It is possible, although infrequent, for persons who have received dermal fillers to develop swelling at or near the site of filler injection (usually face or lips) following administration of a dose of a COVID-19 vaccine. This appears to be temporary and can resolve with medical treatment, including corticosteroid therapy. The COVID-19 vaccines may be administered to people who have received injectable dermal fillers (and who have no contraindications to vaccination). Anyone with a dermal filler who experiences swelling at or near the site of the filler injection should contact a healthcare provider for evaluation.

Should I take the vaccine if I am immunocompromised?

CDC recommends immunocompromised individuals receive the vaccine upon discussion with a healthcare provider. Currently, there is no data on the safety and efficacy of COVID-19 vaccines in immunocompromised people. However, persons with immunocompromising conditions or who take immunosuppressive medications or therapies might be at increased risk for severe disease if they get COVID-19. Therefore, the CDC recommends these individuals receive the COVID-19 vaccine. Immunocompromised individuals should discuss this with a healthcare provider. It is important to note that the COVID-19 vaccines do not contain live virus; so, it is not possible to develop COVID-19 from vaccination.

Are COVID-19 vaccines safe for people with autoimmune disease?

People with autoimmune disease may receive COVID-19 vaccination. Experts say there is no reason to believe that the currently approved COVID-19 vaccines will be unsafe for people with autoimmune disease. Additionally, authorized vaccines are expected to be safe for immunocompromised patients and those on immunosuppressant drugs. However, it is yet unconfirmed whether immunosuppressant medications or unchecked disease activity may reduce vaccine effectiveness. Persons with autoimmune conditions who have no contraindications to vaccination may receive a COVID-19 vaccine. A discussion with a health care provider can help to make an informed decision.

Should I take the vaccine if I've had Guillain-Barre syndrome?

People with a history of Guillain-Barre syndrome (GBS) may receive COVID-19 vaccination. No cases of Guillain-Barre syndrome (GBS) have been reported following vaccination among participants in the mRNA COVID-19 vaccines clinical trials. One case of GBS was reported in a participant in the vaccine group in the Johnson & Johnson/Janssen COVID-19 vaccine clinical trial, compared to one GBS case among those who received placebo. With few exceptions, Advisory Committee on Immunization Practices (ACIP) general best practice guidelines for immunization does not include history of GBS as a contraindication or precaution to vaccination. Persons with a history of GBS may receive an COVID-19 vaccine unless they have a contraindication to vaccination. Any occurrence of GBS following COVID-19 vaccination should be reported to VAERS.

Should I take the vaccine if I have a history of Bell's palsy?

People with a history of Bell's palsy may receive COVID-19 vaccination Cases of Bell's palsy were reported following vaccination in participants in the COVID-19 vaccines' clinical trials. However, the FDA does not consider these to be above the frequency expected in the general population and has not concluded that these cases were causally related to vaccination. The FDA and CDC will continue to monitor the vaccines' safety. In the absence of such evidence, persons with a history of Bell's palsy may receive an mRNA COVID-19 vaccine unless they have a contraindication to vaccination. Any occurrence of Bell's palsy following mRNA COVID-19 vaccination should be reported to VAERS.

Should I take the vaccine if I have had convalescent plasma or monoclonal antibody?

The Advisory Committee on Immunization Practices (ACIP) recommends that vaccination should be deferred until 90 days after receiving convalescent plasma or monoclonal antibodies. Currently, there are no data on the safety and efficacy of COVID-19 vaccines in people who received convalescent plasma or monoclonal antibody therapy. This is to avoid interference of these treatments with vaccine-induced immune responses. The risks and benefits of vaccination based upon the underlying risk factors, including living in a nursing home, could be considered. A discussion with a health care provider can help make an informed decision.

Should I take the vaccine if I have had heparin induced thrombocytopenia (HIT)?

Thrombosis with thrombocytopenia syndrome (TTS) shares similarities with autoimmune heparin induced thrombocytopenia (HIT). HIT is when low platelets develop after a person receives heparin. If a person has had HIT, they may be offered an mRNA COVID-19 vaccine (i.e., Pfizer or Moderna) within 90 days since resolution of HIT, and once 90 days have passed, any COVID-19 vaccine may be offered. For individuals who develop TTS, the use of heparin may be harmful and alternative treatments may be needed. Consultation with hematology specialists is recommended.

Should I take the vaccine if I have a history of Multisystem Inflammatory Syndrome in Children (MIS-C) or Adults (MIS-A)?

People with a history of MIS-C or MIS-A may choose to be vaccinated. Considerations for vaccination may include:

A conversation between the patient, their guardian(s), and their clinical team or a specialist may assist with decisions about the use of a COVID-19 vaccine, though a conversation with a healthcare provider is not required before vaccination.

Healthcare providers and health departments may also request a consultation from the Clinical Immunization Safety Assessment COVIDvax. For more information, visit:

https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/cisa/index.html

Should I take the vaccine if I already had COVID-19 and recovered?

Yes. Data from clinical trials indicate that COVID-19 vaccines are safe in persons with evidence of a prior SARS-CoV-2 infection. Vaccination should be offered to individuals regardless of history of COVID-19 (symptomatic or asymptomatic). The length of immunity after recovering from COVID-19 disease is unknown; early studies show that immunity after disease recovery is not long lasting and rare cases of reinfection have been reported.

Testing specifically to determine whether a person has active or prior COVID-19 infection is not recommended solely for the purpose of vaccine decision-making.

How long after recovering from COVID-19 should I take the vaccine?

While there is no recommended minimum interval between infection and vaccination, current evidence suggests that the risk of COVID-19 reinfection is low within 90 days after initial infection, but risk may increase with time due to waning immunity. Thus vaccination could be deferred during that timeframe.

 

Should I take the vaccine if I currently am infected with COVID-19?

No. Those infected should wait until they have recovered from the acute illness (if the person had symptoms) and criteria have been met for them to end their isolation. This waiting period is essential to avoid exposing healthcare personnel (HCP) or other persons during the vaccination visit. Getting the vaccine while infected is not expected to harm you, but leaving isolation will put others in danger of getting COVID-19. This recommendation applies to persons who get COVID-19 before receiving any vaccine doses as well as those who get COVID-19 after the first dose but before taking the second dose.

 

Should I get a COVID-19 vaccine if I am in quarantine?

Individuals in a community or outpatient setting should defer vaccination until quarantine period has ended to avoid exposing healthcare personnel (HCP) or other persons during the vaccination visit.

 

Residents of congregate healthcare settings (e.g., long-term care facilities) may be vaccinated, as this likely would not result in any additional exposures. HCP are already in close contact with residents and should employ appropriate infection prevention and control procedures.

 

Residents of other congregate settings (e.g., correctional facilities, homeless shelters, residential settings) may be vaccinated, in order to avoid delays and missed opportunities for vaccination. Where possible, precautions should be taken to limit mixing of these individuals with other residents or non-essential staff.

 

 

Can I get the COVID-19 at the same time as other vaccines (i.e., coadministration)?

Yes COVID-19 vaccines can be given to someone at the same time as they are receiving other vaccines. COVID-19 vaccines were previously recommended to be administered alone, with a minimum interval of 14 days before or after administration of any other vaccines. This was out of an abundance of caution and not due to any known safety or immunogenicity concerns. However, substantial data have now been collected regarding the safety of COVID-19 vaccines currently authorized by FDA for use under EUA. Although data are not available for COVID-19 vaccines administered simultaneously with other vaccines, extensive experience with non-COVID-19 vaccines has demonstrated that immunogenicity and adverse event profiles are generally similar when vaccines are administered simultaneously as when they are administered alone.

COVID-19 vaccines may now be coadministered at the same time as other vaccines. COVID-19 vaccines and other vaccines may also be administered within 14 days or more of each other. When deciding whether to coadminister another vaccine(s) with COVID-19 vaccines, providers should consider whether the patient is behind or at risk of becoming behind on recommended vaccines, their risk of vaccine-preventable disease (e.g., during an outbreak or occupational exposures), and the reactogenicity profile of the vaccines.

If multiple vaccines are administered at a single visit, administer each injection in a different injection site. For adolescents and adults, the deltoid muscle can be used for more than one intramuscular injection.

 

Could getting a COVID-19 vaccine affect the results of a mammogram?

Possibly. Some people who receive a COVID-19 vaccine may experience swollen lymph nodes on the same side of the body where they received the injection. This lymph node enlargement is a normal reaction to a COVID-19 vaccine and a sign that the body is responding to the vaccine to build immunity. Some health care professionals are concerned that having a mammogram soon after vaccination may cause unnecessary worry about swollen lymph nodes.

 

For routine mammograms (i.e., regular screenings with no symptoms), some medical societies have recommended either completing a mammogram prior to vaccination or waiting 4-6 weeks after completing the vaccination series (two doses for mRNA vaccines, one dose for viral vector). However, no person should cancel a mammogram appointment without consulting the healthcare provider. Any person who gets a mammogram within 4-6 weeks of COVID-19 vaccination should let the clinician know about when and which arm the vaccine was administered. It is important not to put off cancer screenings - or the opportunity to get a COVID-19 vaccine. Talk to a healthcare professional to ask for guidance.

 

Should premedication be given prior to vaccination?

Taking medications such as acetaminophen or ibuprofen before receiving the vaccine to try to prevent symptoms like fever or pain is not recommended at this time. This is because there is not enough information on how pain-relieving medications will impact immune responses. These medications may be taken after receiving the vaccine for the treatment of symptoms.