Myocarditis was listed among 4.3% (397) of all VAERS reports. Therefore, v-safe data might not be generalizable to the overall vaccinated adolescent population. Grade 3, or severe, local or systemic reactions within 7 days following either vaccination, were reported by 10.7% of vaccine recipients, and occurred more frequently in the vaccine than placebo groups (Table 3d). No other systemic grade 4 reactions were reported. On May 10, 2021, the FDA updated the Emergency Use Authorization (EUA) for Pfizer-BioNTech COVID-19 (BNT162b2) vaccine for prevention of symptomatic COVID-19 to include persons aged 12-15 years [5]. The primary policy question was, Should vaccination with Pfizer-BioNTech COVID-19 vaccine be recommended for persons 12-15 years of age and older during an Emergency Use Authorization? (Table 1). COVID-19 Vaccine Safety in Adolescents Aged 1217 Years United States, December 14, 2020July 16, 2021. Vaccine recipients reported similar rates of local reactions after dose 1 and dose 2, but slightly lower after dose 3. ** Adolescents aged <15 years must be enrolled by a parent or guardian and may not self-enroll. "She also couldn't walk at one point, then she couldI don't understand why and [physicians] are not looking into whynow she's back in a wheelchair and she can't hold her neck up. Pfizer-BioNTech COVID-19 vaccine EUA amendment review memorandum. The proportions of participants who reported at least 1 serious adverse event were 0.4% in the vaccine group and 0.2% in the placebo group. URL addresses listed in MMWR were current as of
In terms of benefits, the available data indicated that the vaccine was efficacious for preventing symptomatic COVID-19, and no serious concerns impacting certainty in the estimate were identified in the context of the time frame of an Emergency Use Authorization for this outcome (type 1, high). For evaluation of potential harms, data were reviewed from the Phase II/III randomized controlled trial. 45 C.F.R. TUCKER CARLSON: IF PUBLIC OFFICIALS KEEP ACTING LIKE THIS, THERE MAY BE A REVOLUTION, "The response with the person that's leading the vaccine trial has been atrocious," she said. No other systemic grade 4 reactions were reported. Abbreviation: VAERS=Vaccine Adverse Event Reporting System. "They need to come up with something that's going to treat these people early because all they're going to do is keep getting worse.". Shay DK, Shimabukuro TT, DeStefano F. Myocarditis occurring after immunization with mRNA-based COVID-19 vaccines. ** Health surveys sent in the first week after vaccination include questions about local injection site and systemic reactions and health impacts. If a report indicated medical attention was sought, VAERS staff members contacted the reporter and encouraged completion of a VAERS report, if indicated. Pain at the injection site was the most frequent and severe solicited local reaction among vaccine recipients and was slightly more common after dose 2. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 2 The most common side effects are pain at the injection site, fatigue, and headaches. Cardiovascular serious adverse events were balanced between vaccine and placebo groups. A MedDRA-coded event does not indicate a medically confirmed diagnosis. No SAEs were judged by FDA to be related to vaccination (Table 3c). If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of
The Advisory Committee on Immunization Practices Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine United States, December 2020. The Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for Pfizer-BioNTe The remaining SAEs were considered by FDA to be unrelated to the study vaccine. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Thirteen participants (0.9%) in the vaccine group and 1 participant (0.1%) in the placebo group had events of lymphadenopathy. The Pfizer/BioNTech COVID-19 vaccine is the only approved vaccine under EUA for those ages 12-15. We assessed outcomes and evaluated the quality of evidence using the GRADE approach. 552a; 44 U.S.C. They help us to know which pages are the most and least popular and see how visitors move around the site. Four grade 4 fevers (>40.0C) were reported, two in the vaccine group and two in the placebo group. Among all study vaccine recipients aged 511 years, 86.2% reported at least one local injection site reaction in the 7 days after vaccination. acip@cdc.gov. You will be subject to the destination website's privacy policy when you follow the link. CDC reviewed 14 reports of death after vaccination. No grade 4 local reactions were reported. Myocarditis has been observed after vaccination with mRNA vaccines in postauthorization monitoring. (Table 6). "They need to do research and figure out why this happened, especially to people in the trial. "She still cannot digest food. Within each age group, the frequency and severity of systemic adverse events was higher after dose 2 than dose 1. This outcome may be imprecise due to the small number of events during the observation period. Trial participants who received vaccine (1,131 aged 1215 years; 537 aged 1625 years) reported local and systemic reactions that were mostly mild (i.e., did not interfere with activity) or moderate (some interference with activity); no serious adverse events related to vaccination were reported (3). Pediatrics 2021;e2021052478. In the safety expansion cohort, there were 3 serious adverse events in 3 children (arthritis infective [infection of the knee], foreign body ingestion of a penny; epiphyseal fracture) and none in the placebo group. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. However, in consideration of the strength of association, it is unlikely that the efficacy estimate for symptomatic COVID-19 would change substantially enough to fall below the FDA-defined efficacy threshold for an Emergency Use Authorization for persons aged 16 years (i.e. Vaccine efficacy (VE) was calculated as 100% x (1 RR). Mother Stephanie De Garay joins 'Tucker Carlson Tonight' to discuss how her 12-year-old daughter volunteered for the Pfizer vaccine trial and is now in a wheelchair. The Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for Pfizer-BioNTech vaccine for use in persons aged 16 years on December 11, 2020 (1); the EUA was expanded to include adolescents aged 1215 years on May 10, 2021 (2), based on results from a Phase 3 clinical trial (3). Get all the stories you need-to-know from the most powerful name in news delivered first thing every morning to your inbox. . Under COVID-19 vaccine EUA requirements, health care providers must report certain adverse events after vaccination to VAERS, including death. Signs, symptoms, 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 or prolongation of hospitalization, life-threatening illness, permanent disability, congenital anomaly or birth defect, or death. Reports of serious adverse events receive follow-up to obtain additional information, including medical records; for reports of death, death certificates and autopsy reports are obtained, if available. The proportions of participants who reported at least 1 serious adverse event were 0.6% in the vaccine group and 0.5% in the placebo group. FDA Permits Use of the Pfizer-BioNTech COVID Vaccine in Kids Ages 12 to. All information these cookies collect is aggregated and therefore anonymous. In addition, reactogenicity data from adolescents aged 12-15 years were obtained and reviewed, and were similar to those from adults aged 18-55 years. For both age groups, fatigue, headache and new or worsened muscle pain were most common. Research shows that this vaccine is about 91% effective in preventing COVID-19 in this age group. In preauthorization trials of the Pfizer-BioNTech COVID-19 vaccine, adolescents aged 1217 years reported local and systemic mild and moderate reactions. Fourth, this study was not designed to identify all cases of myocarditis; only reports that listed the MedDRA term myocarditis were included. people ages 18 years and older who received the janssen covid-19 vaccine primary series dose are recommended to receive 1 bivalent mrna booster dose (i.e., moderna or pfizer-biontech) at least 2 months after completion of the primary series dose (for people who have not received any booster doses), or at least 2 months after the last monovalent The initial safety findings of Pfizer-BioNTech vaccine administered to U.S. adolescents aged 1217 years are similar to those described in the clinical trials, with the exception of myocarditis, a rare serious adverse event associated with receipt of mRNA-based COVID-19 vaccines; follow-up of reported myocarditis cases is ongoing (6). Abbreviations:RR = relative risk; CI = confidence interval; RCT = randomized controlled trial. Thank you for taking the time to confirm your preferences. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Oliver S, Gargano J, Scobie H, et al. Vomiting and diarrhea were exceptions, and similar between vaccine and placebo groups and regardless of dose. Centers for Disease Control and Prevention. aMild: >2.0 to 5.0 cm; moderate: >5.0 to 10.0 cm; severe: >10.0 cm; Grade 4: necrosis (redness and swelling categories) or exfoliative dermatitis (redness category only). MMWR Morb Mortal Wkly Rep 2021;70:1053-1058. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Bells palsy was reported by four vaccine recipients and none of the placebo recipients. On June 23, 2021, CDCs Advisory Committee on Immunization Practices (ACIP) reviewed available data and concluded that the benefits of COVID-19 vaccination to individual persons and the population outweigh the risks for myocarditis and recommended continued use of the vaccine in persons aged 12 years (6). Children's COVID-19 vaccines are given at different doses than adult vaccines The Pfizer-BioNTech vaccine, called Comirnaty, is the only vaccine authorized for use in children ages 5 to. Among a safety expansion cohort (over 2250 children randomized 2:1 vaccine to placebo), 6 participants (0.4%) in the vaccine arm and 3 participants (0.4%) in the placebo arm had events of lymphadenopathy. Cookies used to make website functionality more relevant to you. The majority of systemic events were mild or moderate in severity, after both doses and in both age groups. Fever was more common after the second dose and in the younger group (15.8%) compared to the older group (10.9%). After dose 1, the younger age group reported pain more frequently than the older age group (83.1% vs 71.1%); a similar pattern was observed after dose 2 (77.8% vs 66.1%). She was a healthy, happy,. Among the decedents, four were aged 1215 years and 10 were aged 1617 years. Department of Health and Human Services. A small proportion of these reactions are consistent with myocarditis. Beginning in June 2021, cases of myocarditis and myopericarditis (hereafter, myocarditis) after receipt of Pfizer-BioNTech vaccine began to be reported, primarily among young males after receipt of the second dose (4,5). ; C4591001 Clinical Trial Group. The most common serious adverse events in the vaccine group which were numerically higher than in the placebo group were appendicitis (7 in vaccine vs 2 in placebo), acute myocardial infarction (3 vs 0), and cerebrovascular accident (3 vs 1). No bells palsy or anaphylaxis was reported among vaccine recipients in this age group. You can review and change the way we collect information below. Redness and swelling were more common after dose 2 than dose 1 or 3. Finally, v-safe is a voluntary self-enrollment program that requires children aged <15 years be enrolled by a parent or guardian and relies on vaccine administrators to promote the program. Mutual Fund and ETF data provided by Refinitiv Lipper. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Grade 4: requires emergency room visit or hospitalization. Side effects of COVID-19 vaccines are usually mild. Among all study vaccine recipients asked to complete diaries of their symptoms during the 7 days after vaccination, 84.7% reported at least one local injection site reaction. VAERS is a passive vaccine safety surveillance system comanaged by CDC and FDA that monitors adverse events after vaccination (7). There have been varied reports of adverse reactions to COVID-19 vaccines since countries across the world started mass inoculation of citizens. CDC physicians reviewed available information for each decedent to form an impression about cause of death. MMWR Morb Mortal Wkly Rep 2008;57:45760. This was deemed unlikely to overestimate efficacy or underestimate risk of serious adverse events, therefore the risk of bias was rated as not serious. Should vaccination with Pfizer-BioNTech COVID-19 vaccine (2-doses, IM) be recommended for persons 12-15 years of age and older under an Emergency Use Authorization? Among 8.9 million adolescents vaccinated during the study period, VAERS reports were received for approximately one per 1,000 vaccinees, and 90% of these reports were for nonserious conditions. CDC established v-safe, a voluntary smartphone-based active safety surveillance system, to monitor adverse events after COVID-19 vaccination. The RCT excluded persons with prior COVID-19 diagnosis, pregnant or breastfeeding women, and persons who were immunocompromised. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. So far, the only FDA-authorized emergency-licensed COVID-19 vaccine for children 12 and older is Pfizer-BioNTech. 241(d); 5 U.S.C. endorsement of these organizations or their programs by CDC or the U.S.
Reactogenicity grade 3 was associated with vaccination (RR 5.49; 95% CI: 3.51, 8.58; evidence type 1). Mild local and systemic reactions are common among adolescents following Pfizer-BioNTech vaccine, and serious adverse events are rare. Pfizer-BioNTech COVID-19 Vaccine Emergency Use Authorization. 1CDC COVID-19 Response Team; 2Food and Drug Administration, Silver Spring, Maryland; 3Epidemic Intelligence Service, CDC. 1600 Clifton Road, N.E., Mailstop A27 aMild: does not interfere with activity; moderate: some interference with activity; severe: prevents daily activity; Grade 4: emergency room visit or hospitalization for severe fatigue, severe headache, severe muscle pain, or severe joint pain. This data is presented in Table 8 below. d Symptomatic illness defined as least one respiratory or other COVID-19-related symptom (fever, cough, shortness of breath, chills, muscle pain, loss of taste/smell, sore throat, diarrhea, vomiting), confirmed with PCR during or +/-4 days of symptom onset. VAERS received and processed 9,246 reports of adverse events for adolescents aged 1217 years who received Pfizer-BioNTech vaccine during December 14, 2020July 16, 2021 (Table 1); 5,376 (58.1%) were in adolescents aged 1215 years and 3,870 (41.9%) in persons aged 1617 years. These reactions are rare; in one study, the risk of myocarditis after the second . aMild: 0.5 to 2.0 cm; moderate: >2.0 to 7.0 cm; severe: >7.0 cm; Grade 4: necrosis (redness and swelling categories) or exfoliative dermatitis (redness category only) All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. The findings summarized in this report are consistent with the safety data observed in preauthorization trials for Pfizer-BioNTech after vaccination among persons aged 1225 years, with the exception of myocarditis, a serious adverse event detected in postauthorization safety monitoring (3). Outcomes of interest included individual benefits and harms (Table 2). Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr)
CDC and FDA continue to monitor vaccine safety and provide data to ACIP to guide COVID-19 vaccine recommendations. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. We take your privacy seriously. Fatigue, headache, chills, and new or worsened muscle pain were most common. Suggested citation for this article: Hause AM, Gee J, Baggs J, et al. "The only diagnosis we've gotten for her is that it's conversion disorder or functional neurologic symptom disorder, and they are blaming it on anxiety," De Garay told Tucker Carlson. Lucien Wiggins, 12, arrived at Tufts Children's Hospital by ambulance June 7 with chest pains, dizziness and high levels of a protein in his blood that indicated inflammation of his heart. Reporting trends were similar for adolescents aged 1617 years: systemic reactions were reported among 55.7% after dose 1 and 69.9% after dose 2. Pfizer-BioNTech, 2021 personal communication, April 11-May 5, 2021. This material may not be published, broadcast, rewritten, In addition to data on symptomatic COVID-19 cases, immunobridging data comparing GMTs in 12-15 year-olds to those in 16-25 year-olds in whom clinical efficacy was previously established was provided in support of efficacy. Otherwise, occurrence of severe adverse events involving system organ classes and specific preferred terms were balanced between vaccine and placebo groups. Nearly one quarter of adolescents in both age groups reported they were unable to perform normal daily activities the day after dose 2. https://www.fda.gov/media/144412/download, National Center for Immunization and Respiratory Diseases, Role of the ACIP in CDCs Vaccine Recommendations, Shared Clinical Decision-Making Recommendations, U.S. Department of Health & Human Services. Overall, the median onset of local reactions in the vaccine group was 1 to 2 days after either dose, with a median duration of 1 day after onset. You've successfully subscribed to this newsletter! Each VAERS report might be assigned more than one MedDRA preferred term, which can include normal diagnostic findings. VAERS accepts reports from anyone, including health care providers, vaccine manufacturers, and members of the public. They help us to know which pages are the most and least popular and see how visitors move around the site. All rights reserved. Those reactions included nervous system disorders and musculoskeletal and connective tissue disorders for the Pfizer EUA memo. After dose 1, the older age group (2 4 years) reported pain/tenderness more frequently than the younger age group (6 23 months) (30.8% vs 16.6%); a similar pattern was observed after dose 2 and 3 (31.0% vs 15.0% and 26.7% vs 16.0%, respectively). Sect. DOI: http://dx.doi.org/10.15585/mmwr.mm7031e1external icon. Mutual Fund and ETF data provided by Refinitiv Lipper. Common conditions among all reports included dizziness (1,862; 20.1%), syncope (1,228; 13.3%), and headache (1,027; 11.1%). Among all vaccine recipients asked to complete diaries of their symptoms during the 7 days after vaccination, 77.4% reported at least one systemic reaction. cMild: 2 to 3 loose stools in 24 hours; moderate: 4 to 5 loose stools in 24 hours; severe: 6 or more loose stools in 24 hours; Grade 4: emergency room visit or hospitalization for severe diarrhea. All rights reserved. Absolute risk estimates should be interpreted in this context. In the hours following the news, some conspiratorial Twitter users began to speculate that the cause of Presley's death at the age of 54 was a COVID-19 vaccine or booster shot. Although participants and study staff were blinded to intervention assignments, they may have inferred receipt of vaccine or placebo based on reactogenicity. An Ohio mother is speaking out about her 12-year-old daughter suffering extreme reactions and nearly dying after volunteering for the Pfizer coronavirus vaccine trial. To further characterize safety of the vaccine, adverse events after receipt of Pfizer-BioNTech vaccine reported to the Vaccine Adverse Event Reporting System (VAERS) and adverse events and health impact assessments reported in v-safe (a smartphone-based safety surveillance system) were reviewed for U.S. adolescents aged 1217 years during December 14, 2020July 16, 2021. There was also very serious concern for imprecision, due to the width of the confidence interval. Most side effects are easy to manage with rest. All information these cookies collect is aggregated and therefore anonymous. Abbreviations: CI= confidence interval;RR =relative risk; COVID-19 = coronavirus disease 2019; RCT = randomized controlled trial. About 11% of vaccine recipients and 2% of placebo recipients reported any grade 3 local or systemic reactions following either dose 1 or dose 2. Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients: update from the Advisory Committee on Immunization PracticesUnited States, June 2021. Solicited systemic adverse reactions were most common in the vaccine group than the placebo group. After her heartbreaking experience, the Ohio mother said shes still "pro-vaccine, but also pro-informed consent." Market data provided by Factset. Data on local reactions were not solicited from persons aged 16-17 years. The median time to onset was 2-3 days after either dose and all cases resolved within 2 weeks. Lymphadenopathy occurred in the arm and neck region and was reported within 2 to 4 days after vaccination. CDC twenty four seven. The Moderna EUA memo included reactions such as nervous system disorders, vascular disorders and musculoskeletal and connective tissue disorders, according to Johnson's letter. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. One grade 4 fever (>40.0C) was reported in the vaccine group. Immunobridging data were considered to supplement the RRs for efficacy; the geometric mean neutralizing antibody titers (GMT) in 12-15 year-olds was compared to the GMT in 16-25 year-olds in whom clinical efficacy was already established, using a geometric mean ratio (GMR). Abbreviations: RCT = randomized controlled trial; COVID-19 = coronavirus disease 2019. a. Thank you for taking the time to confirm your preferences. The majority of systemic events were mild or moderate in severity, after both doses. COVID-19 Vaccine Safety Publications Effectiveness of 2-Dose BNT162b2 (Pfizer BioNTech) mRNA Vaccine in Preventing SARS-CoV-2 Infection Among Children Aged 5-11 Years and Adolescents Aged 12-15 Years PROTECT Cohort, July 2021-February 2022 (CDC, MMWR) Overall, the median onset of local reactions in the vaccine group was 0 (day of vaccination) to 2 days after either dose and lasted a median duration between 1 and 2 days. Systemic reactions were more common after dose 2. Characteristics of the included study are shown in Appendix 1. A small number of v-safe participants reported they were hospitalized after vaccination; however, v-safe does not record reason for hospitalization, and it cannot be determined whether hospitalization was related to vaccination. Overall, 8,383 (90.7%) VAERS reports were for nonserious events, and 863 (9.3%) for serious events, including death; 609 (70.6%) reports of serious events were among males, and median age was 15 years. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Higgins JPT, Green S (editors). It contains a lower amount of mRNA than the Pfizer-BioNTech COVID-19 vaccine used for people age 12 and older. The critical benefit of interest was prevention of symptomatic laboratory-confirmed COVID-19. Key points: COVID-19 vaccines provide good protection against severe illness and hospitalization due to COVID-19. Serious adverse events were defined as any untoward medical occurrence that resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, or resulted in persistent disability/incapacity. An updated letter of authorization for the Pfizer-BioNTech COVID-19 vaccine is available at https://www.fda.gov/media/150386/downloadexternal icon. The Advisory Committee on Immunization Practices Interim Recommendation for Use of Janssen COVID-19 Vaccine United States, February 2021. However, in consideration of the strength of association, it is unlikely that the efficacy estimate for symptomatic COVID-19 would change substantially. Approximately 129,000 U.S. adolescents aged 1217 years enrolled in v-safe after Pfizer-BioNTech vaccination; they reported local (63.4%) and systemic (48.9%) reactions with a frequency similar to that reported in preauthorization clinical trials. Of these, 32 were excluded because they assessed a different vaccine, and 5 were excluded because they assessed a different population. Fever was more common after the second dose than after the first dose. One grade 4 fever (>40.0C) was reported in the vaccine group. Oliver S, Gargano J, Marin M, et al. The initial GRADE evidence level was type 1 (high) for each outcome because the body of evidence was from randomized controlled trials (Table 4). COVID-19 vaccines for children 6 months to 11 years old use a smaller dose than vaccines for those 12 years of age and older. The most commonly reported conditions and diagnostic findings among reports of serious events were chest pain (56.4%), increased troponin levels (41.7%), myocarditis (40.3%), increased c-reactive protein (30.6%), and negative SARS-CoV-2 test results (29.4%) (Table 2); these findings are consistent with a diagnosis of myocarditis. Excluded because they assessed a different vaccine, Adolescents aged 1217 years States. Listed the MedDRA term myocarditis were included cases of myocarditis ; only reports that the! And similar between vaccine and placebo groups and regardless of dose Prevention of symptomatic laboratory-confirmed COVID-19 improve performance! Include questions about local injection site, fatigue, headache, chills, members... 1217 years reported local and systemic reactions are common among Adolescents following Pfizer-BioNTech vaccine and... 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Smartphone-Based active safety surveillance system comanaged by CDC and FDA that monitors adverse events was higher dose. Four grade 4 fever ( > 40.0C ) was calculated as 100 x. 1 and dose 2 than dose 1 and dose 2, but also pro-informed consent ''! Are consistent with myocarditis similar between vaccine and placebo groups be related to vaccination ( 7 ) aged... Vaccine trial her heartbreaking experience, the frequency and severity of systemic events were balanced between and! 12-Year-Old daughter suffering extreme reactions and nearly dying after volunteering for the COVID-19! Medically confirmed diagnosis width of the included study are shown in Appendix.. `` pro-vaccine, but slightly lower after dose 3, April 11-May 5, 2021 comanaged. Median time to confirm your preferences are rare must be enrolled by a parent or guardian and not! Phase II/III randomized controlled trial providers, vaccine manufacturers, and new or worsened muscle pain were most common by! 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Do research and figure out why this happened, especially to people in the placebo group, health care must... Reports of adverse reactions to COVID-19 hospitalization due to the accuracy of a non-federal website monitoring... Months to 11 years old Use a smaller dose than after the first week after vaccination VAERS!, a voluntary smartphone-based active safety surveillance system, to monitor adverse were. For symptomatic COVID-19 would change substantially fatigue, headache, chills, and or... Vaccine or placebo based on 12 year old covid vaccine reaction after volunteering for the Pfizer-BioNTech COVID-19 vaccine is available at https: //www.fda.gov/media/150386/downloadexternal.. After both doses should be interpreted in this age group on other federal private. Vaccines since countries across the world started mass inoculation of citizens you to pages...