In the second year of the pandemic, Americans have several options for vaccines against COVID-19: The Pfizer, Moderna, and Johnson & Johnson vaccines are safe, effective, and widely available.

Key Takeaways

  • Pharmaceutical companies intentionally color code and create visual reminders to help tell the difference between different COVID-19 dosages. Going to your local pharmacy for your vaccine may add a layer of reassurance.Verbal communication and checking among providers at pharmacies also help prevent errors when giving vaccines.If someone is given the wrong dose of the vaccine, they might experience more—or more intense—side effects than they normally would.

Keeping track of all the vaccine information—including the correct dosing—has become essential for the people who are tasked with making sure the shots get into arms. That said, the needs for people in different age brackets and risk groups, as well as the addition of booster shots, have made the situation more complex.

They are not without guidance, however: There are standards in place for each vaccine that help ensure that healthcare providers administer them safely.

How do healthcare providers keep track of the differences between the vaccine to ensure that people get the right dose? Verywell spoke to Keri Hurley-Kim, PharmD, MPH, health sciences assistant clinical professor of pharmaceutical sciences at the University of California, Irvine, about the safeguards that are in place for vaccine administration at pharmacies.

COVID Vaccine Doses

  • The Pfizer vaccine is administered in 30 microgram doses for people ages 12 and up for all 3 shots (2 doses in the initial series and 1 booster shot). For children between the ages of 5 and 11, the dose is 10 micrograms.
  • Moderna vaccine is administered in 100 microgram doses for the first 2 shots, and its booster shot contains 50 micrograms. However, people who are immunocompromised or have other risk factors may need to get different doses.
  • Johnson & Johnson’s vaccine is given a single shot, then a booster of the same dosage.

Labeling Rules

Avoiding dosage errors starts with the people who make vaccines. Hurley-Kim told Verywell that a great deal of thought goes into the design of medication bottles to prevent errors.

For example, there are some visual cues that are used, such as color-coding. When a medication has different dosage options or could be confused with another medication, manufacturers try to make sure that people have a way to tell them apart by looking at them.

Hurley-Kim said that Pfizer’s COVID vaccine is color-coded because it comes in both pediatric and adult dosages. According to Hurley-Kim, “an adult dosage is purple, whereas the one for children over [age] 5 is orange.”

Mistakes Happen

According to a report by the Institute for Safe Medical Practices (ISMP), since the introduction of the COVID vaccine for children ages 5 to 11, hundreds of children have received the wrong dosage.

Color-coding helps the people who are preparing the vaccines, but once the vaccine is put into a syringe, the next step is proper labeling and making sure that things stay organized. If a pharmacy knows that they have a specific number of appointments each day, then they can get the vials and syringes ready ahead of time.

Communication

Although color coding and organization can certainly help prevent mistakes, Hurley-Kim said that it’s only the first line of defense; another layer engaging a sense other than sight is even better.

Communicating with the person getting vaccination helps, too. As a safety measure, the person who is giving the vaccine will state which vaccine they are about to administer.

Keri Hurley-Kim, PharmD, MPH

For pharmacists, our bread and butter is avoiding medication errors.

“When [I’m] actually administering it to the patient, I’ll read what I have in my hand and repeat it,” said Hurley-Kim. “When I say, ‘We’re going to be doing the Moderna COVID vaccine today and this is your second dose,’ it gives them an opportunity to say, ‘Oh, no, I should be getting the Pfizer.’ It’s an opportunity to check it against the paperwork you have for them too.”

Careful Checking

According to Hurley-Kim, going to your local pharmacy rather than a doctor’s office might provide you with additional reassurance. Why? Pharmacies have strict rules and “checks” in place to keep people safe.

Hurley-Kim said that “for pharmacists, our bread and butter is avoiding medication errors.” To that end, there are different job functions to organize the distribution of vaccines at a pharmacy.

For example, a licensed pharmacy technician prepares the dosages, which involves taking them from the vial and reconstituting them in the correct proportions.

The reassuring value of a pharmacy comes from the system of checks that are in place from that point forward; each step of the process is double-checked by the pharmacist on duty. That means that there are two sets of eyes to confirm that the proper dosage is prepared and stored.

What If I Get the Wrong Dose?

Even when every precaution is taken, mistakes can still happen. There have been instances where people have been given too much or not enough of a vaccine.

According to Hurley-Kim, if you accidentally get a too-large dose of a COVID shot, you might have the typical side effects of the vaccine (like soreness in your arm where you got the shot, fatigue, a headache, or a mild fever), they just might be more intense.

The Centers for Disease Control and Prevention (CDC) has guidelines that help people figure out what to do if they got too big or too little a dose of a COVID vaccine.

On the other hand, if you receive a smaller dose than recommended, the biggest risk is that you may not generate a good immune response. In this case, it’s best to talk to your doctor about whether you might need to get another dose to be protected.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

What This Means For You

Pharmacists know how to administer vaccines safely and there are checks in place to prevent errors. However, mistakes can still happen.