Just about everyone can and should get vaccinated, but exceptions exist.

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Medical exemptions to the COVID-19 vaccine have been a hot-button topic for months. But now that the Pfizer vaccine, aka Comirnaty, has been fully approved by the Food and Drug Administration and more organizations, workplaces, and public spaces are requiring vaccination, the issue is heating up again.

While plenty of people may claim they have a medical exemption from getting vaccinated, legitimate medical exemptions are "very uncommon," William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, tells Health.

What conditions could cause someone to be medically exempted from the COVID-19 vaccine? The classification is actually pretty narrow. Here's a breakdown.

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What conditions can get you a medical exemption from the COVID-19 vaccine?

It mostly boils down to allergies and allergic reactions, Dr. Schaffner says. A medical exemption is due to a patient having a contraindication to the vaccine, meaning getting it could be bad for their health.

There's only one contraindication listed by the FDA for Comirnaty, and it's pretty easy to understand. The FDA says that people with a "known history of a severe allergic reaction (e.g., anaphylaxis) to any component of Comirnaty" shouldn't get the vaccine. So, if you have a known—severe—allergy to one of the ingredients in the vaccine, you shouldn't get it.

Here's a list of the Comirnaty vaccine ingredients:

  • mRNA
  • Lipids ((4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate), 2 [(polyethylene glycol)-2000]-N,N-ditetradecylacetamide, 1,2-Distearoyl-sn-glycero-3- phosphocholine, and cholesterol)
  • Potassium chloride
  • Monobasic potassium phosphate
  • Sodium chloride
  • Dibasic sodium phosphate dehydrate
  • Sucrose

While we're at it, here's a list of the ingredients in the Moderna COVID-19 vaccine:

  • mRNA
  • Lipids (SM-102, 1,2-dimyristoyl-rac-glycero3-methoxypolyethylene glycol-2000 [PEG2000-DMG], cholesterol, and 1,2-distearoyl-snglycero-3-phosphocholine [DSPC])
  • Tromethamine
  • Tromethamine hydrochloride
  • Acetic acid
  • Sodium acetate
  • Sucrose

And the ingredients for the Johnson & Johnson COVID-19 vaccine:

  • Recombinant, replication-incompetent adenovirus type 26 expressing the SARS-CoV-2 spike protein
  • Citric acid monohydrate
  • Trisodium citrate dihydrate
  • Ethanol
  • 2-hydroxypropyl-β-cyclodextrin (HBCD)
  • Polysorbate-80
  • Sodium chloride

For each vaccine, the contraindication is the same: You shouldn't get it if you have had a severe allergic reaction to one of the ingredients in the vaccine.

It's worth noting that a miniscule number of people have had anaphylactic reactions to COVID-19 vaccines—data shows it's about two to five cases per million doses.

Also, keep this in mind: If you're allergic to something in one of the vaccines, you should be able to get another of the three vaccines available, given that the ingredients are different.

"Because there is more than one type of vaccine available in the United States, I don't think that there are actual true medical exemptions to both mRNA vaccines and the adenovirus vectored vaccine," infectious disease expert Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, tells Health.

"For example, if someone had a severe allergic reaction to dose one of the mRNA vaccines, they could complete their series with the Johnson & Johnson vaccine," Dr. Adalja says. "The same is true for those who have known allergies to the ingredients of one of the vaccines."

There may be at least one other situation where a doctor will write a medical exemption with legitimate intentions, Dr. Schaffner explains: if someone developed a serious health issue soon after getting their first dose of an mRNA vaccine. "There are some people who have received one dose of the vaccine and had a subsequent medical event close in time to the vaccine," he says. "It's not currently listed as a medical contraindication, but doctors are often willing to give patients a medical exemption."

What to do if you have an allergy to a COVID-19 vaccine

Dr. Schaffner recommends meeting with an allergist. They can give you allergy testing to see what, exactly, you're allergic to and then recommend the right COVID-19 vaccine for you based on the findings, he says.

If you do happen to qualify for a medical exemption, it will likely be in the form of a doctor's note, Dr. Schaffner says.

Still, if you happen to be allergic to an ingredient in one COVID-19 vaccine, experts recommend investigating to see if you can get another vaccine. "Getting vaccinated is important," Dr. Schaffner says.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

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