New COVID Booster Labels Look Similar to Old Ones—Here's How To Make Sure You're Getting the Right Shot

Even with lookalike labels on original and updated COVID shots, experts say chances of errors are slim.

Nurse preparing for a COVID vaccination at a hospital
Photo: Luis Velasco/Stocksy

Now that updated COVID-19 booster shots are widely available in the United States, some experts are expressing concern about the potential for mixups between the different vaccines currently available.

During a recent meeting of the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP), some members pointed out that the new updated Pfizer-BioNTech booster for people 12 and up is packaged in a very similar manner as the manufacturer's original COVID vaccine, which is still being given to people who need of their primary vaccine shot. This similarity creates the potential for health care workers to accidentally administer the wrong dose.

While experts say the risk of getting the wrong dose when you make your vaccine appointment is slim—especially because health care workers double check what shots they're administering before giving you the jab—mix ups are still not out of the realm of possibility.

Confusion Over Labels

At the ACIP meeting, this issue of potential mix-up between doses was initially raised by experts who noted just how similar the color-coded vials for both types of COVID shots are.

For example, Moderna's existing vials that contain the original form of the vaccine meant for children 6 to 11 years old feature the same dark blue cap at the top as that of the vials that hold the new bivalent booster for adults. Similarly, the original vaccine and the just-released Pfizer-BioNTech booster are found in vials with gray labels and a matching gray cap.

According to meeting records, ACIP attendee Matthew Daley, MD, senior investigator at Kaiser Permanente Colorado, expressed that he's heard from parents who have "been very concerned about COVID vaccine safety." These patients, Dr. Daley said, went on to eventually get their children vaccinated and then were "told that they were vaccinated with a higher dose."

Dr. Daley's primary concern is that this could contribute to a waning of public trust in continuing efforts to vaccinate more people across the nation.

Dong Heun Lee, MD, professor in the Division of Infectious Diseases at the University of California, San Francisco, told Health that this is a moment for the health care workers and pharmacists who are administering the vaccines to be vigilant.

The alarms raised by those at ACIP mean that accuracy and attention to detail have to be key since these vials might look the same. This might be true especially for health care workers who are tired, stressed, and overworked.

Dr. Lee said the vials should be stored separately and a health care worker should "always verify" what they are giving first.

There Is No Cause for Alarm

In the very unlikely chance you receive an older version of the COVID booster, you would be fine, but would have to wait at least two months before getting the new bivalent vaccine.

"This is a very 'inside baseball concern' that was voiced at the most recent CDC advisory committee meeting," William Schaffner, MD, professor of infectious diseases at the Vanderbilt University Medical Center, told Health. "They were concerned because there are many providers that are going to have both of these—the older booster and the new one— in their refrigerators at the same time."

Dr. Schaffner stressed that this shouldn't be a major concern when going for your booster, especially given the tight standards that are put in place.

"Of course, the rules and practices that are out there for every injection given, in every circumstance, will provide assurance that the vast majority of times, 99%-percent plus, we hope, are accurate because you always are supposed to double check what it is you are injecting before you inject it," Dr. Schaffner added. "It requires healthcare workers to have their due diligence and be careful."

If there is ever an error made, Dr. Lee added that it must be reported to the national Vaccine Adverse Event Reporting System (VAERS).

But he too stressed that your health won't be at risk in any way if you are accidentally administered the wrong form of the COVID vaccine.

"Let's say in the worst worst case scenario, you go there and ask for the 'bivalent vaccine,' the pharmacist checks, gets the vaccine out, an error happens and you get the wrong dose," Dr. Lee said. "You do not have to worry about that— the old vaccine is still effective."

Why the New Boosters Are So Important

The new bivalent vaccines, which were designed to offer protection from both the original SARS-CoV2 virus and the new Omicron BA.4 and BA.5 subvariants, offer roughly the same protection from severe illness and death as the older boosters, Otto Yang, MD, a professor of medicine in the division of infectious diseases and professor of microbiology, immunology and molecular genetics at the David Geffen School of Medicine at UCLA, told Health.

That's because both forms of the COVID vaccines offer the same T-cell protection, which builds the best defense against the most serious outcomes from this coronavirus infection. The difference is that the updated bivalent shots trigger direct antibody responses to the Omicron variants, which will better protect you from symptomatic infection, he added.

"It does offer a small benefit in terms of antibody responses [to the variants]," Dr. Yang said.

With misinformation about the COVID-19 vaccine is still swirling around wildly, Dr. Yang said it is important to stress that individuals get initially vaccinated and then boosted.

One common refrain he hears is that getting vaccinated multiple times is "going to cause our immune system to not be able to react to the virus."

That's simply untrue.

"First of all, there are people getting COVID every few months, and when you get COVID it's a much bigger dose of the virus than what the vaccine provides -- the vaccine is just a tiny dose compared to what your body gets exposed to when you're infected," Dr. Yang said. "So, there's really no evidence that getting vaccinated multiple times means you are unable to fight off the virus, immune system-wise -- it's a false hypothesis that is pretty easy to refute."

Tips For Your Vaccine Appointment

Before making any appointment for a booster shot, you should be clear on what specific vaccination is appropriate for you or a child in your household.

Dr. Lee clarified that the new bivalent vaccines are meant for people 12 and older who already completed their primary COVID vaccine series. This means they received the original initial doses of the original COVID vaccine and already had one or two booster vaccinations, or received the original vaccine and are in need of a first booster.

If you've had an original booster or completed your initial course of vaccination and are in need of a first booster shot, you have to wait at least two months after receiving your most recent vaccine.

Children who are 5 to 11 years old should still be receiving the original version of the Pfizer booster if they already received the primary series of that company's vaccine, Dr. Lee added.

If a child is younger than four and received a primary vaccine series, then they do not need a booster of any kind yet, while children who are 6 to 11 who received Moderna's original series do not need a new booster, Dr. Lee said.

If you're concerned about the issue of being accidentally given the wrong dose, check in with your pharmacist or provider before they administer the shot.

"Sure, I think the patient could say, in a friendly fashion to their provider 'That's the new updated vaccine, right?' And I think that is a perfectly reasonable question to ask. It may slightly startle the provider, but the patient could say 'Let's double check that, just to be sure,' " Dr. Schaffner added. "I think there may be an occasional provider who gets a little testy about that, but the vast majority will say 'why of course, I'm happy to do that' and just provide that extra degree of assurance."

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 CDC, WHO, and their local public health department as resources.

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