COVID-19 Vaccines

• Individuals receiving dialysis (hemodialysis or peritoneal dialysis).
• Individuals receiving active treatment (e.g., chemotherapy, targeted therapies, immunotherapy) for solid tumour or hematologic malignancies. Active treatment includes patients who have completed treatment within 3 months.
• Recipients of solid-organ transplant and taking immunosuppressive therapy.
• Recipients of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy).
• Individuals with moderate to severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome).
• Individuals with HIV with prior AIDS defining illness or prior CD4 count ≤ 200/mm3 or prior CD4 fraction ≤ 15% or (in children six months to 11-years old) perinatally acquired HIV infection.

First, second and third dose interval: Minimum 56 days between each dose.

Proof of eligibility requirement: Verbally attest to have a listed medical condition.

How to receive vaccine: Before vaccination, these individuals should discuss their vaccine plans with their health care providers to check if it will affect their treatment.

See where to get vaccinated.

Who: Individuals five years of age and older (must be at least five years of age at time of immunization) receiving active treatment with the following categories of immunosuppressive therapies: anti-B cell therapies* (monoclonal antibodies targeting CD19, CD20 and CD22), high-dose systemic corticosteroids (refer to the CIG for suggested definition of high dose steroids), alkylating agents, antimetabolites, or tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive.

*Active treatment for patients receiving B-cell depleting therapy includes patients who have completed treatment within 12 months.

See Table 1 of COVID-19 Vaccine Third Dose Recommendations

First, second and third dose interval: Minimum 56 days between each dose.

Proof of eligibility requirement: Verbally attest to receiving listed immunosuppressant medications or therapies.

How to receive vaccine: Before vaccination, these individuals should discuss their vaccine plans with their health care providers to check if it will affect their treatment.

See where to get vaccinated.

Who:

• Individuals 12 to 17-years old are eligible to receive bivalent Pfizer-BioNTech as a booster dose, regardless of previous COVID-19 vaccine products received.
• Individuals 18 years and older can receive bivalent Pfizer-BioNTech or bivalent Moderna Spikevax as a booster dose, regardless of previous COVID-19 vaccine products received. There is no preferential recommendation between the two vaccines for individuals 18 years of age and older.

Interval criteria: Recommended interval of 168 days (six months) following a previous COVID-19 vaccine dose regardless of vaccine product, but residents may receive the vaccine at a minimum of 84 days (three months).

Proof of eligibility requirement: ID with date of birth.

See where to get vaccinated.

Who: Individuals five to 11-years old at the time of immunization.

Proof of eligibility requirement: ID with date of birth.

See where to get vaccinated.

Who: All eligible immunocompromised individuals 12 to 17-years old including those receiving dialysis (hemodialysis or peritoneal dialysis) are eligible to receive a booster dose of bivalent Pfizer-BioNTech or bivalent Moderna Spikevax vaccine.

Interval criteria: Recommended interval of 168 days (six months) following a previous COVID-19 vaccine dose regardless of vaccine product, but residents may receive the vaccine at a minimum of 84 days (three months).

Proof of eligibility requirement: ID with date of birth.

See where to get vaccinated.

Watch this video to learn more.

• Pediatric Pfizer-BioNTech bivalent vaccine is recommended for booster doses for children five to 11-years old. Individuals 12 to 17-years old are eligible to receive bivalent Pfizer-BioNTech for their booster dose. Individuals 18 and older, and immunocompromised individuals 12 and older are eligible to receive bivalent Pfizer-BioNTech or bivalent Moderna Spikevax for their booster dose.
• A booster dose of the monovalent mRNA COVID-19 vaccines may be offered to individuals who do not wish to receive a booster dose of the bivalent mRNA COVID-19 vaccines.
• A booster dose of Novavax Nuvaxovid may be offered to individuals without contraindications who are not able or willing to receive an mRNA vaccine. As part of informed consent, individuals who are not able or willing to receive an mRNA vaccine should be made aware of the longer-term effectiveness and safety data that is available for the mRNA vaccine products as compared to the other authorized COVID-19 vaccines.
• A booster dose of a viral vector vaccine should only be offered when all other Health Canada authorized COVID-19 vaccines are contraindicated.

• Individuals currently eligible for booster dose(s), infected with COVID-19 after their primary series but before their booster dose, are suggested to receive their booster dose at six months (168) after symptom onset or positive test (if asymptomatic) which may provide a better immune response regardless of the product given.
• With informed consent, an individual can receive the booster dose at a minimum of three months (84 days) or later post-infection. Before vaccination, the individual should be no longer considered infectious, symptoms of acute illness are completely resolved, and their isolation period is completed.

COVID-19 infection is defined as a COVID-19 case confirmed by a molecular (e.g. PCR) or rapid antigen test, or an individual who is symptomatic AND is a household contact of a confirmed COVID-19 case.

• Your health care provider.
• Call Ontario’s Provincial Vaccine Information Line at 1-888-999-6488.
• You can also access the SickKids Vaccine Consult Service.
• Book a phone appointment with expert doctors to discuss any questions or concerns about vaccines through the Scarborough Health Network VaxFacts Clinic.

An enhanced vaccine certificate with QR code is required as proof of vaccination

• QR codes can be downloaded digitally or by printing a paper copy. 
• Individuals with a green photo health card can obtain an enhanced vaccine certificate by visiting the COVID-19 Vaccination Portal.
• If you do not have computer, a photo health card, or need help, call the Provincial Vaccine Contact Centre at 1-833-943-3900 to request a copy of your vaccine certificate by email or mail.

For more information visit the COVID-19 Vaccination Portal.

See our frequently asked question what is medical exemption?

• The Moderna Spikevax® (25 mcg) vaccine is a two-dose series. The recommended interval between the two doses is 56 days as this time period provides a stronger immune response and may reduce the risk of myocarditis or pericarditis.
• Infant Pfizer Comirnaty® BioNTech(3mcg) COVID-19 vaccine is a three-dose series. The recommended interval between each dose is 56 days.

Not all children have only mild symptoms. Vaccination is the preferred and safest method to provide additional protection for all children, including those six-months to under five-years old. Having children vaccinated also provides further protection to their family members, especially if they have family members who are at risk for more severe illness.

Even if a child has already had COVID-19, vaccination is still important. While infection alone provides some protection, vaccination after infection helps further improve the immune response.

COVID-19 vaccines, like all medicines can cause side effects, although not everyone may experience them. The most frequently reported short-term side effects for children following the COVID-19 vaccine include redness and pain at injection site, fatigue, headache, chills, muscle aches and loss of appetite. These side effects are typically mild to moderate and on average did not last longer than three days.

Following any vaccine, the vast majority of severe reactions occur within six weeks of receiving the vaccine. In clinical trials for pediatric Moderna Spikevax, children were monitored up to 103 days after receiving their first dose of vaccine and no safety signals were identified. The risk of myocarditis and/or pericarditis with the Moderna Spikevax in children six-months to 11-years old is unknown.

In Ontario there is no minimum age to consent to treatment. Rather, Ontario uses a capacity-based consent model. A person can consent to treatment if they can understand the information that is relevant to making the decision and are able to appreciate the consequences of the decision.

Younger children may not have the ability to provide informed consent for themselves and may require parental consent before receiving the vaccine. Consent will also be required for the collection, use and disclosure of personal health information.

We know it’s normal for kids to be anxious about getting needles. Here are some tips:

Before the appointment:

• Talk about what to expect (explain that the needle might feel like a pinch that only lasts a few seconds).
• Explain why the vaccine is important (to them, to their family, to school mates, etc.).
• Talk to them about what might work best for them. Is it a favorite stuffy? Do they need to listen to music or play a game on your phone/table to help keep them distracted?

During the appointment:

• Stay calm yourself! Children see and feel what their parents are doing. Speak in a positive, normal voice to help calm your child. Demonstrate a calm optimistic presence. Take slow breaths before, during and after the needle together.
• If your child is small enough, you can hold them on your lap while they get their vaccine.
• Practice deep breathing exercises together. For example - try square breathing. Picture a square. Each inhale lasts four seconds and is one side of the square, moving clockwise and alternating.
• If using distraction, choose a distraction that involves multiple senses (sight, hearing and touch).

The Health Department also encourages you to look at the CARD system to help your children through the vaccine process. Comfort Ask Relax and Distract. Get more information from the Government of Ontario's resource Nervous About Getting Needles? Immunizers at our clinics are familiar with the CARD system.

• Children with severe food, insect bite and medication allergies should receive the COVID-19 vaccine and will be monitored for a longer period at the clinic after getting their vaccine.
• COVID-19 vaccines do not contain preservatives, antibiotics, adjuvants, common food allergens, human materials, and animal derived materials.

• The vaccine itself is "new", but the science behind it is not. The mRNA vaccines have been given to millions of Canadians and to even more people worldwide.
• The vaccine is like other vaccines in that it is used to "teach" your child’s body how to respond to the COVID-19 virus.
• Routine childhood vaccines also vary in how they are made. For example, the MMR vaccine is different than the Pediacel® vaccine.

• Your health care provider.
• Call Ontario’s Provincial Vaccine Information Line at 1-888-999-6488.
• You can also access the SickKids Vaccine Consult Service.
• The Scarborough Health Network VaxFacts Clinic at 416-438-2911 extension 5738.

• Talk to your health care provider.
• Sick Kids – book an appointment to speak with a SickKids clinician.
• Scarborough Health Network - book a phone appointment to speak with expert doctors about vaccines in more than 200 languages.
• Vaccine Confidence Line (available at the Provincial Vaccine Contact Centre) 1-833-943-3900 (TTY for people who are deaf, hearing-impaired or speech-impaired: 1-866-797-0007)
• Max the vax – a web page full of COVID-19 vaccination related resources for kids and caregivers; available in both English and French
• About Kids Health
• Immunize Canada
• Kids Health First
• Canadian Pediatric Society
• Children's Health Coalition: ParentHomework.ca
• Government of Canada - vaccines for children: COVID-19
• Fact Sheet - English | French
• Poster - English | French
• Ontario Ministry of Health - COVID-19 vaccines for children and youth English | French
• Ontario Ministry of Health - COVID-19 vaccine information sheet: For children and youth
• Get information from credible resources

Children six-months and older are eligible to receive the COVID-19 vaccine based on their birth date. Children must be at least six-months old at the time of immunization.

Although children and youth are less likely to get really sick from COVID-19, they can still:

• get sick from COVID-19
• be infected and not have any symptoms
• spread COVID-19 to others
• experience longer-term effects if they do get infected
• get a rare but serious complication called multisystem inflammatory syndrome in children (MIS-C)

Children and youth with certain underlying medical conditions may have a higher risk for severe illness from COVID-19.

COVID-19 vaccines help the body fight off the virus and protect against COVID-19 infection which can result in serious illness, hospitalization and in rare instances, death.

Like adults, children and youth are well protected against severe illness 14 days after their second dose. Individuals who have already had COVID-19 infection are still recommended to get vaccinated to protect themselves from getting it again.

• Be honest and direct.
• Share information and answer their questions using age-appropriate language.
• Let them know that getting the vaccine will help them stay healthy and get back to seeing their friends, families and staying in school.

Before the vaccination, let your child know:

• What to expect.
• Why the vaccine is important.
• That the needle might feel like a pinch in the upper arm that only lasts a few seconds.
• That the nurse will help to decrease their fear/pain (e.g.: distraction, deep breathing, relaxing their arm, talking them through the experience etc.)

On the day of the vaccination, have your child:

• Eat something before their appointment.
• Wear a shirt with loose sleeves.
• Wear a mask to access the clinic.
• Follow instructions provided by the public health nurse and your reminder email to access the clinic.

Health Canada has approved the use of the following vaccines for children:

• Infant Pfizer COVID-19 vaccine for children six-months to under five-years of age.
• Moderna (25 mcg) COVID-19 vaccine for children six-months to under five-years of age.
• Pediatric Pfizer COVID-19 vaccine for children five to 11-years old.
• Moderna (50 mcg) COVID-19 vaccine for children six to 11-years old.
• Pediatric Bivalent Pfizer COVID-19 booster vaccine for children five to 11-years old.

As per the National Advisory Committee on Immunization, the use of pediatric Pfizer is preferred to Moderna for children five to 11-years old.

Up to two thirds of children experience some type of fear of needles. Some tips for parents and caregivers to help reduce pain and fear of needles include:

• Preparing your child before the appointment.
• Use of topical anesthetics prior to vaccination (discuss application with your child’s pharmacist or health care provider).
• Your presence as a parent or caregiver to offer support during vaccination.
• Letting your child sit on your lap if possible.
• Distraction such as toy, singing, special object, counting or electronic device.
• Being honest. For example., Instead of saying, "the needle won’t hurt", you could say, "some people feel pressure or a pinch".
• Encouraging your child to relax their arm and be still
• Remaining calm and positive

Some resources that can help with needle fear and pain management are:

• The CARD tool.
• Needles Don’t Have to Hurt.

Please speak to your child’s health care provider if you have questions or concerns about pain management and needle fear.

• The Moderna vaccine (25 mcg) for children ages six-months to under five-years is half of the dose of the Moderna vaccine (50 mcg) offered to children six to 11-years old.
• The pediatric Pfizer vaccine for children five to 11-years old is a smaller dose then the Pfizer vaccine offered to individuals 12-plus.

In clinical trials, lower doses provided children with very good protection against COVID-19. It is not clear yet how long protection will last.

The vaccine is available at similar locations that currently offer COVID-19 vaccines such as community immunization clinics, select doctors' offices, pharmacies and school-based clinics. See where to get your child vaccinated.

Children six-months to 11-years old getting COVID-19 vaccines should receive two doses. The National Advisory Committee on Immunization (NACI) recommends that the second dose should be given at least 56 days after the first dose.

Your child will be given a second dose appointment at the completion of their first dose appointment at the recommended interval of 56 days. To reschedule or cancel the second dose, please visit durham.ca/VaccineAppointment or contact the call centre at 1-888-444-5113.

It is recommended that children 6-months to 11-years old receive their second dose at least 56 days after the first dose. According to the National Advisory Committee on Immunization (NACI), evidence suggests that a longer interval:

• Provides a stronger immune response
• May decrease the risk of myocarditis or pericarditis after the second dose

Although the recommended interval between the first and second dose for this age group is 56 days, children may be able to receive their second dose less than 56 days after the first dose with informed consent. In these instances, the minimum interval is at least 21 days for pediatric Pfizer or 28 days for Moderna.

Yes. With informed consent, individuals six-months of age and older can receive COVID-19 vaccines on the same day, or at any time before or after non-COVID-19 vaccines. This includes both live and non-live vaccines.

In Ontario there is no minimum age to consent to treatment. Rather, Ontario uses a capacity-based consent model. A person is capable of consenting to treatment if they can understand the information that is relevant to making the decision and are able to appreciate the consequences of the decision.

Children six-months to 11-years old do not have the same capacity to consent for themselves as older individuals and will require parental consent before receiving the vaccine in most cases.

Consent will also be required for the collection, use and disclosure of personal health information. 

Health Canada has determined that COVID-19 vaccines are safe and effective at providing a strong immune response against COVID-19.

Pediatric COVID-19 vaccines, like other vaccines, may cause side effects. Some mild side effects that may occur include pain, swelling and redness where the vaccine was given, tiredness, muscle soreness, or decrease in appetite. These side effects are normal signs that the body is building protection.

If your child has a high fever (over 40°C or 104°F) or side effects that are worrying you or do not seem to be going away after a few days, contact your child’s health care provider or seek medical attention.

Go to the nearest emergency department or call 911 if they have serious drowsiness, seizures/convulsions, hives, swelling of the face, throat or mouth, trouble breathing or other serious symptoms.

Seek medical attention if your child develops any of the following symptoms after receiving the vaccine: chest pain, shortness of breath and/or palpitations (pounding or racing heart) or feeling of a rapid or abnormal heart rhythm. These may be symptoms of myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the sac of the heart), which is very rare and treatable.

The vaccine is safe for children who have food, drug, or environmental allergies. Children with allergies will be monitored for a longer period at the clinic following vaccination.

• The pediatric Pfizer and Moderna vaccines do not contain preservatives, antibiotics, adjuvants, common food allergens, human materials, and animal derived materials.
• If your child has had a severe allergic reaction to a vaccine or medical product, speak with their health care provider prior to getting the vaccine.
• Children who are hypersensitive to any substance or ingredient in the formulation should not receive the vaccine.
• If you have any questions or concerns, please speak to your child’s health care provider.

Immunization clinics offering the COVID-19 vaccines for children six-months to 11-years old are designed to provide support for this age group. Community immunization clinics offer the opportunity to book an appointment or walk-in. They are customized to provide a child-friendly environment. For example, movies, posters and stickers will be present and children will be able to use "pop its" to reduce anxiety during the immunization.

Clinic locations occur in municipalities across the region. Community clinics are offered throughout the day and after school hours (e.g., evenings and weekends) to support convenient and welcoming options for children and families.

In addition, clinics occur at some schools to facilitate access and provide another environment to administer the vaccine to this age group.

While many people with COVID-19 have only mild illness, others may get a severe illness or they may even die. There is no way to know how COVID-19 will affect you, even if you are not at increased risk of severe complications. COVID-19 vaccination helps protect you by creating an immune response and helping to protect against COVID-19 infection which can result in serious illness, hospitalization and in rare instances, death.

Although children and youth are less likely to get really sick from COVID-19, they can still:

• Get sick from COVID-19.
• Be infected and not have any symptoms.
• Spread COVID-19 to others.
• Experience longer-term effects if they do get infected.
• Get a rare but serious complication called multisystem inflammatory syndrome in children (MIS-C).

Children and youth with certain underlying medical conditions may have a higher risk for severe illness from COVID-19.

COVID-19 vaccines help the body fight off the virus and protect against COVID-19 infection which can result in serious illness, hospitalization and in rare instances, death.

Like adults, children and youth are well protected against severe illness 14 days after their second dose. Individuals who have already had COVID-19 infection are still recommended to get vaccinated to protect themselves from getting it again.

• Pfizer-BioNTech COVID-19 vaccine was authorized for use in Canada on December 9, 2020. The vaccine name was changed to Pfizer-BioNTech Comirnaty® on September 16, 2021.
• Moderna COVID-19 vaccine was authorized for use in Canada on December 23, 2020. The vaccine name was changed to Moderna Spikevax® on September 16, 2021.
• AstraZeneca COVID-19 vaccine was authorized for use in Canada on February 26, 2021. The vaccine name was changed to AstraZeneca Vaxzevria® on September 16, 2021.
• Janssen (Johnson & Johnson) COVID-19 vaccine was authorized for use in Canada on March 5, 2021.
• Novavax Nuvaxovid® COVID-19 vaccine was authorized for use in Canada on February 17, 2022.
• Medicago Covifenz® COVID-19 vaccine was authorized for use in Canada on February 24, 2022.

The National Advisory Committee on Immunization (NACI) continues to preferentially recommend that a complete primary series of an mRNA COVID-19 vaccine (Pfizer or Moderna) should be offered to individuals in the authorized age group.

The Novavax vaccine may be offered to eligible individuals who are not able or not willing to receive an mRNA COVID-19 vaccine.

A complete primary series of a viral vector COVID19 vaccine (AstraZeneca Vaxzevria, Janssen) may be offered to individuals in the authorized age group only when all other authorized COVID-19 vaccines are contraindicated.

There are two messenger RNA (mRNA) vaccines approved for use in Canada, the Pfizer-BioNTech COVID-19 vaccine and the Moderna COVID-19 vaccine.

• You will need two doses, given by an injection in the shoulder (deltoid) muscle.
• mRNA vaccines do not contain whole or live SARS-CoV-2 and therefore cannot cause a COVID-19 infection.
• mRNA vaccines have been studied for over two decades and are a new vaccine platform, but not a new technology.
• mRNA vaccines do not affect or interact with DNA and mRNA is destroyed by cells once the body has finished using its instructions.

mRNA vaccines differ from live attenuated vaccines and inactivated vaccines. Live attenuated vaccines contain a living virus or bacteria which has been weakened so it cannot cause serious harm. Inactivated vaccines are made by inactivating or killing the bacteria or virus during the manufacturing process.

Learn more about how mRNA vaccines work.

Viral vector-based vaccines use a harmless virus (in this case, adenovirus) as a delivery system. The vector virus is not the virus that causes COVID-19, the adenoviruses are viruses that cause the common cold. Once injected into the body, the virus contained within the vaccine produced the SARS-CoV-2 spike protein. The spike protein doesn’t make you sick, it causes the body to mount a strong immune response against the spike protein by creating antibodies and eliminate it from the body.

Learn more about how viral vector-based vaccines work.

The Novavax vaccine is a 'protein subunit' vaccine. Learn more about how protein subunit vaccines work.

A limited amount of Novavax vaccine is available for eligible adults.

• Who is eligible: Individuals 18 years and older who are not able or not willing to receive an mRNA COVID-19 vaccine.
• How to book: Call the Health Department’s call center at 1-888-444-5113 to book an appointment.

Online appointment booking and walk-ins for the Novavax COVID-19 vaccine are not available.

Some people may experience side effects from the vaccine, but these will likely be mild and resolve after a few days. Some of the symptoms are part of the body's response to developing immunity.

Common side effects reported in clinical trials for these vaccines include:

• Pain, tenderness, itchiness, redness or swelling at the injection site
• Headache
• Tiredness or feeling unwell
• Muscle or joint pain
• Fever or chills
• Nausea
• Swelling or tenderness under the armpit (Moderna only)
• Vomiting or diarrhea

In rare cases, serious allergic reactions (anaphylaxis) can occur. Seek immediate medical attention if you have trouble breathing, have hives, or swelling of the face and throat.

Rare cases of myocarditis (inflammation of the heart muscle) and/or pericarditis (inflammation of the lining around the heart) have been reported following vaccination with COVID-19 mRNA vaccines.

If you have a reaction to the vaccine, contact your health care provider who will report the side effect directly to the health department. The health department will keep track of the reported side effects to make sure the vaccine continues to be safe.

The COVID-19 vaccine is recommended for all eligible individuals in the authorized age groups without contraindications.

• Individuals with a severe allergy (anaphylaxis) or known hypersensitivity to any previous COVID-19 vaccine(s) or any part of its packaging. If you are unsure of the ingredients you are allergic to, talk to a health care provider.
  
  • Polyethylene glycol (PEG) is in both mRNA vaccines. It can also be found in laxatives, makeup, skin care products, personal lubricants, toothpastes, and some contact lenses. It is also in cough syrup and in some food and drinks.
  • Polysorbate 80 is found in both viral vector-based vaccines (AstraZeneca, Janssen)and Novavax. Polysorbate 80 can also be found in medical preparations (vitamin oils, tablets, and anticancer agents), cosmetics.
  • Tromethamine (Moderna, pediatric Pfizer) which is found in products such as contrast media, oral and injectable medications.
• Individuals who are not in the authorized age group should not be offered the vaccine.
• Individuals who are ill with COVID-19 symptoms should wait until they are feeling better.
• Individuals who are unwell for reasons other than COVID-19 should wait until they are feeling better.

The following individuals should discuss the vaccine with their health care provider for further assessment:

• Individuals who are immunosuppressed due to disease or treatment.
• Individuals with an autoimmune condition.

mRNA vaccines (Pfizer and Moderna)

• Yes, the National Advisory Committee on Immunization recommends that if the mRNA vaccine (Pfizer and Moderna) a person received as their first dose is not available, they can safely receive another mRNA vaccine to complete their vaccination.
• Mixing COVID-19 vaccines is safe, effective, and enables Ontarians to benefit from the protection of a booster dose.
• Both the Moderna and Pfizer COVID-19 vaccines provide strong protection against COVID-19 and its variants.
• Both mRNA COVID-19 vaccines (Pfizer and Moderna) authorized for use in Canada work in the same way.
• With increased cases of the Delta and Omicron variant of concern, it is important that all individuals complete their vaccine series with a dose of the most readily available COVID-19 vaccine for optimal protection.

Novavax Nuvaxovid®

Individuals may receive mixed doses of Novavax Nuvaxovid® and mRNA vaccines. If receiving a mixed primary series or additional booster doses with the Novavax vaccine, informed consent should include a discussion of the benefits and potential risks given the currently limited data on the effectiveness and safety of mixed schedules with the Novavax vaccine.

COVID-19 vaccines have been shown to lessen the risk of COVID-19 infection and symptomatic confirmed COVID-19, and are very effective at preventing severe disease, including hospitalization and death due to COVID-19.

Emerging evidence shows Moderna may provide enhanced protection against COVID-19 infection, hospitalization, and ICU admission.

Informed consent is required before a COVID-19 vaccine can be given.

The person receiving the vaccine provides consent if they have the capacity to decide. Otherwise, a substitute decision maker, such as a parent, provides consent. It is recommended individuals discuss the decision to receive a COVID-19 vaccine with a trusted adult, such as a guardian, even if they have the capacity to decide.

To provide consent, the individual needs to understand:

• Why the vaccine is recommended,
• the risks and benefits of accepting or refusing the vaccine, and the treatment.

No. The COVID-19 vaccines do not contain mercury, formaldehyde, aluminum or fetal cells.

pork-derived materials, blood fractions or fetal cell products.

We do not have enough data to understand how long immunity can last after a COVID infection, or with a vaccine. In other types of infections, we’ve seen that sometimes natural immunity doesn’t last as long as vaccine-induced immunity.

It is still recommended that people who have tested positive for COVID-19 get the vaccine.

Individuals should continue to practice recommended public health measures to prevent COVID-19, regardless of vaccination status.

• Continue to wear a mask in required settings and consider wearing a mask in other indoor settings.
• Consider practising physical distancing, when possible.
• Wash your hands often with warm water and soap or an alcohol-based hand sanitizer.
• Consider avoiding enclosed, poorly ventilated spaces and crowded places, when possible.
• Stay home when you are sick.

Yes. COVID-19 vaccines may be administered at the same time, or at any time before or after non-COVID-19 vaccines for individuals six months of age and older with informed consent.

No specific safety concerns have been identified when routine vaccines are given at the same time or within days of each other; however, there is a possibility of increased temporary side effects when a COVID-19 vaccine and another vaccine are administered at the same time or within days of each other.

To increase the province’s booster vaccination capacity, some business groups and large corporate employers may consider opening workplace and community vaccine clinics.

To learn about the criteria and for more information, visit COVID-19 Help for Business or call the Ontario Together Contact Centre at 1-888-777-0554.

• In rare instances where the risks of COVID-19 vaccine administration outweigh the benefits, a medical exemption may be warranted. This occurs in consultation with your health care provider.
• Generally, few actual contraindications to COVID-19 vaccines qualify as medial exemptions, and most individuals can safely receive COVID-19 vaccines.
• As of March 1, 2022, Ontario no longer requires businesses and organizations to check for proof of vaccination or medical exemption. Individual businesses and organizations may choose to require proof of vaccination upon entry.
• Consult your health care provider (physician or nurse practitioner) to assess your need for a medical exemption. If the health care provider determines there is a need, they will submit information directly to the Health Department for review.
• Exemptions will only be accepted from practitioners licenced to practice in Ontario.
• If you would like to obtain a QR code, contact your health care provider as submission to the Health Department is required to obtain a QR code.
• Your consent is required for the collection, use and disclosure of your personal health information with the Health Department.
• Learn more about medical exemptions, including who qualifies.

Rare cases of myocarditis (inflammation of the heart muscle) and/or pericarditis (inflammation of the lining around the heart) have been reported following vaccination with COVID-19 mRNA vaccines (Pfizer of Moderna). Cases of myocarditis and/or pericarditis occur more often after the second dose, usually within a week of vaccination, more often in males and individuals ages 12 to 29. A higher rate of cases has been reported following Moderna vaccine. While long-term follow-up is ongoing, available data shows that most individuals affected, while hospitalized, have generally recovered quickly with moderate treatment.

In alignment with the National Advisory Committee on Immunization (NACI)  recommendation, the Ministry of Health has made a preferential recommendation for the use of Pfizer-BioNTech COVID-19 vaccine for individuals five to 29-years old.

Individuals who received Moderna for their first dose can safely receive the Pfizer vaccine for subsequent doses. Mixing vaccines is safe and effective.

Individuals six to 29-years old who wish to receive Moderna can do so with informed consent. Severe side effects are rare. Seek medical attention right away if you develop any of these symptoms after receiving an mRNA vaccine:

• Chest pain, pressure, or tightness
• Shortness of breath
• Feelings of having a fast beating, fluttering, or pounding heart

In most circumstances, further doses of mRNA COVID-19 vaccines should be deferred for people who experienced myocarditis (with or without pericarditis) within 6 weeks of receiving a previous dose of an mRNA COVID-19 vaccine.

Individuals with a history of pericarditis and who either had no cardiac investigation or normal cardiac investigations, can receive the next dose once they are symptom free and at least 90 days has passed since vaccination.

The National Advisory Committee on Immunization (NACI), Public Health Ontario (PHO), and the Ontario Ministry of Health (MOH) are following this closely and will update this recommendation as more evidence becomes available.

Health Canada’s independent drug authorization process is known worldwide for its high standards and demanding reviews. Decisions to authorize vaccines for use in Canada are based only on scientific and medical evidence demonstrating that vaccines are safe and effective. These stringent requirements have not changed for the approval of COVID-19 vaccines in Canada.

Check out this video about vaccine safety in Canada.

You may be interested in Is the vaccine checked for safety after it has been approved? and How was Health Canada able to approve the COVID-19 vaccine so quickly?

Yes, in Canada there is ongoing monitoring and reporting of every vaccine given. If a reaction occurs after getting a vaccine that is not one of the normal side effects, an adverse event following immunization (AEFI) form is completed by your health care provider. The AEFI form will detail what vaccine was received, when it was received, the reaction that occurred and how long it took the reaction to appear after the vaccine was given.

Check out the COVID-19 Vaccine Safety in Canada website to see the AEFI reports to date.

Yes. Individuals who previously tested positive for COVID-19 are encouraged to get the vaccine if they meet other eligibility criteria. Reinfection with COVID-19 is possible.

Emerging evidence indicates that a longer interval between COVID-19 infection and vaccination is associated with improved antibody responses to COVID-19 vaccines.

Individuals who experience COVID-19 infection before starting or completing their primary COVID-19 vaccine series may receive their next dose eight weeks after symptoms started or after testing positive (if no symptoms were experienced).

Individuals currently eligible for booster dose(s), infected with COVID-19 after their primary series but before their booster dose, are suggested to receive their booster dose at six months (168 days) after symptom onset or positive test (if asymptomatic) which may provide a better immune response regardless of the product given.

With informed consent, an individual can receive the booster dose at a minimum of three months (84 days) or later post-infection. Before vaccination, the individual should be no longer considered infectious, symptoms of acute illness are completely resolved, and their isolation period is completed.

COVID-19 infection is defined as a COVID-19 case confirmed by a molecular (e.g. PCR) or rapid antigen test, or an individual who is symptomatic AND is a household contact of a confirmed COVID-19 case.

Since all Health Canada authorized COVID-19 vaccines are not live vaccines, they are considered safe in autoimmune conditions and immunocompromised persons (due to disease or treatment), however there is limited data on efficacy.

Individuals who were immunocompromised due to disease or treatment were excluded from some of the Phase III trials for COVID-19 vaccines available at present and those with autoimmune conditions had very small representation.

A three-dose primary series is recommended for moderately to severely immunocompromised individuals with the aim of enhancing the immune response and establishing an adequate level of protection.

Third doses and booster doses strengthen the protection of those who may have a weaker immune response after two doses and are at higher risk of serious complications from COVID-19.

Some immunocompromised individuals may be eligible for additional dose(s) following a discussion with your health care provider.

For more information, visit three-dose primary series and boosters for individuals who are immunocompromised.

• Individuals five years of age and older who are moderately to severely immunocompromised who become infected* with COVID-19 before completing or before starting their three-dose primary series, should wait four to eight weeks after their symptoms started or after their positive test (if they had no symptoms) before receiving a dose of the COVID-19 vaccine.
• Individuals 12 years of age and older who are moderately or severely immunocompromised who become infected* with COVID-19 after their three-dose primary series but before a booster dose, are recommended to receive a dose three months after their symptoms started or after their positive test (if they had no symptoms).
  • For 12 to 17-year-olds, it should also be at least six months after they completed their three-dose primary series.
• Children with a previous history of Multisystem Inflammatory Syndrome in children (MIS-C) should receive the vaccine dose when they have recovered or more than 90 days since the onset of MIS-C, whichever is longer.
• With informed consent, individuals who are immunocompromised may receive their COVID-19 vaccine once they are asymptomatic and have completed their isolation.

*A previous infection of COVID-19 confirmed by a molecular (e.g., PCR) or rapid antigen test, or individuals who had COVID-19 symptoms and were a household contact of a confirmed COVID-19 case.

Although pregnant and breastfeeding people were not a part of clinical trials for any of the vaccines, real world evidence shows that mRNA vaccines (Moderna or Pfizer) are safe for this population. A review following vaccination of over 35,000 pregnant women in the United States demonstrated that these women developed strong immunity without safety issues.

The National Advisory Committee on Immunization (NACI) strongly recommends that pregnant or breastfeeding individuals receive a complete mRNA vaccine series.

See the COVID-19 vaccines in pregnancy website for more information about vaccination during pregnancy and while breastfeeding.

There is no need to avoid pregnancy following vaccination with mRNA vaccines.

The SickKids COVID-19 Vaccine Consult Service, in partnership with Scarborough Health Network’s VaxFacts, is available to support people who are pregnant, breastfeeding or planning to conceive. Book a 1:1 appointment to discuss your questions or concerns related to the COVID-19 vaccine.

COVID-19 Vaccination in Pregnancy and Breastfeeding Clinical Support Tool

1. If you have a history of significant allergic reactions and/or anaphylaxis to any food, drug, venom, latex, or other allergens not related to mRNA vaccines, you can be vaccinated with and will be asked to wait 30 minutes for observation after you receive your vaccine.

2. If you have allergy issues such as allergic rhinitis, asthma or eczema, you can be vaccinated, and will be asked to wait 15 to 30 minutes after your vaccine for observation.

3. If you have had an allergic reaction and/or anaphylaxis that occurred after a vaccine, an investigation will need to be done by your local health department. If you have a history of a reaction to a vaccine outside of the normal side effects, please phone the Durham Health Connection Line to have them initiate an investigation.

4. If you have had an allergic reaction including anaphylaxis to a previous dose of a COVID-19 mRNA vaccine or to any of its components, you should not receive any mRNA COVID-19 vaccine in a general vaccine clinic.
   If you experienced an allergic reaction including anaphylaxis, an investigation will need to be completed by your local health department. Please phone the Durham Health Connection Line to have them initiate an investigation. Contact your health care provider to assess your need for a medical exemption.

• Delay vaccination if you:
  • have a fever, or
  • are sick with COVID-19 symptoms, or
  • were diagnosed with myocarditis or pericarditis following mRNA vaccination.
• If you are on blood thinner medication, a smaller needle will be used, and you will need to apply pressure for longer after getting the vaccine to reduce bruising.

As a precautionary measure, individuals who were diagnosed with myocarditis/pericarditis after a previous dose of an mRNA COVID-19 vaccine should wait to receive their second dose until more information is available. The National Advisory Committee on Immunization (NACI), Public Health Ontario (PHO) and the Ministry of Health continue to follow this closely and will update this recommendation as more evidence becomes available.

Seek medical attention if you have trouble breathing, develop hives, or develop swelling of the face and throat. As with all vaccines, vaccine side effects will continue to be monitored as people receive the vaccine.

If you develop a reaction to the vaccine, contact your health care provider who will report the side effect directly to public health. Public health will keep track of the reported side effects to make sure the vaccine continues to be safe.

Credible information is based on up-to-date evidence that comes from proper research. Unless you have special training in ‘research methods’, it can be hard to tell if health information is based on proper research. Look for the following when trying to find credible information:

• Is the information current?
  The website should clearly show when the information was posted, reviewed or last updated. The dates can often be found at the bottom of the page.
• Is there evidence to support the advice?
  Even an expert opinion is still just a point of view unless it’s supported by evidence. The site should provide references and sources for evidence such as articles from trustworthy medical journals or text or include reports or statistics.
• Is the information peer reviewed?
  Peer reviewed means that it has been reviewed by other experts in the field. The site should specify the type of peer review (for example, a board or committee of experts that is not in a conflict of interest). Websites that are not peer reviewed may have unproven claims that seem too good to be true. Unfortunately, when something seems too good to be true, it usually is.
• Does the site explain or provide references?
  The website should be specific about the source of any information by providing a list of references, studies or articles.

• Government of Canada: Vaccines for COVID-19
• Government of Canada: Recommendations on the use of COVID-19 vaccines
• Ontario’s COVID vaccines for Ontario
• Ontario’s COVID-19 pharmacy vaccine locations
• Public Health Ontario: COVID-19 vaccines
• Public Health Ontario: COVID-19 vaccines: mRNA vaccines
• Facts about... COVID-19 vaccines for 12+ years
• Facts about... COVID-19 vaccines for children ages 5-11
• Durham Region Health Department COVID-19 Update page

Fact: None of the COVID-19 vaccines approved for use in Canada use the live virus that causes COVID-19. The vaccines work by teaching the immune system how to recognize and fight the "spike proteins" found on the COVID-19 virus. Sometimes this process can cause symptoms, such as fever. These symptoms are a sign of the immune response to vaccine. These symptoms are minor and resolve in a few days. Most people who get the vaccine continue to go about their daily activities as usual.

After getting the COVID-19 vaccine, it takes about two weeks to build immunity. It is possible that someone could become infected with the COVID-19 virus before or just after getting the vaccine and get sick. This happens because the vaccine has not had enough time to provide protection in the body.

Fact: COVID-19 vaccines do not alter your DNA. mRNA vaccines do not affect or interact with DNA and mRNA is destroyed by cells once the body has finished using its instructions.

Fact: mRNA technology has been around and studied for over two decades, it is not new technology but is a new platform for vaccines.

Fact: The first two COVID-19 vaccines authorized for use in Canada contain mRNA and other, normal vaccine ingredients, such as fats (which protect the mRNA), salts, as well as a small amount of sugar. These COVID-19 vaccines were not developed using fetal tissue, and they do not contain any material, such as implants, microchips or tracking devices. The Pfizer-BioNTech and Moderna vaccines do not contain gelatin or pork products.

Fact: The COVID-19 vaccine is safe and effective.

With any medication, the COVID-19 vaccine can have side effects but most of them are mild and short term, not serious or dangerous. Some people who receive the vaccine experience pain where they were injected, body aches, headache or fever lasting a day or two. These side effects are a sign of the immune response to vaccine. These symptoms are minor and resolve in a few days. Most people who get the vaccine continue to go about their daily activities as usual.

Becoming infected with the COVID-19 virus can lead to a variety of symptoms ranging from mild to severe. The most common symptoms of COVID-19 are fever, dry cough, and tiredness. Other symptoms that are less common and may affect some patients include loss of taste or smell, aches and pains, headache, sore throat, nasal congestion, red eyes, diarrhea, or a skin rash. Complications from COVID-19 can include serious conditions, like pneumonia or kidney failure and, in some cases, death.