Requests for alternative COVID-19 vaccine

In some rare cases, people who had a first dose of Vaxzevria (AstraZeneca) COVID-19 vaccine are recommended to receive the COVID-19 Vaccine Comirnaty (Pfizer) or Spikevax (Moderna) for their second dose. This includes people who are pregnant, have a qualifying medical condition or experienced a serious vaccine-attributed adverse event after the first dose of Vaxzevria (AstraZeneca) COVID-19 Vaccine.

Assessing requests for alternative COVID-19 vaccine

Medical practitioners (including GPs and treating specialists) will assess their patient’s eligibility for an alternative COVID-19 vaccine.

People who want to request an alternative COVID-19 vaccination for their second dose must first discuss with their medical practitioners who will assess their patient’s eligibility for an alternative COVID-19 vaccine.

The GP or treating specialist must fill out the form Recommendation to receive Pfizer or Moderna COVID-19 vaccine (PDF 167KB)

Qualifying medical conditions

Conditions where a Comirnaty (Pfizer) or Spikevax (Moderna) COVID-19 vaccine is recommended as second dose for people following a first dose of Vaxzevria (AstraZeneca) COVID-19 vaccine

  • Pregnancy
  • Anaphylaxis to a previous dose of COVID-19 vaccine Vaxzevria (AstraZeneca)*
  • Thrombosis with thrombocytopenia syndrome (TTS) occurring after the first dose of COVID-19 vaccine Vaxzevria (AstraZeneca)
  • Other serious adverse events attributed to the first dose of COVID-19 vaccine Vaxzevria (AstraZeneca)**
  • A past history of cerebral venous sinus thrombosis (CVST)
  • A past history of heparin-induced thrombocytopenia (HIT)
  • A past history of idiopathic splanchnic (mesenteric, portal and splenic) vein thrombosis
  • Anti-phospholipid syndrome with thrombosis
  • A past history of capillary leak syndrome

*Note – Referral to an immunisation specialist service prior to further vaccination is recommended following anaphylaxis or severe allergic reaction.

**Note – Definition and guidance following a serious adverse event is available in the Australian Immunisation Handbook (external site). ATAGI advises serious adverse events are generally defined as those which require hospitalisation (e.g., thrombosis with thrombocytopenia following the first dose of COVID-19 Vaccine AstraZeneca); are medically significant (e.g., immune thrombocytopenia purpura, myocarditis), are potentially life threatening (e.g., anaphylaxis) and/or result in persistent or significant disability (e.g., Guillain-Barre Syndrome). These reactions do not typically include expected local or systemic reactions known to occur within the first few days after vaccination. Attributing a serious adverse event to a previous dose of a COVID-19 vaccine may require discussion with the individual's GP, local immunisation service or relevant medical specialist.

Determining eligibility for an mRNA vaccine

Persons with qualifying medical condition can be assessed by their usual GP or treating specialist for their eligibility for an mRNA vaccine Comirnaty (Pfizer) or Spikevax (Moderna). The GP or treating specialist must fill out the form Recommendation to receive Pfizer or Moderna COVID-19 vaccine (PDF 167KB).

Persons who are eligible can be vaccinated at a participating GP or pharmacy clinic, Commonwealth Vaccination Clinic, Aboriginal Medical Service or a Community Vaccination Clinic. They must take the completed, signed Recommendation to receive Pfizer or Moderna COVID-19 vaccine (PDF 167KB) form with them at the time of vaccination.

Find a Community Vaccination Clinic on the Healthy WA website or by calling 13 COVID.

Advice on mixed schedules

Based on ATAGI clinical guidance (external site), completing the vaccination course with the same vaccine is recommended. Mixed schedules are only recommended in special circumstances such as for those with serious vaccine-attributed adverse events after the first dose.

People who are offered Comirnaty (Pfizer) or Spikevax (Moderna) as the second dose following a first dose of COVID-19 vaccine Vaxzevria (AstraZeneca) should be aware that short-term adverse reactions may be more frequent but not more severe than if they had received COVID-19 vaccine Vaxzevria (AstraZeneca) as the second dose. Emerging data demonstrates that mixed schedules are effective and have an acceptable safety profile, however larger studies and longer-term studies are required to confirm this approach.

The recommended interval for administration of a second COVID-19 vaccine dose when using a different brand to the first dose is 4 to 12 weeks after the first dose, regardless of first dose brand. An interval longer than 12 weeks is acceptable if the second dose cannot be administered during this time window. Further advice is available in ATAGI clinical advice (external site) on use of a different COVID-19 vaccine as the second dose in special circumstances.

Further information and advice on the COVID-19 vaccine Vaxzevria (AstraZeneca) can be found on the Australian Department of Health Website (external site).

Last reviewed: 16-09-2021