COVID-19 Immunization Guide for B.C. Pharmacies

COVID-19 Immunization Guide for B.C. Pharmacies

Updated: April 21, 2021 7:36 p.m. PDT

This guidance is co-developed with the British Columbia Ministry of Health

Current State

  • Vaccines
    • AstraZeneca COVID-19 vaccine/COVISHIELD
  • Priority group:
    • Individuals 40 years of age and older. The minimum age for vaccine receipt is based on year of birth (i.e., the vaccine may be offered to individuals who will be turning 40 years of age within the current calendar year), per BC Government recommendations.
    • Dose 1 only
  • The two ChAdOx1-S vaccines (AstraZeneca COVID-19 Vaccine/COVISHIELD) are interchangeable within the vaccine series, as per BCCDC product details. They are NOT interchangeable with other COVID-19 vaccines (e.g., mRNA vaccines).  Therefore, if a patient has had a Pfizer or Moderna (COVID-19 mRNA) vaccine for Dose 1, do NOT give the AstraZeneca COVID-19 vaccine/COVISHIELD for Dose 2.

Important Reminders

  • Record immunizations in PharmaNet on the day that they are given.
  • Ensure the PIN for the COVID-19 vaccine is entered correctly.
  • PharmaNet data is extracted by the Provincial Immunization Registry (PIR) every day at 9 pm. If you need to make a change to a claim, please do this before the next 9 pm extract. Only change a claim outside of this time frame if the wrong PIN was used, and back-date to the service date (or else a second record will be made in the Public Immunization Registry)
  • Verify patient ID. Update patient demographics in PharmaNet if needed.
  • If you have CareConnect, check PIR for prior dose before administering a vaccine. Patient interviews are not 100% reliable.  See Registering with CareConnect.

Training and Education 

  • To provide COVID-19 vaccines, B.C. pharmacists must be certified as per the College of Pharmacists of BC’s drug administration requirements.
  • Pharmacists are encouraged to complete BCCDC COVID-19 immunization webinars, which provides a foundation of knowledge for the delivery of safe and effective COVID-19 vaccines. 
  • The BCCDC has developed further resources for health professionals on COVID-19 vaccines.

Community Pharmacy Standards of Practice

  • Pharmacists providing immunizations must follow the College’s Standards, Limits and Condition for Drug Administration by Injection and Intranasal Route.
  • Pharmacists must follow the Community Pharmacy Standards of Practice.
    • Patient counselling
      • If a drug-related problem is identified during pharmacist/patient consultation, the pharmacist must take appropriate action to resolve the problem.
      • At a minimum, the pharmacist must confirm that the right patient is getting the right drug /strength and must also provide a direct opportunity for the patient to ask questions.
    • Reviewing PharmaNet*
      • A pharmacist must review the patient’s personal health information stored on the PharmaNet database before dispensing a drug and take appropriate action if necessary with respect to, but not limited to, appropriateness of drug therapy, drug interactions, allergies, adverse drug reactions, and therapeutic duplication.
    • Performing a final check
      • A pharmacist must review the prescription label to ensure it is consistent with the prescription and/or hardcopy.
      • Always check the expiry date of the product before providing the vaccine. Rotate vaccines according to expiry date (place those with the longest expiry date at the back)

* If COVID-19 vaccine dose is not on PharmaNet, check CareConnect

AstraZeneca COVID-19/COVISHIELD Vaccine Product Information

COVID-19 vaccine Health Canada Product Monograph Storage Temperature Doses and schedule

AstraZeneca COVID-19 Vaccine/ COVISHIELD

(ChAdOx1-S [recombinant])

AstraZeneca product monograph

 

COVISHIELD product monograph

Kept in refrigerated (2-8°C) until ready to be used.


After first vial puncture, the vaccine is stable at room temperature (up to +30°C) for 6 hours OR at +2°C to +8°C for 48 hours.

Vaccine can be pre-loaded into a syringe for up to 6 hours at room temperature (up to +30C)

2 doses given as 0.5 mL IM, 4 months apart

For COVID-19 vaccine product details, refer to BC Immunization Manual Part-4 Biological Products, which includes information on doses and schedule, administration procedures, storage and handling, dilution requirements, contra-indications, precautions, special considerations, and adverse events.

U.S.-labelled AstraZeneca COVID-19 Vaccine

See Health Canada notice regarding U.S.-labelled vaccine supplies of AstraZeneca COVID-19 Vaccines.

Product Name Dosage Form, Strength, and Route of Administration Country of Origin and Identifying Code Manufacturer Importer and Supplier in Canada
AstraZeneca COVID-19 Vaccine, (ChAdOx1-S [recombinant])    

Suspension for Intramuscular Injection

10 Multi-dose vials
(each vial contains 10 doses of 0.5 mL)

USA

NDC 0310-1222-10 (vial)


NDC 0310-1222-15 (carton)

AstraZeneca Pharmaceuticals LP

AstraZeneca Canada Inc.

 

For any medical questions related to AstraZeneca COVID-19 Vaccine, contact Medical Information at 1-800-668-6000 or submit a form online at www.azcovid-19.com

 

Dose 2

As per BCCDC product details, the two ChAdOx1-S vaccines (AstraZeneca COVID-19 Vaccine / COVISHIELD) are interchangeable within the vaccine series. However, they are NOT interchangeable with other COVID-19 vaccines (e.g., mRNA vaccines).  Therefore, if a patient has had a Pfizer or Moderna (COVID-19 mRNA) vaccine for Dose 1, do NOT give the AstraZeneca COVID-19 vaccine/COVISHIELD for Dose 2

Vaccine Expiry Date

U.S. labelled AstraZeneca COVID-19 Vaccine: As per Health Canada notice (March 31, 2021), AstraZeneca is providing US-labelled vaccine supplies with English-only vial and carton labels in order to expedite the distribution of AstraZeneca COVID-19 Vaccine in Canada. Two key points:

1. The expiration date is not printed on the US vial and carton labels. Pharmacists must verify the expiration date prior to vaccination. The expiration date for the corresponding batch/lots can be found in the “Product affected” section of this document, by going to www.AZCOVID-19.com, or by scanning the QR code on the US English-only carton label

Expiration dates for U.S. labelled batches/lots

Batch Number Expiry Date
MT0055 31-May-2021
MT0056 31-May-2021
NA0079 30-June-2021

 

2. There is no DIN on the packaging, it is the U.S. NDC Code.

  • PharmaCare has activated the AstraZeneca COVID-19 Vaccine PIN (66127320) which applies to both 8-dose and 10-dose vials. Please see publicly funded vaccines and COVID-19 vaccine PINs for submission to PharmaNet below

Expiry Date Interpretation

As per BCCDC, the expiry date on vaccines should be interpreted as follows:

  • When specified as month/year, product expires on the last day of the month and may continue to be administered until the end of the month (e.g., expiry of January 2021 means January 31, 2021, and may be used until 11:59 pm in the local time zone)
  • When specified as a day/month/year, product expires at the end of the day of expiry i.e., may be administered up until the last minute of the labelled expiry day, within the time zone of use (e.g., product expiring on April 2, 2021, may be used until 11:59 pm on April 2, in the time zone).

What to do with Expired Product

  • Remove expired vaccines from the refrigerator. 
  • Ensure expired stock is clearly labelled/marked not to be used.
  • Quarantine the clearly labelled/marked expired stock.
  • Do NOT discard unusable expired vaccine doses in your pharmacy. More information to follow from BCCDC on the process for returning vaccines.

Distribution of Vaccine and Supplies

COVID-19 vaccines (AstraZeneca and COVISHIELD) are shipped to the major wholesaler distribution centres in B.C., which will directly ship a pre-determined allocation of doses to each selected pharmacy site. Vaccine supplies and personal protective equipment (PPE) will also be provided along with the vaccines and are available at no cost through the Provincial Health Services Authority (PHSA) supply chain.

The following vaccine and supplies will be delivered directly to your pharmacy:

Vaccines and Supplies Description
AstraZeneca COVID-19 Vaccine/ COVISHIELD Pre-determined allocation 
Safety needles 25G x 1" needle
Syringes 3 mL syringes 
Personal protective equipment (PPE) Procedural masks and gloves

 

*Supplies list may change depending on vaccine.

Vaccine Storage

Reporting Cold Chain Incidents

  1. If a temperature excursion occurs when vaccine has been received at your pharmacy, notify IBCOC_Operations@phsa.ca as soon as possible. Call 1-250-686-6061, if after hours.
  2. Pharmacy sites must notify Public Health, which implements regular provincial reporting process as per section 5.3 Algorithm 1 in BCCDC Communicable Disease Control Manual Chapter 2: Immunization Appendix E – Management of Biologicals.
  3. Within 24 hours, the incident must be resolved, and a report submitted to IBCOC_Operations@phsa.ca with the following information:

    • Date of incident,
    • Location of incident,
    • Situation surrounding incident,
      1. Excursion temperature(s) and duration(s)
      2. Lot number, expiry
      3. Detail description of event
      4. Number of affected doses
      5. Impact on vaccination program.
  4. The Immunize BC Operations Centre will be responsible to report the incident to the National Operations Centre (NOC).

 

Scheduling of Appointments

  • Pharmacies are responsible for booking immunization appointments (online and telephone). Consider options for walk-ins.
  • Pharmacies will be informed of the number of doses they will receive. This will help with scheduling appointments according to available supply.
  • If your pharmacy does not have an online booking system, but is interested in one, the BCPhA offers an online booking platform. More information can be found here

Vaccine Eligibility Screening and Verification of Eligibility

  • Vaccines distributed to pharmacies in April 2021 are to be administered to individuals 40 years of age and older. DOSE 1 only.
    • As per BC Immunization Manual Part 4 – Biological Products, AstraZeneca/ COVISHIELD vaccine is indicated for individuals 40 years and older.

    • Although the vaccines are authorized for those 18 years of age and older, due to a safety signal identified in Europe following use of the AstraZeneca vaccine, the Provincial Health Officer has recommended that neither of the vaccines be used in people under 40 years of age.
    • Health Canada has updated the product monographs for both products to include information about observed events of thromboembolic/ thrombocytopenia, as these vaccines are comparable.
    • The minimum age for vaccine receipt is based on year of birth (i.e., the vaccine may be offered to individuals who will be turning 40 years of age within the current calendar year), per BC Government recommendations.
  • See BCCDC Monitoring vaccine uptake, safety and effectiveness.
  • Review/provide FAQ to patients with questions and concerns about the AstraZeneca/COVISHELD vaccines.
  • Pharmacies must review patient identification (ID) and ensure ID matches the patient profile in PharmaNet.
  • Review BCCDC’s COVID-19 Vaccine Screening Checklist.
    • Note that the only contraindication to receipt of a COVID-19 vaccine is a history of anaphylaxis to a previous dose or to a component of the vaccine.
    • See BCCDC FAQ for health care professionals regarding information on vaccinating special populations and contraindications. 
  • (NEW!) Non-residents of B.C/ Non-Canadians are able to be vaccinated at a community pharmacy:
    • Anyone living, working or studying in B.C. during the pandemic can receive the COVID-19 vaccine, even if they are not a Canadian citizen or permanent resident (with ID showing they meet the age/current eligibility requirement).
    • Pharmacies will be reimbursed for this service. As with any other patient, a PHN is to be generated for the patient if they do not currently have one. No one that is eligible (as per current criteria) is to be turned away for an appointment they have booked. Name and date of birth of patient is required. 
  • Confirm that patients are receiving their first dose. Note: PharmaNet does not show doses given at public health clinics
    • Check PharmaNet to ensure first dose was not already given by another pharmacy
    • If the pharmacy has access to CareConnect, check Provincial Immunization Registry to determine if patient has received a first dose at a public health clinic
    • Verbal confirmations should only be used as a secondary source of verification, as patient interviews are not 100% reliable

Informed Consent

Post-immunization Monitoring and Aftercare

  • Patients are to remain in a designated area for 15-minute observation period following COVID-19 vaccine receipt.
  • Provide the patient a record of immunization, as per PharmaCare policy manual section 8.10. At a minimum the record should include the patient name, dose number, date of administration, product given, lot number and pharmacy information.
  • Encourage patients to sign up to Health GateWay to access their digital immunization record. PharmaNet data is fed into the Provincial Immunization Registry which is subsequently uploaded to Health Gateway where patients can access the health records themselves.
  • Provide patients the COVID-19 Vaccine After care sheet, which includes information about rare cases of blood clots and/or bleeding following the AstraZeneca COVID-19 Vaccine/COVISHIELD and a list of symptoms for when to seek immediate medical attention.
  • Following administration of COVID-19 vaccines pharmacists must provide the patient a record of immunization. This is a requirement in the PharmaCare policy manual section 8.10. At a minimum the record should include the patient name, dose number, date of administration, product given, lot number and pharmacy information.

PharmaNet Data Entry and PINs

As of Apr. 20, 2021, PharmaCare has started using Fan Outs to notify pharmacies on incorrect PharmaNet data entry for COVID-19 vaccines e.g., inventory not received, but administrations recorded; wrong (mismatch) DIN/PIN to LOT and incorrect SIG formats. The Fan Outs are targeted to specific pharmacies and are not broad fan outs. If your pharmacy receives a Fan Out message, please review carefully and follow instructions to correct the issue. Review the following PharmaNet data entry formats to ensure information in entered correctly.

 

PharmaNet Data Entry:

Recently, a connection was made between PharmaNet and the Provincial Immunization Registry (PIR) to ensure that all immunizations recorded in PharmaNet are reflected in a patient’s provincial immunization record. The PIR record is subsequently uploaded to the Health Gateway where patients can access their health records themselves.

Due to the strict reporting requirements of COVID-19 Immunizations, pharmacists must follow these rules:

  1. Provide immunizations as per the immunization priority criteria. 
  2. Record immunizations administered in PharmaNet by 11:59 p.m. on the day that they are given to the patient.
  3. Follow all PharmaNet vaccine administration claim entry requirements for COVID-19 immunizations (see below)
  4. Follow COVID-19 vaccine inventory receipt and daily wastage PharmaNet entry requirements (see below).
  5. Verify patient identification and update demographics in PharmaNet if necessary. Note: address must be updated through the specific address update transaction feature

PharmaNet claim entry:

  1. Use the product identification number (PIN) as assigned by PharmaCare.
  2. The administering pharmacist should be the prescriber.
  3. Follow the protocol for entry of the “Directions for Use” (Sig) field (see below).
  4. Quantity is the amount administered to the patient, in millimetres (e.g., 0.5 mL for AstraZeneca/COVISHIELD) 
  5. Days supply for first doses should be the anticipated interval to next dose (e.g., 112 days for AstraZeneca/COVISHIELD). 

Data to be entered in the Directions for Use field:
Some aspects of immunizations are not recorded in PharmaNet as separate data elements.  The Provincial Immunization Registry (PIR) requires these additional elements to ensure appropriate reporting and clinical follow-up.  To account for this, the pharmacy must follow new data entry requirements in the “Directions for Use”, or “Sig” field sent to PharmaNet.

 
Entry of this information in this format will allow PharmaNet to accurately extract these additional data elements and submit on behalf of providers to the PIR.  Only certain “allowable values” are permitted to be entered for each data element. PharmaNet will verify the information prior to sending to the PIR.  

Data element Order in text Allowable value Description
Lot 1st Lot number as provided on vial The Lot number allows Ministry to determine: 
  • the expiry of the product used, 
  • trace inventory across the province,
  • monitor for trends in adverse effects following immunization (AEFI),
  • contact patients in event of a Lot-specific issue.
Lot 2nd Left Arm/site where the vaccine was injected. 
Right

This information should be recorded in the “Directions for Use” field in the above order separated by an underscore “_”.  DO NOT enter any other characters.


Example entries for “Directions for Use” for COVID-19 vaccines:
For COVISHIELD with lot number 4120Z003, example entries in the “Directions for Use” field are:
 

Lot Site Directions for Use
4120Z003 Left 4120Z003_LEFT
4120Z003 Right 4120Z003_RIGHT

There is no need to add “LOT” or “Arm” or any other information like expiry or IM. 

Please do NOT enter the following example formats, otherwise it will not lead to a complete record in the Provincial Immunization Registry:
 

X WRONG 0.5ML INTRAMUSCULAR INJECTION - LOT#4120Z003 (RIGHT)
X WRONG LOT:4120Z003.1ST 0.5 INTRA MUSCULAR LEFT ARM
X WRONG LOT 4120Z003. 0.5 ML(S) INTRA MUSCULAR 
X WRONG 4120Z003_RIGHT (PIN#66127322)
X WRONG INJECT AS DIRECTED

 

Vaccine PINs for PharmaNet submissions

For vaccine PINS, see Publicly Funded Vaccines.

DIN/NDC PIN Name Brand Name Manufacturer
0310-1222-10 (vial)
NDC 0310-1222-15 (carton)
66127320 CHADOX1-S [RECOMBINANT] ASTRAZENECA COVID-19 VACCINE (10 doses/vial) AstraZeneca
2511444 66127320 CHADOX1-S [RECOMBINANT] ASTRAZENECA COVID-19 VACCINE (8 doses/vial) AstraZeneca
2510847 66127320 CHADOX1-S [RECOMBINANT] ASTRAZENECA COVID-19 VACCINE (10 doses/vial) AstraZeneca
2512947 66127322 CHADOX1-S [RECOMBINANT] COVISHIELD VERITY PHARMACEUTICALS

Ensure the PIN for the COVID-19 vaccine is entered correctly. If the wrong PIN has been submitted, the pharmacy MUST reverse the claim and BACKDATE under the correct PIN (if not, it will appear incorrectly as dose 2 in the Provincial Immunization Registry).

 

Claim Adjudication Results

COVID-19 immunizations will be reimbursed via the usual process for vaccinations.  

At the time of submission, PharmaNet will indicate that the immunization is NOT a benefit. This is expected; reimbursement is done by a secondary process, which identifies the number of immunizations administered by a pharmacy, irrespective of adjudication results. You do not need to reverse and resubmit the claim.

Inventory Management

Accurate daily inventory accounting is critical. Both receipt of inventory and daily wastage of doses must be recorded for central reporting and management of inventory. To achieve this efficiently in PharmaNet, pharmacies must follow the procedures below. 

1. Receiving inventory

  • Submit under the O-Med, a claim to PharmaNet under the PIN for the product received:
    • Quantity = total volume in mL received 
    • Directions for Use = Received_LOT
    • Note the underscore “_
  • This must be done on as soon as you receive/ on the same day you receive the vaccine.

2. Recording wastage

  • Submit to PharmaNet using O-Med PHN, under the vaccine PIN for the product wasted:
    • Quantity = total volume in mL wasted
    • Directions for Use, depending on reason for wastage, please enter the following:
      • Wastage_CCI: Handling Error_Lot [for cold chain incidents]
      • Wastage_Damage to Product_Lot
      • Wastage_Expired Product_Lot
    • Note the underscore “_

  • This must be done on the same day the product is wasted.

  • If you receive damaged or missing vials from the distributor, email IBCOC_Operations@phsa.ca the following information:

    • Damage to vials? If yes, describe how many and to what extent.

    • Missing vials? If yes, how many?

3. Transferring product between pharmacies *NEW*

 

PharmaNet data entry:

  • Note: For transferring product between stores, use the 3-character PEC (e.g. A01) of the store you are transferring to, or the PEC of the store you are transferring from. See table for entry options.
     
  • Pharmacy transferring out the product:
    • Submit to PharmaNet using O-Med PHN, under the vaccine PIN for product transferred:
      • Quantity = total volume in mL being transferred.
      • Directions for Use = Transfer_Lot_(to)PEC  

      • Example: PEC of pharmacy you are transferring to is ZBA. Sig field for transfer to: Transfer_4120Z003_ZBA

    • Must be done on the same day product is being transferred.
  • Pharmacy receiving the transferred product:
    • Submit to PharmaNet using O-Med PHN, under the vaccine PIN for product transferred:
      • Quantity = total volume in mL being transferred.
      • Directions for Use = Received_Lot_(from)PEC

      • Example: PEC of pharmacy you are receiving product from is A01. Sig field for transfer from: Received_4120Z003_A01

    • This must be done on the same day product is received.

4. Returning product to BCCDC for redistribution

The following criteria must be met for vaccine(s) to be considered eligible for return to BCCDC vaccine distribution centre:

  • The temperature was maintained between +2°C and +8°C for these products throughout their storage at site.
  • Products were stored in a safe and secure location with no public access.
  • The refrigerator temperature was logged at the start and end of each business day.
  • Only full, unpunctured vials are being returned.

 

  • PharmaNet data entry: Submit to PharmaNet using O’Med PHN, under the vaccine PIN for product returned:
    • Quantity = total volume in mL being returned
    • Directions for use = Return_LOT_BCCDC
      • Note the underscore “_”
      • This must be done on the same day vaccine is returned to BCCDC.

 

Examples:

Sig field

Example

Immunization Dispense

Lot_SITE

4120Z003_LEFT

Received Inventory

Received_Lot

Received_4120Z003

Wastage of Inventory (choose one)

Wastage_CCI: Handling Error_Lot 

(for cold chain incident)

Wastage_CCI: Handling Error_4120Z003

Wastage_Damage to Product_Lot

Wastage_Damage to Product_4120Z003

Wastage_Expired Product_Lot

Wastage_Expired Product_4120Z003

Stock transfer (use PEC of store you are transferring from or to)

Received_Lot_(from)PEC code

Received_4120Z003_A01

Transfer_Lot_(to)PEC code

Transfer_4120Z003_ZBA

Return

Return_Lot_BCCDC

Return_4120Z003_BCCDC

Reimbursement

  • Pharmacies will be reimbursed for vaccinations using the Product Identification Number (PIN) created for the vaccine. 

Reporting Adverse Events Following Immunizations (AEFI)

  • According to BCCDC, an adverse event following immunization (AEFI) is defined as an untoward event temporarily associated with immunization that may or may not have been caused by the vaccine or immunization process.
  • For criteria on reporting AEFIs, and to help healthcare providers interpret AEFIs and their implications for subsequent immunization, see BC Immunization Manual Part 5 – Vaccine Associated Adverse Events.
  • Other AEFI resources:
  • Pharmacist are encouraged to record relevant Adverse Drug Reactions (ADEs) in PharmaNet in addition to the AEFI form.

Reporting of Vaccine Sub-numbered-dose Withdrawal Concerns

Recently, BCCDC Pharmacy has been receiving reports from immunizers not being able to withdraw the minimum-number of labeled doses from COVID-19 vaccine vials despite taking the appropriate preparation and withdrawal diligence.

Effective immediately, if this occurs in your pharmacy, please complete the survey and send directly to Immunize BC Operations Centre (IBCOC), IBCOC_Operations@phsa.ca.  This will allow IBCOC to better assess the issues and trends for possible solutions.

Registering for CareConnect and Provincial Immunization Registry (PIR)

  • To access the Provincial Immunization Registry (PIR), pharmacists need access to CareConnect. It’s anticipated that all pharmacists will need to access the PIR to administer Dose 2.
  • Getting CareConnect access:
  • Complete the following survey form through this link -   Enrol in CareConnect.  Once completed, the CareConnect team send the instructions for the next steps.
    • IMPORTANT NOTE: You may have received information on CareConnect enrolment through the College of Pharmacists of BC email in mid-March.  The above link is the same link shared by the College. 

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