COVID-19 Immunization Guide for B.C. Pharmacies: AstraZeneca

Updated on July 23, 2021 (Originally posted on June 28, 2021)

AstraZeneca Vaccine in Pharmacies

Updated: July 20, 2021 3:00 p.m. PDT

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

Current State

July 5, 2021

Pharmacy can provide 1st dose of AstraZeneca only in exceptional circumstances

The B.C. Ministry of Health has provided updated guidance that pharmacists may administer AstraZeneca vaccine as a 1st dose in two circumstances, since a documented referral is no longer mandatory: 

  1. To individuals with a contraindication to the mRNA vaccines
  2. To individuals who refuse mRNA vaccines but without contraindication, who indicate that they will only be vaccinated against COVID-19 with AstraZeneca vaccine

While standard informed consent is applicable to both circumstances and pharmacists should address misconceptions that individuals may hold, those individuals who fall into category 2 (above) should be advised that:

  • The mRNA COVID-19 vaccines are very safe and effective. There is a strong recommendation for the preferential use of mRNA COVID-19 vaccines in all authorized age groups.
  • As of June 24, 2021, the estimated rate of vaccine induced thrombosis with thrombocytopenia (VITT) in Canada may be as high as 1 in 50,000 - 73,000 1st doses administered; this is reduced to 1 in 600,000 following the 2nd dose. Six Canadians have died because of this event. This event has not been associated with mRNA vaccines.
  • Rarely, capillary leak syndrome has occurred in people who received AstraZeneca vaccine and this vaccine should be avoided in those with a history of capillary leak syndrome. This event has not been associated with mRNA vaccines.
  • The future supply of AstraZeneca in B.C. is uncertain; for those being immunized based on their preference, it may be necessary to complete the 2nd dose using an mRNA vaccine.
  • Appointments for mRNA vaccine are readily available now through a public health mass clinics.

Because it is expected that there will only be a handful of individuals who would be receiving a
first dose of AstraZeneca, the BC Centre for Disease Control has advised that it will not be updating its immunization manual to reflect these exceptions.

June 11 2021 Update

Patients who received vaccines at other pharmacies:

Pharmacies may be approached by patients who received their first dose at another pharmacy. Pharmacies are asked to please prioritize patients who received their first dose at your pharmacy to ensure patients receive an opportunity to receive a second dose at the same location they received their first dose. If there are extra doses, they may be offered to patients who received their first dose at another pharmacy.

Patients who received vaccines at public health clinics and workplaces

There have been reports that some members of the public who received the first-dose AstraZeneca vaccine at public health clinics have approached pharmacies for their second dose. At this time, generally, pharmacies should not provide second doses to these groups of patients, please provide the information below instead.

There are two groups of patients who received AstraZeneca vaccines from public health:

  • Group 1: Patients who got their first dose at their workplace or through their employer before March 30. The local health authority or their employer should be setting up second doses for these individuals.
  • Group 2: Patients who got their first dose at a community, neighbourhood or pop-up clinic in April or May. The provincial government will be providing these patients more information by June 14, 2021.

June 4 2021 update: 

On June 1, 2021, the National Advisory Committee on Immunization (NACI) updated guidance on the interchangeability of COVID-19 vaccines. NACI recommends that people who received AstraZeneca vaccine as a first dose may be offered either AstraZeneca or an mRNA vaccine as a second dose.  In B.C., people who received AstraZeneca or COVISHIELD vaccine for their first dose may be offered the option of receiving either AstraZeneca in the pharmacy or an mRNA vaccine (Pfizer-BioNTech or Moderna) at a public health clinic for their second dose.

  • Vaccines
    • AstraZeneca COVID-19 vaccine/COVISHIELD
  • Priority group:
    • Dose 2 only
      • For individuals who have already received dose 1 AstraZeneca COVID-19 vaccine/COVISHIELD and choose to get dose 2 AstraZeneca COVID-19 vaccine/COVISHIELD. Pharmacies are asked to contact patients who received Dose 1 of AstraZeneca once they are eligible for a Dose 2 appointment.

      • AstraZeneca COVID-19 Vaccine/COVISHIELD is indicated in individuals 18 years of age and older for dose 2. These vaccines are no longer being offered as first dose, unless there is a contraindication to the mRNA vaccines, or as advised by the Medical Health Officer or an allergist.

    • Informed consent should include the risk of Thrombosis with Thrombocytopenia Syndrome (TTS) versus the individual’s risk of serious illness from COVID-19, and when they would be eligible to receive an mRNA vaccine.

  • A resource for the public is available on the BCCDC’s Vaccine registration and eligibility page that can support an individual to make an informed decision based on the information at this time. The page includes a new document (pdf) for patients “2nd dose choice for people who received AstraZeneca/COVISHIELD” which outlines considerations when choosing second dose vaccine.
  • BCCDC has created a Q&A on second doses, intended for health care professionals, to assist them in responding to patient questions.
  • In making an informed decision, individuals should know:
    • mRNA and AstraZeneca vaccines are both available in Canada and there will be sufficient supply of both types of vaccine to provide second doses;
    • There is a risk of TTS associated with the AstraZeneca/COVISHIELD viral vector vaccine but not the mRNA (Pfizer-BioNTech, Moderna) vaccines; and
    • There is a possibility of increased short-term side effects when mixed COVID-19 vaccine schedules are used. These side effects are temporary and resolve without complications.
  • Interval between Dose 1 and Dose 2: The current interval between doses in B.C. is based on vaccine supply and operational recommendations as outlined on the government of B.C. website. As of May 27, 2021, the recommended interval between dose 1 and 2 is 8 weeks for all COVID-19 vaccines requiring a 2-dose series. Therefore, individuals who received AstraZeneca/COVISHIELD for dose 1 can receive either AstraZeneca or an mRNA vaccine on the same interval as those who received an mRNA vaccine for dose 1 (i.e., 8 weeks).
    • There are a few pharmacies that still have lots of AstraZeneca and COVISHIELD COVID-19 vaccines that will expire at the end of June (Lot# NA0079, CTMAV532 and 4120Z029).  As the expiry date approaches, we have received confirmation from the Province that the interval between first and second dose can be shortened to 4 weeks for these lots to minimize wastage as long as patients are made aware that the shorter interval may potentially shorten the duration of immunity provided. The degree of this potential effect is not currently known.  Pharmacies can also transfer doses to others that may be in need. If you have any questions on transferring, please email info@bcpharmacy.ca.
  • BCCDC has created a Healthcare Provider Q&A document which includes general and evolving information about COVID-19 vaccines currently used in B.C. It can be found on the COVID-19 vaccination toolkit for health professionals webpage.

Important Reminders

  • Record immunizations in PharmaNet on the day that they are given.
  • Days supply for second doses should be entered as 1 day.
  • 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

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, 8 to 12 weeks apart.

The two ChAdOx1-S vaccines are interchangeable within the vaccine series. NACI recommends that individuals who received a first dose of the AstraZeneca/COVISHIELD vaccine may receive either AstraZeneca/COVISHIELD vaccine or an mRNA vaccine (Pfizer-BioNTech or Moderna) for their second dose, unless contraindicated.

While the approved minimum interval between dose 1 and 2 is 4 weeks, the preferred interval is 8 to 12 weeks. If administration of the second dose is delayed, the series does not need to be restarted.

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.

COVAX-labelled AstraZeneca COVID-19 Vaccine

The brand name of the vaccine on the COVAX labels (which is a global supply) is COVID-19 Vaccine AstraZeneca. For COVAX-labelled AstraZeneca vaccines, the QR code links to non-Canadian information (WHO label), which is different from the Health Canada Approved Product Monograph. Therefore, the QR code should be disregarded. Healthcare professionals should refer to the Canadian AstraZeneca Product Monograph for information approved by Health Canada. For more information, refer to the Health Product Risk Communication for the COVAX supply.

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

 

Vaccine Storage

Pharmacies are to adhere to the College of Pharmacists of BC’s Professional Practice Policy – 68: Cold Chain Management of Biologicals. Cold chain management principles and procedures are outlined in BC Immunization Manual Appendix E—Management of Biologicals. BCCDC guidelines outline how to deal with refrigerator temperature excursions, equipment malfunctions and power failures.

Storage requirements for AstraZeneca/COVISHIELD vials

  • AstraZeneca vaccine must not be frozen.
  • Unopened vials have a shelf life of 6 months when stored in a refrigerator at 2°C to 8°C.
  • Keep vials in a 2°C to 8°C environment, i.e., refrigerate until ready for immediate use.
  • Vials should be kept upright in their original (SKU) box.
  • Vials should be kept away from direct sunlight to prevent prolonged light exposure.
  • Opened (after first puncture) vials at room temperature must not exceed a use period of 6 hours.
  • Opened vials can be re-refrigerated at 2°C to 8°C for up to 48 hours, but total cumulative storage time once punctured must not exceed 48 hours. Example: if a vial is punctured and kept at room temperature (up to +30°C) for 4 hours it could be returned to the refrigerator for a total of 42 hours and at room temperature for 2.

See BCCDC SOP for COVID-19 AstraZeneca/COVISHIELD Vaccine Shipping, Storage, and Use Guidelines.

Storage requirements for AstraZeneca/COVISHIELD pre-drawn vaccines

In exceptional circumstances, it is acceptable to pre-draw vaccine:

  • The vaccine is stable for up to 6 hours at room temperature after the vial is first punctured. If a dose is pre-drawn from a vial just removed from refrigeration, then vaccine would have to be administered within 6 hours.
  • If the vial has been at room temperature prior to the vaccine being loaded into a syringe, that time must be subtracted from the total 6 hours for the syringe.
  • Pre-drawn syringes should be carefully labelled to ensure that they are not used outside of their window of stability.
  • Pre-drawn syringes unused at the end of a day may not be returned to the refrigerator for use the next day and must be wasted. To avoid wastage, care should be taken to pre-draw a reasonable number of doses.

See BCCDC SOP for COVID-19 AstraZeneca/COVISHIELD Vaccine Redistribution Guidelines

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

On May 29, 2021, Health Canada has approved an extension to the expiry dates of two lots (MT0055* and MT0056*) of the AstraZeneca COVID-19 vaccine by 30 days, from May 31, 2021, to July 1, 2021. The approval to extend the shelf life was supported by scientific evidence.

See table of vaccine product and expiry below.

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 dates for current vaccines in pharmacies:

Product

Lot Number

Expiry

COVISHIELD

4120Z029

27-Jun

AZ (US)

NA0079

30-Jun

AZ (US)

MT0055* & MT0056*

01-Jul

AZ(COVAX)

CTMAV532

30-Jun

AZ(COVAX)

ABX3120

31-Aug

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.
  • Do a thorough inventory of the numbers of expired doses (including partial vials)
  • Record inventory wasted in PharmaNet. See Inventory Management section.
  • Dispose of the vaccines using your regular biomedical waste disposal procedures for 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.

Reporting Cold Chain Incidents

If a temperature excursion occurs while vaccine is in your pharmacy:

  1. Quarantine affected vaccine and label as “Do Not Use”.
  2. Receiving site notifies IBCOC_Operations@phsa.ca as soon as possible. Call 1-250-686-6061, if after hours.
  3. Cold chain consultation process initiated.
    • Report incident to local public health for determination of vaccine use. If after hours/unable to contact local public health and your need for information is urgent, contact the Provincial Health Duty Officer at 1 (250) 686-6061.
    • Cold chain incident form completed. For instructions and form, see the Vaccine Management webpage.

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4. 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:
    • Excursion temperature(s) and duration
    • Lot number, expiry
    • Detailed description of event
    • Number of affected doses
    • Impact on clinic (e.g., closed early, cancelled, clients redirected to alternate side)
  • Recommendations

5. Upon receipt of this report, the Immunize BC Operations Centre will be responsible to report the incident to the National Operations Centre (NOC).

See BCCDC SOP for COVID-19 Vaccine Cold Chain Incident Reporting Process

Scheduling of Appointments

  • Pharmacies are responsible for booking immunization appointments (online and telephone). Consider options for walk-ins.
  • Updated June 4, 2021: For Dose 2 appointments, pharmacies are to contact patients who received Dose 1 at their pharmacy to schedule Dose 2.  Do not book appointments for Dose 1. Currently, AstraZeneca/COVISHIELD vaccines are reserved for Dose 2 only.
  • 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

  • AstraZeneca/COVISHIELD vaccine is indicated in individuals 18 years of age and older for dose 2.
  • These vaccines are no longer being offered as a first dose, unless there is a contraindication to the mRNA vaccines, or as advised by the Medical Health Officer or an allergist.
    • The contraindication and recommendation for AstraZeneca/COVISHIELD first dose should be documented or communicated by the prescriber rather than self-reported by the patient.
    • Individuals who are not contraindicated to the AstraZeneca/COVISHIELD vaccine but have a strong preference for this vaccine may be referred e.g., by public health, to pharmacies to initiate and complete a vaccination series. Pharmacists must obtain and document informed consent and provide the appropriate aftercare for this product.
    Informed consent should include the risk and symptoms of Thrombosis with Thrombocytopenia Syndrome (TTS) versus the individual’s risk of serious illness from COVID-19, as well as the need to seek immediate medical care should symptoms develop.
  • The minimum age for vaccine receipt is based on year of birth (e.g., the vaccine may be offered to individuals who will be turning 18 years of age within the current calendar year), per BC Government recommendations.
  • Pharmacies must review patient identification (ID) and ensure ID matches the patient profile in PharmaNet.
  • Confirm patients have received their first dose.
    • Check PharmaNet to confirm that first dose was provided.
    • 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
  • Review BCCDC’s COVID-19 Vaccine Screening Checklist.
    • COVID-19 vaccines should not be given to an individual if they have a:
      • History of anaphylactic reaction to a previous dose of the vaccine or to any component of the vaccine. These individuals should be offered an mRNA COVID-19 vaccine and observed for a least 30 minutes after immunization.
      • History of thrombosis with thrombocytopenia following a previous dose of an adenovirus vector COVID-19 vaccine. These individuals should be offered an mRNA vaccine.
      • History of capillary leak syndrome.
  • (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. 
  • BCCDC has created a Healthcare Provider Q&A document which includes general and evolving information about COVID-19 vaccines currently used in B.C. It can be found on the COVID-19 vaccination toolkit for health professionals webpage.

Clinically Extremely Vulnerable (CEV) Patient Population

  • Updated: June 21, 2021. Some pharmacies may be geographically selected to  provide dose 2 AstraZeneca/COVISHIELD vaccines to special patient populations including those who are clinically extremely vulnerable. These individuals have received dose 1 by public health.
  • For information and guidance on COVID-19 vaccines for people who are clinically extremely vulnerable, see guidance documents on the COVID-19 vaccination toolkit for health professionals page.

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. See example vaccine record card.
  • 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.

PharmaNet Data Entry and PINs

PharmaNet fan-out messages: COVID-19 reporting

As per PharmaCare Newsletter (May 4, 2021), a number of pharmacies have received PharmaNet fan-out messages because they are reporting COVID-19 vaccines incorrectly. Correct reporting of COVID-19 vaccine administration and inventory received, transferred, wasted, and returned, is critical for tracking by the Public Immunization Registry (PIR) and for delivery of second doses.

For details on fan-outs and how to correct your entries, see PharmaNet Fan-outs for COVID-19 Vaccine Entry Errors.

Review the following section on PharmaNet data entry formats to ensure information is 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). Days supply for second doses should be entered as 1 day.

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, as per COVID-19 Vaccine Post-Arrival Documentation and Administration Protocols, 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: 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. 

  • 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

  • Effective March 31, 2021, a $5.90 supplement will be temporarily added to PharmaCare’s vaccination administration fee for COVID-19 vaccines in pharmacies.
  • PharmaCare’s fee for publicly funded vaccines is $12.10. The supplement applies to COVID-19 immunizations only. With the supplement added to the vaccine administration fee, pharmacies will receive $18.00 for every COVID-19 vaccine they administer

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.
  • The AEFI with COVID-19 Vaccine Case Report Form is an abbreviated version of the standard AEFI case report form and is available in the COVID-19 Vaccination Toolkit for Health Professionals. It is intended for use by community vaccine providers (i.e., non-public health professionals) and the reporting of AEFIs associated with COVID-19 vaccination.
  • 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 sub-dose vials and other non-cold chain incidents and issues

Consultation on vaccine usability is required when the expected number of doses withdrawn from an AstraZeneca vial is less than labeled. For these instances, and other concerns such as sediment, discoloration, etc., contact local public health for a consultation.

If after hours/unable to contact local public health and your need for information is urgent, contact the Provincial Health Duty Officer at 1 (250) 686-6061.

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. 

Resources

For health professionals

For Patients

Resource Centre