COVID-19 Vaccine Provider Frequently Asked Questions

Find updated guidance on allergic reactions associated with COVID-19 vaccines (CDC). Please visit the CDC Clinical Considerations webpage for all the latest updates.

The below CDC links include Emergency Use Authorization (EUA), standing orders templates, prevaccination screening forms, and storage and handling instructions.

• Pfizer
• Moderna
• Janssen

Download COVID-19 vaccine recipient fact sheets (CDC).

The below CDC links include information about common side effects and adverse reactions:

• Possible Side Effects After Getting a COVID-19 Vaccine (CDC)
• Selected Adverse Events Reported after COVID-19 Vaccination (CDC)

COVID-19 mRNA vaccines give instructions for our cells to make a harmless piece of what is called the “spike protein.” The spike protein is found on the surface of the virus that causes COVID-19. COVID-19 mRNA vaccines are given in the upper arm muscle. Once the instructions (mRNA) are inside the immune cells, the cells use them to make the protein piece. After the protein piece is made, the cell breaks down the instructions and gets rid of them.

Next, the cell displays the protein piece on its surface. Our immune systems recognize that the protein doesn’t belong there and begin building an immune response and making antibodies, like what happens in natural infection against COVID-19.

At the end of the process, our bodies have learned how to protect against future infection. The benefit of mRNA vaccines, like all vaccines, is those vaccinated gain this protection without ever having to risk the serious consequences of getting sick with COVID-19.

Providers must complete their registration in the registration portal, EnrollTexasIZ.dshs.texas.gov, prior to COVID-19 vaccine allocation. The following steps must also be finalized:

1. Complete Module 10 of the CDC’s “You Call the Shots” Training. (Highly recommended)
2. Evaluate patient population. Identify critical population groups of people that are served by your practice.
3. Complete the COVID-19 Provider Agreement form.
4. Agree to maintain vaccine safety and inventory.
5. Agree to report COVID-19 doses administered in the required time frame.

You will first need to register your organization by visiting EnrollTexasIZ.dshs.texas.gov. A registration must be completed for each location where COVID-19 vaccine will be administered. Once the registration has been completed, you will have the option to “pre-book” or request to receive the COVID-19 vaccine.

For questions or more information on the COVID-19 Vaccine Program, email COVID19VacEnroll@dshs.texas.gov or visit the DSHS COVID-19 Vaccine website.

Do existing COVID-19 vaccine providers need to re-enroll or join the Texas Vaccines for Children Program (TVFC) to give the COVID-19 vaccine to children or adolescents?

Do existing TVFC providers need to register for the COVID program?

During the registration process, you will be asked to submit information about your organization such as:

• Address
• Vaccine coordinator contact information
• Vaccine delivery times
• Vaccine storage capacity for each unit at the facility
• The patient profile of the population served
• Administering and reporting information
• List of responsible personnel such as the Chief Medical Officer or Chief Executive Officer
• Sign and agree to the conditions in the CDC COVID-19 Vaccination Program Provider Agreement

Patient population information will remain unpublished and private. Identifying patient population is used to understand the communities you serve and to help allocate the COVID-19 vaccine.

A licensed signing clinician will be required to enroll in the COVID-19 Vaccine Program. Licensed signing clinicians include Medical Doctors (MD), Doctors of Osteopathic Medicine (DO), Nurse Practitioners (NP)/Advanced Practice Nurses (APN), Physician Assistants (PA), Certified Nurse Midwives (CNM), Registered Pharmacists (RPh), Optometrist (OP), Podiatrist (DPM), and Veterinarian (DVM). Any medical professional is eligible to administer the COVID-19 vaccine, including but not limited to licensed nurses, medical assistants, emergency medical services (including paramedic or EMT), or staff members granted authority to vaccinate by a signing clinician.

For additional guidance for PREP Act coverage for qualified technicians and pharmacy interns for COVID-19 vaccines, visit the FDA Emergency Use Authorization page. 

Yes. At this time, additional medical professionals (e.g. RNs, LVNs, EMTs, Certified Medical Assistant) can administer the COVID-19 vaccine can administer the COVID-19 vaccine as authorized by the signing clinician for the vaccine provider.

No. Any facility who has the personnel to immunize and the capacity to safely store and handle the COVID-19 vaccine is eligible to participate in the COVID-19 Vaccine Program; does not have to be enrolled in any additional vaccine program.

Yes. All facilities must enroll in ImmTrac2 to become eligible to participate in the COVID-19 Vaccine Program. Enrollment in ImmTrac2 is included in the COVID-19 Vaccine Program Provider Agreement, which can be found at EnrollTexasIZ.dshs.texas.gov.

Providers already registered in ImmTrac2 will not need to re-register. However, they will need to provide their ImmTrac2 Organization Code and continue to complete the required fields in order to ensure that DSHS has the most current information for the facility.

All providers who are participating in the COVID-19 Vaccine Program are highly encouraged to complete Module 10 of the CDC' s “You Call the Shots” Training. 

Enrollment for the COVID-19 Vaccine Program is now open for providers and can be accessed through EnrollTexasIZ.dshs.texas.gov. There is no close date at this point. Providers are welcome to enroll whenever they feel they are ready to participate in the COVID-19 Vaccine Program.

In order to sign back in and edit the enrollment information, use the following format for the username:

• firstname.lastname

If you do not have a password, enter the username and click “Forgot Password.” The password reset information will be sent to the registered email address.

Once forms are sent off for signatures, the enrollment becomes locked until the review process is complete. Once this review process is completed, the DSHS Immunization Unit can unlock this enrollment if needed.

Fire and EMS departments can enroll in the Texas Immunization Registry, ImmTrac2, as long as:

1. There is a signing clinician/medical authority who is directly associated with the first responder organization.
2. The department meets the requirements to safely store and handle vaccines.

Long Term Care (LTC) facilities can enroll and become a provider with the Texas Department of State Health Services (DSHS): LTC facilities are welcome to enroll as a COVID-19 provider with DSHS. Once a LTC facility is enrolled, DSHS will be able to direct ship COVID-19 vaccine to the LTC facility to be stored and used at that individual site. 

Under the COVID-19 public health emergency, providers not enrolled in Texas Medicaid may use the expedited enrollment application which waives certain state and federal requirements. The process is applicable to medical providers/groups/facilities and pharmacies and allows these providers to be reimbursed for services to Texas Medicaid clients.

Medical providers/groups/facilities may access the application and information on submission link to: https://www.tmhp.com/news/2020-04-01-public-health-emergency-enrollment-application-now-available. 

After signature requests have been sent to the listed email addresses, there will be an option to preview the CDC COVID-19 Provider Agreement and print from your own computer. Email requests for signatures will also include a link to preview the agreement before electronically signing.

CDC will fulfill orders for most vaccine products and associated ancillary supplies. Some vaccine products, such as those with ultra-cold temperature requirements, will be shipped directly from the manufacturer to the vaccination provider site. Because of cold chain requirements, ancillary supply kits (and diluent, if applicable) will ship separately from the vaccine but should arrive before or on the same day as the vaccine. 

The Federal Government will be providing the COVID-19 vaccine through the state.

Texas considers all recommendations made by ACIP but has also gathered a group of Texas experts on vaccine and infectious diseases to provide additional recommendations to the DSHS Commissioner.  DSHS is taking a medical-risk based approach to identify which section of the population is at the highest risk of not only contracting COVID-19 but having a bad outcome if they do become infected.

This applies to Medicaid, Children with Special Health Care Needs (CSHCN) Service program, and Transportation for Indigent Cancer Patients (TICP) eligible clients:

• Yes. HHSC issued a notice with instructions to medical transportation organizations (MTOs) and managed care organizations. The MTOs must provide transportation to and from sites administering Medicaid covered services, including vaccinations. Although some of the sites may not be locations listed in the Combined Master Provider File (CMPF), the MTOs must verify the location with the administering provider to validate the site location before approving the transportation request. All other service and eligibility requirements remain applicable.

Please contact us at COVID19VacShipments@dshs.texas.gov, and we will investigate for shipping information and shipping status. Please include your organization’s name, organization code (found on the VAOS account details page) and allocation request number.

There is currently no timeline between the completion of an enrollment and receiving the COVID-19 vaccine until it becomes available. 

COVID-19 vaccine products are temperature-sensitive and must be stored and handled correctly to ensure efficacy and maximize shelf life. For information on proper vaccine storage and handling, visit the CDC Vaccine Storage and Handling Toolkit. 

For more information, review the COVID-19 Vaccine Product Information Guide. 

For more information on shipping and storage, visit the specific vaccine's website.

• Pfizer
• Moderna
• Janssen

COVID-19 Vaccine Program providers are responsible for providing the required vaccine storage units as listed in the CDC Vaccine Storage and Handling Toolkit.

Facilities are required to have a digital data logger (DDL) to continuously monitor the temperature of the vaccine. Listed below are recommendations that should be considered before purchasing one:

• An active temperature display that can be easily read by all staff from the outside of the unit, without having to open the door.
• The data logger must have functionality that does not require a computer password to access the temperature display.
• The display must remain active for temperature readings (i.e., must not have sleep mode turned on).
• Alarm for out-of-range temperatures.
• A display that shows the current temperature, as well as minimum and maximum temperatures.
• Low battery indicator.
• Accuracy of +/-1°F (+/-0.5°C).
• Detachable probe in buffered material.
• Memory storage of at least 4,000 readings (device must not rewrite over old data and must stop recording when the memory is full).
• User-programmable logging interval (or reading rate) at a maximum time interval of every 30 minutes.

At this time, it is the choice of the COVID-19 Vaccine Program providers to purchase an ultra-cold storage unit if needed. The Texas Department of State Health Services does not recommend that providers purchase a separate ultra-cold storage unit at this time until further guidance is provided by CDC.

Emergency transport procedures can be found in the CDC Vaccine Storage and Handling Toolkit on pages 21 through 26. For information on proper vaccine storage and handling, visit the CDC Vaccine Storage and Handling Toolkit. 

Providers may update their shipping information in the registration portal, EnrollTexasIZ.dshs.texas.gov. However, once signature requests have been emailed, the enrollment will automatically lock and remain locked until the review process is complete. Providers must update their shipping information BEFORE accepting a COVID-19 vaccine allocation to prevent issues with delivery.

Providers may update their contact information on the registration portal, EnrollTexasIZ.dshs.texas.gov. As a reminder, providers must have a primary and back-up vaccine coordinator to receive COVID-19 vaccines.

Providers should call the manufacturer listed on the box for viability determination. If the dose is deemed non-viable, then the doses should be reported as wasted.

COVID-19 vaccines and ancillary supplies will be distributed by the federal government at no cost to enrolled COVID-19 vaccination providers.

Yes. COVID-19 vaccines and other vaccines may now be administered without regard to timing. For more guidance, find CDC COVID-19 vaccine interim clinical considerations.

For more information on vaccine presentation, visit the specific vaccine's website.

• Pfizer
• Moderna
• Janssen

There are multiple presentations of the COVID-19 vaccine which include both one-dose and two-dose series. Each COVID-19 vaccine presentation has its own timeframe between the first and second dose, if applicable. For more information about each COVID-19 vaccine presentation and the interval between doses, visit this link.  

Currently, single-dose vials are not an option. For more information about each COVID-19 vaccine presentation, contact the appropriate manufacturer.

There are multiple presentations of the COVID-19 vaccine which may or may not need to be reconstituted. For more information about each COVID19 vaccine presentation, contact the appropriate manufacturer.

No. Do not pool excess vaccine from multiple vials. If the amount of vaccine remaining in a vial cannot provide a full dose, discard the vial and content. Pooling excess vaccine from multiple vials is considered an administration error and should be reported as such via the Vaccine Adverse Event Reporting System (VAERS). See VAERS section.

Do NOT use or save the remaining vaccine diluent to mix additional vaccine or for other uses. Because the Pfizer-BioNTech COVID-19 vaccine does not contain preservative, it is critical that any further remaining product that does not constitute a full dose should not be pooled from multiple vials to create one dose. After dilution, vials of Pfizer-BioNTech COVID-19 Vaccine contain six doses of 0.3mL of vaccine. Low dead-volume syringes and/or needles can be used to extract six doses from a single vial. If standard syringes and needles are used, there may not be sufficient volume to extract a sixth dose from a single vial. Irrespective of the type of syringe and needle: 

• Each dose must contain 0.3 mL of vaccine.
• If the amount of vaccine remaining in the vial cannot provide a full dose of 0.3 mL, discard the vial and content.
• Do not pool excess vaccine from multiple vials.

Discard vial when there is not enough vaccine to obtain a complete dose. Do NOT combine residual vaccine from multiple vials to obtain a dose. Do not pool excess vaccine from multiple vials to create one dose. CDC recommends healthcare providers follow the dosing guidance from the manufacturer and outlined in the EUAs. CDC will update its guidance if the EUAs and ancillary supply kits support additional doses per vial in the future.

Visit this link to review contraindications and precautions of each vaccine.  

For clinical questions, dial 2-1-1 and choose Option 6.

No. Second dose allocations will no longer be automatically scheduled for shipment to you based on your received first dose allocations. Click here to review the ordering process.  

Providers much place an order for second doses. Click here to review the ordering process. 

Yes, providers should be able to access a patient’s information, including where and when they received vaccinations, in ImmTrac.

Yes. Parental consent is required, but parents don’t need to be present. Texas Family Code Section 32.102 only requires written informed consent when the person authorized to consent for the child’s immunization is not present. Therefore, conversely, oral consent is acceptable if the person authorized to consent is present. This also confirms that a parent is not required to be present when their child is vaccinated if they provided written consent. Written consent can be given either on paper or electronically.

No. There is no additional documentation needed other than informed parental consent. 

An individual may apply for Medicaid through YourTexasBenefits.com and 2-1-1, Option 2. Individuals may be eligible for Medicaid coverage during the three-month period before the month they apply for medical programs. Individuals determined eligible for Medicaid may submit unpaid bills for claims three months prior to the eligibility determination. For uninsured patients, vaccination providers can get this fee reimbursed through the Health Resources and Services Administration’s Provider Relief Fund.  

Registered vaccination providers will be able to charge an administration fee for giving the shot to someone. At this time, CMS has determined the Medicare rate for both one dose and two dose COVID-19 vaccinations. Please find that information here: https://www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment. While DSHS does not determine the fee, we will update this FAQ as additional billing information becomes available.

Once determined, the administration fee can be billed to the patient’s insurance. For uninsured patients, vaccination providers can get this fee reimbursed through the Health Resources and Services Administration’s Provider Relief Fund.

For information on reimbursement updates, TMHP issues banner notifications with the rates and effective dates. The reimbursement rates are also found on our fee schedule site, either the online fee lookup (which is always up to date) or the static fee schedule (which updates periodically).  Please contact HHSC directly if you require additional information on Medicaid reimbursement at RADAcuteCare@hhsc.state.tx.us.

Texas Health and Safety Code Sec. 161.00705 states that any Antiviral, Immunization, or Medication administrations in response to a declared disaster or emergency must be entered into the Texas Immunization Registry (ImmTrac2). 

• ImmTrac2 disaster reporting training video

All COVID-19 vaccine administration data must be reported to the Texas Immunization Registry (ImmTrac2). Requests for ImmTrac2 access can be emailed to ImmTrac2@dshs.texas.gov.

• ImmTrac2 disaster reporting training video

The CDC and DSHS require that organizations enrolled in the COVID-19 Vaccination Program report data elements for each dose administered within 24 hours of administration to the Texas Immunization Registry, ImmTac2.
Additional Requirements for COVID-19 Vaccine Administration:
Organizations must:

• Administer COVID-19 Vaccine in accordance with all requirements and recommendations of CDC and CDC’s Advisory Committee on Immunization Practices (ACIP).
• Administer COVID-19 Vaccine regardless of the vaccine recipient’s ability to pay COVID-19 Vaccine administration fees.
• Report the number of doses of COVID-19 Vaccine and adjuvants that were unused, spoiled, expired, or wasted as required by DSHS
• Preserve the record for at least 3 years as required by DSHS. Such records must be made available to any federal, state, local, or territorial public health department to the extent authorized by law
• Not sell or seek reimbursement for COVID-19 vaccine and any adjuvant, syringes, needles, or other constituent products and ancillary supplies that the federal government provides without cost to the Organization
• Organization must comply with all federal instructions and timelines for disposing COVID-19 vaccine and adjuvant, including unused doses
• Organization’s COVID-19 vaccination services must be conducted in compliance with CDC’s Guidance for Immunization Services During the COVID-19 Pandemic for safe delivery of vaccines.

CDC requires that vaccination providers enrolled in the COVID-19 Vaccination Program report each dose administered within 24 hours of administration to the Texas Immunization Registry (ImmTrac2).

No. COVID-19 vaccine administration data can be entered online in the ImmTrac2 application.

No. Providers enrolled in the COVID-19 Vaccination Program are required to report these data elements to the Texas Immunization Registry (ImmTrac2).

No. User access for ImmTrac2 is all age inclusive since it is a lifetime registry.

Possibly. You should check with your EHR vendor to ensure that COVID administrations will be reported in your existing submissions to the registry. Do not take it for granted that they will automatically be included. For more information, email ImmTracMU@dshs.texas.gov.

The Vaccine Adverse Event Reporting System (VAERS) is a national vaccine safety surveillance program co-sponsored by the Food and Drug Administration (FDA) and the CDC. The purpose of VAERS is to detect possible signals of adverse events associated with vaccines. VAERS collects and analyzes information from reports of adverse events that occur after the administration of U.S. licensed vaccines.

Reports of adverse events are welcome from all concerned individuals, including the following:

• Patients
• Parents
• Health care professionals
• Pharmacist
• Vaccine manufacturers

Requirement: Organizations must report moderate and severe adverse events following vaccination to the Vaccine Adverse Event Reporting System (VAERS). Additional reporting mechanisms and requirements may be implemented by the CDC. DSHS will update this information as it becomes available.

V-safe is a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after someone receives a COVID‑19 vaccination. Through v-safe, vaccine recipients can quickly tell CDC if they have any side effects after getting the COVID‑19 vaccine. Depending on their responses, CDC may follow up with them by phone to get more information. V-safe will also remind them to get their second COVID‑19 vaccine dose, if needed.

At the time of vaccination, providers should give patients a v-safe information sheet and encourage them to enroll and fill out the surveys when prompted.

More information about V-safe is available from the CDC. It is also available in Spanish (CDC).