Update from the London COVID-19 Vaccine Clinical Reference Group

Update from the London COVID-19 Vaccine Clinical Reference Group

We have six clinical updates for local vaccination teams and GPs this week (11.03.2021): 

  1. COVID-19 vaccine allergy clinics in London
  2. Second doses of COVID-19 vaccines
  3. Reporting COVID-19 vaccination in pregnancy
  4. Safe practice for handling multiple COVID-19 vaccines
  5. Pfizer BioNTech COVID-19 vaccine vials contain 6 doses as standard
  6. Reporting of delayed adverse reactions to COVID-19 vaccines 

COVID-19 vaccine allergy clinics in London 

The British Society for Allergy and Clinical Immunology (BSACI) has advised that individuals who have an allergic reaction to the first dose of a COVID-19 vaccine may be able to receive a second dose of vaccine and page 18 of Chapter 14a of The Green Book contains a helpful flowchart for the management of these individuals. According to the flowchart, the majority of these individuals may receive a second dose in any vaccination site with increased observation time and consideration of antihistamine pre-treatment. 

However, for those individuals who had either an immediate onset systemic allergic reaction (including anaphylaxis) or a delayed onset allergic reaction that required medical attention, advice should be sought from an Allergy Specialist at one of six COVID-19 vaccine allergy clinics that have been established at the following sites: 


Clinic site

Referral mechanism

North West

St Mary’s Hospital, W2 1NY


North Central

University College Hospital, NW1 2BU


North East

Homerton University Hospital, E9 6SR

Queen’s Hospital, RM7 0AG


South East

Guy’s Hospital, SE1 9RT


South West

St Thomas’ Hospital, SE1 7EH


Second doses of COVID-19 vaccines 

Please encourage individuals to attend for their second dose – longer term protection against COVID-19 will be provided by the second dose. 

Every effort should be made to administer the second dose of COVID-19 vaccine at an interval of 12 weeks after the first dose. If an interval longer than 12 weeks is left between doses, the second dose should still be given and the first dose should not be repeated. Please note the 12 week interval does not apply to individuals who have immunosuppression, HIV infection or are planning immunosuppressive therapy - please refer to the Green Book for advice on vaccine intervals in these individuals. 

Sites should determine which vaccine the individual received for their first dose and complete the two dose course with the same vaccine. Where this is not possible it is reasonable to offer one dose of the locally available product to complete the schedule if the individual is at immediate high risk or likely not to attend again. 

Reporting COVID-19 vaccination in pregnancy 

All vaccinations given in pregnancy, whether planned or inadvertent, need to be reported to PHE nationally via their notification form. More information here: https://www.gov.uk/guidance/vaccination-in-pregnancy-vip 

Safe practice for handling multiple COVID-19 vaccines

The Specialist Pharmacy Service have published useful guidance on the safe practice for handling multiple COVID-19 vaccines on the same site: https://www.sps.nhs.uk/articles/safe-practice-for-handling-multiple-covid-19-vaccines/ 

Pfizer BioNTech COVID-19 vaccine vials contain 6 doses as standard 

Some sites report that they are not aware that the Pfizer BioNTech COVID-19 vaccine vials now contain 6 doses as standard. The 3rd February update to the guidance “COVID-19 vaccination: information for healthcare workers” https://www.gov.uk/government/publications/covid-19-vaccination-programme-guidance-for-healthcare-practitioners states the following: 

“Each vial contains 0.45 ml of vaccine and should be diluted with 1.8 ml of Sodium Chloride 0.9% Solution for Injection (also referred to as normal saline). Once diluted, each reconstituted vaccine will supply 6 doses of 0.3 ml.” 

We understand the PGD is being updated and will be published shortly. 

Reporting of delayed adverse reactions to COVID-19 vaccines

If an individual notifies their GP of a delayed adverse reaction following vaccination, i.e. an adverse reaction that has happened after the individual has left the site where they were vaccinated, the individual’s GP should complete a yellow card (https://coronavirus-yellowcard.mhra.gov.uk/) and should report the reaction to RVOC on england.london-covid19voc@nhs.net if any of the following conditions are met:   

  • Any side-effect/reaction that is not already noted in the manufacturer's SPC and that the clinician considers to be possibly linked chronologically to the vaccination;
  • A known side-effect/reaction noted on the SPC but that the clinician considers to be an extreme form of this known side-effect, e.g. fever that lasts more than expected number of days, and for which there is no other cause, an urticarial reaction that affects a much larger area than just at the injection site etc;
  • An acute clinical event or hospitalisation linked in time to the vaccination for which the clinician does not consider there to be any other clinical cause. 

The delayed adverse reaction does not need to be reported to the vaccine site where the patient was vaccinated. 

Kind Regards 

London Immunisation Team

NHS England and NHS Improvement - London Region