Mild to moderate systemic signs and symptoms may occur following COVID-19 vaccination (e.g., fever, fatigue, headache, chills, myalgia, arthralgias, nausea, vomiting). It is important for healthcare facilities (HCF) to be able to distinguish between likely post-vaccine immune reactions and the symptoms of acute COVID-19 infection. The following document is intended to give return-to-work guidance for HCF evaluating symptomatic healthcare personnel (HCP) post vaccination.
For additional information see CDC Post Vaccine Considerations for Healthcare Personnel .
Timing: Preliminary data from the mRNA COVID-19 vaccine trials indicate that most systemic post-vaccination signs and symptoms occur within the first 2 days after vaccination (including the day of vaccination and the following 2 days) and resolve within 1-2 days of onset.
The post-vaccination systemic signs and symptoms are more frequent and severe following the second dose compared with the first and are more common among younger persons compared with those who are older (>55).
Signs and symptoms post COVID-19 vaccination:
Fever, fatigue, headache, chills, myalgia, arthralgia, nausea, diarrhea may occur.
The following symptoms are NOT consistent with vaccination: cough, shortness of breath, rhinorrhea, sore throat, or loss of taste or smell.
For more details on systemic reactions see:
- Pfizer-BioNTech COVID-19 Vaccine: Local Reactions, Systemic Reactions, Adverse Events, and Serious Adverse Events
- Moderna COVID-19 Vaccine: Local Reactions, Systemic Reactions, Adverse Events, and Serious Adverse Events
HCF should develop a plan to evaluate HCP with symptoms of possible COVID-19 illness within 2 days after receiving a COVID-19 vaccine dose. The goal of this medical evaluations is to differentiate likely post-vaccine immune reactions from early COVID-19 disease. Clinicians should consider both the timing and the COVID-19 exposure risk of the symptomatic HCP.
Symptomatic HCP who may continue to work post vaccination
HCP who develop mild to moderate symptoms (e.g., headache, muscle aches, fatigue, joint pain, chills, nausea, diarrhea), without fever (temperature ≤38°C or 100.3°F), may continue to work if they meet all of the following criteria:
- Their symptoms developed within 2 days after receiving a COVID-19 vaccine
- They remain afebrile
- They do not have any non-typical vaccine-associated symptoms of COVID-19 (e.g. cough, shortness of breath, sore throat, rhinorrhea, or change in taste or smell)
- They have not had a high-risk workplace or close contact community exposure within the past 14 days.
- Their symptoms resolve within 2 days of onset
Symptomatic HCP who should be excluded from work
The following symptomatic personnel should be excluded from work and managed as outlined in the Return to Work for Symptomatic HCP section of the LAC DPH Guidance for Monitoring Healthcare Personnel. (For EMS personnel, follow the Return to Work for Symptomatic EMS Personnel section of the LAC DPH Guidance for Monitoring EMS Personnel).
- Who develop fever (temperature ≥38°C or 100.3°F) at any time after COVID-19 vaccination.
- Whose symptoms do not resolve within 2 days from onset (i.e., persist >4 days post vaccination) or whose symptoms develop >2 days after vaccination.
- Who had a high-risk workplace exposure or a close contact community exposure within the past 14 days.
- Whose symptoms include non-typical vaccine related symptoms of COVID-19 (e.g. cough, shortness of breath, sore throat, rhinorrhea or change in taste or smell) or symptoms of another infectious etiology (e.g., influenza).
- Positive viral (molecular or antigen) tests for SARS-CoV-2, if performed, should not be attributed to the COVID-19 vaccine, as vaccination does not influence the results of these tests.
- A negative test from a lower sensitivity assay (e.g., antigen tests and some molecular tests) should be considered presumptive in all symptomatic HCP and confirmation with RT-PCR is recommended.