COVID-19 Vaccines for People Vaccinated Outside the United States

For the best protection, CDC recommends everyone stay up to date with COVID-19 vaccines, including people who received a COVID-19 vaccine outside of the United States. A person is up to date with their COVID-19 vaccination if they have received all recommended doses in the primary series and one booster when eligible.

Specific recommendations for people vaccinated outside of the United States (shown below) depend on whether:

• The vaccine(s) received are accepted in the United States
• The primary series was completed
• A booster dose was received

Accepted COVID-19 Vaccines

If You Didn’t Receive an Accepted Vaccine

CDC recommends that people who received a COVID-19 vaccine that FDA has not authorized or approved, or that WHO does not list for emergency use, start COVID-19 vaccination over with an FDA-authorized or approved COVID-19 vaccine. Before receiving an FDA-authorized or approved COVID-19 vaccine, wait at least 28 days after the last dose of the non-FDA-authorized or approved vaccine.

Please note that there may be limited data available on the safety or effectiveness of COVID-19 vaccination after receiving a non-FDA-authorized or approved COVID-19 vaccine.

If You Received an Accepted Vaccine

For people who received an accepted COVID-19 vaccine outside the United States, the next step is to determine if they completed the primary series or not.

Determining primary series completion

People vaccinated outside of the United States completed the primary series if they:

• Received one dose of a single-dose accepted COVID-19 vaccine
• Received two doses (or any combinationexternal icon*) of a two-dose accepted COVID-19 vaccine

*CDC does not recommend mixing different COVID-19 vaccines for the primary series but is aware that this is increasingly common in many countries outside of the United States. Therefore, for the interpretation of vaccination records, people who received a mixed primary series have completed the primary series.

If you didn’t complete the primary series

People vaccinated outside of the United States who have not completed the primary series as described above do not have to start the primary series over. They should get one primary series dose of an mRNA COVID-19 vaccine (Pfizer-BioNTech or Moderna). If the first dose was an mRNA COVID-19 vaccine, it would be best to get the same vaccine again to complete the primary series. They should also receive a booster when eligible.

If you completed the primary series

People vaccinated outside of the United States who completed the primary series should receive a booster when eligible.

Boosters for People Vaccinated Outside the United States

People who were vaccinated outside the United States—and who completed the primary series as described above and have not yet received a booster—should receive a booster of an mRNA COVID-19 vaccine (Pfizer-BioNTech or Moderna) at least 5 months after their last dose of a COVID-19 vaccine.

For People Who are Moderately or Severely Immunocompromised

People who are moderately or severely immunocompromised and received COVID-19 vaccines not available in the United States should either complete or restart the recommended COVID-19 vaccine series. This includes getting a booster when eligible in the United States. If they received booster dose(s) outside of the country with a vaccine listed for emergency use by WHO, they do not need to either complete or restart their COVID-19 vaccinations.

For more information, talk to your healthcare provider or see the COVID-19 Interim Clinical Considerations.

Proof of Vaccination Card in the United States

The white CDC COVID-19 vaccination cards are only issued to people vaccinated in the United States. CDC recommends that people vaccinated outside of the United States keep their documentation of being vaccinated in another country as proof of vaccination. CDC does not keep vaccination records nor determine how vaccination records are used. People can update their records with vaccines they received while outside of the United States by:

• Contacting the immunization information system (IIS) in their state.
• Contacting their healthcare provider or local or state immunization program through their state’s health department.