Nejmoa2027906 Protocol PDF

Protocol
This trial protocol has been provided by the authors to give readers additional information about their work.
Protocol for: Walsh EE, Frenck RW Jr, Falsey AR, et al. Safety and immunogenicity of two RNA-based Covid-19
vaccine candidates. N Engl J Med. DOI: 10.1056/NEJMoa2027906
Safety and Immunogenicity of Two RNA-Based COVID-19 Vaccine Candidates
This supplement contains the following items:
1. Original protocol…………………………………………………………….page 2
2. Final protocol v.6 (redacted) which is the original protocol and all cumulative
amendments………………………………………………………………..page 128
3. Summary of protocol amendments………………………………………….page 265
3. Original approved Statistical Analysis Plan (only one version exists).……..page 271
PF-07302048 (BNT162 RNA-Based COVID-19 Vaccines)
Protocol C4591001
Final Protocol, 15 April 2020
A PHASE 1/2, PLACEBO-CONTROLLED, RANDOMIZED, OBSERVER-BLIND,

DOSE-FINDING STUDY TO DESCRIBE THE SAFETY, TOLERABILITY,
IMMUNOGENICITY, AND POTENTIAL EFFICACY OF SARS-COV-2 RNA
VACCINE CANDIDATES AGAINST COVID-19 IN HEALTHY ADULTS
Study Intervention Number: PF-07302048

Study Intervention Name: RNA-Based COVID-19 Vaccines
US IND Number: 19736
090177e193424de3\Approved\Approved On: 17-Apr-2020 12:10 (GMT)
EudraCT Number: N/A

Protocol Number: C4591001
Phase: 1/2
Short Title: A Phase 1/2 Study to Describe the Safety, Tolerability, Immunogenicity, and
Potential Efficacy of RNA Vaccine Candidates Against COVID-19 in Healthy Adults
This document and accompanying materials contain confidential information belonging to Pfizer. Except as
otherwise agreed to in writing, by accepting or reviewing these documents, you agree to hold this information in
confidence and not copy or disclose it to others (except where required by applicable law) or use it for
unauthorized purposes. In the event of any actual or suspected breach of this obligation, Pfizer must be
promptly notified.
PFIZER CONFIDENTIAL
CT02-GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
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Protocol C4591001
Protocol Amendment Summary of Changes Table
Document History
Document Version Date Summary and Rationale for Changes
Original protocol 15 April 2020 N/A

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TABLE OF CONTENTS
LIST OF TABLES.....................................................................................................................8
1. PROTOCOL SUMMARY...................................................................................................10
1.1. Synopsis ..................................................................................................................10
1.2. Schema ....................................................................................................................15
1.3. Schedule of Activities .............................................................................................16
1.3.1. Stage 1 Sentinel Cohorts.............................................................................16
1.3.2. Stage 1 Nonsentinel Cohorts and Stage 2 Cohorts .....................................20
1.3.3. Stage 3 Cohort(s) ........................................................................................22
2. INTRODUCTION ...............................................................................................................24
2.1. Study Rationale .......................................................................................................24
2.2. Background .............................................................................................................24
2.2.1. Clinical Overview.......................................................................................25
2.3. Benefit/Risk Assessment.........................................................................................25
2.3.1. Risk Assessment .........................................................................................27

2.3.2. Benefit Assessment.....................................................................................28
2.3.3. Overall Benefit/Risk Conclusion................................................................28
3. OBJECTIVES, ESTIMANDS, AND ENDPOINTS ...........................................................28
4. STUDY DESIGN.................................................................................................................30
4.1. Overall Design.........................................................................................................30
4.1.1. Stage 1 ........................................................................................................30
4.1.2. Stage 2 ........................................................................................................31
4.1.3. Stage 3 ........................................................................................................32
4.2. Scientific Rationale for Study Design .....................................................................32
4.3. Justification for Dose ..............................................................................................32
4.4. End of Study Definition ..........................................................................................33
5. STUDY POPULATION ......................................................................................................33
5.1. Inclusion Criteria.....................................................................................................33
5.2. Exclusion Criteria....................................................................................................34
5.3. Lifestyle Considerations..........................................................................................36
5.3.1. Contraception..............................................................................................36
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5.4. Screen Failures ........................................................................................................36

5.5. Criteria for Temporarily Delaying Enrollment/Randomization/Study
Intervention Administration ......................................................................................37
6. STUDY INTERVENTION..................................................................................................37
6.1. Study Intervention(s) Administered ........................................................................41
6.1.1. Administration ............................................................................................41
6.2. Preparation/Handling/Storage/Accountability ........................................................42
6.2.1. Preparation and Dispensing ........................................................................43
6.3. Measures to Minimize Bias: Randomization and Blinding.....................................43
6.3.1. Allocation to Study Intervention ................................................................43
6.3.2. Blinding of Site Personnel ..........................................................................43
6.3.3. Blinding of the Sponsor ..............................................................................44
6.3.4. Breaking the Blind......................................................................................44
6.4. Study Intervention Compliance...............................................................................44
6.5. Concomitant Therapy..............................................................................................44

6.5.1. Prohibited During the Study .......................................................................45
6.5.2. Permitted During the Study ........................................................................45
6.6. Dose Modification...................................................................................................46
6.7. Intervention After the End of the Study ..................................................................46
7. DISCONTINUATION OF STUDY INTERVENTION AND PARTICIPANT
DISCONTINUATION/WITHDRAWAL...........................................................................46
7.1. Discontinuation of Study Intervention ....................................................................46
7.2. Participant Discontinuation/Withdrawal From the Study .......................................46
7.2.1. Withdrawal of Consent ...............................................................................47
7.3. Lost to Follow-up ....................................................................................................47
8. STUDY ASSESSMENTS AND PROCEDURES...............................................................48
8.1. Efficacy and/or Immunogenicity Assessments .......................................................49
8.1.1. Biological Samples .....................................................................................50
8.2. Safety Assessments .................................................................................................50
8.2.1. Clinical Safety Laboratory Assessments (Sentinel-Cohort
Participants Only) ............................................................................................50
8.2.2. Electronic Diary..........................................................................................51
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8.2.2.1. Grading Scales...........................................................................52

8.2.2.2. Local Reactions .........................................................................52
8.2.2.3. Systemic Events ........................................................................53
8.2.2.4. Fever..........................................................................................53
8.2.2.5. Antipyretic Medication .............................................................54
8.2.3. Stopping Rules............................................................................................54
8.2.3.1. Randomization and Vaccination After a Stopping Rule Is
Met.....................................................................................................55
8.2.4. Surveillance of Events That Could Represent Enhanced COVID-19
Disease .............................................................................................................56
8.2.5. Pregnancy Testing ......................................................................................56
8.3. Adverse Events and Serious Adverse Events..........................................................56
8.3.1. Time Period and Frequency for Collecting AE and SAE Information.......57
8.3.1.1. Reporting SAEs to Pfizer Safety...............................................57
8.3.1.2. Recording Nonserious AEs and SAEs on the CRF...................57
8.3.2. Method of Detecting AEs and SAEs ..........................................................58

8.3.3. Follow-up of AEs and SAEs.......................................................................58
8.3.4. Regulatory Reporting Requirements for SAEs...........................................58
8.3.5. Exposure During Pregnancy or Breastfeeding, and Occupational
Exposure ..........................................................................................................59
8.3.5.1. Exposure During Pregnancy......................................................59
8.3.5.2. Exposure During Breastfeeding ................................................60
8.3.5.3. Occupational Exposure .............................................................61
8.3.6. Medication Errors .......................................................................................61
8.4. Treatment of Overdose............................................................................................62
8.5. Pharmacokinetics ....................................................................................................62
8.6. Pharmacodynamics..................................................................................................63
8.7. Genetics ...................................................................................................................63
8.8. Biomarkers ..............................................................................................................63
8.9. Immunogenicity Assessments .................................................................................63
8.10. Health Economics .................................................................................................63
8.11. Study Procedures...................................................................................................63
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8.11.1. Stage 1 Sentinel Cohorts...........................................................................63

8.11.1.1. Screening: (0 to 14 Days Before Visit 1) ................................63
8.11.1.2. Visit 1 – Vaccination 1: (Day 1) .............................................64
8.11.1.3. Visit 2 – Next-Day Follow-up Visit (Vaccination 1): (1
to 3 Days After Visit 1) .....................................................................66
8.11.1.4. Visit 3 – 1-Week Follow-up Visit (Vaccination 1): (6 to
8 Days After Visit 1) .........................................................................67
8.11.1.5. Visit 4 – Vaccination 2: (19 to 23 Days After Visit 1) ...........69
8 Days After Visit 4) .........................................................................71
16 Days After Visit 4) .......................................................................72
8.11.1.8. Visit 7 – 1-Month Follow-up Visit: (28 to 35 Days After
Visit 4) ...............................................................................................73
8.11.1.9. Visit 8 – 6-Month Follow-up Visit: (154 to 168 Days
After Visit 4)......................................................................................73

After Visit 4)......................................................................................74
After Visit 4)......................................................................................74
8.11.2. Stage 1 Nonsentinel Cohorts and Stage 2 Cohorts ...................................75
8.11.2.2. Visit 2 – Vaccination 2: (19 to 23 Days or 56 to 70 Days
After Visit 1)......................................................................................77
8.11.2.3. Visit 3 – 2-Week Follow-up Visit: (12 to 16 Days After
Visit 2) ...............................................................................................79
Visit 2) ...............................................................................................79
After Visit 2)......................................................................................80
After Visit 2)......................................................................................80
After Visit 2)......................................................................................81
8.11.3. Stage 3 Cohort(s) ......................................................................................81
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8.11.3.2. Visit 2 – Vaccination 2: (19 to 23 Days or 56 to 70 Days

After Visit 1)......................................................................................83
8.11.3.3. Visit 3 – 1-Month Follow-up Visit (After Vaccination 2):
(28 to 35 Days After Visit 2).............................................................85
8.11.3.4. Visit 4 – 6-Month Safety Telephone Contact: (154 to
168 Days After Visit 2) .....................................................................86
After Visit 2)......................................................................................86
After Visit 2)......................................................................................86
8.12. Unscheduled Visit for a Grade 3 or Suspected Grade 4 Reaction ........................87
8.13. COVID-19 Disease Surveillance (All Participants)..............................................88
8.13.1. Potential COVID-19 Illness Telehealth Visit: (Optimally Within 3
Days After Potential COVID-19 Illness Onset)...............................................88
8.13.2. Potential COVID-19 Convalescent Visit: (28 to 35 Days After
Potential COVID-19 Illness Visit)..................................................................90
9. STATISTICAL CONSIDERATIONS ................................................................................90

9.1. Estimands and Statistical Hypotheses .....................................................................90
9.1.1. Estimands....................................................................................................90
9.1.2. Statistical Hypotheses.................................................................................91
9.2. Sample Size Determination.....................................................................................91
9.3. Analysis Sets ...........................................................................................................92
9.4. Statistical Analyses .................................................................................................93
9.4.1. Immunogenicity Analyses ..........................................................................93
9.4.2. Efficacy Analyses .......................................................................................96
9.4.3. Safety Analyses ..........................................................................................97
9.4.4. Other Analyses............................................................................................98
9.5. Interim Analyses .....................................................................................................99
9.5.1. Analysis Timing..........................................................................................99
9.6. Data Monitoring Committee or Other Independent Oversight Committee.............99
10. SUPPORTING DOCUMENTATION AND OPERATIONAL
CONSIDERATIONS ........................................................................................................101
10.1. Appendix 1: Regulatory, Ethical, and Study Oversight Considerations .............101
10.1.1. Regulatory and Ethical Considerations ..................................................101
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10.1.1.1. Reporting of Safety Issues and Serious Breaches of the

Protocol or ICH GCP.......................................................................101
10.1.2. Informed Consent Process ......................................................................102
10.1.3. Data Protection .......................................................................................103
10.1.4. Dissemination of Clinical Study Data ....................................................103
10.1.5. Data Quality Assurance ..........................................................................104
10.1.6. Source Documents ..................................................................................106
10.1.7. Study and Site Start and Closure ............................................................106
10.1.8. Sponsor’s Qualified Medical Personnel .................................................107
10.2. Appendix 2: Clinical Laboratory Tests ...............................................................108
10.3. Appendix 3: Adverse Events: Definitions and Procedures for Recording,
Evaluating, Follow-up, and Reporting ....................................................................110
10.3.1. Definition of AE .....................................................................................110
10.3.2. Definition of SAE ...................................................................................111
10.3.3. Recording/Reporting and Follow-up of AEs and/or SAEs.....................113
10.3.4. Reporting of SAEs..................................................................................116

10.4. Appendix 4: Contraceptive Guidance .................................................................117
10.4.1. Male Participant Reproductive Inclusion Criteria ..................................117
10.4.2. Female Participant Reproductive Inclusion Criteria...............................117
10.4.3. Woman of Childbearing Potential ..........................................................117
10.4.4. Contraception Methods...........................................................................118
10.5. Appendix 5: Liver Safety: Suggested Actions and Follow-up Assessments ......120
10.6. Appendix 6: Abbreviations .................................................................................122
11. REFERENCES ................................................................................................................125
LIST OF TABLES
Table 1. Potential Groups in Stage 1 ......................................................................38
Table 2. Local Reaction Grading Scale ..................................................................52
Table 3. Systemic Event Grading Scale..................................................................53
Table 4. Scale for Fever..........................................................................................54
Table 5. Probability of Observing at Least 1 AE by Assumed True Event
Rates With Different Sample Sizes ..........................................................92
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Table 6. Laboratory Abnormality Grading Scale .................................................108

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1. PROTOCOL SUMMARY
1.1. Synopsis
Short Title: A Phase 1/2 Study to Describe the Safety, Tolerability, Immunogenicity, and
Potential Efficacy of RNA Vaccine Candidates Against COVID-19 in Healthy Adults
Rationale
A pneumonia of unknown cause detected in Wuhan, China, was first reported in

December 2019. On 08 January 2020, the pathogen causing this outbreak was identified as a
novel coronavirus 2019. The outbreak was declared a Public Health Emergency of
International Concern on 30 January 2020. On 12 February 2020, the virus was officially
named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the WHO
officially named the disease caused by SARS-CoV-2 as coronavirus disease 2019
(COVID-19). On 11 March 2020, the WHO upgraded the status of the COVID-19 outbreak
from epidemic to pandemic, which is now spreading globally at high speed.
There are currently no vaccines to prevent infection with SARS-CoV-2 or antiviral drugs to
treat COVID-19. Given the rapid transmission of COVID-19 and incidence of disease in the
United States and elsewhere, the rapid development of an effective vaccine is of utmost
importance.
BioNTech has developed RNA-based vaccine candidates using a platform approach that
enables the rapid development of vaccines against emerging viral diseases, including
SARS-CoV-2. Each vaccine candidate is based on 1 of 3 RNA platforms: unmodified
messenger RNA (uRNA), nucleoside-modified messenger RNA (modRNA), or self-
amplifying messenger RNA (saRNA). Each vaccine candidate expresses 1 of 2 antigens: the
SARS-CoV-2 full-length, P2 mutant, “heads up,” prefusion spike glycoprotein (P2 S)
(version 9) or a trimerized SARS-CoV-2 spike glycoprotein receptor-binding domain (RBD)
(version 5). The 4 SARS-CoV-2 vaccine candidates that will be tested in this study are
therefore:
BNT162a1 (variant RBL063.3): a uRNA encoding the RBD;
BNT162b1 (variant RBP020.3): a modRNA encoding the RBD;
BNT162b2 (variant RBP020.2): a modRNA encoding P2 S;
BNT162c2 (variant RBP020.3): an saRNA encoding the RBD.
All candidates are formulated in the same lipid nanoparticle (LNP) composition. This study
is intended to investigate the safety, immunogenicity, and potential efficacy of these
4 prophylactic BNT162 vaccines against COVID-19.
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It is expected that the various candidate vaccines may not all be available from the start of
the study, in which case they will be rolled into the study in a consecutive fashion as they are
released. A Phase 1/2 study of the same vaccine candidates (BNT162-01), conducted in
Germany by BioNTech in adults 18 to 55 years of age, is planned to start in April 2020.
Study C4591001 is designed to complement and expand upon the German study and confirm
the optimal vaccine candidate(s) (BNT162a1, BNT162b1, BNT162b2, or BNT162c2), dose
level(s), number of doses, and schedule of administration.
Objectives, Estimands, and Endpoints
Objectives Estimands Endpoints

Primary: Primary: Primary:
To describe the safety and tolerability In participants receiving at least 1 dose  Local reactions (pain at the
profiles of prophylactic BNT162 of study intervention and having safety injection site, redness, and
vaccines in healthy adults after 1 or 2 data reported after any vaccination, the swelling)
doses percentage of participants reporting:  Systemic events (fever, fatigue,
 Local reactions for up to 7 days headache, chills, vomiting,
following each dose diarrhea, new or worsened muscle
 Systemic events for up to 7 days pain, and new or worsened joint
following each dose pain)
 Adverse events (AEs) from Dose 1  AEs
to 1 month after the last dose  SAEs
 Serious AEs (SAEs) from Dose 1
to 6 months after the last dose

In addition, in sentinel cohorts from Hematology and chemistry laboratory
Stage 1, the percentage of participants parameters detailed in Section 10.2
with:
 Abnormal hematology and
chemistry laboratory values 1 and
7 days after Dose 1; and 7 days
after Dose 2
 Grading shifts in hematology and
chemistry laboratory assessments
between baseline and 1 and 7 days
after Dose 1; and before Dose 2
and 7 days after Dose 2
Secondary: Secondary: Secondary:
To describe the immune responses In participants complying with the key
elicited by prophylactic BNT162 protocol criteria (evaluable participants)
vaccines in healthy adults after 1 or 2 at the following time points after receipt
doses of study intervention:
Stage 1 Sentinel Cohorts: 7 and

21 days after Dose 1; 7 and 14 days and
1, 6, 12, and 24 months after Dose 2
Stage 1 Nonsentinel Cohorts and Stage
2 Cohorts: 21 days after Dose 1;
14 days and 1, 6, 12, and 24 months
after Dose 2
Stage 3 Cohort(s): 1, 12, and 24 months
after Dose 2
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 Geometric mean titers (GMTs) at SARS-CoV-2–specific WT serum
each time point neutralizing titers
 Geometric mean fold rise (GMFR)
from before vaccination to each
subsequent time point after
vaccination
 Proportion of participants
achieving ≥4-fold rise from before
vaccination to each subsequent
time point after vaccination
 Geometric mean concentrations SARS-CoV-2-spike protein–specific
(GMCs) at each time point binding antibody levels and RBD-
 GMFR from rise from before specific binding antibody levels
 Geometric mean ratio (GMR),  SARS-CoV-2–specific WT serum
estimated by the ratio of the neutralizing titers
geometric mean of SARS-CoV-2–  SARS-CoV-2-spike protein–
specific WT serum neutralizing specific binding antibody levels
titers to the geometric mean of  SARS-CoV-2 RBD–specific
SARS-CoV-2–specific binding binding antibody levels

antibody levels at each time point
To evaluate the efficacy of prophylactic In participants complying with the key COVID-19 incidence per 1000 person-
BNT162 vaccines against confirmed protocol criteria (evaluable participants) years of follow-up
COVID-19 following receipt of the last dose of
study intervention:
100 × (1 – infection rate ratio) [ratio of
active vaccine to placebo]
Tertiary/Exploratory: Tertiary/Exploratory: Tertiary/Exploratory:
To describe the relationship between Nonvaccine antigen SARS-CoV-2
SARS-CoV-2 serological parameters antibody levels
and:
 NAAT-confirmed COVID-19
 Symptomatic SARS-CoV-2
infection
 Asymptomatic SARS-CoV-2
infection
Overall Design
This is a Phase 1/2, randomized, placebo-controlled, observer-blind, dose-finding, and

vaccine candidate–selection study in healthy adults.
The study will evaluate the safety, tolerability, immunogenicity, and potential efficacy of up
to 4 different SARS-CoV-2 RNA vaccine candidates against COVID-19:
 As a 2-dose (separated by 21 or 60 days) or single-dose schedule
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 At up to 3 different dose levels
 In 3 age groups (18 to 55 years of age, 65 to 85 years of age, and 18 to 85 years of age
[stratified as ≤55 or >55 years of age])
Dependent upon safety and/or immunogenicity data generated during the course of this
study, or the BioNTech study conducted in Germany (BNT162-01), it is possible that groups
may be started at the next highest dose, groups may not be started, groups may be terminated
early, and/or groups may be added with dose levels below the lowest stated dose or
intermediate between the lowest and highest stated doses.
The study consists of 3 stages. Stage 1: to identify preferred vaccine candidate(s), dose
level(s), number of doses, and schedule of administration (with the first 15 participants at
each dose level of each vaccine candidate comprising a sentinel cohort); Stage 2: an
expanded-cohort stage; and Stage 3: a final candidate/dose large-scale stage. These stages,
and the progression between them, are detailed in the schema (Section 1.2).
Number of Participants
Each group in Stage 1 will comprise 15 participants (12 receiving active vaccine and
3 receiving placebo). In this stage, assuming 2 dose levels are selected following the initial
dose escalation, up to 56 potential groups are foreseen; if all groups are fully enrolled, this
corresponds to a total of 840 participants.
Each group in Stage 2 will comprise 225 participants (180 receiving active vaccine and
45 receiving placebo). The total number of participants to be enrolled in this stage depends
on the number of groups to be pursued.
The vaccine candidate/dose level selected for Stage 3 will comprise 3000 participants. An
equal number of participants will receive placebo, ie, randomized in a 1:1 ratio.
Intervention Groups and Duration
The study may evaluate single-dose and 2-dose (separated by 21 or 60 days) schedules of
3 different dose levels of 4 investigational RNA vaccine candidates for active immunization
against COVID-19 in 3 age groups (18 to 55 years of age, 65 to 85 years of age, and
18 to 85 years of age [stratified as ≤55 or >55 years of age]):
 BNT162a1 (RNA-LNP vaccine utilizing uRNA and encoding the RBD): 3 µg, 10 µg,
30 µg
 BNT162b1 (BNT162 RNA-LNP vaccine utilizing modRNA and encoding the RBD):
10 µg, 30 µg, 100 µg
 BNT162b2 (BNT162 RNA-LNP vaccine utilizing modRNA and encoding the P2 S):
10 µg, 30 µg, 100 µg
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 BNT162c2 (BNT162 RNA-LNP vaccine utilizing saRNA and encoding the RBD): 3 µg,
10 µg, 30 µg
Participants are expected to participate for up to a maximum of approximately 26 months.

The duration of study follow-up may be shorter among participants enrolled in Stage 1 and
Stage 2 dosing arms that are not evaluated in Stage 3.
Data Monitoring Committee or Other Independent Oversight Committee
The study will utilize an IRC, an internal Pfizer committee that will review data to allow
dose escalation or changes to continuation of specific groups.
An external data monitoring committee (DMC) will be formed and will review cumulative
unblinded data throughout the study.
Statistical Methods
The study sample size for the first 2 stages of the study is not based on any statistical
hypothesis testing. For the third stage, with assumptions of a true vaccine efficacy (VE) of
70%, 53 cases of COVID-19 will provide 90% power to conclude true VE >20%. This would
be achieved with 3000 participants per group, based on the assumption of a 1.7% incidence
rate in the placebo group, and 20% of the participants being nonevaluable.
The primary safety objective will be evaluated by descriptive summary statistics for local
reactions, systemic events, abnormal hematology and chemistry laboratory parameters
(sentinel cohorts only), and AEs and SAEs, for each vaccine group. A 3-tier approach will be
used to summarize AEs.
The secondary immunogenicity objectives will be evaluated descriptively by GMT, GMC,

GMFR, percentage of participants with ≥4-fold rise, and GMC ratio, and the associated 95%
confidence intervals (CIs), for SARS-CoV-2–specific WT serum neutralizing titers,
SARS-CoV-2-spike protein–specific binding antibody levels, and RBD-specific binding
levels at the various time points.
For the secondary efficacy objective, VE is defined as VE = 100 × (1 – IRR), where IRR is
the infection rate ratio, the calculated ratio of COVID-19 incidence in the active vaccine
group to the incidence in the placebo group. The null hypothesis (VE ≤ 20%) will be rejected
if the lower bound of the 95% CI for VE is >20%; no interim analysis of VE is planned.
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1.2. Schema
Stage 1 (4:1 randomization active:placebo)
For each vaccine candidate
Age: 18-55 y Age: 65-85 y
Low dose level 2-dose group (n=15):
SENTINEL
IRC (safety & immunogenicity Low dose level 2-dose group (n=15):
IRC (safety) SENTINEL
after Dose 1)
Mid dose level 2-dose group (n=15):
SENTINEL IRC (safety)
IRC (safety & immunogenicity Mid dose level 2-dose group (n=15):
IRC (safety)
after Dose 1) SENTINEL
High dose level 2-dose group (n=15):
SENTINEL IRC (safety)
IRC (safety & immunogenicity High dose level 2-dose group (n=15):
after Dose 1) SENTINEL
IRC choice of group(s) for Stage 2

(safety & immunogenicity after Dose 2)
Dose level(s) selected for Stage 2: 2- Dose level(s) selected for Stage 2: 2-
dose (60 days apart) group(s) (n=15) dose (60 days apart) group(s) (n=15)
& &
Dose level(s) selected for Stage 2: 1- Dose level(s) selected for Stage 2: 1-
dose group(s) (n=15) dose group(s) (n=15)

Age: 18-85
(Stratified 18-55 or 56-85)
Group for each selected vaccine
candidate/dose level
(n=180 per active group)
IRC choice of group(s) for Stage 3

(safety & immunogenicity after Dose 2)

Age: 18-85
(Stratified 18-55 or 56-85)
Selected vaccine candidate/dose level
(n=3000 per group)
Abbreviation: IRC = internal review committee.
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1.3. Schedule of Activities

The SoA table provides an overview of the protocol visits and procedures. Refer to the STUDY ASSESSMENTS AND
PROCEDURES section of the protocol for detailed information on each procedure and assessment required for compliance with the
protocol.
The investigator may schedule visits (unplanned visits) in addition to those listed in the SoA table, in order to conduct evaluations or
assessments required to protect the well-being of the participant.
1.3.1. Stage 1 Sentinel Cohorts

An unplanned potential COVID-19 illness visit and unplanned potential COVID-19 convalescent visit are required at any time
between Visit 1 (Vaccination 1) and Visit 10 (24-month follow-up visit) that COVID-19 is suspected.
Visit Number Screening 1 2 3 4 5 6 7 8 9 10 Unplanned Unplanned

Visit Description Screening Vax 1 Next- 1-Week Vax 2 1-Week 2-Week 1-Month 6-Month 12- 24- Potential Potential
Day Follow- Follow- Follow- Follow- Follow- Month Month COVID-19 COVID-19
Follow- up Visit up Visit up Visit up Visit up Visit Follow- Follow- Illness Convalescent
up Visit (Vax 1) (Vax 2) (Vax 2) up Visit up Visit Telehealth Visit
(Vax 1) Visit
Visit Window (Days) 0 to 14 Day 1 1 to 3 6 to 8 19 to 23 6 to 8 12 to 16 28 to 35 154 to 350 to 714 to Optimally 28 to 35 Days

Days Days Days Days Days Days Days 168 Days 378 Days 742 Days Within 3 After
Before After After After After After After After After After Days After Potential
Visit 1 Visit 1 Visit 1 Visit 1 Visit 4 Visit 4 Visit 4 Visit 4 Visit 4 Visit 4 Potential COVID-19
COVID-19 Illness Visit
Illness
Onset
Obtain informed consent X
Assign participant number X
Obtain demography and X
medical history data
Obtain details of medications X
currently taken
Perform physical examination X X X X X X X
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(Vax 1) Visit

Illness
Onset
Measure vital signs X X X X X X X
(including body temperature)
Collect blood sample for ~10 mL ~10 mL ~10 mL ~10 mL ~10 mL
hematology and chemistry
laboratory testsa
Collect screening blood ~10 mL
sample for HIV, HBsAg,
HBc Ab, and HCV Ab tests
Serological test for prior ~20 mL
COVID-19 infection
Perform urine pregnancy test X X X
(if appropriate)
Obtain nasal (midturbinate) X X X
swab(s)b
Collect nonstudy vaccine X X X X X X X X X
information
Confirm eligibility X X X
Collect prohibited medication X X X X X X X X X X X
use
Review hematology and X X X X X
chemistry results
Review temporary delay X X
criteria
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(Vax 1) Visit

Illness
Onset
Confirm use of contraceptives X X X X X X X X
(if appropriate)
Obtain randomization number X
and study intervention
allocation
Collect blood sample for ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL
immunogenicity assessment
Administer study intervention X X
Assess acute reactions for at X X
least 30 minutes after study
intervention administrationc
Provide participant with 7-day X X
e-diary, thermometer, and
measuring device
Review e-diary data (daily
review is optimal during the
active diary period)
Review ongoing e-diary X X
symptoms and obtain stop
dates
Collect AEs and SAEs as X X X X X X X X X X X X X
appropriate
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(Vax 1) Visit

Illness
Onset
Collect e-diary or assist the X
participant to delete
application
Collection of COVID-19– X X
related clinical and laboratory
information (including local
diagnosis)
Abbreviations: e-diary = electronic diary; HBc Ab = hepatitis B core antibody; HBsAg = hepatitis B surface antigen; HCV Ab = hepatitis C virus antibody; HIV = human
immunodeficiency virus; NAAT = nucleic acid amplification test; vax = vaccination.
a. Hematology: hemoglobin, complete blood count with differential, and platelets. Blood chemistry: alanine aminotransferase (ALT), aspartate aminotransferase (AST),
alkaline phosphatase, total bilirubin, blood urea nitrogen (BUN), and creatinine.
b. Two swabs will be taken at Visits 1 and 4. One will be tested (if possible at the site, otherwise at the central laboratory) within 24 hours and vaccination will only proceed if it
is NAAT-negative for SARS-CoV-2 genomes. The second will be sent to the central laboratory for potential later testing.
c. The first 5 participants in in each sentinel group will be observed at the site for at least 4 hours after study intervention administration. Further vaccination will commence no
sooner than 24 hours after the fifth participant received his or her vaccination.
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1.3.2. Stage 1 Nonsentinel Cohorts and Stage 2 Cohorts

Visit Number 1 2 3 4 5 6 7 Unplanned Unplanned

Visit Description Vaccination 1 Vaccination 2 2-Week 1-Month 6-Month 12-Month 24-Month Potential Potential
Follow-up Follow-up Follow-up Follow-up Follow-up COVID-19 COVID-19

Visit Visit Visit Visit Visit Illness Convalescent
Telehealth Visit
Visit
Visit Window (Days) Day 1 19 to 23 Days 12 to 16 Days 28 to 35 Days 154 to 168 350 to 378 714 to 742 Optimally 28 to 35 Days
After Visit 1 After Visit 2 After Visit 2 Days After Days After Days After Within 3 After
or Visit 2 Visit 2 Visit 2 Days After Potential
56 to 70 Days Potential COVID-19
After Visit 1a COVID-19 Illness Visit
Illness Onset
Obtain demography and medical X
history data
Perform physical examination X
Measure vital signs X
Perform urine pregnancy test X X
(if appropriate)
Collect nonstudy vaccine information X X X X X
Collect prohibited medication use X X X X X X X X
Confirm eligibility X X
Measure temperature (body) X X
Review temporary delay criteria X X
Confirm use of contraceptives X X X X
(if appropriate)
Obtain randomization number and X
study intervention allocation
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Visit Number 1 2 3 4 5 6 7 Unplanned Unplanned

Visit Description Vaccination 1 Vaccination 2 2-Week 1-Month 6-Month 12-Month 24-Month Potential Potential
Follow-up Follow-up Follow-up Follow-up Follow-up COVID-19 COVID-19
Visit Visit Visit Visit Visit Illness Convalescent
Telehealth Visit
Visit
Visit Window (Days) Day 1 19 to 23 Days 12 to 16 Days 28 to 35 Days 154 to 168 350 to 378 714 to 742 Optimally 28 to 35 Days
After Visit 1 After Visit 2 After Visit 2 Days After Days After Days After Within 3 After
Illness Onset
Collect blood sample for ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL
immunogenicity assessment
Obtain nasal (midturbinate) swab X X X
Assess acute reactions for at least 30 X X
minutes after study intervention
administration
Provide participant with 7-day e-diary, X X
thermometer, and measuring device
Review e-diary data (daily review is
optimal during the active diary period)
Review ongoing e-diary symptoms and X X
obtain stop dates
Collect AEs and SAEs as appropriate X X X X X X X X X
Collect e-diary or assist the participant X
to delete application
Collection of COVID-19–related X X
clinical and laboratory information
(including local diagnosis)
Abbreviation: e-diary = electronic diary.
a. The window for Visit 2 is dependent on the dosing schedule for the assigned group.
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1.3.3. Stage 3 Cohort(s)

Visit Number 1 2 3 4 5 6 Unplanned Unplanned

Visit Description Vaccination 1 Vaccination 2 1-Month 6-Month 12-Month 24-Month Potential Potential
Follow-up Safety Follow-up Follow-up COVID-19 COVID-19

Visit Telephone Visit Visit Illness Convalescent
Contact Telehealth Visit
Visit
Visit Window (Days) Day 1 19 to 23 Days 28 to 35 Days 154 to 168 350 to 378 714 to 742 Optimally 28 to 35 Days
After Visit 1 After Visit 2 Days After Days After Days After Within 3 After
Illness Onset
Obtain demography and medical history data X
Perform physical examination X
Measure vital signs X
Perform urine pregnancy test (if appropriate) X X
Collect nonstudy vaccine information X X X X
Collect prohibited medication use X X X X X X X
Confirm use of contraceptives (if appropriate) X X X
Obtain randomization number and study X
intervention allocation
Collect blood sample for immunogenicity ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL
assessment
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Follow-up Safety Follow-up Follow-up COVID-19 COVID-19
Visit Telephone Visit Visit Illness Convalescent
Contact Telehealth Visit
Visit
Visit Window (Days) Day 1 19 to 23 Days 28 to 35 Days 154 to 168 350 to 378 714 to 742 Optimally 28 to 35 Days
Illness Onset
Assess acute reactions for at least 30 minutes after X X
study intervention administration
Provide participant with 7-day e-diary, X X
thermometer, and measuring device
Review e-diary data (daily review is optimal during
the active diary period)
Review ongoing e-diary symptoms and obtain stop X X
dates
Collect AEs and SAEs as appropriate X X X X X X X X
Collect e-diary or assist the participant to delete X
application
Telephone contact X
Collection of COVID-19–related clinical and X X
laboratory information (including local diagnosis)
Abbreviation: e-diary = electronic diary.
a. The window for Visit 2 is dependent on the dosing schedule(s) selected for the Stage 3.
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2. INTRODUCTION
The BNT162 RNA-based COVID-19 vaccines are currently being investigated for
prevention of COVID-19 in healthy adults.
2.1. Study Rationale

The purpose of the study is to rapidly describe the safety, tolerability, immunogenicity, and
potential efficacy of 4 BNT162 RNA-based COVID-19 vaccine candidates against
COVID-19 in healthy adults. There are currently no vaccines to prevent infection with
SARS-CoV-2 or antiviral drugs to treat COVID-19. Given the global crisis of COVID-19
and fast expansion of the disease in the United States and elsewhere, the rapid development
of an effective vaccine is of utmost importance.
2.2. Background
In December 2019, a pneumonia outbreak of unknown cause occurred in Wuhan, China.
In January 2020, it became clear that a novel coronavirus (2019-nCoV) was the underlying
cause. Later in January, the genetic sequence of the 2019-nCoV became available to the
World Health Organization (WHO) and public (MN908947.3), and the virus was categorized
in the Betacoronavirus subfamily. By sequence analysis, the phylogenetic tree revealed a
closer relationship to severe acute respiratory syndrome (SARS) virus isolates than to another
coronavirus infecting humans, the Middle East respiratory syndrome (MERS) virus.
SARS-CoV-2 infections and the resulting disease, COVID-19, have spread globally,
affecting a growing number of countries.
On 11 March 2020, the WHO characterized the COVID-19 outbreak as a pandemic.1

The WHO Situation Update Report dated 30 March 2020 noted 693,224 confirmed cases
with 33,106 deaths globally, including 142,081 confirmed cases with 2457 deaths in the
Americas.2 The United States currently has the most reported cases globally. At the time of
this communication, the number of confirmed cases continues to rise globally. There are
currently no vaccines or effective antiviral drugs to treat SARS-CoV-2 infections or the
disease it causes, COVID-19.3
A prophylactic, RNA-based SARS-CoV-2 vaccine provides one of the most flexible and
fastest approaches available to immunize against the emerging virus.4,5
The development of an RNA-based vaccine encoding a viral antigen, which is then expressed
by the vaccine recipient as a protein capable of eliciting protective immune responses,
provides significant advantages over more traditional vaccine approaches. Unlike live
attenuated vaccines, RNA vaccines do not carry the risks associated with infection and may
be given to people who cannot be administered live virus (eg, pregnant women and
immunocompromised persons). RNA-based vaccines are manufactured via a cell-free in
vitro transcription process, which allows an easy and rapid production and the prospect of
producing high numbers of vaccination doses within a shorter time period than achieved with
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Protocol C4591001
traditional vaccine approaches. This capability is pivotal to enable the most effective
response in outbreak scenarios.
Four SARS-CoV-2–RNA lipid nanoparticle (RNA-LNP) vaccines utilizing different RNA

formats will be evaluated in this study. Each vaccine candidate is based on 1 of 3 RNA
platforms: unmodified messenger RNA (uRNA), nucleoside-modified messenger RNA
(modRNA), or self-amplifying messenger RNA (saRNA). Each vaccine candidate expresses
1 of 2 antigens: the SARS-CoV-2 full-length, P2 mutant, “heads up,” prefusion spike
glycoprotein (P2 S) (version 9) or a trimerized SARS-CoV-2 spike glycoprotein receptor
binding domain (RBD) (version 5). The 4 SARS-CoV-2 vaccine candidates that will be
tested in this study are therefore:
 BNT162a1 (variant RBL063.3): non–nucleoside-modified uridine-containing messenger

RNA (uRNA) with high intrinsic adjuvanticity, encoding the RBD.
 BNT162b1 (variant RBP020.3): nucleoside-modified messenger RNA (modRNA) with

blunted innate immune sensor–activating capacity and augmented expression encoding
the RBD.
 BNT162b2 (variant RBP020.2): nucleoside-modified messenger RNA (modRNA) as

above but encoding P2 S.
 BNT162c2 (variant RBP020.3): self-amplifying messenger RNA (saRNA) encoding the

RBD, in which higher amounts of protein per injected RNA template can be produced.
2.2.1. Clinical Overview

BNT162 vaccines have not been administered to humans before and thus there are no
previous clinical data with these specific vaccines. However, given clinical data from other
similarly formulated uRNA liposomal vaccines from BioNTech in oncology trials6 and
recent published results from clinical trials using modRNA influenza vaccines by Moderna,7
the BNT162 vaccines are expected to have a favorable safety profile with mild, localized,
and transient effects.
2.3. Benefit/Risk Assessment

There is an ongoing global pandemic of COVID-19 with no preventative or therapeutic
options available. While there are currently no data available from clinical trials on the use of
BNT162 vaccines in humans, available nonclinical data with these vaccines, and data from
nonclinical studies and clinical trials with the same or related RNA components, or antigens,
support a favorable risk/benefit profile. Anticipated AEs after vaccination are expected to be
manageable using routine symptom-driven standard of care as determined by the
investigators and, as a result, the profile of these vaccine candidates support initiation of this
Phase 1/2 clinical study.
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Protocol C4591001
More detailed information about the known and expected benefits and risks and reasonably
expected AEs of BNT162 RNA-based COVID-19 vaccines may be found in the
investigator’s brochure (IB), which is the SRSD for this study.
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2.3.1. Risk Assessment

Potential Risk of Clinical Summary of Data/Rationale for Risk Mitigation Strategy
Significance
Study Intervention: BNT162 RNA-Based COVID-19 Vaccine
Potential for local reactions (injection These are common adverse reactions seen The study design includes the use of sentinel cohorts and dose escalation to
site redness, injection site swelling, with other vaccines, as noted in the FDA closely monitor and limit the rate of enrollment to ensure participant safety.
and injection site pain) and systemic Center for Biologics Evaluation and The study employs the use of an e-diary to monitor local reactions and
events (fever, fatigue, headache, Research (CBER) guidelines on toxicity systemic events in real time. Stopping rules are also in place for sentinel
chills, vomiting, diarrhea, muscle grading scales for healthy adult volunteers cohorts. The first 5 sentinel-cohort participants in each group will be
pain, and joint pain) following enrolled in preventive vaccine clinical observed for 4 hours after vaccination to assess any immediate AEs.
vaccination. trials.8
Unknown AEs and laboratory This study is one of the first 2 parallel- The study design includes the use of sentinel cohorts and dose escalation to
abnormalities with a novel vaccine. running clinical studies with the BNT162 closely monitor and limit the rate of enrollment to ensure participant safety.
vaccine candidates and as such there are no An IRC and DMC will also review safety data throughout the study.
clinical data available for this vaccine. Stopping rules are also in place for sentinel cohorts. The first 5 sentinel
cohort participants in each group will be observed for 4 hours after
vaccination to assess any immediate AEs.
Potential for COVID-19 disease Disease enhancement has been seen The study excludes participants with likely previous or current COVID-19.
enhancement. following vaccination with respiratory All participants are followed for SARS-CoV-2 antigen-specific antibody
syncytial virus (RSV), feline coronavirus, and SARS-CoV-2–specific WT serum neutralizing titers, and COVID-19
and Dengue virus vaccines. illness, including markers of severity.
Study Procedures
Participants will be required to attend Without appropriate social distancing and Pfizer will work with sites to ensure an appropriate COVID-19 prevention
healthcare facilities during the global PPE, there is a potential for increased strategy.
SARS-CoV-2 pandemic. exposure to SARS-CoV-2.
Venipuncture will be performed There is the risk of bleeding, bruising, Only appropriately qualified personnel would obtain the blood draw.
during the study. hematoma formation, and infection at the
venipuncture site.
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2.3.2. Benefit Assessment

Benefits to individual participants may include:
 Receipt of a potentially efficacious COVID-19 vaccine during a global pandemic
 Access to COVID-19 diagnostic and antibody testing
 Contributing to research to help others in a time of global pandemic
2.3.3. Overall Benefit/Risk Conclusion

Taking into account the measures taken to minimize risk to participants participating in this
study, the potential risks identified in association with BNT162 RNA-based COVID-19
vaccine are justified by the anticipated benefits that may be afforded to healthy participants.
3. OBJECTIVES, ESTIMANDS, AND ENDPOINTS

To describe the safety and tolerability In participants receiving at least 1 dose  Local reactions (pain at the
profiles of prophylactic BNT162 of study intervention and having safety injection site, redness, and
vaccines in healthy adults after 1 or 2 data reported after any vaccination, the swelling)
doses percentage of participants reporting:  Systemic events (fever, fatigue,

 Local reactions for up to 7 days headache, chills, vomiting,
following each dose diarrhea, new or worsened muscle
 Systemic events for up to 7 days pain, and new or worsened joint
following each dose pain)
 Adverse events (AEs) from Dose 1  AEs
to 1 month after the last dose  SAEs
 Serious AEs (SAEs) from Dose 1
In addition, in sentinel cohorts from Hematology and chemistry laboratory
Stage 1, the percentage of participants parameters detailed in Section 10.2
with:
 Abnormal hematology and
after Dose 2
 Grading shifts in hematology and
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elicited by prophylactic BNT162 protocol criteria (evaluable participants)
vaccines in healthy adults after 1 or 2 at the following time points after receipt
doses of study intervention:

21 days after Dose 1; 7 and 14 days and
1, 6, 12, and 24 months after Dose 2
Stage 1 Nonsentinel Cohorts and Stage
2 Cohorts: 21 days after Dose 1; 14
days and 1, 6, 12, and 24 months after
Dose 2
Stage 3 Cohort(s): 1, 12, and 24 months
after Dose 2
 Geometric mean titers (GMTs) at SARS-CoV-2–specific WT serum
each time point neutralizing titers
 Geometric mean fold rise (GMFR)
vaccination

 Geometric mean concentrations SARS-CoV-2-spike protein–specific
(GMCs) at each time point binding antibody levels and RBD-
 GMFR from prior to first dose of specific binding antibody levels
study intervention to each
subsequent time point
 Geometric mean ratio (GMR),  SARS-CoV2–specific WT serum
estimated by the ratio of the neutralizing titers
geometric mean of SARS-CoV-2–
specific WT serum neutralizing  SARS-CoV-2-spike protein–
titers to the geometric mean of specific binding antibody levels
SARS-CoV-2–specific binding  SARS-CoV-2 RBD–specific
antibody levels at each time point binding antibody levels
To evaluate the efficacy of prophylactic In participants complying with the key COVID-19 incidence per 1000 person-
BNT162 vaccines against confirmed protocol criteria (evaluable participants) years of follow-up
COVID-19 following receipt of the last dose of
study intervention:
100 × (1 – infection rate ratio)
[ratio of active vaccine to placebo]
Tertiary/Exploratory: Tertiary/Exploratory: Tertiary/Exploratory:
To describe the relationship between Nonvaccine antigen SARS-CoV-2
SARS-CoV-2 serological parameters antibody levels
and:
 NAAT-confirmed COVID-19
 Symptomatic SARS-CoV-2
infection
 Asymptomatic SARS-CoV-2
infection
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4. STUDY DESIGN
4.1. Overall Design
 As a 2-dose (separated by 21 or 60 days) or single-dose schedule
 At up to 3 different dose levels
 In 3 age groups (18 to 55 years of age, 65 to 85 years of age, and 18 to 85 years of age
[stratified as ≤55 or >55 years of age])
expanded-cohort stage; and Stage 3; a final candidate/dose large-scale stage. These stages,
and the progression between them, are detailed in the schema (Section 1.2).
The study is observer-blinded, as the physical appearance of the investigational vaccine

candidates and the placebo may differ. The participant, investigator, study coordinator, and
other site staff will be blinded. At the study site, only the dispenser(s)/administrator(s) are
unblinded.
To facilitate rapid review of data in real time, sponsor staff will be unblinded to vaccine
allocation for the participants in Stage 1 and Stage 2.
4.1.1. Stage 1
Each group (vaccine candidate/dose level/age group/number of doses) will comprise
15 participants; 12 participants will be randomized to receive active vaccine and 3 to receive
placebo. On Day 22, those in 2-dose groups will receive the same vaccine they received on
Day 1; for those in single-dose groups, all will receive placebo. Full details of all potential
groups in Stage 1 may be found in Table 1.
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For each vaccine candidate/dose level/age group, the 15 participants randomized into each 2-
dose group will comprise a sentinel cohort, to which the following apply:
 Additional safety assessments (see Section 8.2)
 Controlled enrollment:
 No more than 5 participants (4 active, 1 placebo) can be vaccinated on the first day
 The first 5 participants must be observed by blinded site staff for at least 4 hours after
vaccination for any acute reactions
 Vaccination of the remaining participants will commence no sooner than 24 hours

after the fifth participant received his or her vaccination
 Application of stopping rules
 IRC review of safety data to determine escalation to the next dose level
Groups of participants 65 to 85 years of age will not be started until safety and
immunogenicity data for the same vaccine candidate/dose level have been deemed acceptable
in the 18- to 55-year age cohort by the IRC.
Once the IRC has selected a vaccine candidate/dose level to proceed into Stage 2, for each
age cohort, 2 additional groups will be enrolled into Stage 1 for that vaccine candidate/dose
level:
 A 2-dose group, with the 2 doses administered 60 days apart rather than 21
 A 1-dose group
In this stage, assuming 2 dose levels are selected following the initial dose escalation, up to
56 potential groups are foreseen; if all groups are fully enrolled, this corresponds to a total of
840 participants.
4.1.2. Stage 2
On the basis of safety and/or immunogenicity data generated during the course of this study,
and/or the BioNTech study conducted in Germany (BNT162-01), 1 or more groups (vaccine
candidate/dose level) may be selected to proceed into Stage 2. Participants in this stage will
be 18 to 85 years of age, stratified equally: 18 to 55 or 56 to 85 years. Commencement of
each age stratum will be dependent upon satisfactory safety and immunogenicity data from
the 18- to 55-year and 65- to 85-year groups from Stage 1, respectively. It is therefore
possible that the 2 age strata may not start concurrently.
In each group selected for Stage 2, it is intended that 225 participants will be randomized in a
4:1 ratio to receive active vaccine (180 participants) or placebo (45 participants).
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4.1.3. Stage 3
and/or the BioNTech study conducted in Germany (BNT162-01), 1 group may be selected to
proceed into Stage 3. Participants in this stage will be 18 to 85 years of age, stratified
equally: 18 to 55 years or 56 to 85 years. As in Stage 2, it is possible that the 2 age strata may
not start concurrently.
The vaccine candidate/dose level selected for Stage 3 will comprise 3000 participants. An
equal number of participants will receive placebo, ie, randomized in a 1:1 ratio.

4.2. Scientific Rationale for Study Design

Additional surveillance for COVID-19 will be conducted as part of the study, given the
potential risk of disease enhancement. If a participant experiences respiratory symptoms, as
detailed in Section 8.13, a COVID-19 illness and subsequent convalescent visit will occur.
As part of these visits, samples (nasal [midturbinate] swab and blood) will be taken for
antigen and antibody assessment as well as recording of COVID-19–related clinical and

laboratory information (including local diagnosis).
Human reproductive safety data are not available for BNT162 RNA-based COVID-19
vaccines, but there is no suspicion of human teratogenicity based on the intended mechanism
of action of the compound. Therefore, the use of a highly effective method of contraception
is required (see Appendix 4).
4.3. Justification for Dose

Because of the requirement for a rapid response to the newly emerged COVID-19 pandemic,
sufficient data are not currently available to experimentally validate the dose selection and
initial starting dose. Therefore, the planned starting doses of 3 µg (for BNT162a1 and
BNT162c2) and 10 µg (for BNT162b1 and BNT162b2) in this study are based on nonclinical
experience with the same RNAs encoding other viral antigens (such as influenza and HIV
antigens). The general safety and effectiveness of uRNA and modRNA platforms have been
demonstrated in oncological clinical trials with different administration routes
(NCT02410733, NCT03871348). Doses of up to 400 µg total uRNA have been administered
IV as RNA lipoplex (RNA-LPX) and doses of up to 1000 µg total naked modRNA have been
administered intratumorally, both without signs of unpredictable overstimulation of the
immune system.
Based on nonclinical data of the RNA components (uRNA, modRNA, saRNA), with other
liposomes or in conjunction with the lipid nanoparticles as will be tested clinically in this
study, it is expected that doses in the 1- to 5-µg range will be immunogenic and induce
neutralizing antibodies; however, it is anticipated that 3- to 10-fold higher doses will likely
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Protocol C4591001
be required to elicit a stronger antibody response. Based on previous clinical and nonclinical
experience, it is expected that doses of up to 100 µg will be well tolerated.
Taken together, the planned starting doses in this study in healthy participants are considered
to be safe, but still sufficient to induce an antiviral immune response.
4.4. End of Study Definition

A participant is considered to have completed the study if he/she has completed all phases of
the study, including the last visit. Note that participants enrolled in Stages 1 and 2 in groups
that do not proceed to Stage 3 may be followed for fewer than 24 months (but no less than
6 months after the last vaccination).
The end of the study is defined as the date of last visit of the last participant in the study.
5. STUDY POPULATION
This study can fulfill its objectives only if appropriate participants are enrolled. The
following eligibility criteria are designed to select participants for whom participation in the
study is considered appropriate. All relevant medical and nonmedical conditions should be
taken into consideration when deciding whether a particular participant is suitable for this
protocol.
Prospective approval of protocol deviations to recruitment and enrollment criteria, also

known as protocol waivers or exemptions, is not permitted.
5.1. Inclusion Criteria

Participants are eligible to be included in the study only if all of the following criteria apply:
Age and Sex:
1. Male or female participants between the ages of 18 and 55 years, inclusive, 65 and
85 years, inclusive, or 18 and 85 years, inclusive, at randomization (dependent upon
study stage).
 Refer to Appendix 4 for reproductive criteria for male (Section 10.4.1) and female
(Section 10.4.2) participants.
Type of Participant and Disease Characteristics:
2. Participants who are willing and able to comply with all scheduled visits, vaccination
plan, laboratory tests, lifestyle considerations, and other study procedures.
3. Healthy participants who are determined by medical history, physical examination, and
clinical judgment of the investigator to be eligible for inclusion in the study.
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Note: Healthy participants with preexisting stable disease, defined as disease not
requiring significant change in therapy or hospitalization for worsening disease during
the 6 weeks before enrollment, can be included.
Informed Consent:
4. Capable of giving personal signed informed consent as described in Appendix 1, which

includes compliance with the requirements and restrictions listed in the ICD and in this
protocol.
5.2. Exclusion Criteria

Participants are excluded from the study if any of the following criteria apply:
Medical Conditions:
1. Other medical or psychiatric condition including recent (within the past year) or active
suicidal ideation/behavior or laboratory abnormality that may increase the risk of study
participation or, in the investigator’s judgment, make the participant inappropriate for the
study.
2. Known infection with human immunodeficiency virus (HIV), hepatitis C virus (HCV), or
hepatitis B virus (HBV).
3. History of severe adverse reaction associated with a vaccine and/or severe allergic
reaction (eg, anaphylaxis) to any component of the study intervention(s).
4. Receipt of medications intended to prevent COVID-19.
5. Stages 1 and 2 only: Previous clinical or microbiological diagnosis of COVID-19.
6. Sentinel participants in Stage 1 only: Individuals at high risk for severe COVID-19,
including those with any of the following risk factors:
 Hypertension
 Diabetes mellitus
 Chronic pulmonary disease
 Asthma
 Current vaping or smoking
 History of chronic smoking within the prior year
 BMI >30 kg/m2
 Anticipating the need for immunosuppressive treatment within the next 6 months
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Protocol C4591001
7. Sentinel participants in Stage 1 only: Individuals currently working in occupations with

high risk of exposure to SARS-CoV-2 (eg, healthcare worker, emergency response
personnel).
8. Immunocompromised individuals with known or suspected immunodeficiency, as

determined by history and/or laboratory/physical examination.
9. Individuals with a history of autoimmune disease or an active autoimmune disease

requiring therapeutic intervention, including but not limited to: systemic or cutaneous
lupus erythematosus, autoimmune arthritis/rheumatoid arthritis, Guillain-Barré
syndrome, multiple sclerosis, Sjögren’s syndrome, idiopathic thrombocytopenia purpura,
glomerulonephritis, autoimmune thyroiditis, giant cell arteritis (temporal arteritis),
psoriasis, and insulin-dependent diabetes mellitus (type 1).
10. Bleeding diathesis or condition associated with prolonged bleeding that would, in the
opinion of the investigator, contraindicate intramuscular injection.
11. Women who are pregnant or breastfeeding.
Prior/Concomitant Therapy:
12. Previous vaccination with any coronavirus vaccine.
13. Individuals who receive treatment with immunosuppressive therapy, including cytotoxic
agents or systemic corticosteroids, eg, for cancer or an autoimmune disease, or planned
receipt throughout the study. If systemic corticosteroids have been administered short
term (<14 days) for treatment of an acute illness, participants should not be enrolled into
the study until corticosteroid therapy has been discontinued for at least 28 days before
study intervention administration. Inhaled/nebulized, intra-articular, intrabursal, or
topical (skin or eyes) corticosteroids are permitted.
14. Receipt of blood/plasma products or immunoglobulin, from 60 days before study

intervention administration or planned receipt throughout the study.
Prior/Concurrent Clinical Study Experience:
15. Participation in other studies involving study intervention within 28 days prior to study
entry and/or during study participation.
16. Previous participation in other studies involving study intervention containing lipid
nanoparticles.
Diagnostic Assessments:
17. Sentinel participants in Stage 1 only: Positive serological test for SARS-CoV-2 IgM
and/or IgG antibodies at the screening visit.
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18. Sentinel participants in Stage 1 only: Any screening hematology and/or blood
chemistry laboratory value that meets the definition of a ≥ Grade 1 abnormality.
Note: With the exception of bilirubin, participants with any stable Grade 1 abnormalities
(according to the toxicity grading scale) may be considered eligible at the discretion of
the investigator. (Note: A “stable” Grade 1 laboratory abnormality is defined as a report
of Grade 1 on an initial blood sample that remains ≤ Grade 1 upon repeat testing on a
second sample from the same participant.)
19. Sentinel participants in Stage 1 only: Positive test for HIV, hepatitis B surface antigen
(HBsAg), hepatitis B core antibodies (HBc Abs), or hepatitis C virus antibodies
(HCV Abs) at the screening visit.
20. Sentinel participants in Stage 1 only: SARS-CoV-2 NAAT-positive nasal swab within
24 hours before receipt of study intervention.
Other Exclusions:
21. Investigator site staff or Pfizer employees directly involved in the conduct of the study,
site staff otherwise supervised by the investigator, and their respective family members.
5.3. Lifestyle Considerations

5.3.1. Contraception
The investigator or his or her designee, in consultation with the participant, will confirm that
the participant has selected an appropriate method of contraception for the individual
participant and his or her partner(s) from the permitted list of contraception methods
(see Appendix 4, Section 10.4.4) and will confirm that the participant has been instructed in
its consistent and correct use. At time points indicated in the SoA, the investigator or
designee will inform the participant of the need to use highly effective contraception
consistently and correctly and document the conversation and the participant’s affirmation in
the participant’s chart (participants need to affirm their consistent and correct use of at least 1
of the selected methods of contraception). In addition, the investigator or designee will
instruct the participant to call immediately if the selected contraception method is
discontinued or if pregnancy is known or suspected in the participant or partner.
5.4. Screen Failures

Screen failures are defined as participants who consent to participate in the clinical study but
are not subsequently randomly assigned to study intervention. A minimal set of screen
failure information is required to ensure transparent reporting of screen failure participants to
meet the CONSORT publishing requirements and to respond to queries from regulatory
authorities. Minimal information includes demography, screen failure details, eligibility
criteria, and any SAE.
Individuals who do not meet the criteria for participation in this study (screen failure) may be
rescreened under a different participant number.
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5.5. Criteria for Temporarily Delaying Enrollment/Randomization/Study Intervention

Administration
The following conditions are temporary or self-limiting and a participant may be vaccinated
once the condition(s) has/have resolved and no other exclusion criteria are met.
1. Current febrile illness (body temperature ≥100.4°F [≥38°C]) or other acute illness within
48 hours before study intervention administration. This includes current symptoms that
could represent a potential COVID-19 illness:
 New or increased cough;
 New or increased shortness of breath;
 New or increased sore throat;
 New or increased wheezing;
 New or increased sputum production;
 New or increased nasal congestion;

 New or increased nasal discharge;
 Loss of taste/smell.
2. Receipt of any seasonal or pandemic influenza vaccine within 14 days, or any other
nonstudy vaccine within 28 days, before study intervention administration.
3. Anticipated receipt of any seasonal or pandemic influenza vaccine within 14 days, or any
other nonstudy vaccine within 28 days, after study intervention administration.
4. Receipt of short-term (<14 days) systemic corticosteroids. Study intervention

administration should be delayed until systemic corticosteroid use has been discontinued
for at least 28 days. Inhaled/nebulized, intra-articular, intrabursal, or topical (skin or
eyes) corticosteroids are permitted.
6. STUDY INTERVENTION
Study intervention is defined as any investigational intervention(s), marketed product(s),
placebo, medical device(s), or study procedure(s) intended to be administered to a study
participant according to the study protocol.
The study may evaluate 2-dose (separated by 21 or 60 days) and single-dose schedules of
3 different dose levels of 4 investigational RNA vaccine candidates for active immunization
against COVID-19 in 3 age groups (18 to 55 years of age, 65 to 85 years of age, and
18 to 85 years of age [stratified as ≤55 or >55 years of age]). These 4 investigational RNA
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vaccine candidates, with the addition of saline placebo, are the 5 potential study interventions
that may be administered to a study participant:
 BNT162a1 (RNA-LNP vaccine utilizing uRNA and encoding the RBD): 3 µg, 10 µg,
30 µg
 BNT162b1 (BNT162 RNA-LNP vaccine utilizing modRNA and encoding the RBD):
10 µg, 30 µg, 100 µg
 BNT162b2 (BNT162 RNA-LNP vaccine utilizing modRNA and encoding the P2 S):
10 µg, 30 µg, 100 µg
 BNT162c2 (BNT162 RNA-LNP vaccine utilizing saRNA and encoding the RBD): 3 µg,
10 µg, 30 µg
 Normal saline (0.9% sodium chloride solution for injection)
A list of all potential groups in the Stage 1 are shown in Table 1. Each of these groups may
or may not progress to the later stages of the study.
Table 1. Potential Groups in Stage 1

Groups N Age Dose 1 Dose 2
Group
(Years)
2-Dose Groups (Sentinel Cohorts) Day 1 Day 22
a-3-2-Y (Sentinel) 15 18 to 55 BNT162a1 3 µg (n=12) BNT162a1 3 µg (n=12)
[uRNA 3 µg (2 doses)] Placebo (n=3) Placebo (n=3)
b1-10-2-Y (Sentinel) 15 18 to 55 BNT162b1 10 µg (n=12) BNT162b1 10 µg (n=12)

[modRNA 10 µg (2 doses)] Placebo (n=3) Placebo (n=3)

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Group
(Years)
c-3-2-Y (Sentinel) 15 18 to 55 BNT162c2 3 µg (n=12) BNT162c2 3 µg (n=12)
[saRNA 3 µg (2 doses)] Placebo (n=3) Placebo (n=3)
a-3-2-O (Sentinel) 15 65 to 85 BNT162a1 3 µg (n=12) BNT162a1 3 µg (n=12)

b1-10-2-O (Sentinel) 15 65 to 85 BNT162b1 10 µg (n=12) BNT162b1 10 µg (n=12)


c-3-2-O (Sentinel) 15 65 to 85 BNT162c2 3 µg (n=12) BNT162c2 3 µg (n=12)

Single-Dose Groups Day 1 Day 22

a-x-1-Y 15 18 to 55 BNT162a1 TBD (n=12) Placebo (n=15)
[uRNA dose level(s) Placebo (n=3)
selected for Stage 2
(1 dose)]
b1-x-1-Y 15 18 to 55 BNT162b1 TBD (n=12) Placebo (n=15)
[modRNA dose level(s) Placebo (n=3)
(1 dose)]
(1 dose)]
c-x-1-Y 15 18 to 55 BNT162c2 TBD (n=12) Placebo (n=15)
[saRNA dose level(s) Placebo (n=3)
(1 dose)]
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Group
(Years)
a-x-1-O 15 65 to 85 BNT162a1 TBD (n=12) Placebo (n=15)

[uRNA dose level(s) Placebo (n=3)
(1 dose)]
b1-x-1-O 15 65 to 85 BNT162b1 TBD (n=12) Placebo (n=15)
(1 dose)]
(1 dose)]
c-x-1-O 15 65 to 85 BNT162c2 TBD (n=12) Placebo (n=15)
(1 dose)]
2-Dose Groups (Longer Schedule) Day 1 Day 61

a-x-2L-Y 15 18 to 55 BNT162a1 TBD (n=12) BNT162a1 TBD (n=12)
[uRNA dose level(s) Placebo (n=3) Placebo (n=3)

(2 doses)]
b1-x-2L-Y 15 18 to 55 BNT162b1 TBD (n=12) BNT162b1 TBD (n=12)
[modRNA dose level(s) Placebo (n=3) Placebo (n=3)
(2 doses)]
(2 doses)]
c-x-2L-Y 15 18 to 55 BNT162c2 TBD (n=12) BNT162c2 TBD (n=12)
[saRNA dose level(s) Placebo (n=3) Placebo (n=3)
(2 doses)]
a-x-2L-O 15 65 to 85 BNT162a1 TBD (n=12) BNT162a1 TBD (n=12)

[uRNA dose level(s) Placebo (n=3) Placebo (n=3)
(2 doses)]
b1-x-2L-O 15 65 to 85 BNT162b1 TBD (n=12) BNT162b1 TBD (n=12)
(2 doses)]
(2 doses)]
c-x-2L-O 15 65 to 85 BNT162c2 TBD (n=12) BNT162c2 TBD (n=12)
(2 doses)]
Abbreviations: modRNA = nucleoside-modified messenger ribonucleic acid; saRNA = self-amplifying messenger
ribonucleic acid; TBD = to be determined; uRNA = uridine-containing messenger ribonucleic acid.
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6.1. Study Intervention(s) Administered

Intervention BNT162a1 BNT162b1 BNT162b2 BNT162c2 Saline placebo
Name (BNT 162 RNA- (BNT162 RNA- (BNT162 RNA- (BNT162 RNA-
LNP vaccine LNP vaccine LNP vaccine LNP vaccine
utilizing uRNA) utilizing utilizing utilizing saRNA
modRNA) modRNA)
Type Vaccine Vaccine Vaccine Vaccine Placebo

Dose Formulation uRNA modRNA modRNA saRNA Normal saline
(0.9% sodium
chloride solution
for injection)
Unit Dose 250 µg/0.5 mL 250 µg/0.5 mL 250 µg/0.5 mL 250 µg/0.5 mL N/A
Strength(s)
Dosage Level(s) 3-, 10-, 30-µg 10-, 30-, 100-µg 10-, 30-, 100-µg 3-, 10-, 30-µg N/A
Route of Intramuscular Intramuscular Intramuscular Intramuscular Intramuscular
Administration injection injection injection injection injection
Use Experimental Experimental Experimental Experimental Placebo
IMP or NIMP IMP IMP IMP IMP IMP
Sourcing Provided centrally Provided centrally Provided centrally Provided centrally Provided centrally
by the sponsor by the sponsor by the sponsor by the sponsor by the sponsor
Packaging and Study intervention Study intervention Study intervention Study intervention Study intervention
Labeling will be provided in will be provided in will be provided in will be provided in will be provided in
a glass vial as a glass vial as a glass vial as a glass vial as a glass vial as
open-label supply. open-label supply. open-label supply. open-label supply. open-label supply.
Each vial will be Each vial will be Each vial will be Each vial will be Each vial will be
labeled as required labeled as required labeled as required labeled as required labeled as required
per country per country per country per country per country
requirement requirement requirement requirement requirement
6.1.1. Administration
Participants will receive 1 dose (0.5 mL) of study intervention as randomized at each
vaccination visit (Visits 1 and 4 for Stage 1 sentinel cohort participants, Visits 1 and 2 for all
other participants) in accordance with the study’s SoA.
Study intervention should be administered intramuscularly into the deltoid muscle, preferably
of the nondominant arm, by an unblinded administrator.
Standard vaccination practices must be observed and vaccine must not be injected into blood
vessels. Appropriate medication and other supportive measures for management of an acute
hypersensitivity reaction should be available in accordance with local guidelines for standard
immunization practices.
Administration of study interventions should be performed by an appropriately qualified,

GCP-trained, and vaccine-experienced member of the study staff (eg, physician, nurse,
physician’s assistant, nurse practitioner, pharmacist, or medical assistant) as allowed by
local, state, and institutional guidance.
Study intervention administration details will be recorded on the CRF.
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6.2. Preparation/Handling/Storage/Accountability
1. The investigator or designee must confirm appropriate temperature conditions have been
maintained during transit for all study interventions received and any discrepancies are
reported and resolved before use of the study intervention.
2. Only participants enrolled in the study may receive study intervention and only
authorized site staff may supply or administer study intervention. All study interventions
must be stored in a secure, environmentally controlled, and monitored (manual or
automated recording) area in accordance with the labeled storage conditions with access
limited to the investigator and authorized site staff. At a minimum, daily minimum and
maximum temperatures for all site storage locations must be documented and available
upon request. Data for nonworking days must indicate the minimum and maximum
temperatures since previously documented for all site storage locations upon return to
business.
3. Any excursions from the study intervention label storage conditions should be reported to
Pfizer upon discovery along with any actions taken. The site should actively pursue
options for returning the study intervention to the storage conditions described in the
labeling, as soon as possible. Once an excursion is identified, the study intervention must
be quarantined and not used until Pfizer provides permission to use the study
intervention. Specific details regarding the definition of an excursion and information the
site should report for each excursion will be provided to the site in the IP manual.
4. Any storage conditions stated in the SRSD will be superseded by the storage conditions
stated on the label.
5. Study interventions should be stored in their original containers.
6. See the IP manual for storage conditions of the study intervention.
7. The investigator, institution, or the head of the medical institution (where applicable) is
responsible for study intervention accountability, reconciliation, and record maintenance
(ie, receipt, reconciliation, and final disposition records), such as the IPAL or sponsor-
approved equivalent. All study interventions will be accounted for using a study
intervention accountability form/record.
8. Further guidance and information for the final disposition of unused study interventions
are provided in the IP manual. All destruction must be adequately documented. If
destruction is authorized to take place at the investigator site, the investigator must ensure
that the materials are destroyed in compliance with applicable environmental regulations,
institutional policy, and any special instructions provided by Pfizer.
Upon identification of a product complaint, notify the sponsor within 1 business day of
discovery as described in the IP manual.
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6.2.1. Preparation and Dispensing
See the IP manual for instructions on how to prepare the study intervention for
administration. Study intervention should be prepared and dispensed by an appropriately
qualified and experienced member of the study staff (eg, physician, nurse, physician’s
assistant, nurse practitioner, pharmacy assistant/technician, or pharmacist) as allowed by
local, state, and institutional guidance. A second staff member will verify the dispensing.
Study intervention and placebo will be prepared by qualified unblinded site personnel
according to the IP manual. The study intervention will be administered in such a way to
ensure the participants remain blinded.
6.3. Measures to Minimize Bias: Randomization and Blinding

6.3.1. Allocation to Study Intervention
Allocation (randomization) of participants to vaccine groups will proceed through the use of
an IRT system (IWR). The site personnel (study coordinator or specified designee) will be
required to enter or select information including but not limited to the user’s ID and
password, the protocol number, and the participant number. The site personnel will then be
provided with a vaccine assignment and randomization number. The IRT system will
provide a confirmation report containing the participant number, randomization number, and
study intervention allocation assigned. The confirmation report must be stored in the site’s
files.
The study-specific IRT reference manual and IP manual will provide the contact information
and further details on the use of the IRT system.
6.3.2. Blinding of Site Personnel

In this observer blinded study, the study staff receiving, storing, dispensing, preparing, and
administering the study interventions will be unblinded. All other study and site personnel,
including the investigator, investigator staff, and participants, will be blinded to study
intervention assignments. In particular, the individuals who evaluate participant safety will
be blinded. Because the BNT162 RNA-based COVID-19 vaccine candidates and placebo
are different in physical appearance, the study intervention syringes will be administered in a
manner that prevents the study participants from identifying the study intervention type based
on its appearance.
The responsibility of the unblinded dispenser and administrator must be assigned to an

individual or individuals who will not participate in the evaluation of any study participants.
Contact between the unblinded dispenser and study participants and unblinded administrator
and study participants should be kept to a minimum. The remaining site personnel must not
know study intervention assignments.
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6.3.3. Blinding of the Sponsor

To facilitate rapid review of data in real time, sponsor staff will be unblinded to study
intervention allocation for the participants in Stage 1 and in Stage 2. Sponsor staff will be
blinded to study intervention allocation in Stage 3. All laboratory testing personnel
performing serology assays will remain blinded to study intervention assigned/received
throughout the study.
Those study team members who are involved in ensuring that protocol requirements for
study intervention preparation, handling, allocation, and administration are fulfilled at the site
will be unblinded for the duration of the study (eg, unblinded study manager, unblinded
clinical research associate). Unblinded clinician(s) who are not direct members of the study
team will review unblinded protocol deviations.
6.3.4. Breaking the Blind

The IRT will be programmed with blind-breaking instructions. In case of an emergency, the
investigator has the sole responsibility for determining if unblinding of a participant’s study
intervention assignment is warranted. Participant safety must always be the first
consideration in making such a determination. If the investigator decides that unblinding is
warranted, the investigator should make every effort to contact the sponsor prior to
unblinding a participant’s vaccine assignment unless this could delay further management of
the participant. If a participant’s vaccine assignment is unblinded, the sponsor must be
notified within 24 hours after breaking the blind. The date and reason that the blind was
broken must be recorded in the source documentation and CRF.
6.4. Study Intervention Compliance

When participants are dosed at the site, they will receive study intervention directly from the
investigator or designee, under medical supervision. The date and time of each dose
administered in the clinic will be recorded in the source documents and recorded in the CRF.
The dose of study intervention and study participant identification will be confirmed at the
time of dosing by a member of the study site staff other than the person administering the
study intervention.
6.5. Concomitant Therapy

The following concomitant medications and vaccinations will be recorded in the CRF:
 All vaccinations received from 28 days prior to study enrollment until the 6-month
follow-up visit (Visit 8 for Stage 1 sentinel cohorts, Visit 5 for Stage 1 nonsentinel
cohorts and Stage 2 participants, and Visit 4 for Stage 3 participants).
 Prohibited medications listed in Section 6.5.1 will be recorded, to include start and stop
dates, name of the medication, dose, unit, route, and frequency.
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 In addition, for participants enrolled in the Stage 1 sentinel cohorts, all current
medication at baseline will be recorded, to include start date, name of the medication,
dose, unit, route, and frequency.
6.5.1. Prohibited During the Study

Receipt of the following vaccines and medications during the time periods listed below may
exclude a participant from the per-protocol analysis, and may require vaccinations to be
discontinued in that participant; however, it is anticipated that the participant would not be
withdrawn from the study (see Section 7). Medications should not be withheld if required for
a participant’s medical care.
Unless considered medically necessary, no vaccines other than study intervention should be
administered within 28 days before and 28 days after each study vaccination. One exception
to this is that seasonal and pandemic influenza vaccine can be given at least 14 days after, or
at least 14 days prior to, the administration of study intervention.
Receipt of chronic systemic treatment with known immunosuppressant medications, or

radiotherapy, within 60 days before enrollment through conclusion of the study.
Receipt of systemic corticosteroids (≥20 mg/day of prednisone or equivalent) for ≥14 days is
prohibited from 28 days prior to enrollment to Visit 7 for Stage 1 sentinel cohorts, Visit 4 for
Stage 1 nonsentinel cohorts and Stage 2 participants, and Visit 3 for Stage 3 participants).
Receipt of blood/plasma products or immunoglobulins within 6 months before enrollment

through conclusion of the study.
Receipt of any other (nonstudy) coronavirus vaccine at any time prior to or during study
participation is prohibited.
Prophylactic antipyretics and other pain medication to prevent symptoms associated with
study intervention administration are not permitted. However, if a participant is taking a
medication for another condition, even if it may have antipyretic or pain-relieving properties,
it should not be withheld prior to study vaccination.
6.5.2. Permitted During the Study

The use of antipyretics and other pain medication to treat symptoms associated with study
intervention administration or ongoing conditions is permitted.
Medication other than that described as prohibited in Section 6.5.1 required for treatment of
preexisting stable conditions is permitted.
Inhaled, topical, or localized injections of corticosteroids (eg, intra-articular or intrabursal

administration) are permitted.
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6.6. Dose Modification

Individual participant dose modifications will not be made in this study.
6.7. Intervention After the End of the Study

No intervention will be provided to study participants at the end of the study.

DISCONTINUATION/WITHDRAWAL
7.1. Discontinuation of Study Intervention
In rare instances, it may be necessary for a participant to permanently discontinue study
intervention (definitive discontinuation). Reasons for definitive discontinuation of study
intervention may include the following: AEs; participant request; investigator request;
pregnancy; protocol deviation (including no longer meeting all the inclusion criteria, or
meeting 1 or more exclusion criteria).
Note that discontinuation of study intervention does not represent withdrawal from the study.
Per the study estimands, if study intervention is definitively discontinued, the participant will
remain in the study to be evaluated for safety, immunogenicity, and potential efficacy. See
the SoA for data to be collected at the time of discontinuation of study intervention and
follow-up for any further evaluations that need to be completed.
In the event of discontinuation of study intervention, it must be documented on the

appropriate CRF/in the medical records whether the participant is discontinuing further
receipt of study intervention or also from study procedures, posttreatment study follow-up,
and/or future collection of additional information.
7.2. Participant Discontinuation/Withdrawal From the Study

A participant may withdraw from the study at any time at his/her own request. Reasons for
discontinuation from the study may include the following:
 Refused further follow-up;

 Lost to follow-up;
 Death;
 Study terminated by sponsor;
 AEs;
 Participant request;
 Investigator request;
 Protocol deviation.
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If a participant does not return for a scheduled visit, every effort should be made to contact
the participant. All attempts to contact the participant and information received during
contact attempts must be documented in the participant’s source document. In any
circumstance, every effort should be made to document participant outcome, if possible.
The investigator or his or her designee should capture the reason for withdrawal in the CRF
for all participants.
If a participant withdraws from the study, he/she may request destruction of any remaining
samples taken and not tested, and the investigator must document any such requests in the
site study records and notify the sponsor accordingly.
If the participant withdraws from the study and also withdraws consent (see Section 7.2.1)
for disclosure of future information, no further evaluations should be performed and no
additional data should be collected. The sponsor may retain and continue to use any data
collected before such withdrawal of consent.
Lack of completion of all or any of the withdrawal/early termination procedures will not be
viewed as protocol deviations so long as the participant’s safety was preserved.
7.2.1. Withdrawal of Consent

Participants who request to discontinue receipt of study intervention will remain in the study
and must continue to be followed for protocol-specified follow-up procedures. The only
exception to this is when a participant specifically withdraws consent for any further contact
with him or her or persons previously authorized by the participant to provide this
information. Participants should notify the investigator in writing of the decision to
withdraw consent from future follow-up, whenever possible. The withdrawal of consent
should be explained in detail in the medical records by the investigator, as to whether the
withdrawal is only from further receipt of study intervention or also from study procedures
and/or posttreatment study follow-up, and entered on the appropriate CRF page. In the event
that vital status (whether the participant is alive or dead) is being measured, publicly
available information should be used to determine vital status only as appropriately directed
in accordance with local law.
7.3. Lost to Follow-up

A participant will be considered lost to follow-up if he or she repeatedly fails to return for
scheduled visits and is unable to be contacted by the study site.
The following actions must be taken if a participant fails to attend a required study visit:
 The site must attempt to contact the participant and reschedule the missed visit as soon as
possible and counsel the participant on the importance of maintaining the assigned visit
schedule and ascertain whether or not the participant wishes to and/or should continue in
the study;
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 Before a participant is deemed lost to follow-up, the investigator or designee must make
every effort to regain contact with the participant (where possible, 3 telephone calls and,
if necessary, a certified letter to the participant’s last known mailing address or local
equivalent methods). These contact attempts should be documented in the participant’s
medical record;
 Should the participant continue to be unreachable, he/she will be considered to have

withdrawn from the study.
8. STUDY ASSESSMENTS AND PROCEDURES

The investigator (or an appropriate delegate at the investigator site) must obtain a signed and
dated ICD before performing any study-specific procedures.
The full date of birth will be collected to critically evaluate the immune response and safety
profile by age.
Study procedures and their timing are summarized in the SoA. Protocol waivers or
exemptions are not allowed.
Safety issues should be discussed with the sponsor immediately upon occurrence or
awareness to determine whether the participant should continue or discontinue study

intervention.
Adherence to the study design requirements, including those specified in the SoA, is essential
and required for study conduct.
All screening evaluations must be completed and reviewed to confirm that potential
participants meet all eligibility criteria. The investigator will maintain a screening log to
record details of all participants screened and to confirm eligibility or record reasons for
screening failure, as applicable.
Every effort should be made to ensure that protocol-required tests and procedures are
completed as described. However, it is anticipated that from time to time there may be
circumstances outside the control of the investigator that may make it unfeasible to perform
the test. In these cases, the investigator must take all steps necessary to ensure the safety and
well-being of the participant. When a protocol-required test cannot be performed, the
investigator will document the reason for the missed test and any corrective and preventive
actions that he or she has taken to ensure that required processes are adhered to as soon as
possible. The study team must be informed of these incidents in a timely manner.
For samples being collected and shipped, detailed collection, processing, storage, and
shipment instructions and contact information will be provided to the investigator site prior
to initiation of the study.
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The total blood sampling volume for individual participants in this study is approximately
530 mL for participants in the Stage 1 sentinel cohorts; 350 mL for participants in the Stage 1
nonsentinel cohorts and Stage 2 participants; and 200 mL for Stage 3 participants.
Additionally, 50 mL of blood will be taken at an unplanned convalescent visit at any time a
participant develops respiratory symptoms indicating a potential COVID-19 infection. Other
additional blood samples may be taken for safety assessments at times specified by Pfizer,
provided the total volume taken during the study does not exceed 550 mL during any period
of 60 consecutive days.
8.1. Efficacy and/or Immunogenicity Assessments

Efficacy will be assessed throughout a participant’s involvement in the study through
surveillance for potential cases of COVID-19. If, at any time, a participant develops acute
respiratory illness (see Section 8.13), for the purposes of the study he or she will be
considered to potentially have COVID-19 illness.9 In this circumstance, the participant
should contact the site, a telehealth visit should occur, and assessments should be conducted
as specified in the SoA. The assessments will include a nasal (midturbinate) swab, which will
be tested at a central laboratory using a reverse transcription–polymerase chain reaction (RT-
PCR) test (Cepheid; FDA approved under EUA), or other equivalent nucleic acid
amplification–based test (ie, NAAT), to detect SARS-CoV-2. In addition, clinical
information and results from local standard-of-care tests (as detailed in Section 8.13) will be
assessed. Four definitions of potential SARS-CoV-2–related cases will be considered:
 Centrally confirmed COVID-19: presence of at least 1 symptom described in

Section 8.13 and SARS-CoV-2 NAAT positive at central laboratory
 Locally confirmed COVID-19: presence of at least 1 symptom described in Section 8.13

and investigator-confirmed SARS-CoV-2 NAAT positive at a local testing facility
 Centrally confirmed symptomatic seroconversion to SARS-CoV-2 (exploratory):

presence of at least 1 symptom described in Section 8.13 and a positive nonvaccine
antigen SARS-CoV-2 antibody result in a participant whose most recent prior nonvaccine
antigen SARS-CoV-2 antibody result was negative
 Centrally confirmed asymptomatic seroconversion to SARS-CoV-2 (exploratory):

positive nonvaccine antigen SARS-CoV-2 antibody result in a participant with a prior
nonvaccine antigen SARS-CoV-2 antibody result was negative
Serum samples will be obtained for immunogenicity testing at the visits specified in the SoA.
The following assays will be performed:
 SARS-CoV-2–specific WT serum neutralization assay
 SARS-CoV-2-spike (S) protein–specific IgG direct Luminex immunoassay
 SARS-CoV-2 RBD–specific IgG direct Luminex immunoassay
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 Nonvaccine antigen (NVA) Ig direct Luminex immunoassay. The NVA will include a
SARS-CoV-2 target antigen that is not derived from the S glycoprotein, most likely an
antigen derived from the SARS-CoV-2 nucleoprotein.
8.1.1. Biological Samples

Blood and nasal swab samples will be used only for scientific research. Each sample will be
labeled with a code so that the laboratory personnel testing the samples will not know the
participant’s identity. Samples that remain after performing assays outlined in the protocol
may be stored by Pfizer. Unless a time limitation is required by local regulations or ethical
requirements, the samples will be stored for up to 15 years after the end of the study and then
destroyed. If allowed by the ICD, stored samples may be used for additional testing to better
understand the immune responses to the vaccine(s) under study in this protocol, to inform the
development of other products, and/or for vaccine-related assay work supporting vaccine
programs. No testing of the participant’s DNA will be performed.
The participant may request that his or her samples, if still identifiable, be destroyed at any
time; however, any data already collected from those samples will still be used for this
research. The biological samples may be shared with other researchers as long as
confidentiality is maintained and no testing of the participant’s DNA is performed.
8.2. Safety Assessments

Planned time points for all safety assessments are provided in the SoA. Unscheduled clinical
laboratory measurements may be obtained at any time during the study to assess any
perceived safety issues.
A clinical assessment, including medical history, will be performed on all participants at

his/her first visit to establish a baseline. Significant medical history and observations from
any physical examination, if performed, will be documented in the CRF.
AEs and SAEs are collected, recorded, and reported as defined in Section 8.3.
Acute reactions within the first 4 hours after administration of the study intervention (for the
first 5 participants vaccinated in each Stage 1 sentinel group), and within the first 30 minutes
(for the remainder of participants), will be assessed and documented in the AE CRF.
The safety parameters also include e-diary reports of local reactions and systemic events
(including fever), and use of antipyretic medication that occur in the 7 days after
administration of the study intervention. These prospectively self-collected occurrences of
local reactions and systemic events are graded as described in Section 8.2.2.
8.2.1. Clinical Safety Laboratory Assessments (Sentinel-Cohort Participants Only)

See Appendix 2 for the list of clinical safety laboratory tests to be performed and the SoA for
the timing and frequency. All protocol-required laboratory assessments, as defined in
Appendix 2, must be conducted in accordance with the laboratory manual and the SoA.
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Unscheduled clinical laboratory measurements may be obtained at any time during the study
to assess any perceived safety issues.
The investigator must review the laboratory report, document this review, and record any
clinically relevant changes occurring during the study in the AE section of the CRF. See
Appendix 2 for the grading scale for assessment of clinically significant abnormal laboratory
findings. Clinically significant abnormal laboratory findings are those which are not
associated with the underlying disease, unless judged by the investigator to be more severe
than expected for the participant's condition.
All laboratory tests with values considered clinically significantly abnormal during
participation in the study or within 28 days after the last dose of study intervention should be
repeated until the values return to normal or baseline or are no longer considered clinically
significant by the investigator or medical monitor.
If such values do not return to normal/baseline within a period of time judged reasonable by
the investigator, the etiology should be identified and the sponsor notified.
See Appendix 5 for suggested actions and follow-up assessments in the event of potential
drug-induced liver injury.
8.2.2. Electronic Diary

Participants will be required to complete an e-diary through an application installed on a
provisioned device or on the participant’s own personal device. The participant will be asked
to monitor and record local reactions, systemic events, and antipyretic medication usage for
7 days following administration of the study intervention. The e-diary allows recording of
these assessments only within a fixed time window, thus providing the accurate
representation of the participant’s experience at that time. Data on local reactions and
systemic events reported in the e-diary will be transferred electronically to a third-party
vendor, where they will be available for review by investigators and the Pfizer clinicians at
all times via an internet-based portal.
At intervals agreed to by the vendor and Pfizer, these data will be transferred electronically
into Pfizer's database for analysis and reporting. These data do not need to be reported by the
investigator in the CRF as AEs.
Investigators (or designee) will be required to review the e-diary data online at frequent
intervals as part of the ongoing safety review.
The investigator or designee must obtain stop dates from the participant for any ongoing
local reactions, systemic events, or use of antipyretic medication on the last day that the
e-diary was completed. The stop dates should be documented in the source documents and
the information entered in the CRF.
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8.2.2.1. Grading Scales

The grading scales used in this study to assess local reactions and systemic events as
described below are derived from the FDA Center for Biologics Evaluation and Research
(CBER) guidelines on toxicity grading scales for healthy adult volunteers enrolled in
preventive vaccine clinical trials.8
8.2.2.2. Local Reactions

During the e-diary reporting period, participants will be asked to assess redness, swelling,
and pain at the injection site and to record the symptoms in the e-diary. If a local reaction
persists beyond the end of the e-diary period following vaccination, the participant will be
requested to report that information. The investigator will enter this additional information in
the CRF.
Redness and swelling will be measured and recorded in measuring device units
(range: 1 to 21) and then categorized during analysis as absent, mild, moderate, or severe
based on the grading scale in Table 2. Measuring device units can be converted to
centimeters according to the following formula: 1 measuring device unit = 0.5 cm. Pain at
the injection site will be assessed by the participant as absent, mild, moderate, or severe
according the grading scale in Table 2.
If a Grade 3 local reaction is reported in the e-diary, a telephone contact should occur to
ascertain further details and determine whether a site visit is clinically indicated. Only an
investigator or medically qualified person is able to classify a participant’s local reaction as
Grade 4. If a participant experiences a confirmed Grade 4 local reaction, the investigator
must immediately notify the sponsor and, if it is determined to be related to the
administration of the study intervention, further vaccinations will be discontinued in that
participant.
Table 2. Local Reaction Grading Scale

Mild Moderate Severe Potentially Life
(Grade 1) (Grade 2) (Grade 3) Threatening
(Grade 4)
Pain at the Does not interfere Interferes with activity Prevents daily activity Emergency room visit
injection site with activity or hospitalization for
severe pain
Redness 2.5 cm to 5.0 cm >5.0 cm to 10.0 cm >10 cm Necrosis or exfoliative
(5 to 10 measuring (11 to 20 measuring (≥21 measuring dermatitis
device units) device units) device units)
Swelling 2.5 cm to 5.0 cm >5.0 cm to 10.0 cm >10 cm Necrosis
(5 to 10 measuring (11 to 20 measuring (≥21 measuring
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8.2.2.3. Systemic Events

During the e-diary reporting period, participants will be asked to assess vomiting, diarrhea,
headache, fatigue, chills, new or worsened muscle pain, and new or worsened joint pain and
to record the symptoms in the e-diary. The symptoms will be assessed by the participant as
absent, mild, moderate, or severe according to the grading scale in Table 3.
If a Grade 3 systemic event is reported in the e-diary, a telephone contact should occur to
investigator or medically qualified person is able to classify a participant’s systemic event as
Grade 4. If a participant experiences a confirmed Grade 4 systemic event, the investigator
must immediately notify the sponsor and, if it is determined to be related to the
participant.
Table 3. Systemic Event Grading Scale

(Grade 4)
Vomiting 1-2 times in >2 times in 24 hours Requires IV Emergency room visit or
24 hours hydration hospitalization for

hypotensive shock
Diarrhea 2 to 3 loose stools 4 to 5 loose stools in 6 or more loose Emergency room visit or
in 24 hours 24 hours stools in 24 hours hospitalization for severe
diarrhea
Headache Does not interfere Some interference Prevents daily Emergency room visit or
with activity with activity routine activity hospitalization for severe
headache
Fatigue/ Does not interfere Some interference Prevents daily Emergency room visit or
tiredness with activity with activity routine activity hospitalization for severe
fatigue
Chills Does not interfere Some interference Prevents daily Emergency room visit or
chills
New or Does not interfere Some interference Prevents daily Emergency room visit or
worsened with activity with activity routine activity hospitalization for severe new
muscle pain or worsened muscle pain
worsened joint with activity with activity routine activity hospitalization for severe new
pain or worsened joint pain
Abbreviation: IV = intravenous.
8.2.2.4. Fever
In order to record information on fever, a thermometer will be given to participants with
instructions on how to measure oral temperature at home. Temperature will be collected in
the e-diary in the evening daily during the e-diary reporting period. It will also be collected
at any time during the e-diary data collection periods when fever is suspected. Fever is
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defined as an oral temperature of ≥38.0°C (100.4°F). The highest temperature for each day
will be recorded in the e-diary. Temperature will be measured and recorded to 1 decimal
place and then categorized during analysis according to the scale shown in Table 4.
If a fever of ≥39.0°C (102.1°F) is reported in the e-diary, a telephone contact should occur to
investigator or medically qualified person is able to confirm a participant’s fever as >40.0°C
(>104.0°F). If a participant experiences a confirmed fever >40.0°C (>104.0°F), the
investigator must immediately notify the sponsor and, if it is determined to be related to the
participant.
Table 4. Scale for Fever

38.0-38.4°C (100.4-101.1°F)
38.5-38.9°C (101.2-102.0°F)
39.0-40.0°C (102.1-104.0°F)
>40.0°C (>104.0°F)
8.2.2.5. Antipyretic Medication

The use of antipyretic medication to treat symptoms associated with study intervention
administration will be recorded in the e-diary daily during the reporting period (Day 1 to
Day 7).
8.2.3. Stopping Rules

The following stopping rules are in place for all Stage 1 sentinel-cohort participants, based
on review of AE data and e-diary reactogenicity data. These data will be monitored on an
ongoing basis by the investigator (or medically qualified designee) and sponsor in order to
promptly identify and flag any event that potentially contributes to a stopping rule.
The sponsor study team will be unblinded during the Stage 1, so will be able to assess
whether or not a stopping rule has been met on the basis of a participant’s individual study
intervention allocation.
In the event that sponsor personnel confirm that a stopping rule is met, the following actions
will commence:
 The IRC will review all appropriate data.
 The stopping rule will PAUSE randomization and study intervention administration for
the impacted vaccine candidate all dose levels and age groups.
 The DMC will review all appropriate data.
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 For all participants vaccinated, all other routine study conduct activities, including
ongoing data entry, reporting of AEs, participant e-diary completion, blood sample
collection, and participant follow-up, will continue during the pause.
A stopping rule is met if any of the following rules occur after administration of
investigational BNT162 vaccine; data from placebo recipients will not contribute to the
stopping rules. E-diary data confirmed by the investigator as being entered by the participant
in error will not contribute toward a stopping rule.
BNT162 vaccine candidates will be evaluated for contribution to stopping rules individually;
vaccine candidate dose levels and age groups will contribute to stopping rules together.
However, it is possible that the recommendations may include halting or continuing
randomization with any of the BNT162 vaccine candidates.
Stopping Rule Criteria for Each BNT162 Vaccine Candidate:
1. If any participant vaccinated with the BNT162 candidate (at any dose level) develops an
SAE that is assessed by the investigator as possibly related, or for which there is no
alternative, plausible, attributable cause.
2. If any participant vaccinated with the BNT162 candidate (at any dose level) develops a
Grade 4 local reaction or systemic event within 7 days after vaccination that is assessed
as possibly related by the investigator, or for which there is no alternative, plausible,
attributable cause.
fever >40.0°C (>104.0°F) for at least 1 daily measurement within 7 days after
vaccination that is assessed as possibly related by the investigator, or for which there is
no alternative, plausible, attributable cause.
4. If any 2 participants vaccinated with the BNT162 candidate (at any dose level) report the
same or similar severe (Grade 3) AE (including laboratory abnormalities) within 21 days
after vaccination, assessed as possibly related by the investigator, or for which there is no
5. If any participant dies or requires ICU admission due to SARS-CoV-2 infection; if this
stopping rule is met, all available clinical and preclinical safety and immunogenicity data
should be reviewed to evaluate for enhanced COVID-19 disease.
8.2.3.1. Randomization and Vaccination After a Stopping Rule Is Met

Once the IRC and DMC have reviewed the safety data and provided guidance, a notification
will be sent from the sponsor to the sites with guidance on how to proceed.
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8.2.4. Surveillance of Events That Could Represent Enhanced COVID-19 Disease

As this is a sponsor open-label study during Stages 1 and 2, the sponsor will conduct
unblinded reviews of the data during the course of the study, including for the purpose of
safety assessment.
Participants in all stages of the study will be surveilled for potential COVID-19 illness from
Visit 1 onwards (see Section 8.13). All NAAT-confirmed cases will be reviewed
contemporaneously by the IRC and the DMC (see Section 9.6). In addition, instances of
symptomatic and asymptomatic seroconversion to SARS-CoV-2 (see Section 8.1) will be
reviewed.
The purpose of these reviews will be to identify whether any features of each case appear
unusual, in particular greater severity, compared to available information at the time of
review. Indicators of severity may include accelerated deterioration, need for hospitalization,
need for ventilation, or death. Observed rates of these indicators will be compared with what
could be expected in a similar population to the study participants based upon available
information at the time of review. Since the DMC is able to review unblinded information, it
will also be able to compare cases in active vaccine and placebo recipients in Stage 3 (when
sponsor staff will be blinded).
8.2.5. Pregnancy Testing

Pregnancy tests may be urine or serum tests, but must have a sensitivity of at least
25 mIU/mL. Pregnancy tests will be performed in WOCBP at the times listed in the SoA,
immediately before the administration of each vaccine dose. A negative pregnancy test result
will be required prior to the participant’s receiving the study intervention. Pregnancy tests
may also be repeated if requested by IRBs/ECs or if required by local regulations. In the
case of a positive confirmed pregnancy, the participant will be withdrawn from
administration of study intervention but may remain in the study.
8.3. Adverse Events and Serious Adverse Events

The definitions of an AE and an SAE can be found in Appendix 3.
AEs will be reported by the participant (or, when appropriate, by a caregiver, surrogate, or
the participant's legally authorized representative).
The investigator and any qualified designees are responsible for detecting, documenting, and
recording events that meet the definition of an AE or SAE and remain responsible to pursue
and obtain adequate information both to determine the outcome and to assess whether the
event meets the criteria for classification as an SAE or caused the participant to discontinue
the study intervention (see Section 7.1).
Each participant will be questioned about the occurrence of AEs in a nonleading manner.
In addition, the investigator may be requested by Pfizer Safety to obtain specific follow-up
information in an expedited fashion.
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8.3.1. Time Period and Frequency for Collecting AE and SAE Information
The time period for actively eliciting and collecting AEs and SAEs (“active collection
period”) for each participant begins from the time the participant provides informed consent,
which is obtained before the participant’s participation in the study (ie, before undergoing
any study-related procedure and/or receiving study intervention), through and including
Visit 7 for Stage 1 sentinel-cohort participants, Visit 4 for Stage 1 nonsentinel participants
and Stage 2 participants, and Visit 3 for Stage 3 participants. In addition, any AEs occurring
up to 48 hours after each subsequent blood draw must be recorded on the CRF.
SAEs will be collected from the time the participant provides informed consent to
approximately 6 months after the last dose of study intervention (Visit 8 for Stage 1 sentinel-
cohort participants, Visit 5 for Stage 1 nonsentinel cohort participants and Stage 2
participants, and Visit 4 for Stage 3 participants).
Follow-up by the investigator continues throughout and after the active collection period and
until the AE or SAE or its sequelae resolve or stabilize at a level acceptable to the
investigator and Pfizer concurs with that assessment.
For participants who are screen failures, the active collection period ends when screen failure
status is determined.
If the participant withdraws from the study and also withdraws consent for the collection of
future information, the active collection period ends when consent is withdrawn.
If a participant definitively discontinues or temporarily discontinues study intervention

because of an AE or SAE, the AE or SAE must be recorded on the CRF and the SAE
reported using the Vaccines SAE Report Form.
Investigators are not obligated to actively seek AEs or SAEs after the participant has
concluded study participation. However, if the investigator learns of any SAE, including a
death, at any time after a participant has completed the study, and he/she considers the event
to be reasonably related to the study intervention, the investigator must promptly report the
SAE to Pfizer using the Vaccines SAE Report Form.
8.3.1.1. Reporting SAEs to Pfizer Safety

All SAEs occurring in a participant during the active collection period as described in
Section 8.3.1 are reported to Pfizer Safety on the Vaccines SAE Report Form immediately
upon awareness and under no circumstance should this exceed 24 hours, as indicated in
Appendix 3. The investigator will submit any updated SAE data to the sponsor within
24 hours of it being available.
8.3.1.2. Recording Nonserious AEs and SAEs on the CRF

All nonserious AEs and SAEs occurring in a participant during the active collection period as
described in Section 8.3.1 are recorded on the CRF. AEs and SAEs that begin after obtaining
informed consent but before the start of study intervention will be recorded on the Medical
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History/Current Medical Conditions section of the CRF, not the AE section. AEs and SAEs
that begin after the start of study intervention are recorded on the AE section of the CRF.
The investigator is to record on the CRF all directly observed and all spontaneously reported
AEs and SAEs reported by the participant.
8.3.2. Method of Detecting AEs and SAEs

The method of recording, evaluating, and assessing causality of AEs and SAEs and the
procedures for completing and transmitting SAE reports are provided in Appendix 3.
Care will be taken not to introduce bias when detecting AEs and/or SAEs. Open-ended and
nonleading verbal questioning of the participant is the preferred method to inquire about
AE occurrences.
8.3.3. Follow-up of AEs and SAEs

After the initial AE/SAE report, the investigator is required to proactively follow each
participant at subsequent visits/contacts. For each event, the investigator must pursue and
obtain adequate information until resolution, stabilization, the event is otherwise explained,
or the participant is lost to follow-up (as defined in Section 7.3).
In general, follow-up information will include a description of the event in sufficient detail to
allow for a complete medical assessment of the case and independent determination of
possible causality. Any information relevant to the event, such as concomitant medications
and illnesses, must be provided. In the case of a participant death, a summary of available
autopsy findings must be submitted as soon as possible to Pfizer Safety.
Further information on follow-up procedures is given in Appendix 3.
8.3.4. Regulatory Reporting Requirements for SAEs

Prompt notification by the investigator to the sponsor of an SAE is essential so that legal
obligations and ethical responsibilities towards the safety of participants and the safety of a
study intervention under clinical investigation are met.
The sponsor has a legal responsibility to notify both the local regulatory authority and other
regulatory agencies about the safety of a study intervention under clinical investigation. The
sponsor will comply with country-specific regulatory requirements relating to safety
reporting to the regulatory authority, IRBs/ECs, and investigators.
Investigator safety reports must be prepared for SUSARs according to local regulatory
requirements and sponsor policy and forwarded to investigators as necessary.
An investigator who receives SUSARs or other specific safety information (eg, summary or
listing of SAEs) from the sponsor will review and then file it along with the SRSD(s) for the
study and will notify the IRB/EC, if appropriate according to local requirements.
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8.3.5. Exposure During Pregnancy or Breastfeeding, and Occupational Exposure

Exposure to the study intervention under study during pregnancy or breastfeeding and
occupational exposure are reportable to Pfizer Safety within 24 hours of investigator
awareness.
8.3.5.1. Exposure During Pregnancy

An EDP occurs if:
 A female participant is found to be pregnant while receiving or after discontinuing study

intervention.
 A male participant who is receiving or has discontinued study intervention exposes a

female partner prior to or around the time of conception.
 A female is found to be pregnant while being exposed or having been exposed to study
intervention due to environmental exposure. Below are examples of environmental
exposure during pregnancy:
 A female family member or healthcare provider reports that she is pregnant after
having been exposed to the study intervention by inhalation or skin contact.
 A male family member or healthcare provider who has been exposed to the study
intervention by inhalation or skin contact then exposes his female partner prior to or
around the time of conception.
The investigator must report EDP to Pfizer Safety within 24 hours of the investigator’s
awareness, irrespective of whether an SAE has occurred. The initial information submitted
should include the anticipated date of delivery (see below for information related to
termination of pregnancy).
 If EDP occurs in a participant or a participant’s partner, the investigator must report this
information to Pfizer Safety on the Vaccines SAE Report Form and an EDP
Supplemental Form, regardless of whether an SAE has occurred. Details of the
pregnancy will be collected after the start of study intervention and until 6 months after
the last dose of study intervention.
 If EDP occurs in the setting of environmental exposure, the investigator must report
information to Pfizer Safety using the Vaccines SAE Report Form and EDP
Supplemental Form. Since the exposure information does not pertain to the participant
enrolled in the study, the information is not recorded on a CRF; however, a copy of the
completed Vaccines SAE Report Form is maintained in the investigator site file.
Follow-up is conducted to obtain general information on the pregnancy and its outcome for
all EDP reports with an unknown outcome. The investigator will follow the pregnancy until
completion (or until pregnancy termination) and notify Pfizer Safety of the outcome as a
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follow-up to the initial EDP Supplemental Form. In the case of a live birth, the structural
integrity of the neonate can be assessed at the time of birth. In the event of a termination, the
reason(s) for termination should be specified and, if clinically possible, the structural
integrity of the terminated fetus should be assessed by gross visual inspection (unless
preprocedure test findings are conclusive for a congenital anomaly and the findings are
reported).
Abnormal pregnancy outcomes are considered SAEs. If the outcome of the pregnancy meets
the criteria for an SAE (ie, ectopic pregnancy, spontaneous abortion, intrauterine fetal
demise, neonatal death, or congenital anomaly), the investigator should follow the procedures
for reporting SAEs. Additional information about pregnancy outcomes that are reported to
Pfizer Safety as SAEs follows:
 Spontaneous abortion including miscarriage and missed abortion;
 Neonatal deaths that occur within 1 month of birth should be reported, without regard to
causality, as SAEs. In addition, infant deaths after 1 month should be reported as SAEs
when the investigator assesses the infant death as related or possibly related to exposure
to the study intervention.
Additional information regarding the EDP may be requested by the sponsor. Further
follow-up of birth outcomes will be handled on a case-by-case basis (eg, follow-up on
preterm infants to identify developmental delays). In the case of paternal exposure, the
investigator will provide the participant with the Pregnant Partner Release of Information
Form to deliver to his partner. The investigator must document in the source documents that
the participant was given the Pregnant Partner Release of Information Form to provide to his
partner.
8.3.5.2. Exposure During Breastfeeding

An exposure during breastfeeding occurs if:
 A female participant is found to be breastfeeding while receiving or after discontinuing

study intervention.
 A female is found to be breastfeeding while being exposed or having been exposed to

study intervention (ie, environmental exposure). An example of environmental exposure
during breastfeeding is a female family member or healthcare provider who reports that
she is breastfeeding after having been exposed to the study intervention by inhalation or
skin contact.
The investigator must report exposure during breastfeeding to Pfizer Safety within 24 hours
of the investigator’s awareness, irrespective of whether an SAE has occurred. The
information must be reported using the Vaccines SAE Report Form. When exposure during
breastfeeding occurs in the setting of environmental exposure, the exposure information does
not pertain to the participant enrolled in the study, so the information is not recorded on a
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CRF. However, a copy of the completed Vaccines SAE Report Form is maintained in the
investigator site file.
An exposure during breastfeeding report is not created when a Pfizer drug specifically
approved for use in breastfeeding women (eg, vitamins) is administered in accord with
authorized use. However, if the infant experiences an SAE associated with such a drug, the
SAE is reported together with the exposure during breastfeeding.
8.3.5.3. Occupational Exposure

An occupational exposure occurs when a person receives unplanned direct contact with the
study intervention, which may or may not lead to the occurrence of an AE. Such persons
may include healthcare providers, family members, and other roles that are involved in the
trial participant’s care.
The investigator must report occupational exposure to Pfizer Safety within 24 hours of the
investigator’s awareness, regardless of whether there is an associated SAE. The information
must be reported using the Vaccines SAE Report Form. Since the information does not
pertain to a participant enrolled in the study, the information is not recorded on a CRF;
however, a copy of the completed Vaccines SAE Report Form is maintained in the
8.3.6. Medication Errors

Medication errors may result from the administration or consumption of the study
intervention by the wrong participant, or at the wrong time, or at the wrong dosage strength.
Exposures to the study intervention under study may occur in clinical trial settings, such as
medication errors.
Safety Event Recorded on the CRF Reported on the Vaccines SAE Report
Form to Pfizer Safety Within 24 Hours
of Awareness
Medication errors All (regardless of whether Only if associated with an SAE

associated with an AE)
Medication errors include:
 Medication errors involving participant exposure to the study intervention;
 Potential medication errors or uses outside of what is foreseen in the protocol that do or
do not involve the study participant;
 The administration of expired study intervention;
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 The administration of an incorrect study intervention;
 The administration of an incorrect dosage;
 The administration of study intervention that has undergone temperature excursion from
the specified storage range, unless it is determined by the sponsor that the study
intervention under question is acceptable for use.
Such medication errors occurring to a study participant are to be captured on the medication
error page of the CRF, which is a specific version of the AE page.
In the event of a medication dosing error, the sponsor should be notified immediately.
Whether or not the medication error is accompanied by an AE, as determined by the

investigator, the medication error is recorded on the medication error page of the CRF and, if
applicable, any associated AE(s), serious and nonserious, are recorded on the AE page of the
CRF.
Medication errors should be reported to Pfizer Safety within 24 hours on a Vaccines SAE
Report Form only when associated with an SAE.
8.4. Treatment of Overdose

For this study, any dose of study intervention greater than 1 dose of study intervention within
a 24-hour time period will be considered an overdose.
Pfizer does not recommend specific treatment for an overdose.
In the event of an overdose, the investigator should:
1. Contact the medical monitor immediately.
2. Closely monitor the participant for any AEs/SAEs.
3. Document the quantity of the excess dose as well as the duration of the overdose in the
CRF.
4. Overdose is reportable to Safety only when associated with an SAE.
Decisions regarding dose interruptions or modifications will be made by the investigator in

consultation with the medical monitor based on the clinical evaluation of the participant.
8.5. Pharmacokinetics
Pharmacokinetic parameters are not evaluated in this study.
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8.6. Pharmacodynamics
Pharmacodynamic parameters are not evaluated in this study.
8.7. Genetics
Genetics (specified analyses) are not evaluated in this study.
8.8. Biomarkers
Biomarkers are not evaluated in this study.
8.9. Immunogenicity Assessments

Immunogenicity assessments are described in Section 8.1.
8.10. Health Economics

Health economics/medical resource utilization and health economics parameters are not
evaluated in this study.
8.11. Study Procedures

8.11.1. Stage 1 Sentinel Cohorts
8.11.1.1. Screening: (0 to 14 Days Before Visit 1)

Before enrollment and before any study-related procedures are performed, voluntary, written
study-specific informed consent will be obtained from the participant. Each signature on the
ICD must be personally dated by the signatory. The investigator or his or her designee will
also sign the ICD. A copy of the signed and dated ICD must be given to the participant. The
source data must reflect that the informed consent was obtained before participation in the
study.
It is anticipated that the procedures below will be conducted in a stepwise manner; however,
the visit can occur over more than 1 day.
 Assign a single participant number using the IRT system.
 Obtain the participant’s demography (including date of birth, sex, race, and ethnicity).
The full date of birth will be collected to critically evaluate the immune response and
safety profile by age.
 Obtain any medical history of clinical significance.
 Obtain details of any medications currently taken.
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 Perform physical examination including vital signs (weight, height, body temperature,
pulse rate, and seated blood pressure), evaluating any clinically significant abnormalities
within the following body systems: general appearance; skin; head, eyes, ears, nose, and
throat; heart; lungs; abdomen; musculoskeletal; extremities; neurological; and lymph
nodes.
 Collect a blood sample (approximately 20 mL) for serological assessment of prior

COVID-19 infection.
 Collect a blood sample (approximately 10 mL) for hematology and chemistry laboratory
tests as described in Section 10.2.
 Collect a blood sample (approximately 10 mL) for HIV, HBsAg, HBc Ab, and HCV Ab
tests.
 Perform urine pregnancy test on WOCBP as described in Section 8.2.5.
 Discuss contraceptive use as described in Section 10.4.
 Record nonstudy vaccinations as described in Section 6.5.

 Ensure and document that all of the inclusion criteria and none of the exclusion criteria
are met.
 Record AEs as described in Section 8.3. AEs that occur prior to dosing should be noted
on the Medical History CRF.
 Ask the participant to contact the site staff or investigator immediately if any significant
illness or hospitalization occurs.
 Ask the participant to contact the site staff or investigator immediately if he or she
experiences any respiratory symptoms as detailed in Section 8.13.
 Schedule an appointment for the participant to return for the next study visit.
 Complete the source documents.
 Complete the CRF.
8.11.1.2. Visit 1 – Vaccination 1: (Day 1)

It is anticipated that the procedures below will be conducted in a stepwise manner; ensure
that procedures listed prior to administration of the vaccine are conducted prior to
vaccination.
 Record AEs as described in Section 8.3.
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 Perform physical examination including vital signs (body temperature, pulse rate, and
seated blood pressure), evaluating any clinically significant abnormalities within the
following body systems: general appearance; skin; head, eyes, ears, nose, and throat;
heart; lungs; abdomen; musculoskeletal; extremities; neurological; and lymph nodes.
 Review screening laboratory results (hematology and chemistry, and HIV, HBsAg,
HBc Ab, and HCV Ab tests).
 Obtain 2 nasal (midturbinate) swabs (collected by site staff). One will be tested
(if possible at the site, otherwise at the central laboratory) within 24 hours and
vaccination will proceed only if it is NAAT-negative for SARS-CoV-2 genomes.
The second will be sent to the central laboratory for potential later testing.
are met.
 Ensure that the participant meets none of the temporary delay criteria as described in
Section 5.5.
 Obtain the participant’s randomization number and study intervention allocation using
the IRT system. Either blinded site staff or unblinded site staff member may obtain this
information.
 Collect a blood sample (approximately 50 mL) for immunogenicity testing.
 Unblinded site staff member(s) will dispense/administer 1 dose of study intervention into
the deltoid muscle of the preferably nondominant arm. Please refer to the IP manual for
further instruction on this process.
 The first 5 participants vaccinated in each Stage 1 sentinel group must be observed by
blinded site staff for any acute reactions for at least 4 hours after vaccination. For
participants enrolled thereafter, blinded site staff must observe the participant for at least
30 minutes after study intervention administration for any acute reactions. Record any
acute reactions (including time of onset) in the participant’s source documents and on the
AE page of the CRF, and on an SAE form as applicable.
 Issue a measuring device to measure local reactions at the injection site and a
thermometer for recording daily temperatures and provide instructions on their use.
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 Explain the e-diary technologies available for this study, and assist the participant in
downloading the study application onto the participant’s own device or issue a
provisioned device if required. Provide instructions on e-diary completion and ask the
participant to complete the e-diary from Day 1 to Day 7, with Day 1 being the day of
vaccination.
experiences any of the following from Day 1 to Day 7 after vaccination (where Day 1 is
the day of vaccination) to determine if an unscheduled reactogenicity visit is required:
 Fever ≥39.0°C (≥102.1°F).
 Redness or swelling at the injection site measuring greater than 10 cm

(>20 measuring device units).
 Severe pain at the injection site.
 Any severe systemic event.
 Ask the participant to contact the site staff or investigator if a medically attended event
(eg, doctor’s visit, emergency room visit) or hospitalization occurs.
 Remind the participant to bring the e-diary to the next visit.
 The investigator or an authorized designee completes the CRFs and an unblinded

dispenser/administrator updates the study intervention accountability records.
 The investigator or appropriately qualified designee reviews the e-diary data online
following vaccination to evaluate participant compliance and as part of the ongoing
safety review. Daily review is optimal during the active diary period.
8.11.1.3. Visit 2 – Next-Day Follow-up Visit (Vaccination 1): (1 to 3 Days After Visit 1)
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 Record details of any of the prohibited medications specified in Section 6.5.1 received by
the participant if required for his or her clinical care.
 Fever ≥39.0°C (≥102.1°F).


 The investigator or an authorized designee completes the CRFs.
8.11.1.4. Visit 3 – 1-Week Follow-up Visit (Vaccination 1): (6 to 8 Days After Visit 1)
 Review hematology and chemistry laboratory results and record any AEs in accordance
with Appendix 2.
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 Fever ≥39.0°C (≥102.1°F).

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8.11.1.5. Visit 4 – Vaccination 2: (19 to 23 Days After Visit 1)

vaccination.
 Review the participant’s e-diary data. Collect stop dates of any e-diary events ongoing
on the last day that the e-diary was completed and record stop dates in the CRF if
required.
with Appendix 2.
 Obtain 2 nasal (midturbinate) swabs (collected by site staff). One will be tested (if
possible at the site, otherwise at the central laboratory) within 24 hours and vaccination
will only proceed if it is NAAT-negative for SARS-CoV-2 genomes. The second will be
sent to the central laboratory for potential later testing.
are met. If not, the participant should not receive further study intervention but will
remain in the study to be evaluated for safety, immunogenicity, and potential efficacy
(see Section 7.1).
Section 5.5.
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 Blinded site staff must observe the participant for at least 30 minutes after study
intervention administration for any acute reactions. Record any acute reactions
(including time of onset) in the participant’s source documents and on the AE page of the
CRF, and on an SAE form as applicable.
 Ensure the participant has a measuring device to measure local reactions at the injection
site and a thermometer for recording daily temperatures.
 Ensure the participant remains comfortable with his or her chosen e-diary platform,
confirm instructions on e-diary completion, and ask the participant to complete the e-
diary from Day 1 to Day 7, with Day 1 being the day of vaccination.
 Fever ≥39.0°C (≥102.1°F).

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with Appendix 2.
 Fever ≥39.0°C (≥102.1°F).

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required.
with Appendix 2.
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 Collect the participant’s e-diary or assist the participant to remove the study application
from his or her own personal device.
8.11.1.8. Visit 7 – 1-Month Follow-up Visit: (28 to 35 Days After Visit 4)


 Record SAEs as described in Section 8.3.
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 Record any AEs that occur within the 48 hours after the blood draw as described in
Section 8.3.
Section 8.3.
Section 8.3.
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8.11.2. Stage 1 Nonsentinel Cohorts and Stage 2 Cohorts

Before enrollment and before any study-related procedures are performed, voluntary, written,
study.
It is anticipated that the procedures below will be conducted in a stepwise manner.

Perform physical examination including vital signs (weight, height, body temperature,
nodes.
are met.
Section 5.5.
 Obtain the participant’s randomization number and study intervention allocation using
the IRT system. Either blinded site staff or unblinded site staff member may obtain this
information.
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 Obtain a nasal (midturbinate) swab (collected by site staff).
vaccination.
 Fever ≥39.0°C (≥102.1°F).

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8.11.2.2. Visit 2 – Vaccination 2: (19 to 23 Days or 56 to 70 Days After Visit 1)

The window for Visit 2 is dependent on the dosing schedule for the assigned group.
vaccination.
required.
(see Section 7.1).
 Measure the participant’s body temperature.
Section 5.5.
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confirm instructions on e-diary completion, and ask the participant to complete the
e-diary from Day 1 to Day 7, with Day 1 being the day of vaccination.
 Fever ≥39.0°C (≥102.1°F).


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8.11.2.3. Visit 3 – 2-Week Follow-up Visit: (12 to 16 Days After Visit 2)

required.

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Section 8.3.
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Section 8.3.
Section 8.3.
8.11.3. Stage 3 Cohort(s)

study.
It is anticipated that the procedures below will be conducted in a stepwise manner.
 Perform physical examination including vital signs (weight, height, body temperature,
nodes.
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are met.
Section 5.5.
 Obtain the participant’s randomization number and study intervention allocation number
using the IRT system. Either blinded site staff or unblinded site staff member may obtain
this information.

vaccination.
 Fever ≥39.0°C (≥102.1°F).
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The investigator or appropriately qualified designee reviews the e-diary data online following
vaccination to evaluate participant compliance and as part of the ongoing safety review.
Daily review is optimal during the active diary period.
8.11.3.2. Visit 2 – Vaccination 2: (19 to 23 Days or 56 to 70 Days After Visit 1)

The window for Visit 2 is dependent on the dosing schedule(s) selected for Stage 3.
vaccination.
required.
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(see Section 7.1).
 Measure the participant’s body temperature.
Section 5.5.
e-diary from Day 1 to Day 7, with Day 1 being the day of vaccination.
 Fever ≥39.0°C (≥102.1°F).

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The investigator or appropriately qualified designee reviews the e-diary data online following
vaccination to evaluate participant compliance and as part of the ongoing safety review.
Daily review is optimal during the active diary period.
8.11.3.3. Visit 3 – 1-Month Follow-up Visit (After Vaccination 2): (28 to 35 Days After
Visit 2)
required.
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8.11.3.4. Visit 4 – 6-Month Safety Telephone Contact: (154 to 168 Days After Visit 2)
 Contact the participant by telephone in order to obtain the following information.

Section 8.3.
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Section 8.3.
8.12. Unscheduled Visit for a Grade 3 or Suspected Grade 4 Reaction

If a Grade 3 local reaction (Section 8.2.2.2), systemic event (Section 8.2.2.3), or fever
(Section 8.2.2.4) is reported in the e-diary, a telephone contact should occur to ascertain
further details and determine whether a site visit is clinically indicated. If suspected Grade 4
local reaction (Section 8.2.2.2), systemic event (Section 8.2.2.3), or fever (Section 8.2.2.4) is
reported in the e-diary, a telephone contact or site visit should occur to confirm whether the
event meets the criteria for Grade 4.
A site visit must be scheduled as soon as possible to assess the participant unless any of the
following is true:
 The participant is unable to attend the unscheduled visit.

 The local reaction/systemic event is no longer present at the time of the telephone
contact.
 The participant recorded an incorrect value in the e-diary (confirmation of an e-diary data
entry error).
 The PI or authorized designee determined it was not needed.
This telephone contact will be recorded in the participant’s source documentation and the
CRF.
If the participant is unable to attend the unscheduled visit, or the PI or authorized designee
determined it was not needed, any ongoing local reactions/systemic events must be assessed
at the next study visit.
During the unscheduled visit, the reactions should be assessed by the investigator or a
medically qualified member of the study staff such as a study physician or a study nurse, as
applicable to the investigator’s local practice, who will:
 Measure body temperature (°F/°C).
 Measure minimum and maximum diameters of redness (if present).
 Measure minimum and maximum diameters of swelling (if present).
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 Assess injection site pain (if present) in accordance with the grades provided in
Section 8.2.2.2.
 Assess systemic events (if present) in accordance with the grades provided in
Section 8.2.2.3.
 Assess for other findings associated with the reaction and record on the AE page of the
CRF, if appropriate.
The investigator or an authorized designee will complete the unscheduled visit assessment
page of the CRF.
8.13. COVID-19 Disease Surveillance (All Participants)

If a participant experiences any of the following, he or she is instructed to contact the site
immediately, and if confirmed, participate in a telehealth visit as soon as possible, optimally
within 3 days of symptom onset. Note that this does not substitute for a participant’s routine
medical care. Therefore participants should be encouraged to seek care, if appropriate, from
their usual provider.
 A diagnosis of COVID-19;
 Fever;
 New or increased cough;
 New or increased shortness of breath;
 New or increased sore throat;
 New or increased wheezing;
 New or increased sputum production;
 New or increased nasal congestion;
 New or increased nasal discharge;
 Loss of taste/smell.
8.13.1. Potential COVID-19 Illness Telehealth Visit: (Optimally Within 3 Days After
Potential COVID-19 Illness Onset)
This telehealth visit is expected to involve the sharing of healthcare information and services
via telecommunication technologies (eg, audio, video, video-conferencing software)
remotely, thus allowing the participant and investigator to communicate on aspects of clinical
care.
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As a participant’s COVID-19 illness may evolve over time, several telehealth contacts may
be required to obtain the following information:
 Record AEs, as appropriate as described in Section 8.3.
 Instruct the participant to self-collect a nasal (midturbinate) swab and ship for assessment
at the central laboratory. The result from this swab will be provided to the site once it is
available, but this will not be in real time, and cannot be relied upon to direct clinical
care. Therefore, the participant should be encouraged to seek care, if appropriate, from
his or her usual provider.
 Collect COVID-19–related standard-of-care clinical and laboratory information. This

includes, but is not limited to:
 Symptoms
 Clinical diagnosis
 Local laboratory COVID-19 test result
 Full blood count
 C-reactive protein
 Number and type of any healthcare contact; duration of hospitalization and intensive
care unit stay
 Need for oxygen therapy
 Need for ventilation
 Schedule an appointment for the participant to return for the potential COVID-19
convalescent visit once he or she has recovered.
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8.13.2. Potential COVID-19 Convalescent Visit: (28 to 35 Days After Potential

COVID-19 Illness Visit)
 Record AEs, as appropriate as described in Section 8.3.
 Collect/update COVID-19–related clinical and laboratory information (detailed in

Section 8.13.1).
9. STATISTICAL CONSIDERATIONS
Methodology for summary and statistical analyses of the data collected in this study is
described here and further detailed in a statistical analysis plan (SAP), which will be
maintained by the sponsor. The SAP may modify what is outlined in the protocol where
appropriate; however, any major modifications of the primary endpoint definitions or their
analyses will also be reflected in a protocol amendment.
9.1. Estimands and Statistical Hypotheses

9.1.1. Estimands
The estimand corresponding to each primary, secondary, and tertiary/exploratory objective is
described in the table in Section 3.
In the primary safety objective evaluations, missing e-diary data will not be imputed.
Missing AE dates will be imputed according to Pfizer safety rules. No other missing
information will be imputed in the safety analysis.
The estimands to evaluate the immunogenicity objectives are based on evaluable populations
for immunogenicity (Section 9.3). These estimands estimate the vaccine effect in the
hypothetical setting where participants follow the study schedules and protocol requirements
as directed. Missing antibody results will not be imputed. Immunogenicity results that are
below the LLOQ will be set to 0.5 × LLOQ in the analysis.
The estimands to evaluate the efficacy objectives are based on evaluable populations for
efficacy (Section 9.3). These estimands estimate the vaccine effect in the hypothetical
setting where participants follow the study schedules and protocol requirements as directed.
Missing laboratory results will not be imputed for the primary analysis, but missing data
imputation for the efficacy endpoint may be performed as a sensitivity analysis.
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9.1.2. Statistical Hypotheses

At the end of Stage 3, the vaccine efficacy (VE) will be evaluated. VE is defined as
VE = 100 × (1 – IRR), where IRR is the infection rate ratio, the calculated ratio of the
COVID-19 infection rate in the active vaccine group to the incidence rate in the placebo
group. The efficacy hypothesis is:
H0: VE ≤20% vs Ha: VE >20%
where H0 and Ha represent null hypothesis and alternative hypothesis. For participants with
multiple infections, only the first infection will contribute to the VE calculation in the
hypothesis test.
The efficacy will be demonstrated if the null hypothesis VE ≤20% is rejected at the 0.025
significance level, that is, when the lower limit of the 2-sided 95% CI for VE is >20%, which
is derived using the Clopper-Pearson method as described by Agresti.9
9.2. Sample Size Determination

hypothesis testing. Stage 1 will comprise 15 participants (randomization ratio of 4:1 so that
12 receive active vaccine and 3 receive placebo) per group; up to 56 potential groups are
foreseen; if all groups are fully enrolled, assuming 2 dose levels are selected following the
initial dose escalation, this corresponds to a total of 840 participants. Stage 2 will include 1 or
more vaccine groups selected from Stage 1, and 225 participants will be randomized per
selected vaccine candidate in a 4:1 ratio to receive active vaccine (180 participants) or
placebo (45 participants).
For Stage 3, for the selected vaccine candidate/dose level, with assumptions of a true vaccine
efficacy (VE) of 70%, 53 cases of COVID-19 will provide 90% power to conclude true
VE >20%. This would be achieved with 3000 participants per group (1:1 randomization
ratio), based on the assumption of a 1.7% incidence rate in the placebo group, and 20% of the
participants being nonevaluable.
For safety outcomes, Table 5 shows the probability of observing at least 1 AE for a given
true event rate of a particular AE, for various sample sizes. For example, if the true AE rate
is 10%, with 12 participants in a vaccine group, there is 72% probability of observing at least
1 AE.
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Table 5. Probability of Observing at Least 1 AE by Assumed True Event Rates With

Different Sample Sizes
Assumed True Event N=12 N=45 N=180 N=3000
Rate of an AE
0.10% 0.01 0.04 0.16 0.95
0.50% 0.06 0.20 0.59 >0.99
1.00% 0.11 0.36 0.84 >0.99
2.00% 0.22 0.60 0.97 >0.99
3.00% 0.31 0.75 >0.99 >0.99
5.00% 0.46 0.90 >0.99 >0.99
7.00% 0.58 0.96 >0.99 >0.99
10.00% 0.72 0.99 >0.99 >0.99
9.3. Analysis Sets

For purposes of analysis, the following populations are defined:
Population Description
Enrolled All participants who have a signed ICD.
Randomized All participants who are assigned a randomization number in
the IWR system.

Dose 1 evaluable All eligible randomized participants who are 18 to 85 years of
immunogenicity age (stratified by 18 to 55 and 56 to 85) (inclusive) on the day
of first vaccination, receive the vaccine to which they are
randomly assigned at the first dose, have at least 1 valid and
determinate immunogenicity result 21 days after Dose 1, have
blood collection within an appropriate window after Dose 1,
and have no other major protocol deviations as determined by
the clinician.
Dose 2 evaluable All eligible randomized participants who are 18 to 85 years of
immunogenicity age (stratified by 18 to 55 and 56 to 85) (inclusive) on the day
of first vaccination, receive 2 randomized vaccinations within
the predefined window, have at least 1 valid and determinate
immunogenicity result after Dose 2, have blood collection
within an appropriate window after Dose 2, and have no other
major protocol deviations as determined by the clinician.
Dose 1 all-available All participants who receive at least 1 dose of the study
immunogenicity intervention with at least 1 valid and determinate
immunogenicity result 21 days after Dose 1.
immunogenicity result 14 days after Dose 2.
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Evaluable efficacy All eligible randomized participants who are 18 to 85 years of
age (inclusive) on the day of first vaccination, receive
2 vaccinations as randomized within the predefined window,
have the efficacy measurement after Dose 2, and have no other
All-available efficacy All eligible randomized participants who are 18 to 85 years of
age (inclusive) on the day of first vaccination, receive at least
1 vaccination, and have the efficacy measurement after Dose 2.
Safety All randomized participants who receive at least 1 dose of the
study intervention and have safety data assessed after any dose.
9.4. Statistical Analyses

The SAP will be developed and finalized before database lock for any of the planned
analyses in Section 9.5.1. It will describe the participant populations to be included in the
analyses and the procedures for accounting for missing, unused, and spurious data. This
section provides a summary of the planned statistical analyses of the primary, secondary, and
tertiary/exploratory endpoints.
9.4.1. Immunogenicity Analyses

The statistical analysis of immunogenicity results will be primarily based on the evaluable
immunogenicity populations as defined in Section 9.3.
An additional analysis will be performed based on the all-available populations if there is a

large enough difference in sample size between the all-available immunogenicity population
and the evaluable immunogenicity population. Participants will be summarized according to
the vaccine group to which they were randomized.
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Endpoint Statistical Analysis Methods

Secondary Geometric mean titers/concentrations (GMTs/GMCs) of SARS-
immunogenicity CoV-2–specific WT serum neutralizing titers and SARS-CoV-2-
spike protein–specific binding antibody and RBD-specific binding
antibody
For SARS-CoV-2–specific WT serum neutralizing titers and SARS-

CoV-2-spike protein–specific binding antibody levels and RBD-specific
binding antibody levels, GMTs/GMCs and 2-sided 95% CIs will be
provided for each investigational product (active/placebo) within each
group before vaccination and at each of the following time points:
 Stage 1 sentinel cohorts: 7 and 21 days after Dose 1; 7 and 14

days and 1, 6, 12 and 24 months after Dose 2
 Stage 1 nonsentinel cohorts and Stage 2 cohorts: 21 days after

Dose 1; 14 days and 1, 6, 12, and 24 months after Dose 2
 Stage 3 cohort(s): 1, 12, and 24 months after Dose 2

Geometric means and the associated 2-sided CIs will be derived by

calculating means and CIs on the natural log scale based on the
t-distribution, and then exponentiating the results.
GMFRs of SARS-CoV-2–specific WT serum neutralizing titers and

SARS-CoV-2-spike protein–specific binding antibody and RBD-
specific binding antibody

CoV-2-spike protein–specific antibody levels and RBD-specific binding
levels, the GMFRs and 2-sided 95% CIs will be provided for each
investigational product within each group at each of the following time
points:

days and 1, 6, 12, and 24 months after Dose 2

GMFRs will be limited to participants with nonmissing values prior to

the first dose and at the postvaccination time point. The GMFR will be
calculated as the mean of the difference of logarithmically transformed
assay results (later time point – earlier time point) and transformed back
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to the original scale. Two-sided CIs will be obtained by calculating CIs
using Student’s t-distribution for the mean difference of the
logarithmically transformed assay results and transforming the limits
back to the original scale.
Percentage of participants with ≥4-fold rise in SARS-CoV-2–

specific WT serum neutralizing titers and SARS-CoV-2-spike
protein–specific binding antibody and RBD-specific binding
antibody

CoV-2-spike protein–specific antibody levels and RBD-specific binding
levels, percentages (and 2-sided 95% CIs) of participants with ≥4-fold
rise will be provided for each investigational product within each group
at each of the following time points:


The Clopper-Pearson method will be used to calculate the CIs.
GMR of SARS-CoV-2–specific WT serum neutralizing titer fold

rise to SARS-CoV-2-spike protein–specific antibody and
SARS-CoV-2 RBD–specific binding antibody
For SARS-CoV-2–specific WT serum neutralizing titers and

SARS-CoV-2-spike protein–specific binding antibody levels and RBD-
specific binding antibody levels, the GMRs and 2-sided 95% CIs will be
provided for each investigational product within each group at each of
the following time points:


 Stage 3 Cohort(s): 1, 12, and 24 months after Dose 2
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GMRs will be limited to participants with nonmissing values for both
SARS-CoV-2–specific WT serum neutralizing titers and SARS-CoV-2-
spike protein–specific antibody/SARS-CoV-2 RBD–specific binding
antibody at each time point. The GMR will be calculated as the mean of
the difference of logarithmically transformed assay results (eg, SARS-
CoV-2–specific WT serum neutralizing titers minus SARS-CoV-2-spike
protein–specific antibody for each participant) and transformed back to
the original scale. Two-sided CIs will be obtained by calculating CIs
using Student’s t-distribution for the mean difference of the
logarithmically transformed assay results and transforming the limits
back to the original scale.
The same analysis methods will be applied to the immunogenicity

endpoints in Stages 2 and 3. For all the immunogenicity endpoints, the
analysis will be based on the Dose 1 and Dose 2 evaluable
immunogenicity populations. An additional analysis will be performed
based on the all-available immunogenicity populations if there is a large
enough difference in sample size between the all-available
immunogenicity populations and the evaluable immunogenicity
populations. Participants will be summarized according to the vaccine

group to which they were randomized. Missing serology data will not
be imputed.
Tertiary/ Correlation of an RT-PCR–confirmed COVID-19 infection and

exploratory seropositivity/seroconversion measured by nonvaccine antigen
immunogenicity SARS-CoV-2 antibody
If sufficient data are collected, percentages (and 2-sided 95% CIs) of

participants with confirmed COVID-19 and nonvaccine antigen SARS-
CoV-2 antibody levels after Dose 1 and after Dose 2 will be provided.
RCDCs for immunogenicity results
Empirical RCDCs will be provided for SARS-CoV-2–specific WT

serum neutralizing titers, SARS-CoV-2-spike protein–specific antibody,
and RBD-specific binding antibody after Dose 1 and after Dose 2.
9.4.2. Efficacy Analyses

The statistical analysis of efficacy will be based on the evaluable efficacy population
(primary analysis) and the all-available efficacy population as defined in Section 9.3.
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Secondary efficacy Ratio of COVID-19 incidence per 1000 person-years of follow-up
for the active vaccine group to the placebo group
Vaccine efficacy will be estimated by 100 × (1 – IRR), where IRR is the

infection rate ratio, the calculated ratio of COVID-19 infection
incidence per 1000 person-years follow-up in the active vaccine group
to the corresponding incidence in the placebo group after 2 doses. The
2-sided 95% CI for VE will be derived using the Clopper-Pearson
method.
The analysis will be based on the evaluable efficacy population and the
all-available efficacy population. For the primary analysis, missing
efficacy data will not be imputed. A sensitivity analysis may be
performed by imputing missing values; details will be provided in the
SAP.
9.4.3. Safety Analyses


Primary  Descriptive statistics will be provided for each reactogenicity
endpoint for each dose and vaccine group. Local reactions and
systemic events from Day 1 through Day 7 after each vaccination
will be presented by severity cumulatively across severity levels.
Descriptive summary statistics will include counts and percentages
of participants with the indicated endpoint and the associated
Clopper-Pearson 95% CIs.
 For Stage 1 sentinel cohorts, descriptive statistics will be provided

for abnormal hematology and chemistry laboratory values at 1 and
7 days after Dose 1 and 7 days after Dose 2, including grading shifts
in hematology and chemistry laboratory assessments between
baseline and 1 and 7 days after Dose 1, and before Dose 2 and
7 days after Dose 2. Descriptive summary statistics will include
counts and percentages of participants with the indicated endpoint
and the associated Clopper-Pearson 2-sided 95% CIs.
 AEs will be categorized according to the Medical Dictionary for

Regulatory Activities (MedDRA) terms. A 3-tier approach will be
used to summarize AEs. Under this approach AEs are classified into
1 of 3 tiers: (1) Tier 1 events are prespecified events of clinical
importance and are identified in a list in the product’s safety review
plan; (2) Tier 2 events are those that are not Tier 1 but are
considered “relatively common”; a MedDRA preferred term is
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defined as a Tier 2 event if there are at least 1% of participants in at
least 1 vaccine group reporting the event; and (3) Tier 3 events are
those that are neither Tier 1 nor Tier 2 events. For both Tier 1 and
Tier 2 events, 2-sided 95% CIs for the difference between the
vaccine and placebo groups in the percentage of participants
reporting the events based on the Miettinen and Nurminen method10
will be provided. In addition, for Tier 1 events, the asymptotic p-
values will also be presented for the difference between groups in
the percentage of participants reporting the events, based on the
same test statistic and under the assumption that the test statistic is
asymptotically normally distributed.
 Descriptive summary statistics (counts, percentages, and

associated Clopper-Pearson 95% CIs) will be provided for any
AE events for each vaccine group.
 SAEs will be categorized according to MedDRA terms. Counts,

percentages, and the associated Clopper-Pearson 95% CIs of SAEs
from Dose 1 to 6 months after last dose will be provided for each
vaccine group.
 The safety analyses are based on the safety population. Participants

will be summarized by vaccine group according to the
investigational products they actually received. Missing e-diary data
will not be imputed; missing AE dates will be handled according to
the Pfizer safety rules.
Secondary  Not applicable (N/A)
Exploratory  N/A
9.4.4. Other Analyses

The ratios of (GMFR A to GMFR B) and (GMFR A to GMFR C) may be explored, where
GMFR A is the geometric mean of the ratio of the SARS-CoV-2–specific WT serum
neutralizing titer at the postvaccination time point to the corresponding titer at the
prevaccination time point, GFMR B is the geometric mean of the ratio of the SARS-CoV-2
spike protein–specific binding antibody level at the postvaccination time point to the
corresponding antibody level at the prevaccination time point, and GMFR C is the geometric
mean of the ratio of the SARS-CoV-2 RBD–specific binding antibody level at the
postvaccination time point to the corresponding antibody level at the prevaccination time
point.
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9.5. Interim Analyses

No formal interim analysis is planned in this study. As this is a sponsor open-label study
during Stages 1 and 2, the sponsor may conduct unblinded reviews of the data during the
course of the study for the purpose of safety assessment, facilitating dose escalation
decisions, and/or supporting clinical development.
9.5.1. Analysis Timing

Statistical analyses will be carried out when the following data are available:
 Complete safety and immunogenicity analysis approximately 3 weeks after Dose 2 for
Stage 1.
 Complete safety and immunogenicity analysis approximately 3 weeks after Dose 2 for
Stage 2.
 Complete safety, immunogenicity, and efficacy analysis after complete data are available
for all participants for Stage 3.
9.6. Data Monitoring Committee or Other Independent Oversight Committee

This study will use an IRC and a DMC. The IRC is independent of the study team and
includes only internal members. The DMC is independent of the study team and includes
only external members. The IRC and DMC charters describe the role of the IRC and DMC
in more detail.
The responsibilities of the IRC will include:
 Review of safety data to permit dose escalations
 Review of safety data in the case of a stopping rule being met
 Review of safety and immunogenicity data to:
 Allow groups of participants of 65 to 85 years of age to proceed
 Select vaccine candidate(s)/dose level(s), and schedule(s) to proceed into Stage 2
 Select vaccine candidate(s)/dose level(s), and schedule(s) to proceed into Stage 3
 Review of any available safety and/or immunogenicity data generated during the course
of this study, or the BioNTech study conducted in Germany, to determine:
 Whether any groups may not be started
 Whether any groups may be terminated early
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 Whether any groups may be added with dose levels below the lowest stated dose or
intermediate between the lowest and highest stated doses
 Contemporaneous review of all NAAT-confirmed COVID-19 illnesses
The DMC will be responsible for ongoing monitoring of the safety of participants in the
study according to the charter. This may include, but is not limited to:
 Contemporaneous review of related AEs up to 1 month after completion of the

vaccination schedule
 Contemporaneous review of all SAEs up to 6 months after completion of the vaccination

schedule
 Contemporaneous review of all NAAT-confirmed COVID-19 illnesses
The recommendations made by the DMC to alter the conduct of the study will be forwarded
to the appropriate Pfizer personnel for final decision. Pfizer will forward such decisions,
which may include summaries of aggregate analyses of safety data, to regulatory authorities,
as appropriate.
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10. SUPPORTING DOCUMENTATION AND OPERATIONAL CONSIDERATIONS

10.1. Appendix 1: Regulatory, Ethical, and Study Oversight Considerations
10.1.1. Regulatory and Ethical Considerations
This study will be conducted in accordance with the protocol and with the following:
 Consensus ethical principles derived from international guidelines including the

Declaration of Helsinki and CIOMS International Ethical Guidelines;
 Applicable ICH GCP guidelines;
 Applicable laws and regulations, including applicable privacy laws.
The protocol, protocol amendments, ICD, SRSD(s), and other relevant documents
(eg, advertisements) must be reviewed and approved by the sponsor and submitted to an
IRB/EC by the investigator and reviewed and approved by the IRB/EC before the study is
initiated.
Any amendments to the protocol will require IRB/EC approval before implementation of
changes made to the study design, except for changes necessary to eliminate an immediate
hazard to study participants.
The investigator will be responsible for the following:
 Providing written summaries of the status of the study to the IRB/EC annually or more
frequently in accordance with the requirements, policies, and procedures established by
the IRB/EC;
 Notifying the IRB/EC of SAEs or other significant safety findings as required by IRB/EC
procedures;
 Providing oversight of the conduct of the study at the site and adherence to requirements
of 21 CFR, ICH guidelines, the IRB/EC, European regulation 536/2014 for clinical
studies (if applicable), and all other applicable local regulations.
10.1.1.1. Reporting of Safety Issues and Serious Breaches of the Protocol or ICH GCP
In the event of any prohibition or restriction imposed (ie, clinical hold) by an applicable
regulatory authority in any area of the world, or if the investigator is aware of any new
information that might influence the evaluation of the benefits and risks of the study
intervention, Pfizer should be informed immediately.
In addition, the investigator will inform Pfizer immediately of any urgent safety measures
taken by the investigator to protect the study participants against any immediate hazard, and
of any serious breaches of this protocol or of ICH GCP that the investigator becomes aware
of.
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10.1.2. Informed Consent Process

The investigator or his/her representative will explain the nature of the study to the
participant and answer all questions regarding the study. The participant should be given
sufficient time and opportunity to ask questions and to decide whether or not to participate in
the trial.
Participants must be informed that their participation is voluntary. Participants will be

required to sign a statement of informed consent that meets the requirements of 21 CFR 50,
local regulations, ICH guidelines, HIPAA requirements, where applicable, and the IRB/EC
or study center.
The investigator must ensure that each study participant is fully informed about the nature
and objectives of the study, the sharing of data related to the study, and possible risks
associated with participation, including the risks associated with the processing of the
participant’s personal data.
The participant must be informed that his/her personal study-related data will be used by the
sponsor in accordance with local data protection law. The level of disclosure must also be
explained to the participant.
The participant must be informed that his/her medical records may be examined by Clinical
Quality Assurance auditors or other authorized personnel appointed by the sponsor, by
appropriate IRB/EC members, and by inspectors from regulatory authorities.
The investigator further must ensure that each study participant is fully informed about his or
her right to access and correct his or her personal data and to withdraw consent for the
processing of his or her personal data.
The medical record must include a statement that written informed consent was obtained
before the participant was enrolled in the study and the date the written consent was obtained.
The authorized person obtaining the informed consent must also sign the ICD.
Participants must be reconsented to the most current version of the ICD(s) during their
participation in the study.
A copy of the ICD(s) must be provided to the participant. Participants who are rescreened are
required to sign a new ICD.
Unless prohibited by local requirements or IRB/EC decision, the ICD will contain a separate
section that addresses the use of samples for optional additional research. The optional
additional research does not require the collection of any further samples. The investigator
or authorized designee will explain to each participant the objectives of the additional
research. Participants will be told that they are free to refuse to participate and may
withdraw their consent at any time and for any reason during the storage period.
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10.1.3. Data Protection

All parties will comply with all applicable laws, including laws regarding the implementation
of organizational and technical measures to ensure protection of participant data.
Participants’ personal data will be stored at the study site in encrypted electronic and/or paper
form and will be password protected or secured in a locked room to ensure that only
authorized study staff have access. The study site will implement appropriate technical and
organizational measures to ensure that the personal data can be recovered in the event of
disaster. In the event of a potential personal data breach, the study site will be responsible
for determining whether a personal data breach has in fact occurred and, if so, providing
breach notifications as required by law.
To protect the rights and freedoms of participants with regard to the processing of personal
data, participants will be assigned a single, participant-specific numerical code. Any
participant records or data sets that are transferred to the sponsor will contain the numerical
code; participant names will not be transferred. All other identifiable data transferred to the
sponsor will be identified by this single, participant-specific code. The study site will
maintain a confidential list of participants who participated in the study, linking each
participant’s numerical code to his or her actual identity and medical record identification. In
case of data transfer, the sponsor will protect the confidentiality of participants’ personal data
consistent with the clinical study agreement and applicable privacy laws.
10.1.4. Dissemination of Clinical Study Data

Pfizer fulfills its commitment to publicly disclose clinical study results through posting the
results of studies on www.clinicaltrials.gov (ClinicalTrials.gov), the EudraCT, and/or
www.pfizer.com, and other public registries in accordance with applicable local
laws/regulations. In addition, Pfizer reports study results outside of the requirements of local
laws/regulations pursuant to its SOPs.
In all cases, study results are reported by Pfizer in an objective, accurate, balanced, and
complete manner and are reported regardless of the outcome of the study or the country in
which the study was conducted.
www.clinicaltrials.gov
Pfizer posts clinical trial results on www.clinicaltrials.gov for Pfizer-sponsored interventional

studies (conducted in patients) that evaluate the safety and/or efficacy of a product,
regardless of the geographical location in which the study is conducted. These results are
submitted for posting in accordance with the format and timelines set forth by US law.
EudraCT
Pfizer posts clinical trial results on EudraCT for Pfizer-sponsored interventional studies in
accordance with the format and timelines set forth by EU requirements.
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www.pfizer.com
Pfizer posts public disclosure synopses (CSR synopses in which any data that could be used
to identify individual participants have been removed) on www.pfizer.com for
Pfizer-sponsored interventional studies at the same time the corresponding study results are
posted to www.clinicaltrials.gov.
Documents within marketing authorization packages/submissions
Pfizer complies with the European Union Policy 0070, the proactive publication of clinical
data to the EMA website. Clinical data, under Phase 1 of this policy, includes clinical
overviews, clinical summaries, CSRs, and appendices containing the protocol and protocol
amendments, sample CRFs, and statistical methods. Clinical data, under Phase 2 of this
policy, includes the publishing of individual participant data. Policy 0070 applies to new
marketing authorization applications submitted via the centralized procedure since
01 January 2015 and applications for line extensions and for new indications submitted via
the centralized procedure since 01 July 2015.
Data Sharing
Pfizer provides researchers secure access to patient-level data or full CSRs for the purposes
of “bona-fide scientific research” that contributes to the scientific understanding of the

disease, target, or compound class. Pfizer will make available data from these trials
24 months after study completion. Patient-level data will be anonymized in accordance with
applicable privacy laws and regulations. CSRs will have personally identifiable information
redacted.
Data requests are considered from qualified researchers with the appropriate competencies to
perform the proposed analyses. Research teams must include a biostatistician. Data will not
be provided to applicants with significant conflicts of interest, including individuals
requesting access for commercial/competitive or legal purposes.
10.1.5. Data Quality Assurance

All participant data relating to the study will be recorded on printed or electronic CRF unless
transmitted to the sponsor or designee electronically (eg, laboratory data). The investigator is
responsible for verifying that data entries are accurate and correct by physically or
electronically signing the CRF.
The investigator must maintain accurate documentation (source data) that supports the
information entered in the CRF.
The investigator must ensure that the CRFs are securely stored at the study site in encrypted
electronic and/or paper form and are password protected or secured in a locked room to
prevent access by unauthorized third parties.
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The investigator must permit study-related monitoring, audits, IRB/EC review, and
regulatory agency inspections and provide direct access to source data documents. This
verification may also occur after study completion. It is important that the investigator(s)
and their relevant personnel are available during the monitoring visits and possible audits or
inspections and that sufficient time is devoted to the process.
Monitoring details describing strategy (eg, risk-based initiatives in operations and quality
such as risk management and mitigation strategies and analytical risk-based monitoring),
methods, responsibilities, and requirements, including handling of noncompliance issues and
monitoring techniques (central, remote, or on-site monitoring), are provided in the
monitoring plan.
The sponsor or designee is responsible for the data management of this study, including
quality checking of the data.
Study monitors will perform ongoing source data verification to confirm that data entered
into the CRF by authorized site personnel are accurate, complete, and verifiable from source
documents; that the safety and rights of participants are being protected; and that the study is
being conducted in accordance with the currently approved protocol and any other study
agreements, ICH GCP, and all applicable regulatory requirements.
Records and documents, including signed ICDs, pertaining to the conduct of this study must
be retained by the investigator for 15 years after study completion unless local regulations or
institutional policies require a longer retention period. No records may be destroyed during
the retention period without the written approval of the sponsor. No records may be
transferred to another location or party without written notification to the sponsor. The
investigator must ensure that the records continue to be stored securely for as long as they are
maintained.
When participant data are to be deleted, the investigator will ensure that all copies of such
data are promptly and irrevocably deleted from all systems.
The investigator(s) will notify the sponsor or its agents immediately of any regulatory
inspection notification in relation to the study. Furthermore, the investigator will cooperate
with the sponsor or its agents to prepare the investigator site for the inspection and will allow
the sponsor or its agent, whenever feasible, to be present during the inspection. The
investigator site and investigator will promptly resolve any discrepancies that are identified
between the study data and the participant's medical records. The investigator will promptly
provide copies of the inspection findings to the sponsor or its agent. Before response
submission to the regulatory authorities, the investigator will provide the sponsor or its
agents with an opportunity to review and comment on responses to any such findings.
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10.1.6. Source Documents

Source documents provide evidence for the existence of the participant and substantiate the
integrity of the data collected. Source documents are filed at the investigator site.
Data reported on the CRF or entered in the eCRF that are from source documents must be
consistent with the source documents or the discrepancies must be explained. The
investigator may need to request previous medical records or transfer records, depending on
the study. Also, current medical records must be available.
Definition of what constitutes source data can be found in the study monitoring plan.
Description of the use of computerized system is documented in the Data Management Plan.
10.1.7. Study and Site Start and Closure

The study start date is the date on which the clinical study will be open for recruitment of
participants.
The first act of recruitment is the date of the first participant’s first visit and will be the study
start date.
The sponsor designee reserves the right to close the study site or terminate the study at any
time for any reason at the sole discretion of the sponsor. Study sites will be closed upon
study completion. A study site is considered closed when all required documents and study
supplies have been collected and a study-site closure visit has been performed.
The investigator may initiate study-site closure at any time upon notification to the sponsor
or designee if requested to do so by the responsible IRB/EC or if such termination is required
to protect the health of study participants.
Reasons for the early closure of a study site by the sponsor may include but are not limited
to:
 Failure of the investigator to comply with the protocol, the requirements of the IRB/EC
or local health authorities, the sponsor's procedures, or GCP guidelines;
 Inadequate recruitment of participants by the investigator;
 Discontinuation of further study intervention development.
If the study is prematurely terminated or suspended, the sponsor shall promptly inform the
investigators, the ECs/IRBs, the regulatory authorities, and any CRO(s) used in the study of
the reason for termination or suspension, as specified by the applicable regulatory
requirements. The investigator shall promptly inform the participant and should assure
appropriate participant therapy and/or follow-up.
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Study termination is also provided for in the clinical study agreement. If there is any conflict
between the contract and this protocol, the contract will control as to termination rights.
10.1.8. Sponsor’s Qualified Medical Personnel

The contact information for the sponsor's appropriately qualified medical personnel for the
study is documented in the study contact list located in the supporting study documentation.
To facilitate access to appropriately qualified medical personnel on study-related medical

questions or problems, participants are provided with a contact card at the time of informed
consent. The contact card contains, at a minimum, protocol and study intervention
identifiers, participant numbers, contact information for the investigator site, and contact
details for a contact center in the event that the investigator site staff cannot be reached to
provide advice on a medical question or problem originating from another healthcare
professional not involved in the participant’s participation in the study. The contact number
can also be used by investigator staff if they are seeking advice on medical questions or
problems; however, it should be used only in the event that the established communication
pathways between the investigator site and the study team are not available. It is therefore
intended to augment, but not replace, the established communication pathways between the
investigator site and the study team for advice on medical questions or problems that may
arise during the study. The contact number is not intended for use by the participant directly,
and if a participant calls that number, he or she will be directed back to the investigator site.
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10.2. Appendix 2: Clinical Laboratory Tests

The following safety laboratory tests will be performed at times defined in the SoA section of
this protocol. Additional laboratory results may be reported on these samples as a result of
the method of analysis or the type of analyzer used by the clinical laboratory, or as derived
from calculated values. These additional tests would not require additional collection of
blood. Unscheduled clinical laboratory measurements may be obtained at any time during
the study to assess any perceived safety issues.
Hematology Chemistry Other

Hemoglobin BUN and creatinine  Urine pregnancy test (β-hCG)
Hematocrit AST, ALT At screening only:
RBC count Total bilirubin  Hepatitis B core antibody
MCV Alkaline phosphatase  Hepatitis B surface antigen
MCH  Hepatitis C antibody
MCHC  Human immunodeficiency virus
Platelet count
WBC count
Total neutrophils (Abs)
Eosinophils (Abs)
Monocytes (Abs)
Basophils (Abs)
Lymphocytes (Abs)
Investigators must document their review of each laboratory safety report.
Clinically significant abnormal laboratory findings should be recorded in the AE CRF in

accordance with the following grading scale (Table 6).
Table 6. Laboratory Abnormality Grading Scale

Hematology Mild (Grade 1) Moderate Severe (Grade 3) Potentially Life
(Grade 2) Threatening
(Grade 4)
Hemoglobin 11.0 – 12.0 9.5 – 10.9 8.0 – 9.4 <8.0
(Female) - g/dL
Hemoglobin Any decrease – 1.5 1.6 – 2.0 2.1 – 5.0 >5.0
(Female)
change from
baseline
value - g/dL
Hemoglobin 12.5 – 13.5 10.5 – 12.4 8.5 – 10.4 <8.5
(Male) - g/dL
(Male)
change from
baseline
value – g/dL
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(Grade 4)
WBC increase - 10,800 – 15,000 15,001 – 20,000 20,001 – 25, 000 >25,000
cells/mm3
WBC decrease - 2,500 – 3,500 1,500 – 2,499 1,000 – 1,499 <1,000
cells/mm3
Lymphocytes 750 – 1,000 500 – 749 250 – 499 <250
decrease - cells/mm3
Neutrophils decrease 1,500 – 2,000 1,000 – 1,499 500 – 999 <500
- cells/mm3
Eosinophils - 650 – 1500 1501 - 5000 >5000 Hypereosinophilic
cells/mm3
Platelets decreased - 125,000 – 140,000 100,000 – 124,000 25,000 – 99,000 <25,000
cells/mm3
Chemistry Mild (Grade 1) Moderate Severe Potentially Life
(Grade 2) (Grade 3) Threatening
(Grade 4)
BUN - mg/dL 23 – 26 27 – 31 > 31 Requires dialysis
Creatinine – mg/dL 1.5 – 1.7 1.8 – 2.0 2.1 – 2.5 > 2.5 or requires
dialysis
Alkaline phosphate – 1.1 – 2.0 x ULN 2.1 – 3.0 x ULN 3.1 – 10 x ULN >10 x ULN
increase by factor
Liver function tests – 1.1 – 2.5 x ULN 2.6 – 5.0 x ULN 5.1 – 10 x ULN >10 x ULN
ALT, AST
increase by factor
Bilirubin – when 1.1 – 1.25 x ULN 1.26 – 1.5 x ULN 1.51 – 1.75 x ULN >1.75 x ULN
accompanied
by any increase in
liver function test -
increase by factor
liver function test is
normal - increase by
factor
Abbreviations: ALT = alanine aminotransferase; AST = aspartate aminotransferase; BUN = blood urea nitrogen;
ULN = upper limit of normal; WBC = white blood cell.
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Evaluating, Follow-up, and Reporting
10.3.1. Definition of AE
AE Definition
 An AE is any untoward medical occurrence in a patient or clinical study participant,
temporally associated with the use of study intervention, whether or not considered
related to the study intervention.
 NOTE: An AE can therefore be any unfavorable and unintended sign (including an

abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally
associated with the use of study intervention.
Events Meeting the AE Definition

 Any abnormal laboratory test results (hematology, clinical chemistry, or urinalysis) or
other safety assessments (eg, ECG, radiological scans, vital sign measurements),
including those that worsen from baseline, considered clinically significant in the
medical and scientific judgment of the investigator Any abnormal laboratory test
results that meet any of the conditions below must be recorded as an AE:
 Is associated with accompanying symptoms.
 Requires additional diagnostic testing or medical/surgical intervention.
 Leads to a change in study dosing (outside of any protocol-specified dose

adjustments) or discontinuation from the study, significant additional concomitant
drug treatment, or other therapy.
 Exacerbation of a chronic or intermittent preexisting condition including either an

increase in frequency and/or intensity of the condition.
 New conditions detected or diagnosed after study intervention administration even

though it may have been present before the start of the study.
 Signs, symptoms, or the clinical sequelae of a suspected drug-drug interaction.
 Signs, symptoms, or the clinical sequelae of a suspected overdose of either study

intervention or a concomitant medication. Overdose per se will not be reported as an
AE/SAE unless it is an intentional overdose taken with possible suicidal/self-harming
intent. Such overdoses should be reported regardless of sequelae.
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Events NOT Meeting the AE Definition

 Any clinically significant abnormal laboratory findings or other abnormal safety
assessments which are associated with the underlying disease, unless judged by the
investigator to be more severe than expected for the participant’s condition.
 The disease/disorder being studied or expected progression, signs, or symptoms of the

disease/disorder being studied, unless more severe than expected for the participant’s
condition.
 Medical or surgical procedure (eg, endoscopy, appendectomy): the condition that

leads to the procedure is the AE.
 Situations in which an untoward medical occurrence did not occur (social and/or
convenience admission to a hospital).
 Anticipated day-to-day fluctuations of preexisting disease(s) or condition(s) present

or detected at the start of the study that do not worsen.
10.3.2. Definition of SAE

If an event is not an AE per definition above, then it cannot be an SAE even if serious
conditions are met (eg, hospitalization for signs/symptoms of the disease under study, death
due to progression of disease).
An SAE is defined as any untoward medical occurrence that, at any dose:
a. Results in death
b. Is life-threatening
The term “life-threatening” in the definition of “serious” refers to an event in which the
participant was at risk of death at the time of the event. It does not refer to an event that
hypothetically might have caused death if it were more severe.
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c. Requires inpatient hospitalization or prolongation of existing hospitalization

In general, hospitalization signifies that the participant has been detained (usually involving
at least an overnight stay) at the hospital or emergency ward for observation and/or treatment
that would not have been appropriate in the physician’s office or outpatient setting.
Complications that occur during hospitalization are AEs. If a complication prolongs
hospitalization or fulfills any other serious criteria, the event is serious. When in doubt as to
whether “hospitalization” occurred or was necessary, the AE should be considered serious.
Hospitalization for elective treatment of a preexisting condition that did not worsen from
baseline is not considered an AE.
d. Results in persistent disability/incapacity

 The term disability means a substantial disruption of a person’s ability to conduct
normal life functions.
 This definition is not intended to include experiences of relatively minor medical

significance such as uncomplicated headache, nausea, vomiting, diarrhea, influenza,
and accidental trauma (eg, sprained ankle) which may interfere with or prevent
everyday life functions but do not constitute a substantial disruption.
e. Is a congenital anomaly/birth defect
f. Other situations:
 Medical or scientific judgment should be exercised in deciding whether SAE
reporting is appropriate in other situations such as important medical events that may
not be immediately life-threatening or result in death or hospitalization but may
jeopardize the participant or may require medical or surgical intervention to prevent
one of the other outcomes listed in the above definition. These events should usually
be considered serious.
 Examples of such events include invasive or malignant cancers, intensive treatment in

an emergency room or at home for allergic bronchospasm, blood dyscrasias or
convulsions that do not result in hospitalization, or development of drug dependency
or drug abuse.
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10.3.3. Recording/Reporting and Follow-up of AEs and/or SAEs
AE and SAE Recording/Reporting
The table below summarizes the requirements for recording adverse events on the CRF and
for reporting serious adverse events on the Vaccines SAE Report Form to Pfizer Safety.
These requirements are delineated for 3 types of events: (1) SAEs; (2) nonserious adverse
events (AEs); and (3) exposure to the study intervention under study during pregnancy or
breastfeeding, and occupational exposure.
It should be noted that the Vaccines SAE Report Form for reporting of SAE information is
not the same as the AE page of the CRF. When the same data are collected, the forms must
be completed in a consistent manner. AEs should be recorded using concise medical
terminology and the same AE term should be used on both the CRF and the Vaccines SAE
Report Form for reporting of SAE information.
Safety Event Recorded on the CRF Reported on the Vaccines

SAE Report Form to
Pfizer Safety Within 24
Hours of Awareness
SAE All All

Nonserious AE All None
Exposure to the study None All (and EDP supplemental
intervention under study form for EDP)
during pregnancy or
breastfeeding, and
occupational exposure
 When an AE/SAE occurs, it is the responsibility of the investigator to review all

documentation (eg, hospital progress notes, laboratory reports, and diagnostic reports)
related to the event.
 The investigator will then record all relevant AE/SAE information in the CRF.
 It is not acceptable for the investigator to send photocopies of the participant’s

medical records to Pfizer Safety in lieu of completion of the Vaccines SAE Report
Form/AE/SAE CRF page.
 There may be instances when copies of medical records for certain cases are
requested by Pfizer Safety. In this case, all participant identifiers, with the exception
of the participant number, will be redacted on the copies of the medical records
before submission to Pfizer Safety.
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 The investigator will attempt to establish a diagnosis of the event based on signs,
symptoms, and/or other clinical information. Whenever possible, the diagnosis
(not the individual signs/symptoms) will be documented as the AE/SAE.
Assessment of Intensity
The investigator will make an assessment of intensity for each AE and SAE reported during
the study and assign it to 1 of the following categories:
GRADE If required on the AE page of the CRF, the investigator will use the adjectives
MILD, MODERATE, SEVERE, or LIFE-THREATENING to describe the
maximum intensity of the AE. For purposes of consistency, these intensity
grades are defined as follows:
1 MILD Does not interfere with participant's usual function.
2 MODERATE Interferes to some extent with participant's usual

function.
3 SEVERE Interferes significantly with participant's usual

function.
4 LIFE-THREATENING Life-threatening consequences; urgent intervention

indicated.
Assessment of Causality
 The investigator is obligated to assess the relationship between study intervention and
each occurrence of each AE/SAE.
 A “reasonable possibility” of a relationship conveys that there are facts, evidence,

and/or arguments to suggest a causal relationship, rather than a relationship cannot be
ruled out.
 The investigator will use clinical judgment to determine the relationship.
 Alternative causes, such as underlying disease(s), concomitant therapy, and other risk
factors, as well as the temporal relationship of the event to study intervention
administration, will be considered and investigated.
 The investigator will also consult the IB and/or product information, for marketed
products, in his/her assessment.
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 For each AE/SAE, the investigator must document in the medical notes that he/she
has reviewed the AE/SAE and has provided an assessment of causality.
 There may be situations in which an SAE has occurred and the investigator has
minimal information to include in the initial report to the sponsor. However, it is
very important that the investigator always make an assessment of causality for
every event before the initial transmission of the SAE data to the sponsor.
 The investigator may change his/her opinion of causality in light of follow-up

information and send an SAE follow-up report with the updated causality assessment.
 The causality assessment is one of the criteria used when determining regulatory
reporting requirements.
 If the investigator does not know whether or not the study intervention caused the
event, then the event will be handled as “related to study intervention” for reporting
purposes, as defined by the sponsor. In addition, if the investigator determines that an
SAE is associated with study procedures, the investigator must record this causal
relationship in the source documents and CRF, and report such an assessment in the
dedicated section of the Vaccines SAE Report Form and in accordance with the SAE
Follow-up of AEs and SAEs

 The investigator is obligated to perform or arrange for the conduct of supplemental
measurements and/or evaluations as medically indicated or as requested by the
sponsor to elucidate the nature and/or causality of the AE or SAE as fully as possible.
This may include additional laboratory tests or investigations, histopathological
examinations, or consultation with other healthcare providers.
 If a participant dies during participation in the study or during a recognized follow-up

period, the investigator will provide Pfizer Safety with a copy of any postmortem
findings including histopathology.
 New or updated information will be recorded in the originally completed CRF.
 The investigator will submit any updated SAE data to the sponsor within 24 hours of
receipt of the information.
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10.3.4. Reporting of SAEs
SAE Reporting to Pfizer Safety via Vaccines SAE Report Form

 Facsimile transmission of the Vaccines SAE Report Form is the preferred method to
transmit this information to Pfizer Safety.
 In circumstances when the facsimile is not working, notification by telephone is

acceptable with a copy of the Vaccines SAE Report Form sent by overnight mail or
courier service.
 Initial notification via telephone does not replace the need for the investigator to
complete and sign the Vaccines SAE Report Form pages within the designated
reporting time frames.
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10.4. Appendix 4: Contraceptive Guidance

10.4.1. Male Participant Reproductive Inclusion Criteria
Male participants are eligible to participate if they agree to the following requirements during
the intervention period and for at least 28 days after the last dose of study intervention, which
corresponds to the time needed to eliminate reproductive safety risk of the study
intervention(s):
 Refrain from donating sperm.
PLUS either:
 Be abstinent from heterosexual intercourse with a female of childbearing potential as

their preferred and usual lifestyle (abstinent on a long-term and persistent basis) and
agree to remain abstinent.
OR
 Must agree to use a male condom when engaging in any activity that allows for passage
of ejaculate to another person.
 In addition to male condom use, a highly effective method of contraception may be

considered in WOCBP partners of male participants (refer to the list of highly effective
methods below in Section 10.4.4).
10.4.2. Female Participant Reproductive Inclusion Criteria

A female participant is eligible to participate if she is not pregnant or breastfeeding, and at
least 1 of the following conditions applies:
 Is not a WOCBP (see definitions below in Section 10.4.3).
OR
 Is a WOCBP and using an acceptable contraceptive method as described below during

the intervention period (for a minimum of 28 days after the last dose of study
intervention). The investigator should evaluate the effectiveness of the contraceptive
method in relationship to the first dose of study intervention.
The investigator is responsible for review of medical history, menstrual history, and recent
sexual activity to decrease the risk for inclusion of a woman with an early undetected
pregnancy.
10.4.3. Woman of Childbearing Potential

A woman is considered fertile following menarche and until becoming postmenopausal
unless permanently sterile (see below).
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If fertility is unclear (eg, amenorrhea in adolescents or athletes) and a menstrual cycle cannot
be confirmed before the first dose of study intervention, additional evaluation should be
considered.
Women in the following categories are not considered WOCBP:
1. Premenopausal female with 1 of the following:
 Documented hysterectomy;
 Documented bilateral salpingectomy;
 Documented bilateral oophorectomy.
For individuals with permanent infertility due to an alternate medical cause other than the
above, (eg, mullerian agenesis, androgen insensitivity), investigator discretion should be
applied to determining study entry.
Note: Documentation for any of the above categories can come from the site personnel’s
review of the participant’s medical records, medical examination, or medical history
interview. The method of documentation should be recorded in the participant’s medical
record for the study.
2. Postmenopausal female:
 A postmenopausal state is defined as no menses for 12 months without an alternative

medical cause. In addition, a
 high FSH level in the postmenopausal range must be used to confirm a

postmenopausal state in women under 60 years of age and not using hormonal
contraception or HRT.
 Female on HRT and whose menopausal status is in doubt will be required to use
one of the nonestrogen hormonal highly effective contraception methods if they
wish to continue their HRT during the study. Otherwise, they must discontinue
HRT to allow confirmation of postmenopausal status before study enrollment.
10.4.4. Contraception Methods

Contraceptive use by men or women should be consistent with local availability/regulations
regarding the use of contraceptive methods for those participating in clinical trials.
1. Implantable progestogen-only hormone contraception associated with inhibition of

ovulation.
2. Intrauterine device.
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3. Intrauterine hormone-releasing system.
4. Bilateral tubal occlusion.
5. Vasectomized partner:
 Vasectomized partner is a highly effective contraceptive method provided that the

partner is the sole sexual partner of the woman of childbearing potential and the
absence of sperm has been confirmed. If not, an additional highly effective method
of contraception should be used. The spermatogenesis cycle is approximately
90 days.
6. Combined (estrogen- and progestogen-containing) hormonal contraception associated

with inhibition of ovulation:
 Oral;
 Intravaginal;
 Transdermal;
 Injectable.
7. Progestogen-only hormone contraception associated with inhibition of ovulation:
 Oral;
 Injectable.
8. Sexual abstinence:
 Sexual abstinence is considered a highly effective method only if defined as

refraining from heterosexual intercourse during the entire period of risk associated
with the study intervention. The reliability of sexual abstinence needs to be evaluated
in relation to the duration of the study and the preferred and usual lifestyle of the
participant.
9. Progestogen-only oral hormonal contraception where inhibition of ovulation is not the

primary mode of action.
10. Male or female condom with or without spermicide.
11. Cervical cap, diaphragm, or sponge with spermicide.
12. A combination of male condom with either cervical cap, diaphragm, or sponge with
spermicide (double-barrier methods).
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10.5. Appendix 5: Liver Safety: Suggested Actions and Follow-up Assessments

Potential Cases of Drug-Induced Liver Injury
Humans exposed to a drug who show no sign of liver injury (as determined by elevations in
transaminases) are termed “tolerators,” while those who show transient liver injury, but adapt
are termed “adaptors.” In some participants, transaminase elevations are a harbinger of a
more serious potential outcome. These participants fail to adapt and therefore are
"susceptible" to progressive and serious liver injury, commonly referred to as DILI.
Participants who experience a transaminase elevation above 3 × ULN should be monitored
more frequently to determine if they are an “adaptor” or are “susceptible.”
LFTs are not required as a routine safety monitoring procedure for all participants in this
study. However, should an investigator deem it necessary to assess LFTs because a
participant presents with clinical signs/symptoms, such LFT results should be managed and
followed as described below.
In the majority of DILI cases, elevations in AST and/or ALT precede TBili elevations
(>2 × ULN) by several days or weeks. The increase in TBili typically occurs while
AST/ALT is/are still elevated above 3 × ULN (ie, AST/ALT and TBili values will be
elevated within the same laboratory sample). In rare instances, by the time TBili elevations
are detected, AST/ALT values might have decreased. This occurrence is still regarded as a
potential DILI. Therefore, abnormal elevations in either AST OR ALT in addition to TBili
that meet the criteria outlined below are considered potential DILI (assessed per Hy’s law
criteria) cases and should always be considered important medical events, even before all
other possible causes of liver injury have been excluded.
The threshold of laboratory abnormalities for a potential DILI case depends on the
participant’s individual baseline values and underlying conditions. Participants who present
with the following laboratory abnormalities should be evaluated further as potential DILI
(Hy’s law) cases to definitively determine the etiology of the abnormal laboratory values:
 Participants with AST/ALT and TBili baseline values within the normal range who
subsequently present with AST OR ALT values >3 × ULN AND a TBili value >2 × ULN
with no evidence of hemolysis and an alkaline phosphatase value <2 × ULN or not
available.
 For participants with baseline AST OR ALT OR TBili values above the ULN, the
following threshold values are used in the definition mentioned above, as needed,
depending on which values are above the ULN at baseline:
 Preexisting AST or ALT baseline values above the normal range: AST or ALT values
>2 times the baseline values AND >3 × ULN; or >8 × ULN (whichever is smaller).
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 Preexisting values of TBili above the normal range: TBili level increased from
baseline value by an amount of at least 1 × ULN or if the value reaches >3 × ULN
(whichever is smaller).
Rises in AST/ALT and TBili separated by more than a few weeks should be assessed
individually based on clinical judgment; any case where uncertainty remains as to whether it
represents a potential Hy’s law case should be reviewed with the sponsor.
The participant should return to the investigator site and be evaluated as soon as possible,
preferably within 48 hours from awareness of the abnormal results. This evaluation should
include laboratory tests, detailed history, and physical assessment.
In addition to repeating measurements of AST and ALT and TBili for suspected cases of
Hy’s law, additional laboratory tests should include albumin, CK, direct and indirect
bilirubin, GGT, PT/INR, total bile acids, and alkaline phosphatase. Consideration should
also be given to drawing a separate tube of clotted blood and an anticoagulated tube of blood
for further testing, as needed, for further contemporaneous analyses at the time of the
recognized initial abnormalities to determine etiology. A detailed history, including relevant
information, such as review of ethanol, acetaminophen/paracetamol (either by itself or as a
coformulated product in prescription or over-the-counter medications), recreational drug,
supplement (herbal) use and consumption, family history, sexual history, travel history,
history of contact with a jaundiced person, surgery, blood transfusion, history of liver or
allergic disease, and potential occupational exposure to chemicals, should be collected.
Further testing for acute hepatitis A, B, C, D, and E infection and liver imaging (eg, biliary
tract) and collection of serum samples for acetaminophen/paracetamol drug and/or protein
adduct levels may be warranted.
All cases demonstrated on repeat testing as meeting the laboratory criteria of AST/ALT and
TBili elevation defined above should be considered potential DILI (Hy’s law) cases if no
other reason for the LFT abnormalities has yet been found. Such potential DILI (Hy’s law)
cases are to be reported as SAEs, irrespective of availability of all the results of the
investigations performed to determine etiology of the LFT abnormalities.
A potential DILI (Hy’s law) case becomes a confirmed case only after all results of
reasonable investigations have been received and have excluded an alternative etiology.
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10.6. Appendix 6: Abbreviations

The following is a list of abbreviations that may be used in the protocol.
Abbreviation Term
2019-nCoV novel coronavirus 2019
Abs absolute (in Appendix 2)
AE adverse event
ALT alanine aminotransferase
AST aspartate aminotransferase
-hCG beta-human chorionic gonadotropin
BMI body mass index
BUN blood urea nitrogen
CBER Center for Biologics Evaluation and Research
CFR Code of Federal Regulations
CI confidence interval
CIOMS Council for International Organizations of Medical Sciences
CONSORT Consolidated Standards of Reporting Trials
COVID-19 coronavirus disease 2019
CRF case report form
CRO contract research organization

CSR clinical study report
CT clinical trial
DILI drug-induced liver injury
DMC data monitoring committee
DNA deoxyribonucleic acid
DU dosing unit
EC ethics committee
ECG electrocardiogram
eCRF electronic case report form
e-diary electronic diary
EDP exposure during pregnancy
EMA European Medicines Agency
EU European Union
EUA emergency use application
EudraCT European Clinical Trials Database
FDA Food and Drug Administration
FSH follicle-stimulating hormone
GCP Good Clinical Practice
GGT gamma-glutamyl transferase
GMC geometric mean concentration
GMFR geometric mean fold rise
GMR geometric mean ratio
GMT geometric mean titer
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Abbreviation Term
HBc Ab hepatitis B core antibody
HBsAg hepatitis B surface antigen
HBV hepatitis B virus
HCV hepatitis C virus
HCV Ab hepatitis C virus antibody
HIPAA Health Insurance Portability and Accountability Act
HIV human immunodeficiency virus
HRT hormone replacement therapy
IB investigator’s brochure
ICD informed consent document
ICH International Council for Harmonisation
ICU intensive care unit
ID identification
Ig immunoglobulin
IgG immunoglobulin G
IgM immunoglobulin M
IMP investigational medicinal product
IND investigational new drug
INR international normalized ratio

IP manual investigational product manual
IPAL Investigational Product Accountability Log
IRB institutional review board
IRC internal review committee
IRR infection rate ratio
IRT interactive response technology
IV intravenous(ly)
IWR interactive Web-based response
LFT liver function test
LLOQ lower limit of quantitation
LNP lipid nanoparticle
LPX lipoplex
MCH mean corpuscular hemoglobin
MCHC mean corpuscular hemoglobin concentration
MCV mean corpuscular volume
MedDRA Medical Dictionary for Regulatory Activities
MERS Middle East respiratory syndrome
modRNA nucleoside-modified messenger ribonucleic acid
N/A not applicable
NAAT nucleic acid amplification test
NVA nonvaccine antigen
P2 S SARS-CoV-2 full-length, P2 mutant, “heads up,” prefusion spike
glycoprotein
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Abbreviation Term
PCR polymerase chain reaction
PI principal investigator
PPE personal protective equipment
PT prothrombin time
RBC red blood cell
RBD receptor-binding domain
RCDC reverse cumulative distribution curve
RNA ribonucleic acid
RSV respiratory syncytial virus
RT-PCR reverse transcription–polymerase chain reaction
SAE serious adverse event
SAP statistical analysis plan
saRNA self-amplifying messenger ribonucleic acid
SARS severe acute respiratory syndrome
SARS-CoV-2 severe acute respiratory syndrome coronavirus 2
SoA schedule of activities
SOP standard operating procedure
SRSD single reference safety document
SUSAR suspected unexpected serious adverse reaction

TBD to be determined
TBili total bilirubin
ULN upper limit of normal
uRNA uridine-containing messenger ribonucleic acid
US United States
vax vaccination
VE vaccine efficacy
WBC white blood cell
WHO World Health Organization
WOCBP woman/women of childbearing potential
WT wild type
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11. REFERENCES
1
World Health Organization. WHO Director-General's opening remarks at the media
briefing on COVID-19. Available from: https://www.who.int/dg/speeches/detail/who-
director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-
2020. Published: 11 March 2020. Accessed: 01 Apr 2020.
2
World Health Organization. Coronavirus disease 2019 (COVID-19) situation report - 70.
In: Data as reported by national authorities by 10:00 CET 30 March 2020. Geneva,
Switzerland: World Health Organization; 2020: 10 pages.
3
Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19):
therapeutic options. Available from: https://www.cdc.gov/coronavirus/2019-
ncov/hcp/therapeutic-options.html. Accessed: 12 Apr 2020.
4
Rauch S, Jasny E, Schmidt KE, et al. New vaccine technologies to combat outbreak
situations. Front Immunol 2018;9:1963.
5
Sahin U, Karikó K, Türeci Ö. mRNA-based therapeutics—developing a new class of
drugs. Nat Rev Drug Discov 2014;13(10):759-80.
6
BioNTech RNA Pharmaceuticals GmbH. CorVAC/BNT162 Investigator’s Brochure.
Mainz, Germany: BioNTech RNA Pharmaceuticals GmbH; 25 March 2020.
7
Feldman RA, Fuhr R, Smolenov I, et al. mRNA vaccines against H10N8 and H7N9
influenza viruses of pandemic potential are immunogenic and well tolerated in healthy
adults in phase 1 randomized clinical trials. Vaccine. 2019;37(25):3326-34.
8
US Food and Drug Administration. Guidance for industry: toxicity grading scale for
healthy adult and adolescent volunteers enrolled in preventive vaccine clinical trials.
Rockville, MD: Center for Biologics Evaluation and Research; September 2007.
9
Agresti A. Introduction: distributions and inference for categorical data. In: Agresti A,
editor. Categorical data analysis. 2nd ed. Hoboken, NJ: John Wiley & Sons; 2002:1-35.
10
Miettinen O, Nurminen M. Comparative analysis of two rates. Stat Med
1985;4(2):213-26.
PFIZER CONFIDENTIAL
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Protocol C4591001
A PHASE 1/2/3, PLACEBO-CONTROLLED, RANDOMIZED, OBSERVER-BLIND,

DOSE-FINDING STUDY TO EVALUATE THE SAFETY, TOLERABILITY,
IMMUNOGENICITY, AND EFFICACY OF SARS-COV-2 RNA VACCINE
CANDIDATES AGAINST COVID-19 IN HEALTHY INDIVIDUALS
Study Sponsor: BioNTech

Study Conducted By: Pfizer
Study Intervention Number: PF-07302048
Study Intervention Name: RNA-Based COVID-19 Vaccines
US IND Number: 19736
EudraCT Number: 2020-002641-42
Protocol Number: C4591001
Phase: 1/2/3
Short Title: A Phase 1/2/3 Study to Evaluate the Safety, Tolerability, Immunogenicity, and
Efficacy of RNA Vaccine Candidates Against COVID-19 in Healthy Individuals
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Protocol C4591001
TABLE OF CONTENTS
LIST OF TABLES .....................................................................................................................7
1. PROTOCOL SUMMARY .....................................................................................................9
1.1. Synopsis ....................................................................................................................9
1.2. Schema ....................................................................................................................16
1.3. Schedule of Activities .............................................................................................17
1.3.1. Phase 1 ........................................................................................................17
1.3.2. Phase 2/3 .....................................................................................................22
2. INTRODUCTION ...............................................................................................................24
2.1. Study Rationale .......................................................................................................24
2.2. Background .............................................................................................................24
2.2.1. Clinical Overview .......................................................................................25
2.3. Benefit/Risk Assessment .........................................................................................25
2.3.1. Risk Assessment .........................................................................................27
2.3.2. Benefit Assessment .....................................................................................28
2.3.3. Overall Benefit/Risk Conclusion ................................................................28
3. OBJECTIVES, ESTIMANDS, AND ENDPOINTS ...........................................................28
3.1. For Phase 1 ..............................................................................................................28
3.2. For Phase 2/3 ...........................................................................................................30
4. STUDY DESIGN.................................................................................................................32
4.1. Overall Design.........................................................................................................32
4.1.1. Phase 1 ........................................................................................................33
4.1.2. Phase 2/3 .....................................................................................................34
4.2. Scientific Rationale for Study Design .....................................................................34
4.3. Justification for Dose ..............................................................................................35
4.4. End of Study Definition ..........................................................................................36
5. STUDY POPULATION ......................................................................................................36
5.1. Inclusion Criteria .....................................................................................................36
5.2. Exclusion Criteria ....................................................................................................37
5.3. Lifestyle Considerations ..........................................................................................39
5.3.1. Contraception ..............................................................................................39
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Protocol C4591001
5.4. Screen Failures ........................................................................................................40

5.5. Criteria for Temporarily Delaying Enrollment/Randomization/Study
Intervention Administration ......................................................................................40
6. STUDY INTERVENTION ..................................................................................................41
6.1. Study Intervention(s) Administered ........................................................................41
6.1.1. Administration ............................................................................................42
6.2. Preparation/Handling/Storage/Accountability ........................................................42
6.2.1. Preparation and Dispensing ........................................................................43
6.3. Measures to Minimize Bias: Randomization and Blinding.....................................44
6.3.1. Allocation to Study Intervention ................................................................44
6.3.2. Blinding of Site Personnel ..........................................................................44
6.3.3. Blinding of the Sponsor ..............................................................................44
6.3.4. Breaking the Blind ......................................................................................45
6.4. Study Intervention Compliance ...............................................................................45
6.5. Concomitant Therapy ..............................................................................................45
6.5.1. Prohibited During the Study .......................................................................46
6.5.2. Permitted During the Study ........................................................................46
6.6. Dose Modification ...................................................................................................47
6.7. Intervention After the End of the Study ..................................................................47
DISCONTINUATION/WITHDRAWAL ...........................................................................47
7.1. Discontinuation of Study Intervention ....................................................................47
7.2. Participant Discontinuation/Withdrawal From the Study .......................................47
7.2.1. Withdrawal of Consent ...............................................................................48
7.3. Lost to Follow-up ....................................................................................................48
8. STUDY ASSESSMENTS AND PROCEDURES ...............................................................49
8.1. Efficacy and/or Immunogenicity Assessments .......................................................50
8.1.1. Biological Samples .....................................................................................52
8.2. Safety Assessments .................................................................................................53
8.2.1. Clinical Safety Laboratory Assessments (Phase 1 Participants Only) .......53
8.2.2. Electronic Diary ..........................................................................................54
8.2.2.1. Grading Scales ...........................................................................54
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Protocol C4591001
8.2.2.2. Local Reactions .........................................................................54

8.2.2.3. Systemic Events ........................................................................55
8.2.2.4. Fever ..........................................................................................56
8.2.2.5. Antipyretic Medication .............................................................57
8.2.3. Phase 1 Stopping Rules ..............................................................................57
8.2.4. Surveillance of Events That Could Represent Enhanced COVID-19
and Phase 2/3 Stopping Rule ...........................................................................58
8.2.5. Randomization and Vaccination After a Stopping Rule Is Met .................59
8.2.6. Pregnancy Testing ......................................................................................59
8.3. Adverse Events and Serious Adverse Events ..........................................................60
8.3.1. Time Period and Frequency for Collecting AE and SAE Information .......60
8.3.1.1. Reporting SAEs to Pfizer Safety ...............................................61
8.3.1.2. Recording Nonserious AEs and SAEs on the CRF ...................61
8.3.2. Method of Detecting AEs and SAEs ..........................................................61
8.3.3. Follow-up of AEs and SAEs.......................................................................61
8.3.4. Regulatory Reporting Requirements for SAEs...........................................62
8.3.5. Exposure During Pregnancy or Breastfeeding, and Occupational
Exposure ..........................................................................................................62
8.3.5.1. Exposure During Pregnancy ......................................................62
8.3.5.2. Exposure During Breastfeeding ................................................64
8.3.5.3. Occupational Exposure .............................................................64
8.3.6. Cardiovascular and Death Events ...............................................................64
8.3.7. Disease-Related Events and/or Disease-Related Outcomes Not
Qualifying as AEs or SAEs..............................................................................65
8.3.8. Adverse Events of Special Interest .............................................................65
8.3.8.1. Lack of Efficacy ........................................................................65
8.3.9. Medical Device Deficiencies ......................................................................65
8.3.10. Medication Errors .....................................................................................65
8.4. Treatment of Overdose ............................................................................................66
8.5. Pharmacokinetics ....................................................................................................67
8.6. Pharmacodynamics ..................................................................................................67
8.7. Genetics ...................................................................................................................67
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Protocol C4591001
8.8. Biomarkers ..............................................................................................................67

8.9. Immunogenicity Assessments .................................................................................67
8.10. Health Economics .................................................................................................67
8.11. Study Procedures ...................................................................................................67
8.11.1. Phase 1 ......................................................................................................67
8.11.1.1. Screening: (0 to 28 Days Before Visit 1) ................................67
8.11.1.3. Visit 2 – Next-Day Follow-up Visit (Vaccination 1): (1
to 3 Days After Visit 1) .....................................................................71
8 Days After Visit 1) .........................................................................72
8 Days After Visit 4) .........................................................................75
16 Days After Visit 4) .......................................................................76
Visit 4) ...............................................................................................77
After Visit 4)......................................................................................78
After Visit 4)......................................................................................79
After Visit 4)......................................................................................79
8.11.2. Phase 2/3 ...................................................................................................80
8.11.2.3. Visit 3 – 1-Month Follow-up Visit (After Vaccination 2):
(28 to 35 Days After Visit 2) .............................................................84
After Visit 2)......................................................................................85
After Visit 2)......................................................................................85
After Visit 2)......................................................................................86
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Protocol C4591001
8.12. Unscheduled Visit for a Grade 3 or Suspected Grade 4 Reaction ........................86

8.13. COVID-19 Surveillance (All Participants) ...........................................................88
8.13.1. Potential COVID-19 Illness Visit: (Optimally Within 3 Days After
Potential COVID-19 Illness Onset) .................................................................88
8.13.2. Potential COVID-19 Convalescent Visit: (28 to 35 Days After
Potential COVID-19 Illness Visit) ..................................................................90
8.14. Communication and Use of Technology ...............................................................91
9. STATISTICAL CONSIDERATIONS ................................................................................91
9.1. Estimands and Statistical Hypotheses .....................................................................91
9.1.1. Estimands ....................................................................................................91
9.1.2. Statistical Hypotheses .................................................................................92
9.2. Sample Size Determination .....................................................................................92
9.3. Analysis Sets ...........................................................................................................93
9.4. Statistical Analyses .................................................................................................94
9.4.1. Immunogenicity Analyses ..........................................................................94
9.4.2. Efficacy Analyses .......................................................................................99
9.4.3. Safety Analyses ........................................................................................100
9.4.4. Other Analyses..........................................................................................102
9.5. Interim Analyses ...................................................................................................102
9.5.1. Analysis Timing........................................................................................105
9.6. Data Monitoring Committee or Other Independent Oversight Committee ...........105
10. SUPPORTING DOCUMENTATION AND OPERATIONAL
CONSIDERATIONS ........................................................................................................107
10.1. Appendix 1: Regulatory, Ethical, and Study Oversight Considerations .............107
10.1.1. Regulatory and Ethical Considerations ..................................................107
10.1.1.1. Reporting of Safety Issues and Serious Breaches of the
Protocol or ICH GCP.......................................................................107
10.1.2. Informed Consent Process ......................................................................108
10.1.3. Data Protection .......................................................................................109
10.1.4. Dissemination of Clinical Study Data ....................................................109
10.1.5. Data Quality Assurance ..........................................................................110
10.1.6. Source Documents ..................................................................................112
10.1.7. Study and Site Start and Closure ............................................................112
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Protocol C4591001
10.1.8. Sponsor’s Qualified Medical Personnel .................................................113

10.2. Appendix 2: Clinical Laboratory Tests ...............................................................114
Evaluating, Follow-up, and Reporting ....................................................................116
10.3.1. Definition of AE .....................................................................................116
10.3.2. Definition of SAE ...................................................................................117
10.3.3. Recording/Reporting and Follow-up of AEs and/or SAEs.....................119
10.3.4. Reporting of SAEs ..................................................................................122
10.4. Appendix 4: Contraceptive Guidance .................................................................123
10.4.1. Male Participant Reproductive Inclusion Criteria ..................................123
10.4.2. Female Participant Reproductive Inclusion Criteria...............................123
10.4.3. Woman of Childbearing Potential ..........................................................124
10.4.4. Contraception Methods ...........................................................................125
10.5. Appendix 5: Liver Safety: Suggested Actions and Follow-up Assessments ......127
10.6. Appendix 6: Abbreviations .................................................................................129
10.7. Appendix 7: Stopping and Alert Rules for Enhanced COVID-19 ......................133
10.8. Appendix 8: Criteria for Allowing Inclusion of Participants With Chronic
Stable HIV, HCV, or HBV Infection ......................................................................136
11. REFERENCES ................................................................................................................137
LIST OF TABLES
Table 1. Local Reaction Grading Scale ..................................................................55
Table 2. Systemic Event Grading Scale..................................................................56
Table 3. Scale for Fever ..........................................................................................57
Table 4. Probability of Observing at Least 1 AE by Assumed True Event
Rates With Different Sample Sizes ..........................................................93
Table 5. Interim Analysis Plan and Boundaries for Efficacy and Futility ............103
Table 6. Statistical Design Operating Characteristics: Probability of Success
or Failure for Interim Analyses...............................................................104
Table 7. Statistical Design Operating Characteristics: Probability of Success
for Final Analysis and Overall ................................................................104
Table 8. Laboratory Abnormality Grading Scale .................................................114
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Table 9. Stopping Rule: Enrollment Is Stopped if the Number of Severe

Cases in the Vaccine Group Is Greater Than or Equal to the
Prespecified Stopping Rule Value (S) ....................................................134
Table 10. Alert Rule: Further Action Is Taken if the Number of Severe Cases
in the Vaccine Group Is Greater Than or Equal to the Prespecified
Alert Rule Value (A) ..............................................................................135
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1. PROTOCOL SUMMARY
1.1. Synopsis
Short Title: A Phase 1/2/3 Study to Evaluate the Safety, Tolerability, Immunogenicity, and
Efficacy of RNA Vaccine Candidates Against COVID-19 in Healthy Individuals
Rationale
A pneumonia of unknown cause detected in Wuhan, China, was first reported in

December 2019. On 08 January 2020, the pathogen causing this outbreak was identified as a
novel coronavirus 2019. The outbreak was declared a Public Health Emergency of
International Concern on 30 January 2020. On 12 February 2020, the virus was officially
named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the WHO
officially named the disease caused by SARS-CoV-2 as coronavirus disease 2019
(COVID-19). On 11 March 2020, the WHO upgraded the status of the COVID-19 outbreak
from epidemic to pandemic, which is now spreading globally at high speed.
There are currently no licensed vaccines to prevent infection with SARS-CoV-2 or

COVID-19. Given the rapid transmission of COVID-19 and incidence of disease in the
United States and elsewhere, the rapid development of an effective vaccine is of utmost
importance.
BioNTech has developed RNA-based vaccine candidates using a platform approach that
enables the rapid development of vaccines against emerging viral diseases, including
SARS-CoV-2. Each vaccine candidate is based on a platform of nucleoside-modified
messenger RNA (modRNA, BNT162b). Each vaccine candidate expresses 1 of 2 antigens:
the SARS-CoV-2 full-length, P2 mutant, prefusion spike glycoprotein (P2 S) (version 9) or a
trimerized SARS-CoV-2 spike glycoprotein receptor-binding domain (RBD) (version 5).
The 2 SARS-CoV-2 vaccine candidates that will be tested in this study are therefore:
BNT162b1 (variant RBP020.3): a modRNA encoding the RBD;
BNT162b2 (variant RBP020.2): a modRNA encoding P2 S.
All candidates are formulated in the same lipid nanoparticle (LNP) composition. This study
is intended to investigate the safety, immunogenicity, and efficacy of these prophylactic
BNT162 vaccines against COVID-19.
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Protocol C4591001
Objectives, Estimands, and Endpoints
For Phase 1

To describe the safety and tolerability In participants receiving at least 1 dose • Local reactions (pain at the
profiles of prophylactic BNT162 of study intervention, the percentage of injection site, redness, and
vaccines in healthy adults after 1 or 2 participants reporting: swelling)
doses • Local reactions for up to 7 days • Systemic events (fever, fatigue,
following each dose headache, chills, vomiting,
• Systemic events for up to 7 days diarrhea, new or worsened muscle
following each dose pain, and new or worsened joint
• Adverse events (AEs) from pain)
Dose 1 to 1 month after the last • AEs
dose • SAEs
• Serious AEs (SAEs) from Dose 1
In addition, the percentage of Hematology and chemistry laboratory
participants with: parameters detailed in Section 10.2
• Abnormal hematology and
after Dose 2
• Grading shifts in hematology and
elicited by prophylactic BNT162 protocol criteria (evaluable
vaccines in healthy adults after 1 or 2 participants) at the following time
doses points after receipt of study
intervention:
7 and 21 days after Dose 1; 7 and 14

days and 1, 6, 12, and 24 months after
Dose 2
• Geometric mean titers (GMTs) at SARS-CoV-2 neutralizing titers

each time point
• Geometric mean fold rise (GMFR)
vaccination
• Proportion of participants
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Protocol C4591001

• Geometric mean concentrations S1-binding IgG levels and RBD-
(GMCs) at each time point binding IgG levels
• GMFR from before vaccination to
each subsequent time point after
vaccination
• Geometric mean ratio (GMR), • SARS-CoV-2 neutralizing titers
estimated by the ratio of the • S1-binding IgG levels
geometric mean of SARS-CoV-2 • RBD-binding IgG levels
neutralizing titers to the geometric
mean of binding IgG levels at each
time point
For Phase 2/3
Objectivesa Estimands Endpoints

Primary Efficacy
To evaluate the efficacy of In participants complying with the COVID-19 incidence per 1000
prophylactic BNT162b2 against key protocol criteria (evaluable person-years of follow-up based on
confirmed COVID-19 in participants participants) at least 7 days after central laboratory or locally
without evidence of infection before receipt of the last dose of study confirmed NAAT in participants with
vaccination intervention: no serological or virological evidence
100 × (1 – IRR) [ratio of active (up to 7 days after receipt of the last
vaccine to placebo] dose) of past SARS-CoV-2 infection
with and without evidence of receipt of the last dose of study confirmed NAAT
infection before vaccination intervention:
100 × (1 – IRR) [ratio of active
vaccine to placebo]
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Protocol C4591001

Primary Safety
To define the safety profile of In participants receiving at least 1 • Local reactions (pain at the
prophylactic BNT162b2 in the first dose of study intervention, the injection site, redness, and
360 participants randomized (Phase 2) percentage of participants reporting: swelling)
• Local reactions for up to 7 days • Systemic events (fever, fatigue,
• Systemic events for up to 7 days diarrhea, new or worsened
following each dose muscle pain, and new or
• AEs from Dose 1 to 7 days after worsened joint pain)
the last dose • AEs
• SAEs from Dose 1 to 7 days • SAEs
after the last dose
To define the safety profile of In participants receiving at least • AEs
prophylactic BNT162b2 in all 1 dose of study intervention, the • SAEs
participants randomized in Phase 2/3 percentage of participants reporting: • In a subset of at least 6000
• Local reactions for up to 7 days participants:
following each dose o Local reactions (pain at the
• Systemic events for up to 7 days injection site, redness, and
following each dose swelling)
• AEs from Dose 1 to 1 month o Systemic events (fever,
after the last dose fatigue, headache, chills,
• SAEs from Dose 1 to 6 months vomiting, diarrhea, new or
after the last dose worsened muscle pain, and
new or worsened joint pain)
Secondary Efficacy
To evaluate the efficacy of In participants complying with the Confirmed severe COVID-19
prophylactic BNT162b2 against key protocol criteria (evaluable incidence per 1000 person-years of
confirmed severe COVID-19 in participants) at least 7 days after follow-up in participants with no
participants without evidence of receipt of the last dose of study serological or virological evidence of
infection before vaccination intervention: past SARS-CoV-2 infection
vaccine to placebo]
confirmed severe COVID-19 in participants) at least 7 days after follow-up
participants with and without receipt of the last dose of study
evidence of infection before intervention:
vaccination 100 × (1 – IRR) [ratio of active
vaccine to placebo]
To describe the efficacy of In participants complying with the COVID-19 incidence per 1000
confirmed COVID-19 (according to participants) at least 7 days after central laboratory or locally
the CDC-defined symptoms) in receipt of the last dose of study confirmed NAAT in participants with
participants without evidence of intervention: no serological or virological evidence
infection before vaccination 100 × (1 – IRR) [ratio of active (up to 7 days after receipt of the last
the CDC-defined symptoms) in receipt of the last dose of study confirmed NAAT
participants with and without intervention:
evidence of infection before 100 × (1 – IRR) [ratio of active
vaccination vaccine to placebo]
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Protocol C4591001

Exploratory
To evaluate the immune response GMC/GMT, GMFR, and percentage • S1-binding IgG levels and/or
over time to prophylactic BNT162b2 of participants with titers greater than RBD-binding IgG levels
and persistence of immune response defined threshold(s), at baseline and • SARS-CoV-2 neutralizing titers
in participants with and without 1, 6, 12, and 24 months after
serological or virological evidence of completion of vaccination
SARS-CoV-2 infection before
vaccination
To evaluate the immune response • N-binding antibody
(non-S) to SARS-CoV-2 in
participants with and without
confirmed COVID-19 during the
study
To describe the serological responses • S1-binding IgG levels and/or
to the BNT vaccine candidate in cases RBD-binding IgG levels
of: • SARS-CoV-2 neutralizing titers
• Confirmed COVID-19 • N-binding antibody
• Confirmed severe COVID-19 • SARS-CoV-2 detection by
• SARS-CoV-2 infection without NAAT
confirmed COVID-19
To describe the safety, • All safety, immunogenicity, and
immunogenicity, and efficacy of efficacy endpoints described
prophylactic BNT162b2 in above
individuals with confirmed stable HIV
disease
a. HIV-positive participants in Phase 3 will not be included in analyses of the objectives, with the
exception of the specific exploratory objective.
Overall Design
This is a Phase 1/2/3, multicenter, multinational, randomized, placebo-controlled, observer-

blind, dose-finding, vaccine candidate–selection, and efficacy study in healthy individuals.
The study consists of 2 parts: Phase 1: to identify preferred vaccine candidate(s) and dose
level(s); Phase 2/3: an expanded cohort and efficacy part. These parts, and the progression
between them, are detailed in the schema (Section 1.2).
The study will evaluate the safety, tolerability, and immunogenicity of 2 different
SARS-CoV-2 RNA vaccine candidates against COVID-19 and the efficacy of 1 candidate:
• As a 2-dose (separated by 21 days) schedule;
• At various different dose levels in Phase 1;
• In 3 age groups (Phase 1: 18 to 55 years of age, 65 to 85 years of age; Phase 2/3: ≥16
years of age [stratified as ≤55 or >55 years of age]).
in Phase 1 may be started at the next highest dose, groups may not be started, groups may be
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Protocol C4591001
terminated early, and/or groups may be added with dose levels below the lowest stated dose
or intermediate between the lowest and highest stated doses.
The vaccine candidate selected for Phase 2/3 evaluation is BNT162b2 at a dose of 30 µg.
Number of Participants
Each group in Phase 1 will comprise 15 participants (12 receiving active vaccine and
3 receiving placebo). In this phase, 13 groups will be studied, corresponding to a total of
195 participants.
The vaccine candidate selected for Phase 2/3, BNT162b2 at a dose of 30 µg, will comprise
21,999 vaccine recipients. It is intended that a minimum of 40% of participants will be in the
>55-year stratum. An equal number of participants will receive placebo, ie, randomized in a
1:1 ratio.
Intervention Groups and Duration
The study will evaluate a 2-dose (separated by 21 days) schedule of various different dose
levels of 2 investigational RNA vaccine candidates for active immunization against
COVID-19 in 3 age groups (Phase 1: 18 to 55 years of age, 65 to 85 years of age; Phase 2/3:
≥16 years of age [stratified as ≤55 or >55 years of age]):
• BNT162b1 (BNT162 RNA-LNP vaccine utilizing modRNA and encoding the RBD):
10 µg, 20 µg, 30 µg, 100 µg
• BNT162b2 (BNT162 RNA-LNP vaccine utilizing modRNA and encoding the P2 S):
10 µg, 20 µg, 30 µg

The duration of study follow-up may be shorter among participants enrolled in Phase 1
dosing arms that are not evaluated in Phase 2/3.
Data Monitoring Committee or Other Independent Oversight Committee
The study will utilize an IRC, an internal Pfizer committee that will review data to allow
dose escalation or changes to continuation of specific groups.
An external data monitoring committee (DMC) will be formed and will review cumulative
unblinded data throughout the study.
Statistical Methods
The sample size for Phase 1 of the study is not based on any statistical hypothesis testing.
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Protocol C4591001
For Phase 2/3, the VE evaluation will be the primary objective. The VE is defined as
VE = 100 × (1 – IRR), where IRR is calculated as the ratio of the first confirmed COVID-19
illness rate in the vaccine group to the corresponding illness rate in the placebo group. With
assumptions of a true VE of 60% and 4 IAs planned, 164 COVID-19 cases will provide 90%
power to conclude true VE >30%. This would be achieved with a total 43,998 participants
(21,999 vaccine recipients), based on the assumption of a 1.3% per year incidence in the
placebo group, accrual of 164 primary-endpoint cases within 6 months, and 20% of the
participants being nonevaluable. If the attack rate is much higher, case accrual would be
expected to be more rapid, enabling the study’s primary endpoint to be evaluated much
sooner. The total number of participants enrolled in Phase 2/3 may vary depending on the
incidence of COVID-19 at the time of the enrollment, the true underlying VE, and a potential
early stop for efficacy or futility.
VE will be evaluated using a beta-binomial model and the posterior probability of VE being
>30% will be assessed.
The primary safety objective will be evaluated by descriptive summary statistics for local
reactions, systemic events, AEs/SAEs, and abnormal hematology and chemistry laboratory
parameters (Phase 1 only), for each vaccine group. A 3-tier approach will be used to
summarize AEs in Phase 2/3.
The immunogenicity objectives will be evaluated descriptively by GMT, GMC, GMFR,

percentage of participants with ≥4-fold rise, percentage of participants with ≥ specified
threshold, and GMC ratio, and the associated 95% confidence intervals (CIs), for
SARS-CoV-2 neutralizing titers, S1-binding IgG levels, and RBD-binding IgG levels at the
various time points.
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Protocol C4591001
1.2. Schema
Phase 1 For each vaccine candidate (4:1 randomization active:placebo)
Age: 18-55 y Age: 65-85 y

Low-dose-level 2-dose group (n=15)
IRC (safety) IRC (safety Low-dose-level 2-dose group (n=15)
after Dose 1)
Mid-dose-level 2-dose group (n=15)
IRC (safety) IRC (safety Mid-dose-level 2-dose group (n=15)

after Dose 1)
High-dose-level 2-dose group (n=15)
IRC (safety High-dose-level 2-dose group (n=15)

after Dose 1)
IRC choice of group(s) for Phase 2/3

(safety & immunogenicity after Doses 1 and 2)
Phase 2/3 Single vaccine candidate (1:1 randomization active:placebo)

Safety and immunogenicity analysis of Age: ≥16
Phase 2 data (first 360 participants) (Stratified 16-55 or >55)
by unblinded team (these participants BNT162b2 30 µg or placebo 2 doses
will also be included in Phase 3 (n~21,999 per group, total n~43.998)
analyses)
Abbreviation: IRC = internal review committee.
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Protocol C4591001
1.3. Schedule of Activities

The SoA table provides an overview of the protocol visits and procedures. Refer to the STUDY ASSESSMENTS AND
PROCEDURES section of the protocol for detailed information on each procedure and assessment required for compliance with the
protocol.
The investigator may schedule visits (unplanned visits) in addition to those listed in the SoA table, in order to conduct evaluations or
assessments required to protect the well-being of the participant.
1.3.1. Phase 1

up Visit (Vax 1) (Vax 2) (Vax 2) up Visit up Visit Visita Visit
(Vax 1)
Illness
Onset
Obtain demography and X
medical history data
Obtain details of medications X
currently taken
Perform physical examination X X X X X X X
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Protocol C4591001

(Vax 1)
Illness
Onset
Measure vital signs X X X X X X X
(including body temperature)
Collect blood sample for ~10 mL ~10 mL ~10 mL ~10 mL ~10 mL
hematology and chemistry
laboratory testsb
Collect screening blood ~10 mL
sample for HIV, HBsAg,
HBc Ab, and HCV Ab tests
Serological test for prior ~20 mL
COVID-19 infection
Perform urine pregnancy test X X X
(if appropriate)
Obtain nasal (midturbinate) X X X
swab(s)c
Collect nonstudy vaccine X X X X X X X X X
information
Confirm eligibility X X X
Collect prohibited medication X X X X X X X X X X X
use
Review hematology and X X X X X
chemistry results
Review temporary delay X X
criteria
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Protocol C4591001

(Vax 1)
Illness
Onset
Confirm use of contraceptives X X X X X X X X
(if appropriate)
Obtain randomization number X
and study intervention
allocation
Collect blood sample for ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~20 mL ~20 mL ~20 mL ~20 mL
immunogenicity assessment + + +
optionale optionale optionale
~170 mL ~170 mL ~170 mL
Assess acute reactions for at X X
least 30 minutes after study
intervention administrationd
Explain participant X
communication methods
(including for e-diary
completion), assist the
participant with downloading
the app, or issue provisioned
device, if required
Provide thermometer and X X
measuring device
Review reactogenicity e-diary
data (daily review is optimal
during the active diary period)
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Protocol C4591001

(Vax 1)
Illness
Onset
Review ongoing X X
reactogenicity e-diary
symptoms and obtain stop
dates
Collect AEs and SAEs as X X X X X X X X X X X X X
appropriate
Collect e-diary or assist the X
participant to delete
application
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Protocol C4591001

(Vax 1)
Illness
Onset
Collection of COVID-19– X X
related clinical and laboratory
information (including local
diagnosis)
Abbreviations: e-diary = electronic diary; HBc Ab = hepatitis B core antibody; HBsAg = hepatitis B surface antigen; HCV Ab = hepatitis C virus antibody;
HIV = human immunodeficiency virus; NAAT = nucleic acid amplification test; vax = vaccination.
a. The COVID-19 illness visit may be conducted as an in-person or telehealth visit.
b. Hematology: hemoglobin, complete blood count with differential, and platelets. Blood chemistry: alanine aminotransferase (ALT), aspartate
aminotransferase (AST), alkaline phosphatase, total bilirubin, blood urea nitrogen (BUN), and creatinine.
c. Two swabs will be taken at Visits 1 and 4. One will be tested (if possible at the site, otherwise at the central laboratory) within 24 hours and vaccination will
only proceed if it is NAAT-negative for SARS-CoV-2 genomes. The second will be sent to the central laboratory for potential later testing.
d. The first 5 participants in in each group will be observed at the site for at least 4 hours after study intervention administration. Further vaccination will
commence no sooner than 24 hours after the fifth participant received his or her vaccination.
e. An optional blood draw of ~170 mL will be taken at 1 of the visits (from selected participants who consent) for exploratory COVID-19 research.
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1.3.2. Phase 2/3


Follow-up Follow-up Follow-up Follow-up COVID-19 COVID-19
Visit Visit Visit Visit Illness Visita Convalescent
Visit
Visit Window (Days) Day 1b 19 to 23 Days 28 to 35 Days 175 to 189 350 to 378 714 to 742 Optimally 28 to 35 Days
Visit 2 Visit 2 Visit 2 Days After Potential
Potential COVID-19
Illness Onset
Obtain demography and medical history data X
c X
Perform clinical assessment
For participants who are HIV positive, record latest X X X X X
CD4 count and HIV viral load
Measure height and weight X
Perform urine pregnancy test (if appropriate) X X
Confirm use of contraceptives (if appropriate) X X X
Collect nonstudy vaccine information X X X X
Collect prohibited medication use X X X X X X X
Collect blood sample for immunogenicity ~20 mL ~20 mL ~20 mL ~20 mL ~20 mL ~20 mL
assessmentd
Obtain randomization number and study X
intervention allocation
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Follow-up Follow-up Follow-up Follow-up COVID-19 COVID-19
Visit Visit Visit Visit Illness Visita Convalescent
Visit
Visit Window (Days) Day 1b 19 to 23 Days 28 to 35 Days 175 to 189 350 to 378 714 to 742 Optimally 28 to 35 Days
Visit 2 Visit 2 Visit 2 Days After Potential
Potential COVID-19
Illness Onset
Assess acute reactions for at least 30 minutes after X X
study intervention administration
Explain participant communication methods X
(including for e-diary completion), assist the
participant with downloading the app, or issue
provisioned device, if required
Provide/ensure the participant has a thermometer X X
(all participants) and measuring device
(reactogenicity subset participants only)
Review reactogenicity e-diary data (daily review is
optimal during the active diary period)d
Review ongoing reactogenicity e-diary symptoms X X
and obtain stop datesd
Collect AEs and SAEs as appropriate X X X Xe Xe Xe X Xe
Collect e-diary or assist the participant to delete X
application
Collection of COVID-19–related clinical and X X
laboratory information (including local diagnosis)
Abbreviations: HIV = human immunodeficiency virus; e-diary = electronic diary.
a. The COVID-19 illness visit may be conducted as an in-person or telehealth visit.
b. The visit may be conducted across 2 consecutive days; if so, all steps from assessing the inclusion and exclusion criteria onwards must be conducted on the
same day.
c. Including, if indicated, a physical examination.
d. Reactogenicity subset participants only.
e. Any AEs occurring up to 48 hours after the blood draw must be recorded (see Section 8.3.1).
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Protocol C4591001
2. INTRODUCTION
The BNT162 RNA-based COVID-19 vaccines are currently being investigated for
prevention of COVID-19 in healthy individuals.
2.1. Study Rationale

The purpose of the study is to rapidly describe the safety, tolerability, and immunogenicity of
2 BNT162 RNA-based COVID-19 vaccine candidates against COVID-19, and the efficacy
of 1 candidate, in healthy individuals. There are currently no licensed vaccines to prevent
infection with SARS-CoV-2 or COVID-19. Given the global crisis of COVID-19 and fast
expansion of the disease in the United States and elsewhere, the rapid development of an
effective vaccine is of utmost importance.
2.2. Background
In December 2019, a pneumonia outbreak of unknown cause occurred in Wuhan, China.
In January 2020, it became clear that a novel coronavirus (2019-nCoV) was the underlying
cause. Later in January, the genetic sequence of the 2019-nCoV became available to the
World Health Organization (WHO) and public (MN908947.3), and the virus was categorized
in the Betacoronavirus subfamily. By sequence analysis, the phylogenetic tree revealed a
closer relationship to severe acute respiratory syndrome (SARS) virus isolates than to another
coronavirus infecting humans, the Middle East respiratory syndrome (MERS) virus.
SARS-CoV-2 infections and the resulting disease, COVID-19, have spread globally,
affecting a growing number of countries.
On 11 March 2020, the WHO characterized the COVID-19 outbreak as a pandemic.1

The WHO Situation Update Report dated 30 March 2020 noted 693,224 confirmed cases
with 33,106 deaths globally, including 142,081 confirmed cases with 2457 deaths in the
Americas.2 The United States currently has the most reported cases globally. At the time of
this communication, the number of confirmed cases continues to rise globally. There are
currently no vaccines or effective antiviral drugs to treat SARS-CoV-2 infections or the
disease it causes, COVID-19.3
A prophylactic, RNA-based SARS-CoV-2 vaccine provides one of the most flexible and
fastest approaches available to immunize against the emerging virus.4,5
The development of an RNA-based vaccine encoding a viral antigen, which is then expressed
by the vaccine recipient as a protein capable of eliciting protective immune responses,
provides significant advantages over more traditional vaccine approaches. Unlike live
attenuated vaccines, RNA vaccines do not carry the risks associated with infection and may
be given to people who cannot be administered live virus (eg, pregnant women and
immunocompromised persons). RNA-based vaccines are manufactured via a cell-free in
vitro transcription process, which allows an easy and rapid production and the prospect of
producing high numbers of vaccination doses within a shorter time period than achieved with
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Protocol C4591001
traditional vaccine approaches. This capability is pivotal to enable the most effective
response in outbreak scenarios.
Two SARS-CoV-2–RNA lipid nanoparticle (RNA-LNP) vaccines based on a platform of

nucleoside-modified messenger RNA (modRNA, BNT162b) will be evaluated in this study.
Each vaccine candidate expresses 1 of 2 antigens: the SARS-CoV-2 full-length, P2 mutant,
prefusion spike glycoprotein (P2 S) (version 9) or a trimerized SARS-CoV-2 spike
glycoprotein-receptor binding domain (RBD) (version 5). The 2 SARS-CoV-2 vaccine
candidates that will be tested in this study are therefore:
• BNT162b1 (variant RBP020.3): nucleoside-modified messenger RNA (modRNA) with

blunted innate immune sensor–activating capacity and augmented expression encoding
the RBD.
• BNT162b2 (variant RBP020.2): nucleoside-modified messenger RNA (modRNA) as

above, but encoding P2 S.
The vaccine candidate selected for Phase 2/3 evaluation is BNT162b2.
2.2.1. Clinical Overview

Prior to this study, given clinical data from other similarly formulated uRNA liposomal
vaccines from BioNTech in oncology trials6 and recent published results from clinical trials
using modRNA influenza vaccines by Moderna,7 the BNT162 vaccines were expected to
have a favorable safety profile with mild, localized, and transient effects. BNT162 vaccines
based on modRNA have now been administered to humans for the first time in this study and
the BNT162-01 study conducted in Germany by BioNTech, at doses between 1 µg and
100 µg. The currently available safety and immunogenicity data are presented in the BNT162
IB.
2.3. Benefit/Risk Assessment

There is an ongoing global pandemic of COVID-19 with no preventative or therapeutic
options available. While there were no data available from clinical trials on the use of
BNT162 vaccines in humans at the outset of this study, available nonclinical data with these
vaccines, and data from nonclinical studies and clinical trials with the same or related RNA
components, or antigens, supported a favorable risk/benefit profile. Anticipated AEs after
vaccination were expected to be manageable using routine symptom-driven standard of care
as determined by the investigators and, as a result, the profile of these vaccine candidates
supported initiation of this Phase 1/2/3 clinical study.
Updates as part of protocol amendment 6:
• In order for the overall Phase 3 study population to be as representative and diverse as
possible, the inclusion of participants with known chronic stable HIV, HCV, or HBV
infection is permitted. Individuals with chronic viral diseases are at increased risk for
COVID-19 complications and severe disease. In addition, with the currently available
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Protocol C4591001
therapies for their treatment, many individuals with chronic stable HIV, HCV, and HBV
infections are unlikely to be at higher safety risk as a participant in this vaccine study
than individuals with other chronic stable medical conditions.
• All participants with chronic stable HIV disease will be included in the reactogenicity
subset (see Section 8.2.2).
More detailed information about the known and expected benefits and risks and reasonably
expected AEs of BNT162 RNA-based COVID-19 vaccines may be found in the IB, which is
the SRSD for this study.
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Protocol C4591001
2.3.1. Risk Assessment

Potential Risk of Clinical Summary of Data/Rationale for Risk Mitigation Strategy
Significance
Study Intervention: BNT162 RNA-Based COVID-19 Vaccine
Potential for local reactions (injection These are common adverse reactions seen The Phase 1 study design includes the use of controlled vaccination and
site redness, injection site swelling, with other vaccines, as noted in the FDA dose escalation to closely monitor and limit the rate of enrollment to ensure
and injection site pain) and systemic Center for Biologics Evaluation and participant safety. The study employs the use of a reactogenicity e-diary to
events (fever, fatigue, headache, Research (CBER) guidelines on toxicity monitor local reactions and systemic events in real time. Stopping rules are
chills, vomiting, diarrhea, muscle grading scales for healthy adult volunteers also in place. The first 5 participants in each group in Phase 1 will be
pain, and joint pain) following enrolled in preventive vaccine clinical observed for 4 hours after vaccination to assess any immediate AEs. All
vaccination. trials.8 other participants will be observed for at least 30 minutes after vaccination.
Unknown AEs and laboratory This study is one of the first 2 parallel- The Phase 1 study design includes the use of controlled vaccination and
abnormalities with a novel vaccine. running clinical studies with the BNT162 dose escalation to closely monitor and limit the rate of enrollment to ensure
vaccine candidates and as such there are no participant safety. An IRC (in Phase 1) and DMC (throughout the study)
clinical data available for this vaccine. will also review safety data. Stopping rules are also in place. The first 5
participants in each group in Phase 1 will be observed for 4 hours after
vaccination to assess any immediate AEs. All other participants will be
observed for at least 30 minutes after vaccination.
Potential for COVID-19 Disease enhancement has been seen Phase 1 excludes participants with likely previous or current COVID-19. In
enhancement. following vaccination with respiratory Phase 2/3, temporary delay criteria defer vaccination of participants with
syncytial virus (RSV), feline coronavirus, possible current clinical COVID-19. All participants are followed for
and Dengue virus vaccines. SARS-CoV-2 antigen-specific antibody and SARS-CoV-2 neutralizing
titers, and COVID-19 illness, including markers of severity.
Study Procedures
Participants will be required to attend Without appropriate social distancing and Pfizer will work with sites to ensure an appropriate COVID-19 prevention
healthcare facilities during the global PPE, there is a potential for increased strategy. Potential COVID-19 illness visits can be conducted via telehealth,
SARS-CoV-2 pandemic. exposure to SARS-CoV-2. without the need for an in-person visit, if required, with the participant
performing a self-swab.
Venipuncture will be performed There is the risk of bleeding, bruising, Only appropriately qualified personnel would obtain the blood draw.
during the study. hematoma formation, and infection at the
venipuncture site.
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Protocol C4591001
2.3.2. Benefit Assessment

Benefits to individual participants may include:
• Receipt of a potentially efficacious COVID-19 vaccine during a global pandemic
• Access to COVID-19 diagnostic and antibody testing
• Contributing to research to help others in a time of global pandemic
2.3.3. Overall Benefit/Risk Conclusion

Taking into account the measures taken to minimize risk to participants participating in this
study, the potential risks identified in association with BNT162 RNA-based COVID-19
vaccine are justified by the anticipated benefits that may be afforded to healthy participants.
3. OBJECTIVES, ESTIMANDS, AND ENDPOINTS

3.1. For Phase 1
To describe the safety and tolerability In participants receiving at least 1 dose • Local reactions (pain at the
profiles of prophylactic BNT162 of study intervention, the percentage of injection site, redness, and
vaccines in healthy adults after 1 or 2 participants reporting: swelling)
doses • Local reactions for up to 7 days • Systemic events (fever, fatigue,
• Systemic events for up to 7 days diarrhea, new or worsened muscle
following each dose pain, and new or worsened joint
• Adverse events (AEs) from pain)
Dose 1 to 1 month after the last • AEs
dose • SAEs
• Serious AEs (SAEs) from Dose 1
In addition, the percentage of Hematology and chemistry laboratory

participants with: parameters detailed in Section 10.2
after Dose 2
• Grading shifts in hematology and
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Protocol C4591001

elicited by prophylactic BNT162 protocol criteria (evaluable
vaccines in healthy adults after 1 or 2 participants) at the following time
doses points after receipt of study
intervention: 7 and 21 days after Dose
1; 7 and 14 days and 1, 6, 12, and 24
months after Dose 2
• Geometric mean titers (GMTs) at SARS-CoV-2 neutralizing titers
each time point
• Geometric mean fold rise (GMFR)
vaccination
• Geometric mean concentrations S1-binding IgG levels and RBD-

(GMCs) at each time point binding IgG levels
• GMFR from prior to first dose of
study intervention to each
subsequent time point
• Geometric mean ratio (GMR), • SARS-CoV-2 neutralizing titers

estimated by the ratio of the
geometric mean of SARS-CoV-2 • S1-binding IgG levels
neutralizing titers to the geometric • RBD-binding IgG levels
mean of binding IgG levels at
each time point
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Protocol C4591001
3.2. For Phase 2/3

Primary Efficacy
without evidence of infection before receipt of the last dose of study confirmed NAAT in participants with
vaccination intervention: no serological or virological evidence
100 × (1 – IRR) [ratio of active (up to 7 days after receipt of the last
with and without evidence of receipt of the last dose of study confirmed NAAT
infection before vaccination intervention:
vaccine to placebo]
Primary Safety
To define the safety profile of In participants receiving at least 1 • Local reactions (pain at the
prophylactic BNT162b2 in the first dose of study intervention, the injection site, redness, and
360 participants randomized (Phase 2) percentage of participants reporting: swelling)
• Local reactions for up to 7 days • Systemic events (fever, fatigue,
• Systemic events for up to 7 days diarrhea, new or worsened
following each dose muscle pain, and new or
• AEs from Dose 1 to 7 days after worsened joint pain)
the last dose • AEs
• SAEs from Dose 1 to 7 days • SAEs
after the last dose
To define the safety profile of In participants receiving at least • AEs

prophylactic BNT162b2 in all 1 dose of study intervention, the • SAEs
participants randomized in Phase 2/3 percentage of participants reporting: • In a subset of at least 6000
• Local reactions for up to 7 days participants:
following each dose o Local reactions (pain at the
• Systemic events for up to 7 days injection site, redness, and
following each dose swelling)
• AEs from Dose 1 to 1 month o Systemic events (fever,
after the last dose fatigue, headache, chills,
• SAEs from Dose 1 to 6 months vomiting, diarrhea, new or
after the last dose worsened muscle pain, and
new or worsened joint pain)
Secondary Efficacy
confirmed severe COVID-19 in participants) at least 7 days after follow-up in participants with no
participants without evidence of receipt of the last dose of study serological or virological evidence of
infection before vaccination intervention: past SARS-CoV-2 infection
vaccine to placebo]
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Protocol C4591001

confirmed severe COVID-19 in participants) at least 7 days after follow-up
participants with and without receipt of the last dose of study
evidence of infection before intervention:
vaccination 100 × (1 – IRR) [ratio of active
vaccine to placebo]
the CDC-defined symptoms) in receipt of the last dose of study confirmed NAAT in participants with
participants without evidence of intervention: no serological or virological evidence
infection before vaccination 100 × (1 – IRR) [ratio of active (up to 7 days after receipt of the last
the CDC-defined symptoms) in receipt of the last dose of study confirmed NAAT
participants with and without intervention:
evidence of infection before 100 × (1 – IRR) [ratio of active
vaccination vaccine to placebo]
Exploratory
To evaluate the immune response GMC/GMT, GMFR, and percentage • S1-binding IgG levels and/or
over time to prophylactic BNT162b2 of participants with titers greater than RBD-binding IgG levels
and persistence of immune response defined threshold(s), at baseline and • SARS-CoV-2 neutralizing titers
in participants with and without 1, 6, 12, and 24 months after
serological or virological evidence of completion of vaccination
SARS-CoV-2 infection before
vaccination
To evaluate the immune response • N-binding antibody
(non-S) to SARS-CoV-2 in
participants with and without
confirmed COVID-19 during the
study
To describe the serological responses • S1-binding IgG levels and/or
to the BNT vaccine candidate in cases RBD-binding IgG levels
of: • SARS-CoV-2 neutralizing titers
• Confirmed COVID-19 • N-binding antibody
• Confirmed severe COVID-19 • SARS-CoV-2 detection by
• SARS-CoV-2 infection without NAAT
confirmed COVID-19
To describe the safety, • All safety, immunogenicity, and
immunogenicity, and efficacy of efficacy endpoints described
prophylactic BNT162b2 in above
individuals with confirmed stable
HIV disease
a. HIV-positive participants in Phase 3 will not be included in analyses of the objectives, with the
exception of the specific exploratory objective.
This protocol will use a group of internal case reviewers to determine whether certain
investigator-reported events meet the definition of disease-related efficacy endpoints, using
predefined endpoint criteria.
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Protocol C4591001
For those AEs that are handled as disease-related efficacy endpoints (which may include
death), a DMC will conduct unblinded reviews on a regular basis throughout the trial
(see Section 9.6).
Any AE that is determined by the internal case reviewers NOT to meet endpoint criteria is
reported back to the investigator site of incidence. Refer to Section 8.3.1.1 for instructions
on how to report any such AE that meets the criteria for seriousness to Pfizer Safety.
4. STUDY DESIGN
4.1. Overall Design
This is a multicenter, multinational, Phase 1/2/3, randomized, placebo-controlled, observer-
blind, dose-finding, vaccine candidate–selection, and efficacy study in healthy individuals.
The study consists of 2 parts. Phase 1: to identify preferred vaccine candidate(s) and dose
level(s); Phase 2/3: an expanded cohort and efficacy part. These parts, and the progression
between them, are detailed in the schema (Section 1.2).
The study will evaluate the safety, tolerability, and immunogenicity of 2 different
SARS-CoV-2 RNA vaccine candidates against COVID-19 and the efficacy of 1 candidate:
• As a 2-dose (separated by 21 days) schedule;
• At various different dose levels in Phase 1;
• In 3 age groups (Phase 1: 18 to 55 years of age, 65 to 85 years of age; Phase 2/3: ≥16
years of age [stratified as ≤55 or >55 years of age]).
in Phase 1 may be started at the next highest dose, groups may not be started, groups may be
terminated early, and/or groups may be added with dose levels below the lowest stated dose
or intermediate between the lowest and highest stated doses.

unblinded.
allocation for the participants in Phase 1.
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Protocol C4591001
4.1.1. Phase 1
Each group (vaccine candidate/dose level/age group) will comprise 15 participants;
12 participants will be randomized to receive active vaccine and 3 to receive placebo.
For each vaccine candidate/dose level/age group, the following apply:
• Additional safety assessments (see Section 8.2)
• Controlled enrollment (required only for the first candidate and/or dose level studied):
• No more than 5 participants (4 active, 1 placebo) can be vaccinated on the first day
• The first 5 participants must be observed by blinded site staff for at least 4 hours after
vaccination for any acute reactions
• Vaccination of the remaining participants will commence no sooner than 24 hours

after the fifth participant received his or her vaccination
• Application of stopping rules
• IRC review of safety data to determine escalation to the next dose level in the 18- to
55-year age cohort:
• Escalation between dose levels will be based on IRC review of at least 7-day
post–Dose 1 safety data in this study and/or the BioNTech study conducted in
Germany (BNT162-01)
• Note that, since both candidates are based upon the same RNA platform, dose
escalation for the second candidate studied may be based upon the safety profile of
the first candidate studied being deemed acceptable at the same, or a higher, dose
level by the IRC
Groups of participants 65 to 85 years of age will not be started until safety data for the RNA
platform have been deemed acceptable at the same, or a higher, dose level in the 18- to
55-year age cohort by the IRC.
In this phase, 13 groups will be studied, corresponding to a total of 195 participants.
The IRC will select 1 vaccine candidate that, in Phase 1, has an established dose level per age
group based on induction of a post–Dose 2 immune response, including neutralizing
antibodies, which is expected to be associated with protection against COVID-19, for
progression into Phase 2/3.
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Protocol C4591001
4.1.2. Phase 2/3

and/or the BioNTech study conducted in Germany (BNT162-01), 1 vaccine candidate was
selected to proceed into Phase 2/3. Participants in this phase will be ≥16 years of age,
stratified as follows: 16 to 55 years or >55 years. It is intended that a minimum of 40% of
participants will be in the >55-year stratum. Commencement of each age stratum will be
based upon satisfactory post–Dose 2 safety and immunogenicity data from the 18- to 55-year
and 65- to 85-year age groups in Phase 1, respectively. The vaccine candidate selected for
Phase 2/3 evaluation is BNT162b2 at a dose of 30 µg.
Phase 2/3 is event-driven. Under the assumption of a true VE rate of ≥60%, after the last
dose of investigational product, a target of 164 primary-endpoint cases of confirmed
COVID-19 due to SARS-CoV-2 occurring at least 7 days following the last dose of the
primary series of the candidate vaccine will be sufficient to provide 90% power to conclude
true VE >30% with high probability. The total number of participants enrolled in Phase 2/3
may vary depending on the incidence of COVID-19 at the time of the enrollment, the true
underlying VE, and a potential early stop for efficacy or futility.
Assuming a COVID-19 attack rate of 1.3% per year in the placebo group, accrual of 164
primary-endpoint cases within 6 months, an estimated 20% nonevaluable rate, and 1:1
randomization, the BNT162b2 vaccine candidate selected for Phase 2/3 is expected to
comprise approximately 21,999 vaccine recipients. This is the number of participants
initially targeted for Phase 2/3 and may be adjusted based on advice from DMC analyses of
case accumulation and the percentage of participants who are seropositive at baseline.
Dependent upon the evolution of the pandemic, it is possible that the COVID-19 attack rate
may be much higher, in which case accrual would be expected to be more rapid, enabling the
study’s primary endpoint to be evaluated much sooner.
The first 360 participants enrolled (180 to active vaccine and 180 to placebo, stratified
equally between 18 to 55 years and >55 to 85 years) will comprise the “Phase 2” portion.
Safety data through 7 days after Dose 2 and immunogenicity data through 1 month after
Dose 2 from these 360 participants will be analyzed by the unblinded statistical team,
reviewed by the DMC, and submitted to appropriate regulatory authorities for review.
Enrollment may continue during this period and these participants would be included in the
efficacy evaluation in the “Phase 3” portion of the study.

The duration of study follow-up may be shorter among participants enrolled in Phase 1
dosing arms that are not evaluated in Phase 2/3.
4.2. Scientific Rationale for Study Design

Additional surveillance for COVID-19 will be conducted as part of the study, given the
potential risk of disease enhancement. If a participant experiences symptoms, as detailed in
Section 8.13, a COVID-19 illness and subsequent convalescent visit will occur. As part of
these visits, samples (nasal [midturbinate] swab and blood) will be taken for antigen and
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Protocol C4591001
antibody assessment as well as recording of COVID-19–related clinical and laboratory

information (including local diagnosis).
Human reproductive safety data are not available for BNT162 RNA-based COVID-19
vaccines, but there is no suspicion of human teratogenicity based on the intended mechanism
of action of the compound. Therefore, the use of a highly effective method of contraception
is required (see Appendix 4).
4.3. Justification for Dose

Because of the requirement for a rapid response to the newly emerged COVID-19 pandemic,
sufficient data were not available to experimentally validate the dose selection and initial
starting dose. Therefore, the original planned starting dose of 10 µg (for both BNT162b1 and
BNT162b2) in this study was based on nonclinical experience with the same RNAs encoding
other viral antigens (such as influenza and HIV antigens). The general safety and
effectiveness of uRNA and modRNA platforms have been demonstrated in oncological
clinical trials with different administration routes (NCT02410733, NCT03871348). Doses of
up to 400 µg total uRNA have been administered IV as RNA lipoplex (RNA-LPX) and doses
of up to 1000 µg total naked modRNA have been administered intratumorally, both without
signs of unpredictable overstimulation of the immune system.
Based on nonclinical data of the RNA components, with other liposomes or in conjunction
with the lipid nanoparticles as will be tested clinically in this study, it was expected that
doses in the 1- to 5-µg range would be immunogenic and induce neutralizing antibodies;
however, it was anticipated that 3- to 10-fold higher doses would likely be required to elicit a
stronger antibody response. Based on previous clinical and nonclinical experience, it was
expected that doses of up to 100 µg would be well tolerated.
Update as part of protocol amendment 2: preliminary experience in this study and the
BioNTech study conducted in Germany (BNT162-01) suggests that, for vaccine candidates
based on the modRNA platform, a dose level between 30 µg and 100 µg warrants
consideration. Therefore, a 50-µg dose level is formally included for BNT162b1 and
BNT162b2.
Update as part of protocol amendment 3: as data have become available from this study and
the BNT162-01 study in Germany, it was decided:
• To not study the BNT162a1 and BNT162c2 vaccine candidates at this time, so these
candidates have been removed from the protocol; and
• That lower dose levels of BNT162b1 and BNT162b2 warrant consideration. Therefore, a
20-µg dose level is formally included for both candidates.
Update as part of protocol amendment 4: the 50-µg dose level for BNT162b1 and BNT162b2
is removed and the 100-µg dose level for BNT162b2 is removed; similar dose levels of
BNT162b3 may be studied as for BNT162b1 and BNT162b2.
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Protocol C4591001
Update as part of protocol amendment 5: the vaccine candidate selected for Phase 2/3
evaluation is BNT162b2 at a dose of 30 µg. BNT162b3 will not be studied.
4.4. End of Study Definition

A participant is considered to have completed the study if he/she has completed all phases of
the study, including the last visit. Note that participants enrolled in Phase 1 in groups that do
not proceed to Phase 2/3 may be followed for fewer than 24 months (but no less than
6 months after the last vaccination).
The end of the study is defined as the date of last visit of the last participant in the study.
5. STUDY POPULATION
This study can fulfill its objectives only if appropriate participants are enrolled. The
following eligibility criteria are designed to select participants for whom participation in the
study is considered appropriate. All relevant medical and nonmedical conditions should be
taken into consideration when deciding whether a particular participant is suitable for this
protocol.
Prospective approval of protocol deviations to recruitment and enrollment criteria, also

known as protocol waivers or exemptions, is not permitted.
5.1. Inclusion Criteria

Participants are eligible to be included in the study only if all of the following criteria apply:
Age and Sex:
1. Male or female participants between the ages of 18 and 55 years, inclusive, and 65 and
85 years, inclusive (Phase 1), or ≥16 years (Phase 2/3), at randomization.
• Refer to Appendix 4 for reproductive criteria for male (Section 10.4.1) and female
(Section 10.4.2) participants.
Type of Participant and Disease Characteristics:
2. Participants who are willing and able to comply with all scheduled visits, vaccination
plan, laboratory tests, lifestyle considerations, and other study procedures.
3. Healthy participants who are determined by medical history, physical examination

(if required), and clinical judgment of the investigator to be eligible for inclusion in the
study.
Note: Healthy participants with preexisting stable disease, defined as disease not
requiring significant change in therapy or hospitalization for worsening disease during
the 6 weeks before enrollment, can be included. Specific criteria for Phase 3 participants
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Protocol C4591001
with known stable infection with human immunodeficiency virus (HIV), hepatitis C virus
(HCV), or hepatitis B virus (HBV) can be found in Section 10.8.
4. Phase 2/3 only: Participants who, in the judgment of the investigator, are at higher risk
for acquiring COVID-19 (including, but not limited to, use of mass transportation,
relevant demographics, and frontline essential workers).
Informed Consent:
5. Capable of giving personal signed informed consent as described in Appendix 1, which

includes compliance with the requirements and restrictions listed in the ICD and in this
protocol.
5.2. Exclusion Criteria

Participants are excluded from the study if any of the following criteria apply:
Medical Conditions:
1. Other medical or psychiatric condition including recent (within the past year) or active
suicidal ideation/behavior or laboratory abnormality that may increase the risk of study
participation or, in the investigator’s judgment, make the participant inappropriate for the
study.
2. Phases 1 and 2 only: Known infection with human immunodeficiency virus (HIV),
hepatitis C virus (HCV), or hepatitis B virus (HBV).
3. History of severe adverse reaction associated with a vaccine and/or severe allergic
reaction (eg, anaphylaxis) to any component of the study intervention(s).
4. Receipt of medications intended to prevent COVID-19.
5. Previous clinical or microbiological diagnosis of COVID-19.
6. Phase 1 only: Individuals at high risk for severe COVID-19, including those with any of
the following risk factors:
• Hypertension
• Diabetes mellitus
• Chronic pulmonary disease
• Asthma
• Current vaping or smoking
• History of chronic smoking within the prior year
• Chronic liver disease
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Protocol C4591001
• Stage 3 or worse chronic kidney disease (glomerular filtration rate

<60 mL/min/1.73 m2)
• Resident in a long-term facility
• BMI >30 kg/m2
• Anticipating the need for immunosuppressive treatment within the next 6 months
7. Phase 1 only: Individuals currently working in occupations with high risk of exposure to
SARS-CoV-2 (eg, healthcare worker, emergency response personnel).
8. Immunocompromised individuals with known or suspected immunodeficiency, as

determined by history and/or laboratory/physical examination.
9. Phase 1 only: Individuals with a history of autoimmune disease or an active autoimmune

disease requiring therapeutic intervention, including but not limited to: systemic or
cutaneous lupus erythematosus, autoimmune arthritis/rheumatoid arthritis, Guillain-Barré
syndrome, multiple sclerosis, Sjögren’s syndrome, idiopathic thrombocytopenia purpura,
glomerulonephritis, autoimmune thyroiditis, giant cell arteritis (temporal arteritis),
psoriasis, and insulin-dependent diabetes mellitus (type 1).
10. Bleeding diathesis or condition associated with prolonged bleeding that would, in the
opinion of the investigator, contraindicate intramuscular injection.
11. Women who are pregnant or breastfeeding.
Prior/Concomitant Therapy:
12. Previous vaccination with any coronavirus vaccine.
13. Individuals who receive treatment with immunosuppressive therapy, including cytotoxic
agents or systemic corticosteroids, eg, for cancer or an autoimmune disease, or planned
receipt throughout the study. If systemic corticosteroids have been administered short
term (<14 days) for treatment of an acute illness, participants should not be enrolled into
the study until corticosteroid therapy has been discontinued for at least 28 days before
study intervention administration. Inhaled/nebulized (except for participants in
Phase 1 – see exclusion criterion 14), intra-articular, intrabursal, or topical (skin or eyes)
corticosteroids are permitted.
14. Phase 1 only: Regular receipt of inhaled/nebulized corticosteroids.
15. Receipt of blood/plasma products or immunoglobulin, from 60 days before study

intervention administration or planned receipt throughout the study.
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Protocol C4591001
Prior/Concurrent Clinical Study Experience:
16. Participation in other studies involving study intervention within 28 days prior to study
entry and/or during study participation.
17. Previous participation in other studies involving study intervention containing lipid
nanoparticles.
Diagnostic Assessments:
18. Phase 1 only: Positive serological test for SARS-CoV-2 IgM and/or IgG antibodies at
the screening visit.
19. Phase 1 only: Any screening hematology and/or blood chemistry laboratory value that
meets the definition of a ≥ Grade 1 abnormality.
Note: With the exception of bilirubin, participants with any stable Grade 1 abnormalities
(according to the toxicity grading scale) may be considered eligible at the discretion of
the investigator. (Note: A “stable” Grade 1 laboratory abnormality is defined as a report
of Grade 1 on an initial blood sample that remains ≤ Grade 1 upon repeat testing on a
second sample from the same participant.)
20. Phase 1 only: Positive test for HIV, hepatitis B surface antigen (HBsAg), hepatitis B
core antibodies (HBc Abs), or hepatitis C virus antibodies (HCV Abs) at the screening
visit.
21. Phase 1 only: SARS-CoV-2 NAAT-positive nasal swab within 24 hours before receipt of
study intervention.
Other Exclusions:
22. Investigator site staff or Pfizer/BioNTech employees directly involved in the conduct of
the study, site staff otherwise supervised by the investigator, and their respective family
members.
5.3. Lifestyle Considerations

5.3.1. Contraception
The investigator or his or her designee, in consultation with the participant, will confirm that
the participant has selected an appropriate method of contraception for the individual
participant and his or her partner(s) from the permitted list of contraception methods
(see Appendix 4, Section 10.4.4) and will confirm that the participant has been instructed in
its consistent and correct use. At time points indicated in the SoA, the investigator or
designee will inform the participant of the need to use highly effective contraception
consistently and correctly and document the conversation and the participant’s affirmation in
the participant’s chart (participants need to affirm their consistent and correct use of at least 1
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Protocol C4591001
of the selected methods of contraception). In addition, the investigator or designee will

instruct the participant to call immediately if the selected contraception method is
discontinued or if pregnancy is known or suspected in the participant or partner.
5.4. Screen Failures

Screen failures are defined as participants who consent to participate in the clinical study but
are not subsequently randomly assigned to study intervention. A minimal set of screen
failure information is required to ensure transparent reporting of screen failure participants to
meet the CONSORT publishing requirements and to respond to queries from regulatory
authorities. Minimal information includes demography, screen failure details, eligibility
criteria, and any SAE.
Individuals who do not meet the criteria for participation in this study (screen failure) may be
rescreened under a different participant number.
5.5. Criteria for Temporarily Delaying Enrollment/Randomization/Study Intervention

Administration
The following conditions are temporary or self-limiting and a participant may be vaccinated
once the condition(s) has/have resolved and no other exclusion criteria are met.
1. Current febrile illness (body temperature ≥100.4°F [≥38°C]) or other acute illness within
48 hours before study intervention administration. This includes current symptoms that
could represent a potential COVID-19 illness:
• New or increased cough;
• New or increased shortness of breath;
• Chills;
• New or increased muscle pain;
• New loss of taste/smell;
• Sore throat;
• Diarrhea;
• Vomiting.
2. Receipt of any seasonal or pandemic influenza vaccine within 14 days, or any other
nonstudy vaccine within 28 days, before study intervention administration.
3. Anticipated receipt of any seasonal or pandemic influenza vaccine within 14 days, or any
other nonstudy vaccine within 28 days, after study intervention administration.
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Protocol C4591001
4. Receipt of short-term (<14 days) systemic corticosteroids. Study intervention

administration should be delayed until systemic corticosteroid use has been discontinued
for at least 28 days. Inhaled/nebulized, intra-articular, intrabursal, or topical (skin or
eyes) corticosteroids are permitted.
6. STUDY INTERVENTION
Study intervention is defined as any investigational intervention(s), marketed product(s),
placebo, medical device(s), or study procedure(s) intended to be administered to a study
participant according to the study protocol.
The study will evaluate a 2-dose (separated by 21 days) schedule of various different dose
levels of 2 investigational RNA vaccine candidates for active immunization against
COVID-19 in 3 age groups (18 to 55 years of age, 65 to 85 years of age, and ≥16 years of
age [stratified as ≤55 or >55 years of age]).
These 2 investigational RNA vaccine candidates, with the addition of saline placebo, are the
3 potential study interventions that may be administered to a study participant:
• BNT162b1 (BNT162 RNA-LNP vaccine utilizing modRNA and encoding the RBD):
10 µg, 20 µg, 30 µg, 100 µg
• BNT162b2 (BNT162 RNA-LNP vaccine utilizing modRNA and encoding the P2 S):
10 µg, 20 µg, 30 µg
• Normal saline (0.9% sodium chloride solution for injection)
6.1. Study Intervention(s) Administered

Intervention Name BNT162b1 BNT162b2 Saline Placebo
(BNT162 RNA-LNP (BNT162 RNA-LNP
vaccine utilizing vaccine utilizing
modRNA) modRNA)
Type Vaccine Vaccine Placebo
Dose Formulation modRNA modRNA Normal saline (0.9%
sodium chloride solution
for injection)
Unit Dose Strength(s) 250 µg/0.5 mL 250 µg/0.5 mL N/A
a
Dosage Level(s) 10-, 20-, 30-, 100-µg 10-, 20-, 30-µg N/A
Route of Administration Intramuscular injection Intramuscular injection Intramuscular injection
Use Experimental Experimental Placebo
IMP or NIMP IMP IMP IMP
Sourcing Provided centrally by the Provided centrally by the Provided centrally by the
sponsor sponsor sponsor
Packaging and Labeling Study intervention will be Study intervention will be Study intervention will be
provided in a glass vial as provided in a glass vial as provided in a glass or
open-label supply. Each open-label supply. Each plastic vial as open-label
vial will be labeled as vial will be labeled as supply. Each vial will be
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Protocol C4591001
Intervention Name BNT162b1 BNT162b2 Saline Placebo

(BNT162 RNA-LNP (BNT162 RNA-LNP
vaccine utilizing vaccine utilizing
modRNA) modRNA)
required per country required per country labeled as required per
requirement requirement country requirement
a. Dependent upon safety and/or immunogenicity data generated during the course of this study, or the
BioNTech study conducted in Germany (BNT162-01), it is possible that groups may be started at the next
highest dose, groups may not be started, groups may be terminated early, and/or groups may be added
with dose levels below the lowest stated dose or intermediate between the lowest and highest stated doses.
6.1.1. Administration
Participants will receive 1 dose of study intervention as randomized at each vaccination visit
(Visits 1 and 4 for Phase 1 participants, Visits 1 and 2 for Phase 2/3 participants) in
accordance with the study’s SoA. The volume to be administered may vary by vaccine
candidate and dose level; full details are described in the IP manual.
Study intervention should be administered intramuscularly into the deltoid muscle, preferably
of the nondominant arm, by an unblinded administrator.
Standard vaccination practices must be observed and vaccine must not be injected into blood
vessels. Appropriate medication and other supportive measures for management of an acute
hypersensitivity reaction should be available in accordance with local guidelines for standard
immunization practices.
Administration of study interventions should be performed by an appropriately qualified,

GCP-trained, and vaccine-experienced member of the study staff (eg, physician, nurse,
physician’s assistant, nurse practitioner, pharmacist, or medical assistant) as allowed by
local, state, and institutional guidance.
Study intervention administration details will be recorded on the CRF.
6.2. Preparation/Handling/Storage/Accountability
1. The investigator or designee must confirm appropriate temperature conditions have been
maintained during transit for all study interventions received and any discrepancies are
reported and resolved before use of the study intervention.
2. Only participants enrolled in the study may receive study intervention and only
authorized site staff may supply or administer study intervention. All study interventions
must be stored in a secure, environmentally controlled, and monitored (manual or
automated recording) area in accordance with the labeled storage conditions with access
limited to the investigator and authorized site staff. At a minimum, daily minimum and
maximum temperatures for all site storage locations must be documented and available
upon request. Data for nonworking days must indicate the minimum and maximum
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Protocol C4591001
temperatures since previously documented for all site storage locations upon return to
business.
3. Any excursions from the study intervention label storage conditions should be reported to
Pfizer upon discovery along with any actions taken. The site should actively pursue
options for returning the study intervention to the storage conditions described in the
labeling, as soon as possible. Once an excursion is identified, the study intervention must
be quarantined and not used until Pfizer provides permission to use the study
intervention. Specific details regarding the definition of an excursion and information the
site should report for each excursion will be provided to the site in the IP manual.
4. Any storage conditions stated in the SRSD will be superseded by the storage conditions
stated on the label.
5. Study interventions should be stored in their original containers.
6. See the IP manual for storage conditions of the study intervention.
7. The investigator, institution, or the head of the medical institution (where applicable) is
responsible for study intervention accountability, reconciliation, and record maintenance
(ie, receipt, reconciliation, and final disposition records), such as the IPAL or
sponsor-approved equivalent. All study interventions will be accounted for using a study
intervention accountability form/record.
8. Further guidance and information for the final disposition of unused study interventions
are provided in the IP manual. All destruction must be adequately documented. If
destruction is authorized to take place at the investigator site, the investigator must ensure
that the materials are destroyed in compliance with applicable environmental regulations,
institutional policy, and any special instructions provided by Pfizer.
Upon identification of a product complaint, notify the sponsor within 1 business day of
discovery as described in the IP manual.
6.2.1. Preparation and Dispensing
See the IP manual for instructions on how to prepare the study intervention for
administration. Study intervention should be prepared and dispensed by an appropriately
qualified and experienced member of the study staff (eg, physician, nurse, physician’s
assistant, nurse practitioner, pharmacy assistant/technician, or pharmacist) as allowed by
local, state, and institutional guidance. A second staff member will verify the dispensing.
Study intervention and placebo will be prepared by qualified unblinded site personnel
according to the IP manual. The study intervention will be administered in such a way to
ensure the participants remain blinded.
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6.3. Measures to Minimize Bias: Randomization and Blinding

6.3.1. Allocation to Study Intervention
Allocation (randomization) of participants to vaccine groups will proceed through the use of
an IRT system (IWR). The site personnel (study coordinator or specified designee) will be
required to enter or select information including but not limited to the user’s ID and
password, the protocol number, and the participant number. The site personnel will then be
provided with a vaccine assignment and randomization number. The IRT system will
provide a confirmation report containing the participant number, randomization number, and
study intervention allocation assigned. The confirmation report must be stored in the site’s
files.
6.3.2. Blinding of Site Personnel

In this observer blinded study, the study staff receiving, storing, dispensing, preparing, and
administering the study interventions will be unblinded. All other study and site personnel,
including the investigator, investigator staff, and participants, will be blinded to study
intervention assignments. In particular, the individuals who evaluate participant safety will
be blinded. Because the BNT162 RNA-based COVID-19 vaccine candidates and placebo
are different in physical appearance, the study intervention syringes will be administered in a
manner that prevents the study participants from identifying the study intervention type based
on its appearance.
The responsibility of the unblinded dispenser and administrator must be assigned to an

individual or individuals who will not participate in the evaluation of any study participants.
Contact between the unblinded dispenser and study participants and unblinded administrator
and study participants should be kept to a minimum. The remaining site personnel must not
know study intervention assignments.
6.3.3. Blinding of the Sponsor

To facilitate rapid review of data in real time, sponsor staff will be unblinded to study
intervention allocation for the participants in Phase 1. The majority of sponsor staff will be
blinded to study intervention allocation in Phase 2/3. All laboratory testing personnel
performing serology assays will remain blinded to study intervention assigned/received
throughout the study. The following sponsor staff, who will have no part in the blinded
conduct of the study, will be unblinded in Phase 2/3 (further details will be provided in a data
blinding plan):
• Those study team members who are involved in ensuring that protocol requirements for
study intervention preparation, handling, allocation, and administration are fulfilled at the
site will be unblinded for the duration of the study (eg, unblinded study manager,
unblinded clinical research associate).
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• Unblinded clinician(s), who are not direct members of the study team and will not
participate in any other study-related activities, will review unblinded protocol
deviations.
• An unblinded team supporting interactions with, and analyses for, the DMC
(see Section 9.6). This will comprise a statistician, programmer(s), and a medical
monitor who will review cases of severe COVID-19 as they are received, and will review
AEs at least weekly for additional potential cases of severe COVID-19
(see Section 8.2.3).
• An unblinded submissions team will be responsible for preparing unblinded analyses and
documents to support regulatory activities that may be required while the study is
ongoing. All statistical analyses conducted on Phase 2/3 data while the study is ongoing,
that are not in support of the DMC, will be performed by this team. This team will not
have access to unblinded COVID-19 cases unless efficacy is achieved in either an interim
analysis or the final analysis, as determined by the DMC.
6.3.4. Breaking the Blind

The IRT will be programmed with blind-breaking instructions. In case of an emergency, the
investigator has the sole responsibility for determining if unblinding of a participant’s study
intervention assignment is warranted. Participant safety must always be the first
consideration in making such a determination. If the investigator decides that unblinding is
warranted, the investigator should make every effort to contact the sponsor prior to
unblinding a participant’s vaccine assignment unless this could delay further management of
the participant. If a participant’s vaccine assignment is unblinded, the sponsor must be
notified within 24 hours after breaking the blind. The date and reason that the blind was
broken must be recorded in the source documentation and CRF.
6.4. Study Intervention Compliance

When participants are dosed at the site, they will receive study intervention directly from the
investigator or designee, under medical supervision. The date and time of each dose
administered in the clinic will be recorded in the source documents and recorded in the CRF.
The dose of study intervention and study participant identification will be confirmed at the
time of dosing by a member of the study site staff other than the person administering the
study intervention.
6.5. Concomitant Therapy

• All vaccinations received from 28 days prior to study enrollment until the 6-month
follow-up visit (Visit 8 for Phase 1 participants, and Visit 4 for Phase 2/3 participants).
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• Prohibited medications listed in Section 6.5.1 will be recorded, to include start and stop
dates, name of the medication, dose, unit, route, and frequency.
• In addition, for participants enrolled in Phase 1, all current medication at baseline will be
recorded, to include start date, name of the medication, dose, unit, route, and frequency.
6.5.1. Prohibited During the Study

Receipt of the following vaccines and medications during the time periods listed below may
exclude a participant from the per-protocol analysis from that point onwards, and may
require vaccinations to be discontinued in that participant; however, it is anticipated that the
participant would not be withdrawn from the study (see Section 7). Medications should not
be withheld if required for a participant’s medical care.
Unless considered medically necessary, no vaccines other than study intervention should be
administered within 28 days before and 28 days after each study vaccination. One exception
to this is that seasonal and pandemic influenza vaccine can be given at least 14 days after, or
at least 14 days prior to, the administration of study intervention.
Receipt of chronic systemic treatment with known immunosuppressant medications, or

radiotherapy, within 60 days before enrollment through conclusion of the study.
Receipt of systemic corticosteroids (≥20 mg/day of prednisone or equivalent) for ≥14 days is
prohibited from 28 days prior to enrollment to Visit 7 for Phase 1 participants, and Visit 3 for
Phase 2/3 participants).
Receipt of inhaled/nebulized corticosteroids from 28 days prior to enrollment to Visit 7

(1-month follow-up visit) for Phase 1 participants.
Receipt of blood/plasma products or immunoglobulins within 60 days before enrollment

through conclusion of the study.
Receipt of any other (nonstudy) coronavirus vaccine at any time prior to or during study
participation is prohibited.
Prophylactic antipyretics and other pain medication to prevent symptoms associated with
study intervention administration are not permitted. However, if a participant is taking a
medication for another condition, even if it may have antipyretic or pain-relieving properties,
it should not be withheld prior to study vaccination.
6.5.2. Permitted During the Study

The use of antipyretics and other pain medication to treat symptoms associated with study
intervention administration or ongoing conditions is permitted.
Medication other than that described as prohibited in Section 6.5.1 required for treatment of
preexisting stable conditions is permitted.
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Inhaled (except in Phase 1 participants – see Section 6.5.1), topical, or localized injections of
corticosteroids (eg, intra-articular or intrabursal administration) are permitted.
6.6. Dose Modification

This protocol allows some alteration of vaccine dose for individual participants and/or dose
groups from the currently outlined dosing schedule. For reasons of reactogenicity,
tolerability, or safety, the IRC may recommend to reduce the second dose of study
intervention and/or increase the interval between doses.
6.7. Intervention After the End of the Study

No intervention will be provided to study participants at the end of the study.

DISCONTINUATION/WITHDRAWAL
7.1. Discontinuation of Study Intervention
In rare instances, it may be necessary for a participant to permanently discontinue study
intervention (definitive discontinuation). Reasons for definitive discontinuation of study
intervention may include the following: AEs; participant request; investigator request;
pregnancy; protocol deviation (including no longer meeting all the inclusion criteria, or
meeting 1 or more exclusion criteria). Note that a positive SARS-CoV-2 NAAT result
without symptoms should not result in discontinuation of study intervention.
Note that discontinuation of study intervention does not represent withdrawal from the study.
Per the study estimands, if study intervention is definitively discontinued, the participant will
remain in the study to be evaluated for safety, immunogenicity, and efficacy. See the SoA
for data to be collected at the time of discontinuation of study intervention and follow-up for
any further evaluations that need to be completed.
In the event of discontinuation of study intervention, it must be documented on the

appropriate CRF/in the medical records whether the participant is discontinuing further
receipt of study intervention or also from study procedures, posttreatment study follow-up,
and/or future collection of additional information.
7.2. Participant Discontinuation/Withdrawal From the Study

A participant may withdraw from the study at any time at his/her own request. Reasons for
discontinuation from the study may include the following:
• Refused further follow-up;

• Lost to follow-up;
• Death;
• Study terminated by sponsor;
• AEs;
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• Participant request;
• Investigator request;
• Protocol deviation.
If a participant does not return for a scheduled visit, every effort should be made to contact
the participant. All attempts to contact the participant and information received during
contact attempts must be documented in the participant’s source document. In any
circumstance, every effort should be made to document participant outcome, if possible.
The investigator or his or her designee should capture the reason for withdrawal in the CRF
for all participants.
If a participant withdraws from the study, he/she may request destruction of any remaining
samples taken and not tested, and the investigator must document any such requests in the
site study records and notify the sponsor accordingly.
If the participant withdraws from the study and also withdraws consent (see Section 7.2.1)
for disclosure of future information, no further evaluations should be performed and no
additional data should be collected. The sponsor may retain and continue to use any data
collected before such withdrawal of consent.
Lack of completion of all or any of the withdrawal/early termination procedures will not be
viewed as protocol deviations so long as the participant’s safety was preserved.
7.2.1. Withdrawal of Consent

Participants who request to discontinue receipt of study intervention will remain in the study
and must continue to be followed for protocol-specified follow-up procedures. The only
exception to this is when a participant specifically withdraws consent for any further contact
with him or her or persons previously authorized by the participant to provide this
information. Participants should notify the investigator in writing of the decision to
withdraw consent from future follow-up, whenever possible. The withdrawal of consent
should be explained in detail in the medical records by the investigator, as to whether the
withdrawal is only from further receipt of study intervention or also from study procedures
and/or posttreatment study follow-up, and entered on the appropriate CRF page. In the event
that vital status (whether the participant is alive or dead) is being measured, publicly
available information should be used to determine vital status only as appropriately directed
in accordance with local law.
7.3. Lost to Follow-up

A participant will be considered lost to follow-up if he or she repeatedly fails to return for
scheduled visits and is unable to be contacted by the study site.
The following actions must be taken if a participant fails to attend a required study visit:
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• The site must attempt to contact the participant and reschedule the missed visit as soon as
possible and counsel the participant on the importance of maintaining the assigned visit
schedule and ascertain whether or not the participant wishes to and/or should continue in
the study;
• Before a participant is deemed lost to follow-up, the investigator or designee must make
every effort to regain contact with the participant (where possible, 3 telephone calls and,
if necessary, a certified letter to the participant’s last known mailing address or local
equivalent methods). These contact attempts should be documented in the participant’s
medical record;
• Should the participant continue to be unreachable, he/she will be considered to have

withdrawn from the study.
8. STUDY ASSESSMENTS AND PROCEDURES

The investigator (or an appropriate delegate at the investigator site) must obtain a signed and
dated ICD before performing any study-specific procedures.
The full date of birth will be collected to critically evaluate the immune response and safety
profile by age.
Study procedures and their timing are summarized in the SoA. Protocol waivers or
exemptions are not allowed.
Safety issues should be discussed with the sponsor immediately upon occurrence or
awareness to determine whether the participant should continue or discontinue study
intervention.
Adherence to the study design requirements, including those specified in the SoA, is essential
and required for study conduct.
All screening evaluations must be completed and reviewed to confirm that potential
participants meet all eligibility criteria. The investigator will maintain a screening log to
record details of all participants screened and to confirm eligibility or record reasons for
screening failure, as applicable.
Every effort should be made to ensure that protocol-required tests and procedures are
completed as described. However, it is anticipated that from time to time there may be
circumstances outside the control of the investigator that may make it unfeasible to perform
the test. In these cases, the investigator must take all steps necessary to ensure the safety and
well-being of the participant. When a protocol-required test cannot be performed, the
investigator will document the reason for the missed test and any corrective and preventive
actions that he or she has taken to ensure that required processes are adhered to as soon as
possible. The study team must be informed of these incidents in a timely manner.
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For samples being collected and shipped, detailed collection, processing, storage, and
shipment instructions and contact information will be provided to the investigator site prior
to initiation of the study.
The total blood sampling volume for individual participants in this study is approximately up
to 515 mL for participants in Phase 1, and approximately up to 110 mL for Phase 2/3
participants. Additionally, 20 mL of blood will be taken at an unplanned convalescent visit
at any time a participant develops respiratory symptoms indicating a potential COVID-19
infection. Select participants in Phase 1 will also be asked to provide an additional blood
sample of approximately 170 mL at either Visit 5, 6, or 7. These participants would
therefore have a total blood sampling volume of 700 mL during the 24-month study period.
Other additional blood samples may be taken for safety assessments at times specified by
Pfizer, provided the total volume taken during the study does not exceed 550 mL during any
period of 60 consecutive days.
8.1. Efficacy and/or Immunogenicity Assessments

Efficacy will be assessed throughout a participant’s involvement in the study through
surveillance for potential cases of COVID-19. If, at any time, a participant develops acute
respiratory illness (see Section 8.13), for the purposes of the study he or she will be
considered to potentially have COVID-19 illness.9 In this circumstance, the participant
should contact the site, an in-person or telehealth visit should occur, and assessments should
be conducted as specified in the SoA. The assessments will include a nasal (midturbinate)
swab, which will be tested at a central laboratory using a reverse transcription–polymerase
chain reaction (RT-PCR) test (Cepheid; FDA approved under EUA), or other equivalent
nucleic acid amplification–based test (ie, NAAT), to detect SARS-CoV-2. In addition,
clinical information and results from local standard-of-care tests (as detailed in Section 8.13)
will be assessed. A local NAAT result will be considered acceptable if it was obtained using:
• An FDA-cleared (including Emergency Use Authorization) assay; or
• An assay that is not FDA-cleared but was conducted in a laboratory that is currently
CLIA-certified; or
• An assay performed by a laboratory accredited according to the ISO 15189 standard by a

national or regional accreditation body.
Two definitions of SARS-CoV-2–related cases, and SARS-CoV-2–related severe cases, will

be considered (for both, the onset date of the case will be the date that symptoms were first
experienced by the participant):
• Confirmed COVID-19: presence of at least 1 of the following symptoms and

SARS-CoV-2 NAAT positive during, or within 4 days before or after, the symptomatic
period, either at the central laboratory or at a local testing facility (using an acceptable
test):
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Protocol C4591001
• Fever;
• Chills;
• New loss of taste or smell;
• Sore throat;
• Diarrhea;
• Vomiting.
The second definition, which may be updated as more is learned about COVID-19, will
include the following additional symptoms defined by the CDC (listed at
https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html):
• Fatigue;
• Headache;
• Nasal congestion or runny nose;
• Nausea.
• Confirmed severe COVID-19: confirmed COVID-19 and presence of at least 1 of the

following:
• Clinical signs at rest indicative of severe systemic illness (RR ≥30 breaths per minute,
HR ≥125 beats per minute, SpO2 ≤93% on room air at sea level, or PaO2/FiO2
<300 mm Hg);
• Respiratory failure (defined as needing high-flow oxygen, noninvasive ventilation,

mechanical ventilation, or ECMO);
• Evidence of shock (SBP <90 mm Hg, DBP <60 mm Hg, or requiring vasopressors);
• Significant acute renal, hepatic, or neurologic dysfunction*;
• Admission to an ICU;
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• Death.
The DMC may recommend modification of the definition of severe disease according to
emerging information.
* Three blinded case reviewers (medically qualified Pfizer staff members) will review all
potential COVID-19 illness events. If a NAAT-confirmed case in Phase 2/3 may be
considered severe, or not, solely on the basis of this criterion, the blinded data will be
reviewed by the case reviewers to assess whether the criterion is met; the majority opinion
will prevail.
In addition, a serological definition will be used for participants without clinical presentation
of COVID-19:
• Confirmed seroconversion to SARS-CoV-2 without confirmed COVID-19: positive

N-binding antibody result in a participant with a prior negative N-binding antibody result
Serum samples will be obtained for immunogenicity testing at the visits specified in the SoA.
The following assays will be performed:
• SARS-CoV-2 neutralization assay
• S1-binding IgG level assay
• RBD-binding IgG level assay
• N-binding antibody assay
Note that all immunogenicity analyses will be based upon samples analyzed at the central
laboratory; the rapid test will only be performed at screening by all sites recruiting
participants in Phase 1 (see Section 8.11.1.1) to determine eligibility.
Serum obtained from the additional ~170-mL blood sample from select participants in Phase
1 at either Visit 5, 6, or 7 will be used for exploratory COVID-19 research, intended to
establish a surrogate endpoint that is reasonably likely to predict clinical benefit.
8.1.1. Biological Samples

Blood and nasal swab samples will be used only for scientific research. Each sample will be
labeled with a code so that the laboratory personnel testing the samples will not know the
participant’s identity. Samples that remain after performing assays outlined in the protocol
may be stored by Pfizer. Unless a time limitation is required by local regulations or ethical
requirements, the samples will be stored for up to 15 years after the end of the study and then
destroyed. If allowed by the ICD, stored samples may be used for additional testing to better
understand the immune responses to the vaccine(s) under study in this protocol, to inform the
development of other products, and/or for vaccine-related assay work supporting vaccine
programs. No testing of the participant’s DNA will be performed.
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The participant may request that his or her samples, if still identifiable, be destroyed at any
time; however, any data already collected from those samples will still be used for this
research. The biological samples may be shared with other researchers as long as
confidentiality is maintained and no testing of the participant’s DNA is performed.
8.2. Safety Assessments

Planned time points for all safety assessments are provided in the SoA. Unscheduled clinical
laboratory measurements may be obtained at any time during the study to assess any
perceived safety issues.
A clinical assessment, including medical history, will be performed on all participants at

his/her first visit to establish a baseline. Significant medical history and observations from
any physical examination, if performed, will be documented in the CRF.
AEs and SAEs are collected, recorded, and reported as defined in Section 8.3.
Acute reactions within the first 4 hours after administration of the study intervention (for the
first 5 participants vaccinated in each Phase 1 group), and within the first 30 minutes (for the
remainder of participants), will be assessed and documented in the AE CRF.
The safety parameters also include reactogenicity e-diary reports of local reactions and
systemic events (including fever), and use of antipyretic medication that occur in the 7 days
after administration of the study intervention. These prospectively self-collected occurrences
of local reactions and systemic events are graded as described in Section 8.2.2.
8.2.1. Clinical Safety Laboratory Assessments (Phase 1 Participants Only)

See Appendix 2 for the list of clinical safety laboratory tests to be performed and the SoA for
the timing and frequency. All protocol-required laboratory assessments, as defined in
Appendix 2, must be conducted in accordance with the laboratory manual and the SoA.
Unscheduled clinical laboratory measurements may be obtained at any time during the study
to assess any perceived safety issues.
The investigator must review the laboratory report, document this review, and record any
clinically relevant changes occurring during the study in the AE section of the CRF. See
Appendix 2 for the grading scale for assessment of clinically significant abnormal laboratory
findings. Clinically significant abnormal laboratory findings are those which are not
associated with the underlying disease, unless judged by the investigator to be more severe
than expected for the participant's condition.
All laboratory tests with values considered clinically significantly abnormal during
participation in the study or within 28 days after the last dose of study intervention should be
repeated until the values return to normal or baseline or are no longer considered clinically
significant by the investigator or medical monitor.
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If such values do not return to normal/baseline within a period of time judged reasonable by
the investigator, the etiology should be identified and the sponsor notified.
See Appendix 5 for suggested actions and follow-up assessments in the event of potential
drug-induced liver injury (DILI).
8.2.2. Electronic Diary

Participants will be required to complete a reactogenicity e-diary through an application
(see Section 8.14) installed on a provisioned device or on the participant’s own personal
device. All participants in Phase 1, and a subset of at least the first 6000 randomized in
Phase 2/3, will be asked to monitor and record local reactions, systemic events, and
antipyretic medication usage for 7 days following administration of the study intervention.
All participants in Phase 3 who are HIV positive will be included in this subset. The
reactogenicity e-diary allows recording of these assessments only within a fixed time
window, thus providing the accurate representation of the participant’s experience at that
time. Data on local reactions and systemic events reported in the reactogenicity e-diary will
be transferred electronically to a third-party vendor, where they will be available for review
by investigators and the Pfizer clinicians at all times via an internet-based portal.
At intervals agreed to by the vendor and Pfizer, these data will be transferred electronically
into Pfizer's database for analysis and reporting. These data do not need to be reported by the
investigator in the CRF as AEs.
Investigators (or designee) will be required to review the reactogenicity e-diary data online at
frequent intervals as part of the ongoing safety review.
The investigator or designee must obtain stop dates from the participant for any ongoing
local reactions, systemic events, or use of antipyretic medication on the last day that the
reactogenicity e-diary was completed. The stop dates should be documented in the source
documents and the information entered in the CRF.
8.2.2.1. Grading Scales

The grading scales used in this study to assess local reactions and systemic events as
described below are derived from the FDA Center for Biologics Evaluation and Research
(CBER) guidelines on toxicity grading scales for healthy adult volunteers enrolled in
preventive vaccine clinical trials.8
8.2.2.2. Local Reactions

During the reactogenicity e-diary reporting period, participants will be asked to assess
redness, swelling, and pain at the injection site and to record the symptoms in the
reactogenicity e-diary. If a local reaction persists beyond the end of the reactogenicity
e-diary period following vaccination, the participant will be requested to report that
information. The investigator will enter this additional information in the CRF.
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If a Grade 3 local reaction is reported in the reactogenicity e-diary, a telephone contact

should occur to ascertain further details and determine whether a site visit is clinically
indicated. Only an investigator or medically qualified person is able to classify a
participant’s local reaction as Grade 4. If a participant experiences a confirmed Grade 4 local
reaction, the investigator must immediately notify the sponsor and, if it is determined to be
related to the administration of the study intervention, further vaccinations will be
discontinued in that participant.

(Grade 4)
Pain at the Does not interfere Interferes with Prevents daily activity Emergency room visit
injection site with activity activity or hospitalization for
severe pain
Redness >2.0 cm to 5.0 cm >5.0 cm to 10.0 cm >10 cm Necrosis or
(5 to 10 measuring (11 to 20 measuring (≥21 measuring exfoliative dermatitis
Swelling >2.0 cm to 5.0 cm >5.0 cm to 10.0 cm >10 cm Necrosis
8.2.2.3. Systemic Events

During the reactogenicity e-diary reporting period, participants will be asked to assess
vomiting, diarrhea, headache, fatigue, chills, new or worsened muscle pain, and new or
worsened joint pain and to record the symptoms in the reactogenicity e-diary. The symptoms
will be assessed by the participant as absent, mild, moderate, or severe according to the
grading scale in Table 2.
If a Grade 3 systemic event is reported in the reactogenicity e-diary, a telephone contact

indicated. Only an investigator or medically qualified person is able to classify a
participant’s systemic event as Grade 4. If a participant experiences a confirmed Grade 4
systemic event, the investigator must immediately notify the sponsor and, if it is determined
to be related to the administration of the study intervention, further vaccinations will be
discontinued in that participant.
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(Grade 4)
Vomiting 1-2 times in >2 times in Requires IV Emergency room visit or
24 hours 24 hours hydration hospitalization for
hypotensive shock
Diarrhea 2 to 3 loose stools 4 to 5 loose stools 6 or more loose Emergency room visit or
in 24 hours in 24 hours stools in 24 hours hospitalization for severe
diarrhea
Headache Does not interfere Some interference Prevents daily Emergency room visit or
headache
Fatigue/ Does not interfere Some interference Prevents daily Emergency room visit or
tiredness with activity with activity routine activity hospitalization for severe
fatigue
Chills Does not interfere Some interference Prevents daily Emergency room visit or
chills
worsened with activity with activity routine activity hospitalization for severe
muscle pain new or worsened muscle
pain
worsened with activity with activity routine activity hospitalization for severe
joint pain new or worsened joint pain
8.2.2.4. Fever
In order to record information on fever, a thermometer will be given to participants with
instructions on how to measure oral temperature at home. Temperature will be collected in
the reactogenicity e-diary in the evening daily during the reactogenicity e-diary reporting
period. It will also be collected at any time during the reactogenicity e-diary data collection
periods when fever is suspected. Fever is defined as an oral temperature of ≥38.0°C
(100.4°F). The highest temperature for each day will be recorded in the reactogenicity
e-diary. Temperature will be measured and recorded to 1 decimal place and then categorized
during analysis according to the scale shown in Table 3.
If a fever of ≥39.0°C (102.1°F) is reported in the reactogenicity e-diary, a telephone contact

indicated. Only an investigator or medically qualified person is able to confirm a
participant’s fever as >40.0°C (>104.0°F). If a participant experiences a confirmed fever
>40.0°C (>104.0°F), the investigator must immediately notify the sponsor and, if it is
determined to be related to the administration of the study intervention, further vaccinations
will be discontinued in that participant.
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≥38.0-38.4°C (100.4-101.1°F)
>38.4-38.9°C (101.2-102.0°F)
>38.9-40.0°C (102.1-104.0°F)
>40.0°C (>104.0°F)
8.2.2.5. Antipyretic Medication

The use of antipyretic medication to treat symptoms associated with study intervention
administration will be recorded in the reactogenicity e-diary daily during the reporting period
(Day 1 to Day 7).
8.2.3. Phase 1 Stopping Rules

The following stopping rules are in place for all Phase 1 participants, based on review of AE
data and e-diary reactogenicity data, until the start of Phase 2/3 or 30 days after the last dose
of study intervention in Phase 1, whichever is later. These data will be monitored on an
ongoing basis by the investigator (or medically qualified designee) and sponsor in order to
promptly identify and flag any event that potentially contributes to a stopping rule.
The sponsor study team will be unblinded during Phase 1, so will be able to assess whether
or not a stopping rule has been met on the basis of a participant’s individual study
intervention allocation.
In the event that sponsor personnel confirm that a stopping rule is met, the following actions
will commence:
• The IRC will review all appropriate data.
• The stopping rule will PAUSE randomization and study intervention administration for
the impacted vaccine candidate all dose levels and age groups.
• The DMC will review all appropriate data.
• For all participants vaccinated, all other routine study conduct activities, including
ongoing data entry, reporting of AEs, participant reactogenicity e-diary completion,
blood sample collection, and participant follow-up, will continue during the pause.
A stopping rule is met if any of the following rules occur after administration of
investigational BNT162 vaccine; data from placebo recipients will not contribute to the
stopping rules. Reactogenicity e-diary data confirmed by the investigator as being entered by
the participant in error will not contribute toward a stopping rule.
The BNT162b RNA platform will be evaluated for contribution to stopping rules overall;
vaccine candidate dose levels within the platform and age groups will contribute to stopping
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rules together. However, it is possible that the recommendations may include halting or
continuing randomization with any of the BNT162 vaccine candidates.
Stopping Rule Criteria for Each BNT162 Vaccine Candidate:
1. If any participant vaccinated with the BNT162 candidate (at any dose level) develops an
SAE that is assessed by the investigator as possibly related, or for which there is no
Grade 4 local reaction or systemic event after vaccination (see Section 8.2.2) that is
assessed as possibly related by the investigator, or for which there is no alternative,
plausible, attributable cause.
fever >40.0°C (>104.0°F) for at least 1 daily measurement after vaccination
(see Section 8.2.2.4) that is assessed as possibly related by the investigator, or for which
there is no alternative, plausible, attributable cause.
4. If any 2 participants vaccinated with the BNT162 candidate (at any dose level) report the
same or similar severe (Grade 3) AE (including laboratory abnormalities) after
vaccination, assessed as possibly related by the investigator, or for which there is no
5. If any participant dies or requires ICU admission due to SARS-CoV-2 infection; if this
stopping rule is met, all available clinical and preclinical safety and immunogenicity data
should be reviewed to evaluate for enhanced COVID-19.
8.2.4. Surveillance of Events That Could Represent Enhanced COVID-19 and Phase 2/3
Stopping Rule
Participants in all phases of the study will be surveilled for potential COVID-19 illness from
Visit 1 onwards (see Section 8.13).
As this is a sponsor open-label study during Phase 1, the sponsor will conduct unblinded
reviews of the data during the course of the study, including for the purpose of safety
assessment. All NAAT-confirmed cases in Phase 1 will be reviewed contemporaneously by
the IRC and the DMC (see Section 9.6).
In Phase 2/3, the unblinded team supporting the DMC, including an unblinded medical
monitor, will review cases of severe COVID-19 as they are received and will review AEs at
least weekly for additional potential cases of severe COVID-19. At any point, the unblinded
team may discuss with the DMC chair whether the DMC should review cases for an adverse
imbalance of cases of COVID-19 and/or severe COVID-19 between the vaccine and placebo
groups.
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The purpose of these reviews will be to identify whether any features of each case appear
unusual, in particular greater in severity, compared to available information at the time of
review. Indicators of severity may include accelerated deterioration, need for hospitalization,
need for ventilation, or death. Observed rates of these indicators will be compared with what
could be expected in a similar population to the study participants based upon available
information at the time of review.
Stopping and alert rules will be applied as follows. The stopping rule will be triggered when
the 1-sided probability of observing the same or a more extreme case split is 5% or less when
the true incidence of severe disease is the same for vaccine and placebo participants, and alert
criteria are triggered when this probability is less than 11%. In addition, when the total
number of severe cases is low (15 or less), the unblinded team supporting the DMC will
implement the alert rule when a reverse case split of 2:1 or worse is observed. For example,
at 3 cases 2:1, at 4 cases 3:1, etc. Below 15 cases, this rule is more rigorous than requiring
the probability of an observed adverse split or worse be <11%. Further details can be found
in Section 10.7.
8.2.5. Randomization and Vaccination After a Stopping Rule Is Met

Once the IRC (if in Phase 1) and DMC (all phases) have reviewed the safety data and
provided guidance, a notification will be sent from the sponsor to the sites with guidance on
how to proceed.
8.2.6. Pregnancy Testing

Pregnancy tests may be urine or serum tests, but must have a sensitivity of at least
25 mIU/mL. Pregnancy tests will be performed in WOCBP at the times listed in the SoA,
immediately before the administration of each vaccine dose. A negative pregnancy test result
will be required prior to the participant’s receiving the study intervention. Pregnancy tests
may also be repeated if requested by IRBs/ECs or if required by local regulations. In the
case of a positive confirmed pregnancy, the participant will be withdrawn from
administration of study intervention but may remain in the study.
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8.3. Adverse Events and Serious Adverse Events

The definitions of an AE and an SAE can be found in Appendix 3.
AEs will be reported by the participant (or, when appropriate, by a caregiver, surrogate, or
the participant's legally authorized representative).
The investigator and any qualified designees are responsible for detecting, documenting, and
recording events that meet the definition of an AE or SAE and remain responsible to pursue
and obtain adequate information both to determine the outcome and to assess whether the
event meets the criteria for classification as an SAE or caused the participant to discontinue
the study intervention (see Section 7.1).
Each participant will be questioned about the occurrence of AEs in a nonleading manner.
In addition, the investigator may be requested by Pfizer Safety to obtain specific follow-up
information in an expedited fashion.
8.3.1. Time Period and Frequency for Collecting AE and SAE Information
The time period for actively eliciting and collecting AEs and SAEs (“active collection
period”) for each participant begins from the time the participant provides informed consent,
which is obtained before the participant’s participation in the study (ie, before undergoing
any study-related procedure and/or receiving study intervention), through and including
Visit 7 for Phase 1 participants, and Visit 3 for Phase 2/3 participants. In addition, any AEs
occurring up to 48 hours after each subsequent blood draw must be recorded on the CRF.
approximately 6 months after the last dose of study intervention (Visit 8 for Phase 1
participants, and Visit 4 for Phase 2/3 participants).
Follow-up by the investigator continues throughout and after the active collection period and
until the AE or SAE or its sequelae resolve or stabilize at a level acceptable to the
investigator and Pfizer concurs with that assessment.
For participants who are screen failures, the active collection period ends when screen failure
status is determined.
If the participant withdraws from the study and also withdraws consent for the collection of
future information, the active collection period ends when consent is withdrawn.
If a participant definitively discontinues or temporarily discontinues study intervention

because of an AE or SAE, the AE or SAE must be recorded on the CRF and the SAE
reported using the Vaccines SAE Report Form.
Investigators are not obligated to actively seek AEs or SAEs after the participant has
concluded study participation. However, if the investigator learns of any SAE, including a
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death, at any time after a participant has completed the study, and he/she considers the event
to be reasonably related to the study intervention, the investigator must promptly report the
SAE to Pfizer using the Vaccines SAE Report Form.
8.3.1.1. Reporting SAEs to Pfizer Safety

All SAEs occurring in a participant during the active collection period as described in
Section 8.3.1 are reported to Pfizer Safety on the Vaccines SAE Report Form immediately
upon awareness and under no circumstance should this exceed 24 hours, as indicated in
Appendix 3. The investigator will submit any updated SAE data to the sponsor within
24 hours of it being available.
8.3.1.2. Recording Nonserious AEs and SAEs on the CRF

All nonserious AEs and SAEs occurring in a participant during the active collection period,
which begins after obtaining informed consent as described in Section 8.3.1, will be recorded
on the AE section of the CRF.
The investigator is to record on the CRF all directly observed and all spontaneously reported
AEs and SAEs reported by the participant.
8.3.2. Method of Detecting AEs and SAEs

The method of recording, evaluating, and assessing causality of AEs and SAEs and the
procedures for completing and transmitting SAE reports are provided in Appendix 3.
Care will be taken not to introduce bias when detecting AEs and/or SAEs. Open-ended and
nonleading verbal questioning of the participant is the preferred method to inquire about
AE occurrences.
8.3.3. Follow-up of AEs and SAEs

After the initial AE/SAE report, the investigator is required to proactively follow each
participant at subsequent visits/contacts. For each event, the investigator must pursue and
obtain adequate information until resolution, stabilization, the event is otherwise explained,
or the participant is lost to follow-up (as defined in Section 7.3).
In general, follow-up information will include a description of the event in sufficient detail to
allow for a complete medical assessment of the case and independent determination of
possible causality. Any information relevant to the event, such as concomitant medications
and illnesses, must be provided. In the case of a participant death, a summary of available
autopsy findings must be submitted as soon as possible to Pfizer Safety.
Further information on follow-up procedures is given in Appendix 3.
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8.3.4. Regulatory Reporting Requirements for SAEs

Prompt notification by the investigator to the sponsor of an SAE is essential so that legal
obligations and ethical responsibilities towards the safety of participants and the safety of a
study intervention under clinical investigation are met.
The sponsor has a legal responsibility to notify both the local regulatory authority and other
regulatory agencies about the safety of a study intervention under clinical investigation. The
sponsor will comply with country-specific regulatory requirements relating to safety
reporting to the regulatory authority, IRBs/ECs, and investigators.
Investigator safety reports must be prepared for SUSARs according to local regulatory
requirements and sponsor policy and forwarded to investigators as necessary.
An investigator who receives SUSARs or other specific safety information (eg, summary or
listing of SAEs) from the sponsor will review and then file it along with the SRSD(s) for the
study and will notify the IRB/EC, if appropriate according to local requirements.
8.3.5. Exposure During Pregnancy or Breastfeeding, and Occupational Exposure

Exposure to the study intervention under study during pregnancy or breastfeeding and
occupational exposure are reportable to Pfizer Safety within 24 hours of investigator
awareness.
8.3.5.1. Exposure During Pregnancy

An EDP occurs if:
• A female participant is found to be pregnant while receiving or after discontinuing study

intervention.
• A male participant who is receiving or has discontinued study intervention exposes a

female partner prior to or around the time of conception.
• A female is found to be pregnant while being exposed or having been exposed to study
intervention due to environmental exposure. Below are examples of environmental
exposure during pregnancy:
• A female family member or healthcare provider reports that she is pregnant after
having been exposed to the study intervention by inhalation or skin contact.
• A male family member or healthcare provider who has been exposed to the study
intervention by inhalation or skin contact then exposes his female partner prior to or
around the time of conception.
The investigator must report EDP to Pfizer Safety within 24 hours of the investigator’s
awareness, irrespective of whether an SAE has occurred. The initial information submitted
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should include the anticipated date of delivery (see below for information related to
termination of pregnancy).
• If EDP occurs in a participant or a participant’s partner, the investigator must report this
information to Pfizer Safety on the Vaccines SAE Report Form and an EDP
Supplemental Form, regardless of whether an SAE has occurred. Details of the
pregnancy will be collected after the start of study intervention and until 6 months after
the last dose of study intervention.
• If EDP occurs in the setting of environmental exposure, the investigator must report
information to Pfizer Safety using the Vaccines SAE Report Form and EDP
Supplemental Form. Since the exposure information does not pertain to the participant
enrolled in the study, the information is not recorded on a CRF; however, a copy of the
completed Vaccines SAE Report Form is maintained in the investigator site file.
Follow-up is conducted to obtain general information on the pregnancy and its outcome for
all EDP reports with an unknown outcome. The investigator will follow the pregnancy until
completion (or until pregnancy termination) and notify Pfizer Safety of the outcome as a
follow-up to the initial EDP Supplemental Form. In the case of a live birth, the structural
integrity of the neonate can be assessed at the time of birth. In the event of a termination, the
reason(s) for termination should be specified and, if clinically possible, the structural
integrity of the terminated fetus should be assessed by gross visual inspection (unless
preprocedure test findings are conclusive for a congenital anomaly and the findings are
reported).
Abnormal pregnancy outcomes are considered SAEs. If the outcome of the pregnancy meets
the criteria for an SAE (ie, ectopic pregnancy, spontaneous abortion, intrauterine fetal
demise, neonatal death, or congenital anomaly), the investigator should follow the procedures
for reporting SAEs. Additional information about pregnancy outcomes that are reported to
Pfizer Safety as SAEs follows:
• Spontaneous abortion including miscarriage and missed abortion;
• Neonatal deaths that occur within 1 month of birth should be reported, without regard to
causality, as SAEs. In addition, infant deaths after 1 month should be reported as SAEs
when the investigator assesses the infant death as related or possibly related to exposure
to the study intervention.
Additional information regarding the EDP may be requested by the sponsor. Further
follow-up of birth outcomes will be handled on a case-by-case basis (eg, follow-up on
preterm infants to identify developmental delays). In the case of paternal exposure, the
investigator will provide the participant with the Pregnant Partner Release of Information
Form to deliver to his partner. The investigator must document in the source documents that
the participant was given the Pregnant Partner Release of Information Form to provide to his
partner.
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8.3.5.2. Exposure During Breastfeeding

An exposure during breastfeeding occurs if:
• A female participant is found to be breastfeeding while receiving or after discontinuing

study intervention.
• A female is found to be breastfeeding while being exposed or having been exposed to

study intervention (ie, environmental exposure). An example of environmental exposure
during breastfeeding is a female family member or healthcare provider who reports that
she is breastfeeding after having been exposed to the study intervention by inhalation or
skin contact.
The investigator must report exposure during breastfeeding to Pfizer Safety within 24 hours
of the investigator’s awareness, irrespective of whether an SAE has occurred. The
information must be reported using the Vaccines SAE Report Form. When exposure during
breastfeeding occurs in the setting of environmental exposure, the exposure information does
not pertain to the participant enrolled in the study, so the information is not recorded on a
CRF. However, a copy of the completed Vaccines SAE Report Form is maintained in the
An exposure during breastfeeding report is not created when a Pfizer drug specifically
approved for use in breastfeeding women (eg, vitamins) is administered in accord with
authorized use. However, if the infant experiences an SAE associated with such a drug, the
SAE is reported together with the exposure during breastfeeding.
8.3.5.3. Occupational Exposure

An occupational exposure occurs when a person receives unplanned direct contact with the
study intervention, which may or may not lead to the occurrence of an AE. Such persons
may include healthcare providers, family members, and other roles that are involved in the
trial participant’s care.
The investigator must report occupational exposure to Pfizer Safety within 24 hours of the
investigator’s awareness, regardless of whether there is an associated SAE. The information
must be reported using the Vaccines SAE Report Form. Since the information does not
pertain to a participant enrolled in the study, the information is not recorded on a CRF;
however, a copy of the completed Vaccines SAE Report Form is maintained in the
8.3.6. Cardiovascular and Death Events

Not applicable.
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8.3.7. Disease-Related Events and/or Disease-Related Outcomes Not Qualifying as AEs

or SAEs
Potential COVID-19 illnesses and their sequelae that are consistent with the clinical endpoint
definition should not be recorded as AEs. These data will be captured as efficacy assessment
data only on the relevant pages of the CRF, as these are expected endpoints.
Potential COVID-19 illnesses and their sequelae will not be reported according to the
standard process for expedited reporting of SAEs, even though the event may meet the
definition of an SAE. These events will be recorded on the COVID-19 illness pages in the
participant’s CRF within 1 day.
Potential COVID-19 illness events and their sequelae will be reviewed by a group of internal
blinded case reviewers. Any SAE that is determined by the internal case reviewers NOT to
meet endpoint criteria is reported back to the investigator site of incidence. The investigator
must report the SAE to Pfizer Safety within 24 hours of being made aware that the SAE did
not meet endpoint criteria. The investigator’s SAE awareness date is the date on which the
investigator site of incidence receives the SAE back from the internal case reviewers.
8.3.8. Adverse Events of Special Interest

Not applicable.
8.3.8.1. Lack of Efficacy

Lack of efficacy is reportable to Pfizer Safety only if associated with an SAE.
8.3.9. Medical Device Deficiencies

Not applicable.
8.3.10. Medication Errors

Medication errors may result from the administration or consumption of the study
intervention by the wrong participant, or at the wrong time, or at the wrong dosage strength.
Exposures to the study intervention under study may occur in clinical trial settings, such as
medication errors.
Safety Event Recorded on the CRF Reported on the Vaccines SAE Report
Form to Pfizer Safety Within 24 Hours
of Awareness
Medication errors All (regardless of whether Only if associated with an SAE

associated with an AE)
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Medication errors include:
• Medication errors involving participant exposure to the study intervention;
• Potential medication errors or uses outside of what is foreseen in the protocol that do or
do not involve the study participant;
• The administration of expired study intervention;
• The administration of an incorrect study intervention;
• The administration of an incorrect dosage;
• The administration of study intervention that has undergone temperature excursion from
the specified storage range, unless it is determined by the sponsor that the study
intervention under question is acceptable for use.
Such medication errors occurring to a study participant are to be captured on the medication
error page of the CRF, which is a specific version of the AE page.
In the event of a medication dosing error, the sponsor should be notified within 24 hours.
Whether or not the medication error is accompanied by an AE, as determined by the

investigator, the medication error is recorded on the medication error page of the CRF and, if
applicable, any associated AE(s), serious and nonserious, are recorded on the AE page of the
CRF.
Medication errors should be reported to Pfizer Safety within 24 hours on a Vaccines SAE
Report Form only when associated with an SAE.
8.4. Treatment of Overdose

For this study, any dose of study intervention greater than 1 dose of study intervention within
a 24-hour time period will be considered an overdose.
Pfizer does not recommend specific treatment for an overdose.
In the event of an overdose, the investigator should:
1. Contact the medical monitor within 24 hours.
2. Closely monitor the participant for any AEs/SAEs.
3. Document the quantity of the excess dose as well as the duration of the overdose in the
CRF.
4. Overdose is reportable to Safety only when associated with an SAE.
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Decisions regarding dose interruptions or modifications will be made by the investigator in

consultation with the medical monitor based on the clinical evaluation of the participant.
8.5. Pharmacokinetics
Pharmacokinetic parameters are not evaluated in this study.
8.6. Pharmacodynamics
Pharmacodynamic parameters are not evaluated in this study.
8.7. Genetics
Genetics (specified analyses) are not evaluated in this study.
8.8. Biomarkers
Biomarkers are not evaluated in this study.
8.9. Immunogenicity Assessments

Immunogenicity assessments are described in Section 8.1.
8.10. Health Economics

Health economics/medical resource utilization and health economics parameters are not
evaluated in this study.
8.11. Study Procedures

8.11.1. Phase 1
8.11.1.1. Screening: (0 to 28 Days Before Visit 1)
Before enrollment and before any study-related procedures are performed, voluntary, written
study.
It is anticipated that the procedures below will be conducted in a stepwise manner; however,
the visit can occur over more than 1 day.
• Assign a single participant number using the IRT system.
• Obtain the participant’s demography (including date of birth, sex, race, and ethnicity).
• Obtain any medical history of clinical significance.
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• Obtain details of any medications currently taken.
• Perform physical examination including vital signs (weight, height, body temperature,
nodes.
• Collect a blood sample (approximately 20 mL) for potential future serological assessment
and to perform a rapid test for prior COVID-19 infection.
• Collect a blood sample (approximately 10 mL) for hematology and chemistry laboratory
• Collect a blood sample (approximately 10 mL) for HIV, HBsAg, HBc Ab, and HCV Ab
tests.
• Perform urine pregnancy test on WOCBP as described in Section 8.2.6.
• Discuss contraceptive use as described in Section 10.4.
• Record nonstudy vaccinations as described in Section 6.5.
• Ensure and document that all of the inclusion criteria and none of the exclusion criteria
are met.
• Record AEs as described in Section 8.3. AEs that occur prior to dosing should be noted
on the Medical History CRF.
• Ask the participant to contact the site staff or investigator immediately if any significant
illness or hospitalization occurs.
• Ask the participant to contact the site staff or investigator immediately if he or she
• Schedule an appointment for the participant to return for the next study visit.
• Complete the source documents.
• Complete the CRF.

vaccination.
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• Record AEs as described in Section 8.3.
• Measure vital signs (body temperature, pulse rate, and seated blood pressure), and, if
indicated by any change in the participant’s health since the previous visit, perform a
physical examination, evaluating any clinically significant abnormalities within the
• Review screening laboratory results (hematology and chemistry, and HIV, HBsAg,
HBc Ab, and HCV Ab tests).
• Obtain 2 nasal (midturbinate) swabs (collected by site staff). One will be tested
(if possible at the site, otherwise at the central laboratory) within 24 hours and
vaccination will proceed only if it is NAAT-negative for SARS-CoV-2 genomes.
The second will be sent to the central laboratory for potential later testing.
are met.
• Ensure that the participant meets none of the temporary delay criteria as described in
Section 5.5.
• Obtain the participant’s randomization number and study intervention allocation using
the IRT system. Only an unblinded site staff member may obtain this information.
• Collect a blood sample (approximately 50 mL) for immunogenicity testing.
• Unblinded site staff member(s) will dispense/administer 1 dose of study intervention into
• The first 5 participants vaccinated in each group must be observed by blinded site staff
for any acute reactions for at least 4 hours after vaccination. For participants enrolled
thereafter, blinded site staff must observe the participant for at least 30 minutes after
study intervention administration for any acute reactions. Record any acute reactions
• Issue a measuring device to measure local reactions at the injection site and a
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• Explain the e-diary technologies available for this study (see Section 8.14), and assist the
participant in downloading the study application onto the participant’s own device or
issue a provisioned device if required. Provide instructions on e-diary completion and
ask the participant to complete the reactogenicity e-diary from Day 1 to Day 7, with
Day 1 being the day of vaccination and, if utilized, the COVID-19 illness e-diary (to be
completed if the participant is diagnosed with COVID-19 or has possible new or
increased symptoms, and when he/she receives a reminder, at least weekly).
• Fever ≥39.0°C (≥102.1°F).
• Redness or swelling at the injection site measuring greater than 10 cm

• Severe pain at the injection site.
• Any severe systemic event.
• Ask the participant to contact the site staff or investigator if a medically attended event
• Ask the participant to contact the site staff or investigator (this could be via the
COVID-19 illness e-diary) immediately if he or she experiences any respiratory
symptoms as detailed in Section 8.13.
• Remind the participant to bring the e-diary to the next visit.
• The investigator or an authorized designee completes the CRFs and an unblinded

• The investigator or appropriately qualified designee reviews the reactogenicity e-diary

data online following vaccination to evaluate participant compliance and as part of the
ongoing safety review. Daily review is optimal during the active diary period.
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8.11.1.3. Visit 2 – Next-Day Follow-up Visit (Vaccination 1): (1 to 3 Days After Visit 1)
• Record details of any of the prohibited medications specified in Section 6.5.1 received by
• Fever ≥39.0°C (≥102.1°F).

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• The investigator or an authorized designee completes the CRFs.

• Review hematology and chemistry laboratory results and record any AEs in accordance
with Appendix 2.
• Fever ≥39.0°C (≥102.1°F).

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vaccination.
• Review the participant’s reactogenicity e-diary data. Collect stop dates of any
reactogenicity e-diary events ongoing on the last day that the reactogenicity e-diary was
completed and record stop dates in the CRF if required.
with Appendix 2.
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• Obtain 2 nasal (midturbinate) swabs (collected by site staff). One will be tested (if
possible at the site, otherwise at the central laboratory) within 24 hours and vaccination
will only proceed if it is NAAT-negative for SARS-CoV-2 genomes. The second will be
sent to the central laboratory for potential later testing.
remain in the study to be evaluated for safety, immunogenicity, and efficacy
(see Section 7.1).
Section 5.5.
• Blinded site staff must observe the participant for at least 30 minutes after study
• Ensure the participant has a measuring device to measure local reactions at the injection
• Ensure the participant remains comfortable with his or her chosen e-diary platform,
reactogenicity e-diary from Day 1 to Day 7, with Day 1 being the day of vaccination.
• Fever ≥39.0°C (≥102.1°F).

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with Appendix 2.
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• If the participant (select participants only, details will be provided by the sponsor)
consents, collect an additional 170 mL blood sample for exploratory COVID-19 research.
• Fever ≥39.0°C (≥102.1°F).


• Review the participant’s reactogenicity e-diary data. Collect stop dates of any
reactogenicity e-diary events ongoing on the last day that the reactogenicity e-diary was
completed and record stop dates in the CRF if required.
with Appendix 2.
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• If not collected at Visit 5, and the participant (select participants only, details will be
provided by the sponsor) consents, collect an additional 170-mL blood sample for
exploratory COVID-19 research.
• Ask the participant to contact the site staff or investigator immediately (this could be via
the COVID-19 illness e-diary) if he or she experiences any respiratory symptoms as
detailed in Section 8.13.

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• If not collected at Visit 5 or 6, and the participant (select participants only, details will be
provided by the sponsor) consents, collect an additional 170-mL blood sample for
exploratory COVID-19 research.
• Record SAEs as described in Section 8.3.
• Record any AEs that occur within the 48 hours after the blood draw as described in
Section 8.3.
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Section 8.3.
• Collect the participant’s e-diary or assist the participant to remove the study application
Section 8.3.
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8.11.2. Phase 2/3

study.
It is anticipated that the procedures below will be conducted in a stepwise manner. The visit
may be conducted across 2 consecutive days; if so, all steps from assessing the inclusion and
exclusion criteria onwards must be conducted on the same day.
• Assign a single participant number using the IRT system.
• Obtain the participant’s demography (including date of birth, sex, race, and ethnicity).
• Obtain any medical history of clinical significance. For participants who are HIV
positive, record HIV viral load and CD4 count results from the most recent test
performed in the previous 6 months.
• Perform a clinical assessment. If the clinical assessment indicates that a physical

examination is necessary to comprehensively evaluate the participant, perform a physical
examination and record any findings in the source documents and, if clinically
significant, record on the medical history CRF.
• Measure the participant’s height and weight.
• Measure the participant’s body temperature.
are met.
Section 5.5.
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• Obtain a nasal (midturbinate) swab (collected by site staff).
• Obtain the participant’s randomization number and study intervention allocation number
using the IRT system. Only an unblinded site staff member may obtain this information.
• For participants in the reactogenicity subset, issue a measuring device to measure local
reactions at the injection site and a thermometer for recording daily temperatures and
provide instructions on their use.
• For participants not in the reactogenicity subset, issue a thermometer to monitor for fever
(for COVID-19 surveillance) and provide instructions on its use.
• Explain the e-diary technologies available for this study (see Section 8.14), and assist the
participant in downloading the study application onto the participant’s own device or
issue a provisioned device if required.
• For participants in the reactogenicity subset, provide instructions on reactogenicity

e-diary completion and ask the participant to complete the reactogenicity e-diary from
Day 1 to Day 7, with Day 1 being the day of vaccination.
• For all participants, provide instructions on COVID-19 illness e-diary completion and
ask the participant to complete the COVID-19 illness e-diary if he/she is diagnosed
with COVID-19 or has possible new or increased symptoms, and when he/she
receives a reminder, at least weekly. See Section 8.14 for further details.
• If the participant is part of the reactogenicity subset, ask the participant to contact the site
staff or investigator immediately if he or she experiences any of the following from Day
1 to Day 7 after vaccination (where Day 1 is the day of vaccination) to determine if an
unscheduled reactogenicity visit is required:
• Fever ≥39.0°C (≥102.1°F).

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If the participant is part of the reactogenicity subset, the investigator or appropriately

qualified designee reviews the reactogenicity e-diary data online following vaccination to
evaluate participant compliance and as part of the ongoing safety review. Daily review is
optimal during the active diary period.

vaccination.
• If the participant is part of the reactogenicity subset, review the participant’s

reactogenicity e-diary data. Collect stop dates of any reactogenicity e-diary events
ongoing on the last day that the reactogenicity e-diary was completed and record stop
dates in the CRF if required.
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are met. If not, the participant may not receive further study intervention but will remain
in the study to be evaluated for safety, immunogenicity, and efficacy
(see Section 7.1).
• Measure the participant’s body temperature.
Section 5.5.
• Obtain a nasal (midturbinate) swab (collected by site staff).
• Ensure the participant has a measuring device to measure local reactions at the injection
• Ensure the participant remains comfortable with his or her chosen e-diary platform,
confirm instructions on e-diary completion, and, if the participant is part of the
reactogenicity subset, ask the participant to complete the reactogenicity e-diary from
Day 1 to Day 7, with Day 1 being the day of vaccination.
• If the participant is part of the reactogenicity subset, ask the participant to contact the site
staff or investigator immediately if he or she experiences any of the following from
Day 1 to Day 7 after vaccination (where Day 1 is the day of vaccination) to determine if
an unscheduled reactogenicity visit is required:
• Fever ≥39.0°C (≥102.1°F).

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If the participant is part of the reactogenicity subset, the investigator or appropriately

qualified designee reviews the reactogenicity e-diary data online following vaccination to
evaluate participant compliance and as part of the ongoing safety review. Daily review is
optimal during the active diary period.
8.11.2.3. Visit 3 – 1-Month Follow-up Visit (After Vaccination 2): (28 to 35 Days After
Visit 2)
• Review the participant’s reactogenicity e-diary data. If the participant is part of the
reactogenicity subset, review the participant’s reactogenicity e-diary data. Collect stop
dates of any reactogenicity e-diary events ongoing on the last day that the reactogenicity
e-diary was completed and record stop dates in the CRF if required.
• For participants who are HIV positive, record HIV viral load and CD4 count results from
the most recent test performed since Visit 1 (if any).
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• Record SAEs as described in Section 8.3.
Section 8.3.
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Section 8.3.
• Collect the participant’s e-diary or assist the participant to remove the study application
Section 8.3.
8.12. Unscheduled Visit for a Grade 3 or Suspected Grade 4 Reaction

If a Grade 3 local reaction (Section 8.2.2.2), systemic event (Section 8.2.2.3), or fever
(Section 8.2.2.4) is reported in the reactogenicity e-diary, a telephone contact should occur to
ascertain further details and determine whether a site visit is clinically indicated. If suspected
Grade 4 local reaction (Section 8.2.2.2), systemic event (Section 8.2.2.3), or fever
(Section 8.2.2.4) is reported in the reactogenicity e-diary, a telephone contact or site visit
should occur to confirm whether the event meets the criteria for Grade 4.
A site visit must be scheduled as soon as possible to assess the participant unless any of the
following is true:
• The participant is unable to attend the unscheduled visit.
• The local reaction/systemic event is no longer present at the time of the telephone
contact.
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• The participant recorded an incorrect value in the reactogenicity e-diary (confirmation of

a reactogenicity e-diary data entry error).
• The PI or authorized designee determined it was not needed.
This telephone contact will be recorded in the participant’s source documentation and the
CRF.
If the participant is unable to attend the unscheduled visit, or the PI or authorized designee
determined it was not needed, any ongoing local reactions/systemic events must be assessed
at the next study visit.
During the unscheduled visit, the reactions should be assessed by the investigator or a
medically qualified member of the study staff such as a study physician or a study nurse, as
applicable to the investigator’s local practice, who will:
• Measure body temperature (°F/°C).
• Measure minimum and maximum diameters of redness (if present).
• Measure minimum and maximum diameters of swelling (if present).
• Assess injection site pain (if present) in accordance with the grades provided in
Section 8.2.2.2.
• Assess systemic events (if present) in accordance with the grades provided in
Section 8.2.2.3.
• Assess for other findings associated with the reaction and record on the AE page of the
CRF, if appropriate.
The investigator or an authorized designee will complete the unscheduled visit assessment
page of the CRF.
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8.13. COVID-19 Surveillance (All Participants)

If a participant experiences any of the following (irrespective of perceived etiology or
clinical significance), he or she is instructed to contact the site immediately and, if
confirmed, participate in an in-person or telehealth visit as soon as possible, optimally within
3 days of symptom onset (and at the latest 4 days after symptom resolution). During the
7 days following each vaccination, potential COVID-19 symptoms that overlap with solicited
systemic events (ie, fever, chills, new or increased muscle pain, diarrhea, vomiting) should
not trigger a potential COVID-19 illness visit unless, in the investigator’s opinion, the
clinical picture is more indicative of a possible COVID-19 illness than vaccine
reactogenicity. Participants may utilize a COVID-19 illness e-diary through an application
(see Section 8.14) installed on a provisioned device or on the participant’s own personal
device to prompt him/her to report any symptoms. Note that this does not substitute for a
participant’s routine medical care. Therefore, participants should be encouraged to seek care,
if appropriate, from their usual provider.
• A diagnosis of COVID-19;
• Fever;
• Chills;
• New loss of taste/smell;
• Sore throat;
• Diarrhea;
• Vomiting.
8.13.1. Potential COVID-19 Illness Visit: (Optimally Within 3 Days After Potential
COVID-19 Illness Onset)
This visit may be conducted as an in-person or telehealth visit; a telehealth visit involves the
sharing of healthcare information and services via telecommunication technologies (eg,
audio, video, video-conferencing software) remotely, thus allowing the participant and
investigator to communicate on aspects of clinical care.
As a participant’s COVID-19 illness may evolve over time, several contacts may be required
to obtain the following information:
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• Record AEs, as appropriate as described in Section 8.3. Note: Potential COVID-19

illnesses that are consistent with the clinical endpoint definition should not be recorded as
AEs. These data will be captured as efficacy assessment data only on the relevant pages
of the CRF, as these are expected endpoints.
• If the visit is conducted in person, obtain a nasal (midturbinate) swab (collected by site
staff). Alternatively, if conducted by telehealth, instruct the participant to self-collect a
nasal (midturbinate) swab and ship for assessment at the central laboratory. The result
from this swab will be provided to the site once it is available, but this will not be in real
time, and cannot be relied upon to direct clinical care. Therefore, the participant should
be encouraged to seek care, if appropriate, from his or her usual provider.
• Collect COVID-19–related standard-of-care clinical and laboratory information. This

includes, but is not limited to:
• Symptoms and signs, including
• Clinical signs at rest indicative of severe systemic illness (RR ≥30 breaths per
minute, HR ≥125 beats per minute, SpO2 ≤93% on room air at sea level, or
PaO2/FiO2 <300 mm Hg)
• Evidence of shock (SBP <90 mm Hg, DBP <60 mm Hg, or requiring

vasopressors)
• Significant acute renal, hepatic, or neurologic dysfunction
• Respiratory failure (defined as needing high-flow oxygen, noninvasive

ventilation, mechanical ventilation, or ECMO)
• Clinical diagnosis
• Local laboratory COVID-19 test result
• Full blood count
• Blood chemistry, specifically creatinine, urea, liver function tests, and C-reactive
protein
• Imaging results (eg, CT or MRI scan) to document neurologic dysfunction
• Number and type of any healthcare contact; duration of hospitalization and ICU stay
• Death
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• Schedule an appointment for the participant to return for the potential COVID-19
convalescent visit once he or she has recovered.
8.13.2. Potential COVID-19 Convalescent Visit: (28 to 35 Days After Potential

COVID-19 Illness Visit)
• Record AEs, as appropriate as described in Section 8.3. Note: Potential COVID-19
illnesses that are consistent with the clinical endpoint definition should not be recorded as
AEs. These data will be captured as efficacy assessment data only on the relevant pages
of the CRF, as these are expected endpoints.
• Collect/update COVID-19–related clinical and laboratory information (detailed in

Section 8.13.1).
Section 8.3.
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8.14. Communication and Use of Technology

In a study of this nature that requires illness events to be reported outside of scheduled study
visits, it is vital that communication between the study site and the participant is maintained
to ensure that endpoint events are not missed. This study will employ various methods,
tailored to the individual participant, to ensure that communication is maintained and study
information can be transmitted securely. Using appropriate technology, such as a study
application, a communication pathway between the participant and the study site staff will be
established. The participant may be able to utilize his or her own devices to access this
technology, or use a device provided by the sponsor. Traditional methods of telephone
communication will also be available. The technology solution may facilitate the following:
• Contact with the investigator, including the ability of the participant to report whether or
not he or she has experienced symptoms that could represent a potential COVID-19
illness (COVID-19 illness e-diary; see Section 8.13).
• An alert in the event that the participant is hospitalized.
• Visit reminders.
• Messages of thanks and encouragement from the study team.
• A platform for recording local reactions and systemic events (reactogenicity e-diary) –
see Section 8.2.2.
If a participant is not actively completing either the reactogenicity or COVID-19 illness

e-diary, the investigator or designee is required to contact the participant to ascertain why
and also to obtain details of any missed events.
9. STATISTICAL CONSIDERATIONS
Methodology for summary and statistical analyses of the data collected in this study is
described here and further detailed in a statistical analysis plan (SAP), which will be
maintained by the sponsor. The SAP may modify what is outlined in the protocol where
appropriate; however, any major modifications of the primary endpoint definitions or their
analyses will also be reflected in a protocol amendment.
9.1. Estimands and Statistical Hypotheses

9.1.1. Estimands
The estimand corresponding to each primary, secondary, and tertiary/exploratory objective is
described in the table in Section 3.
In the primary safety objective evaluations, missing reactogenicity e-diary data will not be
imputed. Missing AE dates will be imputed according to Pfizer safety rules. No other
missing information will be imputed in the safety analysis.
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for immunogenicity (Section 9.3). These estimands estimate the vaccine effect in the
as directed. Missing antibody results will not be imputed. Immunogenicity results that are
below the LLOQ will be set to 0.5 × LLOQ in the analysis; this may be adjusted once
additional data on the assay characteristics become available.
efficacy (Section 9.3). These estimands estimate the vaccine effect in the hypothetical
setting where participants follow the study schedules and protocol requirements as directed.
In addition, VE will be analyzed by all--available efficacy population. Missing laboratory
results will not be imputed for the primary analysis, but missing data imputation for the
efficacy endpoint may be performed as a sensitivity analysis.
9.1.2. Statistical Hypotheses

Phase 2/3 of the study has 2 primary efficacy endpoints evaluating VE, which is defined as
VE = 100 × (1 – IRR). IRR is calculated as the ratio of first confirmed COVID-19 illness rate
in the vaccine group to the corresponding illness rate in the placebo group. In Phase 2/3, the
assessment of VE will be based on posterior probabilities of VE1 > 30% and VE2 > 30%.
VE1 represents VE for prophylactic BNT162b2 against confirmed COVID-19 in participants
without evidence of infection before vaccination, and VE2 represents VE for prophylactic
BNT162b2 against confirmed COVID-19 in all participants after vaccination.
For participants with multiple confirmed cases, only the first case will contribute to the VE
calculation for each hypothesis. VE1 and VE2 will be evaluated sequentially to control the
overall type I error to the desired level of 2.5%. VE is demonstrated if there is sufficient
evidence (posterior probability) that either VE1 >30% or both VE1 and VE2 are >30%. The
assessment for the primary analysis will be based on posterior probability using a Bayesian
model.
9.2. Sample Size Determination

The study sample size for Phase 1 of the study is not based on any statistical hypothesis
testing. Phase 1 comprises 15 participants (randomization ratio of 4:1 so that 12 receive
active vaccine and 3 receive placebo) per group; 13 vaccine groups are studied,
corresponding to a total of 195 participants.
For Phase 2/3, with assumptions of a true VE of 60% after the last dose of investigational
product, a total of approximately 164 first confirmed COVID-19 illness cases will provide
90% power to conclude true VE >30% with high probability, allowing early stopping for
efficacy at the IA. This would be achieved with 17,600 evaluable participants per group or
21,999 vaccine recipients randomized in a 1:1 ratio with placebo, for a total sample size of
43,998, based on the assumption of a 1.3% illness rate per year in the placebo group, accrual
of 164 primary-endpoint cases within 6 months, and 20% of the participants being
nonevaluable or having serological evidence of prior infection with SARS-CoV-2,
potentially making them immune to further infection. Dependent upon the evolution of the
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pandemic, it is possible that the COVID-19 attack rate may be much higher, in which case
accrual would be expected to be more rapid, enabling the study’s primary endpoint to be
evaluated much sooner. The total number of participants enrolled in Phase 2/3 may vary
depending on the incidence of COVID-19 at the time of the enrollment, the true underlying
VE, and a potential early stop for efficacy or futility.
1 AE.
Table 4. Probability of Observing at Least 1 AE by Assumed True Event Rates

With Different Sample Sizes
Assumed N=12 N=45 N=180 N=3000 N=6000 N=9000 N=15000
True Event
Rate of an
AE
0.01% 0.00 0.00 0.02 0.26 0.45 0.59 0.78
0.02% 0.00 0.01 0.04 0.45 0.70 0.83 0.95
0.04% 0.00 0.02 0.07 0.70 0.91 0.97 >0.99
0.06% 0.01 0.03 0.10 0.83 0.97 0.99 >0.99
0.08% 0.01 0.04 0.13 0.91 0.99 0.99 >0.99
0.10% 0.01 0.04 0.16 0.95 0.99 0.99 >0.99
0.15% 0.02 0.07 0.24 0.99 0.99 >0.99 >0.99
0.20% 0.02 0.09 0.30 >0.99 >0.99 >0.99 >0.99
0.25% 0.03 0.11 0.36 >0.99 >0.99 >0.99 >0.99
0.30% 0.04 0.13 0.42 >0.99 >0.99 >0.99 >0.99
0.35% 0.04 0.15 0.47 >0.99 >0.99 >0.99 >0.99
0.50% 0.06 0.20 0.59 >0.99 >0.99 >0.99 >0.99
1.00% 0.11 0.36 0.84 >0.99 >0.99 >0.99 >0.99
2.00% 0.22 0.60 0.97 >0.99 >0.99 >0.99 >0.99
3.00% 0.31 0.75 >0.99 >0.99 >0.99 >0.99 >0.99
5.00% 0.46 0.90 >0.99 >0.99 >0.99 >0.99 >0.99
7.00% 0.58 0.96 >0.99 >0.99 >0.99 >0.99 >0.99
10.00% 0.72 0.99 >0.99 >0.99 >0.99 >0.99 >0.99
Note: N = number in sample.
9.3. Analysis Sets

For purposes of analysis, the following populations are defined:
Randomized All participants who are assigned a randomization number in
the IWR system.
Dose 1 evaluable For Phase 1 only, all eligible randomized participants who
immunogenicity receive the vaccine to which they are randomly assigned at the
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first dose, have at least 1 valid and determinate
Dose 2 evaluable All eligible randomized participants who receive 2 doses of
immunogenicity the vaccine to which they are randomly assigned, within the
predefined window, have at least 1 valid and determinate
Dose 1 all-available For Phase 1 only: all participants who receive at least 1 dose
immunogenicity of the study intervention with at least 1 valid and determinate
immunogenicity result after Dose 1 but before Dose 2.
immunogenicity result after Dose 2.
Evaluable efficacy All eligible randomized participants who receive all
vaccination(s) as randomized within the predefined window
and have no other major protocol deviations as determined by
the clinician.
All-available efficacy 1. All eligible randomized participants who receive at least
1 vaccination.
2. All eligible randomized participants who complete

2 vaccination doses.
Safety All randomized participants who receive at least 1 dose of the

study intervention.
9.4. Statistical Analyses

The SAP will be developed and finalized before database lock for any of the planned
analyses in Section 9.5.1. It will describe the participant populations to be included in the
analyses and the procedures for accounting for missing, unused, and spurious data. This
section provides a summary of the planned statistical analyses of the primary, secondary, and
tertiary/exploratory endpoints.
9.4.1. Immunogenicity Analyses

Immunogenicity samples will be drawn for all participants. Immunogenicity analyses will be
based upon results from appropriately sized subsets of samples, according to the purpose.
The statistical analysis of immunogenicity results will be primarily based on the evaluable
immunogenicity populations as defined in Section 9.3.
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An additional analysis will be performed based on the all-available populations if there is a

large enough difference in sample size between the all-available immunogenicity population
and the evaluable immunogenicity population. Participants will be summarized according to
the vaccine group to which they were randomized.

Secondary Geometric mean titers/concentrations (GMTs/GMCs) of
immunogenicity SARS-CoV-2 neutralizing titers, S1-binding IgG level, and
RBD-binding IgG level
For SARS-CoV-2 neutralizing titers, S1-binding IgG levels, and

RBD-binding IgG levels, GMTs/GMCs and 2-sided 95% CIs will be
provided for each investigational product within each group before
vaccination and at each of the following time points:
• Phase 1: 7 and 21 days after Dose 1; 7 and 14 days and 1, 6, 12

and 24 months after Dose 2
Geometric means will be calculated as the mean of the assay results

after making the logarithm transformation and then exponentiating the
mean to express results on the original scale. Two-sided 95% CIs will
be obtained by taking natural log transforms of concentrations/titers,
calculating the 95% CI with reference to the t-distribution, and then
exponentiating the confidence limits.
GMFRs of SARS-CoV-2 neutralizing titers, S1-binding IgG level,

and RBD-binding IgG level

RBD-binding IgG levels, the GMFRs and 2-sided 95% CIs will be
• Phase 1: 7 and 21 days after Dose 1; 7 and 14 days and 1, 6, 12,


assay results (later time point – earlier time point) and exponentiating
the mean. The associated 2-sided CIs will be obtained by calculating
CIs using Student’s t-distribution for the mean difference of the
logarithmically transformed assay results and exponentiating the
confidence limits.
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Percentage of participants with ≥4-fold rise in SARS-CoV-2
neutralizing titers, S1-binding IgG level, and RBD-binding IgG
level

RBD-binding IgG levels, percentages (and 2-sided 95% CIs) of
participants with ≥4-fold rise will be provided for each investigational
product within each group at each of the following time points:

GMR of SARS-CoV-2 neutralizing titer to S1-binding IgG level

and to RBD-binding IgG level

RBD-binding IgG levels, the GMRs and 2-sided 95% CIs will be

GMRs will be limited to participants with nonmissing values for both

SARS-CoV-2 neutralizing titers and S1-binding IgG level/RBD-
binding IgG level at each time point. The GMR will be calculated as
the mean of the difference of logarithmically transformed assay results
(eg, SARS-CoV-2 neutralizing titers minus S1-binding IgG level for
each participant) and exponentiating the mean. Two-sided CIs will be
obtained by calculating CIs using Student’s t-distribution for the mean
difference of the logarithmically transformed assay results and
For all the immunogenicity endpoints, the analysis will be based on the
Dose 1 and Dose 2 evaluable immunogenicity populations. An
additional analysis will be performed based on the all-available
immunogenicity populations if there is a large enough difference in
sample size between the all-available immunogenicity populations and
the evaluable immunogenicity populations. Participants will be
summarized according to the vaccine group to which they were
randomized. Missing serology data will not be imputed.
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Exploratory Geometric mean titers/concentrations (GMTs/GMCs) of
immunogenicity SARS-CoV-2 neutralizing titers, S1-binding IgG level, and
RBD-binding IgG level

RBD-binding IgG levels, GMTs/GMCs and 2-sided 95% CIs will be
provided for each investigational product within each group before
vaccination and at each of the following time points in Phase 2/3:
• 1, 6, 12, and 24 months after completion of vaccination in

participants with and without serological or virological evidence of
SARS-CoV-2 infection before vaccination
Geometric means will be calculated as the mean of the assay results

after making the logarithm transformation and then exponentiating the
mean to express results on the original scale. Two-sided 95% CIs will
be obtained by taking natural log transforms of concentrations/titers,
calculating the 95% CI with reference to the t-distribution, and then
GMFRs of SARS-CoV-2 neutralizing titers, S1-binding IgG level,

and RBD-binding IgG level

RBD-binding IgG levels, the GMFRs and 2-sided 95% CIs will be
the following time points in Phase 2/3:

participants with and without serological or virological
evidence of SARS-CoV-2 infection before vaccination

assay results (later time point – earlier time point) and exponentiating
the mean. The associated 2-sided CIs will be obtained by calculating
CIs using Student’s t-distribution for the mean difference of the
logarithmically transformed assay results and exponentiating the
confidence limits.
Percentage of participants with antibody levels ≥ predefined

threshold(s) for SARS-CoV-2 serological parameters
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For SARS-CoV-2 neutralizing titers, S1-binding IgG levels and/or
RBD-binding IgG levels, N-binding antibody, and SARS-CoV-2
detection by NAAT, percentages (and 2-sided 95% CIs) of participants
with antibody levels ≥ predefined threshold(s) will be provided for
each investigational product within each group at baseline and each of
the following time points in Phase 2/3:

participants with and without serological or virological evidence of
SARS-CoV-2 infection before vaccination
Percentage of participants with the immune response (non-S) to

SARS-CoV-2 for N-binding antibody at the time points when data
are available
For all of the immunogenicity endpoints, the analysis will be based on

the Dose 1 and Dose 2 evaluable immunogenicity populations. An
additional analysis will be performed based on the all-available
immunogenicity populations if there is a large enough difference in
sample size between the all-available immunogenicity populations and
the evaluable immunogenicity populations. Participants will be
summarized according to the vaccine group to which they were
randomized. Missing serology data will not be imputed.
RCDCs for immunogenicity results
Empirical RCDCs will be provided for SARS-CoV-2 neutralizing

titers, S1-binding IgG level, and RBD-binding IgG level after Dose 1
and after Dose 2.
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9.4.2. Efficacy Analyses

The statistical analysis of efficacy will be based on the evaluable efficacy population
(primary analysis) and the all-available efficacy population as defined in Section 9.3.

Primary efficacy Ratio of confirmed COVID-19 illness per 1000 person-years of
follow-up in participants without evidence of infection before
vaccination for the active vaccine group to the placebo group
VE will be estimated by 100 × (1 – IRR), where IRR is the calculated

ratio of confirmed COVID-19 illness per 1000 person-years follow-up
in the active vaccine group to the corresponding illness rate in the
placebo group 7 days after the last dose. VE will be analyzed using a
beta-binomial model.
After the above objective is met, the second primary endpoint will be
evaluated as below.
Ratio of confirmed COVID-19 illness per 1000 person-years of

follow-up in participants with and without evidence of infection
before vaccination for the active vaccine group to the placebo
group
VE will be estimated by 100 × (1 – IRR), where IRR is the calculated

ratio of confirmed COVID-19 illness per 1000 person-years follow-up
in the active vaccine group to the corresponding illness rate in the
placebo group after 7 days after the last dose. VE will be analyzed
using a beta-binomial model.
The efficacy analysis for the first primary objective evaluation will be
based on the participants without evidence of infection before
vaccination and included in the evaluable efficacy population and in
the all-available efficacy population.
The efficacy analysis for the second primary objective evaluation will
be based on all participants included in the evaluable efficacy
population and in the all-available efficacy population.
For the primary endpoint analysis, missing efficacy data will not be
imputed. A sensitivity analysis will be performed by imputing missing
values with the assumption of MAR. A missing efficacy endpoint may
be imputed based on predicted probability using the fully conditional
specification method. Other imputation methods without the MAR
assumption may be explored. The details will be provided in the SAP.
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Secondary Ratio of confirmed severe COVID-19 illness per 1000 person-years
of follow-up in participants without evidence of infection before
Ratio of confirmed severe COVID-19 illness per 1000 person-years

of follow-up for the active vaccine group to the placebo group
These secondary efficacy objectives will be evaluated after the primary

objectives are met. The analysis will be based on the evaluable efficacy
population and the all-available efficacy population. The analysis
methodology used for the primary efficacy endpoints will be applied
for the analysis of the above secondary efficacy endpoints.
The following secondary efficacy endpoints will be evaluated

descriptively with 95% CIs.
Ratio of confirmed COVID-19 illness (according to the

CDC-defined symptoms) per 1000 person-years of follow-up in
participants without evidence of infection before vaccination for
the active vaccine group to the placebo group
Ratio of confirmed COVID-19 illness (according to the

CDC-defined symptoms) per 1000 person-years of follow-up in
participants with and without evidence of infection before
VE = 100 × (1 – IRR) will be estimated with confirmed COVID-19

illness according to the CDC-defined symptoms after 7 days after the
last dose. The 2-sided 95% CI for VE will be derived using the
Clopper-Pearson method as described by Agresti.9
Missing efficacy data will not be imputed.
9.4.3. Safety Analyses

Primary Descriptive statistics will be provided for each reactogenicity endpoint
for each dose and vaccine group. Local reactions and systemic events
from Day 1 through Day 7 after each vaccination will be presented by
severity cumulatively across severity levels. Descriptive summary
statistics will include counts and percentages of participants with the
indicated endpoint and the associated Clopper-Pearson 95% CIs.
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For Phase 1, descriptive statistics will be provided for abnormal
hematology and chemistry laboratory values at 1 and 7 days after
Dose 1 and 7 days after Dose 2, including grading shifts in
hematology and chemistry laboratory assessments between baseline
and 1 and 7 days after Dose 1, and before Dose 2 and 7 days after
Dose 2. Descriptive summary statistics will include counts and
percentages of participants with the indicated endpoint and the
associated Clopper-Pearson 2-sided 95% CIs.
AEs will be categorized according to the Medical Dictionary for

Regulatory Activities (MedDRA) terms. A 3-tier approach will be
used to summarize AEs in Phase 2/3. Under this approach AEs are
classified into 1 of 3 tiers: (1) Tier 1 events are prespecified events of
clinical importance and are identified in a list in the product’s safety
review plan; (2) Tier 2 events are those that are not Tier 1 but are
considered “relatively common”; a MedDRA preferred term is defined
as a Tier 2 event if there are at least 1% of participants in at least 1
vaccine group reporting the event; and (3) Tier 3 events are those that
are neither Tier 1 nor Tier 2 events. For both Tier 1 and Tier 2 events,
2-sided 95% CIs for the difference between the vaccine and placebo
groups in the percentage of participants reporting the events based on
the Miettinen and Nurminen method10 will be provided. In addition,
for Tier 1 events, the asymptotic p-values will also be presented for
the difference between groups in the percentage of participants
reporting the events, based on the same test statistic and under the
assumption that the test statistic is asymptotically normally
distributed.
Descriptive summary statistics (counts, percentages, and associated

Clopper-Pearson 95% CIs) will be provided for any AE events for
each vaccine group.
SAEs will be categorized according to MedDRA terms. Counts,

percentages, and the associated Clopper-Pearson 95% CIs of SAEs
from Dose 1 to 6 months after last dose will be provided for each
vaccine group.
The safety analyses are based on the safety population. Participants

will be summarized by vaccine group according to the investigational
products they actually received. Missing reactogenicity e-diary data
will not be imputed; missing AE dates will be handled according to
the Pfizer safety rules.
Secondary Not applicable (N/A)
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Exploratory N/A
9.4.4. Other Analyses

The ratios of (GMFR A to GMFR B) and (GMFR A to GMFR C) may be explored, where
GMFR A is the geometric mean of the ratio of the SARS-CoV-2 neutralizing titer at the
postvaccination time point to the corresponding titer at the prevaccination time point,
GFMR B is the geometric mean of the ratio of the S1-binding IgG level at the
postvaccination time point to the corresponding IgG level at the prevaccination time point,
and GMFR C is the geometric mean of the ratio of the RBD-binding IgG level at the
postvaccination time point to the corresponding antibody level at the prevaccination time
point.
The safety data and immunogenicity results for individuals with confirmed stable HIV
disease will be summarized descriptively. Furthermore, VE may be assessed if there is a
sufficient number of COVID-19 cases in this group of participants.
9.5. Interim Analyses

As this is a sponsor open-label study during Phase 1, the sponsor may conduct unblinded
reviews of the data during the course of the study for the purpose of safety assessment,
facilitating dose escalation decisions, and/or supporting clinical development.
During Phase 2/3, 4 IAs are planned and will be performed by an unblinded statistical team
after accrual of 32, 62, 92, and 120 cases. At each IA:
• VE for the first primary objective will be evaluated . Overwhelming efficacy will be
declared if the first primary study objective is met. The criteria for success at an interim
analysis are based on the posterior probability (ie, P[VE >30%|data]) at the current
number of cases. Overwhelming efficacy will be declared if the posterior probability is
higher than the success threshold. The success threshold for each interim analysis will be
calibrated to protect overall type I error at 2.5%. Additional details about the success
threshold or boundary calculation at each interim analysis will be provided in the SAP.
• The study will stop for lack of benefit (futility) if the predicted probability of success at
the final analysis or study success is <5%. The posterior predictive POS will be
calculated using a beta-binomial model. The futility assessment will be performed for the
first primary endpoint and the futility boundary may be subject to change to reflect
subsequent program-related decisions by the sponsor.
• Efficacy and futility boundaries will be applied in a nonbinding way.
Bayesian approaches require specification of a prior distribution for the possible values of the
unknown vaccine effect, thereby accounting for uncertainty in its value. A minimally
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informative beta prior, beta (0.700102, 1), is proposed for θ = (1-VE)/(2-VE). The prior is
centered at θ = 0.4118 (VE=30%) which can be considered pessimistic. The prior allows
considerable uncertainty; the 95% interval for θ is (0.005, 0.964) and the corresponding 95%
interval for VE is (-26.2, 0.995).
Table 5 illustrates the boundary for efficacy and futility if IAs are performed after accrual of
32 62, 92, and 120 cases in participants without evidence of infection before vaccination.
Table 5. Interim Analysis Plan and Boundaries for Efficacy and Futility
Analysis Number of Success Criteriaa Futility Boundary
Cases
VE Point Estimate VE Point Estimate
(Case Split) (Case Split)
IA1 32 76.9% (6:26) 11.8% (15:17)
IA2 62 68.1% (15:47) 27.8% (26:36)
IA3 92 62.7% (25:67) 38.6% (35:57)
IA4 120 58.8% (35:85) N/A
Final 164 52.3% (53:111)
Abbreviations: IA = interim analysis; N/A = not applicable; VE = vaccine efficacy.
Note: Case split = vaccine : placebo.
a. Interim efficacy claim: P(VE >30%|data) > 0.995; success at the final analysis: P(VE >30%|data)
> 0.986.
Additional design operating characteristics (the boundary based on the number of cases
observed in the vaccine group; the probabilities for efficacy and futility given assumed
various VEs with a 1:1 randomization ratio) are listed in Table 6 and Table 7.
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Table 6. Statistical Design Operating Characteristics: Probability of Success or

Failure for Interim Analyses
Vaccine Interim Analysis 1 Interim Analysis 2 Interim Analysis 3 Interim
Efficacy (Total Cases = 32) (Total Cases = 62) (Total Cases = 92) Analysis 4
(%) (Total Cases
= 120)
Probability Probability Probability Probability Probability Probability Probability of
of Success of Failure of Success of Failure of Success of Failure Success
(Cases in (Cases in (Cases in (Cases in (Cases in (Cases in (Cases
Vaccine Vaccine Vaccine Vaccine Vaccine Vaccine Vaccine
Group ≤6) Group ≥15) Group ≤15) Group ≥26) Group ≤25) Group ≥35) Group ≤35)
30 0.006 0.315 0.003 0.231 0.002 0.239 0.002
50 0.054 0.078 0.051 0.056 0.063 0.103 0.075
60 0.150 0.021 0.160 0.010 0.175 0.019 0.160
70 0.368 0.003 0.310 <0.001 0.195 0.001 0.085
80 0.722 <0.001 0.238 <0.001 0.037 <0.001 0.003
Table 7. Statistical Design Operating Characteristics: Probability of Success for

Final Analysis and Overall
Vaccine Efficacy (%) Final Analysis Overall Probability of Success
(Total Cases = 164)
Probability of Success (Cases in Vaccine
Group ≤53)
30 0.007 0.021
50 0.196 0.439
60 0.220 0.866
70 0.036 >0.999
80 <0.001 >0.999
If neither success nor futility has been declared after all IAs, the final analysis will be
performed and the first primary objective will have been met if there are 53 or fewer cases
observed in the vaccine group out of a total of 164 first confirmed cases from 7 days after
receipt of the last dose of investigational product onwards.
After the primary objectives are met, the secondary VE endpoints (confirmed severe
COVID-19 in participants without evidence of infection before vaccination and confirmed
severe COVID-19 in all participants) will be evaluated sequentially, by the same method
used for the primary VE endpoint evaluation. Success thresholds for secondary VE will be
appropriately chosen to control overall Type I error at 2.5%. Further details will be provided
in the SAP. The remaining secondary VE endpoints will be evaluated descriptively to
calculate the observed VE with 95% CIs.
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9.5.1. Analysis Timing

• Complete safety and immunogenicity analysis approximately 1 month after Dose 2 for
Phase 1.
• Safety data through 7 days after Dose 2 and immunogenicity data through 1 month after
Dose 2 from the first 360 participants enrolled (180 to active vaccine and 180 to placebo,
stratified equally between 18 to 55 years and >55 to 85 years) in Phase 2/3.
• Safety data through 1 month after Dose 2 from the first 6000 participants enrolled (3000
to active vaccine and 3000 to placebo) in Phase 2/3.
• IAs for efficacy at 32, 62, 92, and 120 cases and futility at 32, 62, and 92 cases.
• Complete safety and immunogenicity analysis approximately 6 months after Dose 2 for
all participants in Phase 2/3.
• Complete efficacy and persistence-of-immunogenicity analysis after complete data are

available at the end of the study.
All analyses conducted on Phase 2/3 data while the study is ongoing will be performed by an
unblinded statistical team.
9.6. Data Monitoring Committee or Other Independent Oversight Committee

This study will use an IRC, a DMC, and a group of internal case reviewers. The IRC is
independent of the study team and includes only internal members. The DMC is independent
of the study team and includes only external members. The IRC and DMC charters describe
the role of the IRC and DMC in more detail.
The responsibilities of the IRC are only in Phase 1 and will include:
• Review of safety data to permit dose escalations in the 18- to 55-year age cohort
• Review of safety data in the case of a stopping rule being met
• Review of safety and/or immunogenicity data to:
• Allow groups of participants of 65 to 85 years of age to proceed
• Select vaccine candidate/dose level(s) to proceed into Phase 2/3. Data supporting the
selection, including results for both binding antibody levels and neutralizing titers,
and the ratio between them, will also be submitted to the FDA for review
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• Review of any available safety and/or immunogenicity data generated during the course
of this study, or the BioNTech study conducted in Germany, to determine:
• Whether any groups may not be started
• Whether any groups may be terminated early
• Whether any groups may be added with dose levels below the lowest stated dose or
intermediate between the lowest and highest stated doses
• Contemporaneous review of all NAAT-confirmed COVID-19 illnesses in Phase 1
The DMC will be responsible for ongoing monitoring of the safety of participants in the
study according to the charter. This may include, but is not limited to:
• Contemporaneous review of related AEs up to 1 month after completion of the

vaccination schedule
• Contemporaneous review of all SAEs up to 6 months after completion of the vaccination

schedule
• Contemporaneous review of all NAAT-confirmed COVID-19 illnesses in Phase 1
• At the time of the planned IAs, and ad hoc if requested by the unblinded team, review of
cases of COVID-19 for an adverse imbalance of cases of COVID-19 and/or severe
COVID-19 between the vaccine and placebo groups
The recommendations made by the DMC to alter the conduct of the study will be forwarded
to the appropriate Pfizer personnel for final decision. Pfizer will forward such decisions,
which may include summaries of aggregate analyses of safety data, to regulatory authorities,
as appropriate.
Three blinded case reviewers (medically qualified Pfizer staff members) will review all
potential COVID-19 illness events. If a NAAT-confirmed case in Phase 2/3 may be
considered severe, or not, solely on the basis of “significant acute renal, hepatic, or
neurologic dysfunction,” the blinded data will be reviewed by the case reviewers to assess
whether the criterion is met; the majority opinion will prevail.
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10. SUPPORTING DOCUMENTATION AND OPERATIONAL CONSIDERATIONS

10.1. Appendix 1: Regulatory, Ethical, and Study Oversight Considerations
10.1.1. Regulatory and Ethical Considerations
This study will be conducted in accordance with the protocol and with the following:
• Consensus ethical principles derived from international guidelines including the

Declaration of Helsinki and CIOMS International Ethical Guidelines;
• Applicable ICH GCP guidelines;
• Applicable laws and regulations, including applicable privacy laws.
The protocol, protocol amendments, ICD, SRSD(s), and other relevant documents
(eg, advertisements) must be reviewed and approved by the sponsor and submitted to an
IRB/EC by the investigator and reviewed and approved by the IRB/EC before the study is
initiated.
Any amendments to the protocol will require IRB/EC approval before implementation of
changes made to the study design, except for changes necessary to eliminate an immediate
hazard to study participants.
The investigator will be responsible for the following:
• Providing written summaries of the status of the study to the IRB/EC annually or more
frequently in accordance with the requirements, policies, and procedures established by
the IRB/EC;
• Notifying the IRB/EC of SAEs or other significant safety findings as required by IRB/EC
procedures;
• Providing oversight of the conduct of the study at the site and adherence to requirements
of 21 CFR, ICH guidelines, the IRB/EC, European regulation 536/2014 for clinical
studies (if applicable), and all other applicable local regulations.
10.1.1.1. Reporting of Safety Issues and Serious Breaches of the Protocol or ICH GCP
In the event of any prohibition or restriction imposed (ie, clinical hold) by an applicable
regulatory authority in any area of the world, or if the investigator is aware of any new
information that might influence the evaluation of the benefits and risks of the study
intervention, Pfizer should be informed immediately.
In addition, the investigator will inform Pfizer immediately of any urgent safety measures
taken by the investigator to protect the study participants against any immediate hazard, and
of any serious breaches of this protocol or of ICH GCP that the investigator becomes aware
of.
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10.1.2. Informed Consent Process

The investigator or his/her representative will explain the nature of the study to the
participant and answer all questions regarding the study. The participant should be given
sufficient time and opportunity to ask questions and to decide whether or not to participate in
the trial.
Participants must be informed that their participation is voluntary. Participants will be

required to sign a statement of informed consent that meets the requirements of 21 CFR 50,
local regulations, ICH guidelines, HIPAA requirements, where applicable, and the IRB/EC
or study center.
The investigator must ensure that each study participant is fully informed about the nature
and objectives of the study, the sharing of data related to the study, and possible risks
associated with participation, including the risks associated with the processing of the
participant’s personal data.
The participant must be informed that his/her personal study-related data will be used by the
sponsor in accordance with local data protection law. The level of disclosure must also be
explained to the participant.
The participant must be informed that his/her medical records may be examined by Clinical
Quality Assurance auditors or other authorized personnel appointed by the sponsor, by
appropriate IRB/EC members, and by inspectors from regulatory authorities.
The investigator further must ensure that each study participant is fully informed about his or
her right to access and correct his or her personal data and to withdraw consent for the
processing of his or her personal data.
The medical record must include a statement that written informed consent was obtained
before the participant was enrolled in the study and the date the written consent was obtained.
The authorized person obtaining the informed consent must also sign the ICD.
Participants must be reconsented to the most current version of the ICD(s) during their
participation in the study.
A copy of the ICD(s) must be provided to the participant. Participants who are rescreened are
required to sign a new ICD.
Unless prohibited by local requirements or IRB/EC decision, the ICD will contain a separate
section that addresses the use of samples for optional additional research. The optional
additional research does not require the collection of any further samples. The investigator
or authorized designee will explain to each participant the objectives of the additional
research. Participants will be told that they are free to refuse to participate and may
withdraw their consent at any time and for any reason during the storage period.
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10.1.3. Data Protection

All parties will comply with all applicable laws, including laws regarding the implementation
of organizational and technical measures to ensure protection of participant data.
Participants’ personal data will be stored at the study site in encrypted electronic and/or paper
form and will be password protected or secured in a locked room to ensure that only
authorized study staff have access. The study site will implement appropriate technical and
organizational measures to ensure that the personal data can be recovered in the event of
disaster. In the event of a potential personal data breach, the study site will be responsible
for determining whether a personal data breach has in fact occurred and, if so, providing
breach notifications as required by law.
To protect the rights and freedoms of participants with regard to the processing of personal
data, participants will be assigned a single, participant-specific numerical code. Any
participant records or data sets that are transferred to the sponsor will contain the numerical
code; participant names will not be transferred. All other identifiable data transferred to the
sponsor will be identified by this single, participant-specific code. The study site will
maintain a confidential list of participants who participated in the study, linking each
participant’s numerical code to his or her actual identity and medical record identification. In
case of data transfer, the sponsor will protect the confidentiality of participants’ personal data
consistent with the clinical study agreement and applicable privacy laws.
10.1.4. Dissemination of Clinical Study Data

Pfizer fulfills its commitment to publicly disclose clinical study results through posting the
results of studies on www.clinicaltrials.gov (ClinicalTrials.gov), the EudraCT, and/or
www.pfizer.com, and other public registries in accordance with applicable local
laws/regulations. In addition, Pfizer reports study results outside of the requirements of local
laws/regulations pursuant to its SOPs.
In all cases, study results are reported by Pfizer in an objective, accurate, balanced, and
complete manner and are reported regardless of the outcome of the study or the country in
which the study was conducted.
www.clinicaltrials.gov
Pfizer posts clinical trial results on www.clinicaltrials.gov for Pfizer-sponsored interventional

studies (conducted in patients) that evaluate the safety and/or efficacy of a product,
regardless of the geographical location in which the study is conducted. These results are
submitted for posting in accordance with the format and timelines set forth by US law.
EudraCT
Pfizer posts clinical trial results on EudraCT for Pfizer-sponsored interventional studies in
accordance with the format and timelines set forth by EU requirements.
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www.pfizer.com
Pfizer posts public disclosure synopses (CSR synopses in which any data that could be used
to identify individual participants have been removed) on www.pfizer.com for
Pfizer-sponsored interventional studies at the same time the corresponding study results are
posted to www.clinicaltrials.gov.
Documents within marketing authorization packages/submissions
Pfizer complies with the European Union Policy 0070, the proactive publication of clinical
data to the EMA website. Clinical data, under Phase 1 of this policy, includes clinical
overviews, clinical summaries, CSRs, and appendices containing the protocol and protocol
amendments, sample CRFs, and statistical methods. Clinical data, under Phase 2 of this
policy, includes the publishing of individual participant data. Policy 0070 applies to new
marketing authorization applications submitted via the centralized procedure since
01 January 2015 and applications for line extensions and for new indications submitted via
the centralized procedure since 01 July 2015.
Data Sharing
Pfizer provides researchers secure access to patient-level data or full CSRs for the purposes
of “bona-fide scientific research” that contributes to the scientific understanding of the
disease, target, or compound class. Pfizer will make available data from these trials
24 months after study completion. Patient-level data will be anonymized in accordance with
applicable privacy laws and regulations. CSRs will have personally identifiable information
redacted.
Data requests are considered from qualified researchers with the appropriate competencies to
perform the proposed analyses. Research teams must include a biostatistician. Data will not
be provided to applicants with significant conflicts of interest, including individuals
requesting access for commercial/competitive or legal purposes.
10.1.5. Data Quality Assurance

All participant data relating to the study will be recorded on printed or electronic CRF unless
transmitted to the sponsor or designee electronically (eg, laboratory data). The investigator is
responsible for verifying that data entries are accurate and correct by physically or
electronically signing the CRF.
The investigator must maintain accurate documentation (source data) that supports the
information entered in the CRF.
The investigator must ensure that the CRFs are securely stored at the study site in encrypted
electronic and/or paper form and are password protected or secured in a locked room to
prevent access by unauthorized third parties.
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The investigator must permit study-related monitoring, audits, IRB/EC review, and
regulatory agency inspections and provide direct access to source data documents. This
verification may also occur after study completion. It is important that the investigator(s)
and their relevant personnel are available during the monitoring visits and possible audits or
inspections and that sufficient time is devoted to the process.
Monitoring details describing strategy (eg, risk-based initiatives in operations and quality
such as risk management and mitigation strategies and analytical risk-based monitoring),
methods, responsibilities, and requirements, including handling of noncompliance issues and
monitoring techniques (central, remote, or on-site monitoring), are provided in the
monitoring plan.
The sponsor or designee is responsible for the data management of this study, including
quality checking of the data.
Study monitors will perform ongoing source data verification to confirm that data entered
into the CRF by authorized site personnel are accurate, complete, and verifiable from source
documents; that the safety and rights of participants are being protected; and that the study is
being conducted in accordance with the currently approved protocol and any other study
agreements, ICH GCP, and all applicable regulatory requirements.
Records and documents, including signed ICDs, pertaining to the conduct of this study must
be retained by the investigator for 15 years after study completion unless local regulations or
institutional policies require a longer retention period. No records may be destroyed during
the retention period without the written approval of the sponsor. No records may be
transferred to another location or party without written notification to the sponsor. The
investigator must ensure that the records continue to be stored securely for as long as they are
maintained.
When participant data are to be deleted, the investigator will ensure that all copies of such
data are promptly and irrevocably deleted from all systems.
The investigator(s) will notify the sponsor or its agents immediately of any regulatory
inspection notification in relation to the study. Furthermore, the investigator will cooperate
with the sponsor or its agents to prepare the investigator site for the inspection and will allow
the sponsor or its agent, whenever feasible, to be present during the inspection. The
investigator site and investigator will promptly resolve any discrepancies that are identified
between the study data and the participant's medical records. The investigator will promptly
provide copies of the inspection findings to the sponsor or its agent. Before response
submission to the regulatory authorities, the investigator will provide the sponsor or its
agents with an opportunity to review and comment on responses to any such findings.
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10.1.6. Source Documents

Source documents provide evidence for the existence of the participant and substantiate the
integrity of the data collected. Source documents are filed at the investigator site.
Data reported on the CRF or entered in the eCRF that are from source documents must be
consistent with the source documents or the discrepancies must be explained. The
investigator may need to request previous medical records or transfer records, depending on
the study. Also, current medical records must be available.
Definition of what constitutes source data can be found in the study monitoring plan.
Description of the use of computerized system is documented in the Data Management Plan.
10.1.7. Study and Site Start and Closure

The study start date is the date on which the clinical study will be open for recruitment of
participants.
The first act of recruitment is the date of the first participant’s first visit and will be the study
start date.
The sponsor designee reserves the right to close the study site or terminate the study at any
time for any reason at the sole discretion of the sponsor. Study sites will be closed upon
study completion. A study site is considered closed when all required documents and study
supplies have been collected and a study-site closure visit has been performed.
The investigator may initiate study-site closure at any time upon notification to the sponsor
or designee if requested to do so by the responsible IRB/EC or if such termination is required
to protect the health of study participants.
Reasons for the early closure of a study site by the sponsor may include but are not limited
to:
• Failure of the investigator to comply with the protocol, the requirements of the IRB/EC
or local health authorities, the sponsor's procedures, or GCP guidelines;
• Inadequate recruitment of participants by the investigator;
• Discontinuation of further study intervention development.
If the study is prematurely terminated or suspended, the sponsor shall promptly inform the
investigators, the ECs/IRBs, the regulatory authorities, and any CRO(s) used in the study of
the reason for termination or suspension, as specified by the applicable regulatory
requirements. The investigator shall promptly inform the participant and should assure
appropriate participant therapy and/or follow-up.
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Study termination is also provided for in the clinical study agreement. If there is any conflict
between the contract and this protocol, the contract will control as to termination rights.
10.1.8. Sponsor’s Qualified Medical Personnel

The contact information for the sponsor's appropriately qualified medical personnel for the
study is documented in the study contact list located in the supporting study documentation.
To facilitate access to appropriately qualified medical personnel on study-related medical

questions or problems, participants are provided with a contact card at the time of informed
consent. The contact card contains, at a minimum, protocol and study intervention
identifiers, participant numbers, contact information for the investigator site, and contact
details for a contact center in the event that the investigator site staff cannot be reached to
provide advice on a medical question or problem originating from another healthcare
professional not involved in the participant’s participation in the study. The contact number
can also be used by investigator staff if they are seeking advice on medical questions or
problems; however, it should be used only in the event that the established communication
pathways between the investigator site and the study team are not available. It is therefore
intended to augment, but not replace, the established communication pathways between the
investigator site and the study team for advice on medical questions or problems that may
arise during the study. The contact number is not intended for use by the participant directly,
and if a participant calls that number, he or she will be directed back to the investigator site.
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10.2. Appendix 2: Clinical Laboratory Tests

The following safety laboratory tests will be performed at times defined in the SoA section of
this protocol. Additional laboratory results may be reported on these samples as a result of
the method of analysis or the type of analyzer used by the clinical laboratory, or as derived
from calculated values. These additional tests would not require additional collection of
blood. Unscheduled clinical laboratory measurements may be obtained at any time during
the study to assess any perceived safety issues.
Hematology Chemistry Other

Hemoglobin BUN and creatinine • Urine pregnancy test (β-hCG)
Hematocrit AST, ALT At screening only:
RBC count Total bilirubin • Hepatitis B core antibody
MCV Alkaline phosphatase • Hepatitis B surface antigen
MCH • Hepatitis C antibody
MCHC • Human immunodeficiency virus
Platelet count
WBC count
Eosinophils (Abs)
Monocytes (Abs)
Basophils (Abs)
Lymphocytes (Abs)
Investigators must document their review of each laboratory safety report.

accordance with the following grading scale (Table 8).

(Grade 4)
Hemoglobin 11.0 – 12.0 9.5 – 10.9 8.0 – 9.4 <8.0
(Female) - g/dL
Hemoglobin 12.5 – 13.5 10.5 – 12.4 8.5 – 10.4 <8.5
(Male) - g/dL
WBC increase - 10,800 – 15,000 15,001 – 20,000 20,001 – 25, 000 >25,000
cells/mm3
WBC decrease - 2,500 – 3,500 1,500 – 2,499 1,000 – 1,499 <1,000
cells/mm3
Lymphocytes 750 – 1,000 500 – 749 250 – 499 <250
Neutrophils decrease 1,500 – 2,000 1,000 – 1,499 500 – 999 <500
- cells/mm3
Eosinophils - 650 – 1500 1501 - 5000 >5000 Hypereosinophilic
cells/mm3
cells/mm3
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(Grade 4)
BUN - mg/dL 23 – 26 27 – 31 > 31 Requires dialysis
Creatinine – mg/dL 1.5 – 1.7 1.8 – 2.0 2.1 – 2.5 > 2.5 or requires
dialysis
Alkaline 1.1 – 2.0 x ULN 2.1 – 3.0 x ULN 3.1 – 10 x ULN >10 x ULN
phosphate –
increase by factor
Liver function tests 1.1 – 2.5 x ULN 2.6 – 5.0 x ULN 5.1 – 10 x ULN >10 x ULN
– ALT, AST
increase by factor
accompanied
by any increase in
increase by factor
factor
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Evaluating, Follow-up, and Reporting
10.3.1. Definition of AE
AE Definition
• An AE is any untoward medical occurrence in a patient or clinical study participant,
temporally associated with the use of study intervention, whether or not considered
related to the study intervention.
• NOTE: An AE can therefore be any unfavorable and unintended sign (including an

abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally
associated with the use of study intervention.
Events Meeting the AE Definition

• Any abnormal laboratory test results (hematology, clinical chemistry, or urinalysis)
or other safety assessments (eg, ECG, radiological scans, vital sign measurements),
including those that worsen from baseline, considered clinically significant in the
medical and scientific judgment of the investigator Any abnormal laboratory test
results that meet any of the conditions below must be recorded as an AE:
• Is associated with accompanying symptoms.
• Requires additional diagnostic testing or medical/surgical intervention.
• Leads to a change in study dosing (outside of any protocol-specified dose

adjustments) or discontinuation from the study, significant additional
concomitant drug treatment, or other therapy.
• Exacerbation of a chronic or intermittent preexisting condition including either an

increase in frequency and/or intensity of the condition.
• New conditions detected or diagnosed after study intervention administration even

though it may have been present before the start of the study.
• Signs, symptoms, or the clinical sequelae of a suspected drug-drug interaction.
• Signs, symptoms, or the clinical sequelae of a suspected overdose of either study

intervention or a concomitant medication. Overdose per se will not be reported as
an AE/SAE unless it is an intentional overdose taken with possible suicidal/self-
harming intent. Such overdoses should be reported regardless of sequelae.
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Events NOT Meeting the AE Definition

• Any clinically significant abnormal laboratory findings or other abnormal safety
assessments which are associated with the underlying disease, unless judged by the
investigator to be more severe than expected for the participant’s condition.
• The disease/disorder being studied or expected progression, signs, or symptoms of

the disease/disorder being studied, unless more severe than expected for the
participant’s condition.
• Medical or surgical procedure (eg, endoscopy, appendectomy): the condition that

leads to the procedure is the AE.
• Situations in which an untoward medical occurrence did not occur (social and/or
convenience admission to a hospital).
• Anticipated day-to-day fluctuations of preexisting disease(s) or condition(s) present

or detected at the start of the study that do not worsen.
10.3.2. Definition of SAE

If an event is not an AE per definition above, then it cannot be an SAE even if serious
conditions are met (eg, hospitalization for signs/symptoms of the disease under study, death
due to progression of disease).
An SAE is defined as any untoward medical occurrence that, at any dose:
a. Results in death
b. Is life-threatening
The term “life-threatening” in the definition of “serious” refers to an event in which the
participant was at risk of death at the time of the event. It does not refer to an event that
hypothetically might have caused death if it were more severe.
c. Requires inpatient hospitalization or prolongation of existing hospitalization

In general, hospitalization signifies that the participant has been detained (usually involving
at least an overnight stay) at the hospital or emergency ward for observation and/or
treatment that would not have been appropriate in the physician’s office or outpatient
setting. Complications that occur during hospitalization are AEs. If a complication
prolongs hospitalization or fulfills any other serious criteria, the event is serious. When in
doubt as to whether “hospitalization” occurred or was necessary, the AE should be
considered serious.
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Hospitalization for elective treatment of a preexisting condition that did not worsen from
baseline is not considered an AE.
d. Results in persistent disability/incapacity

• The term disability means a substantial disruption of a person’s ability to conduct
normal life functions.
• This definition is not intended to include experiences of relatively minor medical

significance such as uncomplicated headache, nausea, vomiting, diarrhea, influenza,
and accidental trauma (eg, sprained ankle) which may interfere with or prevent
everyday life functions but do not constitute a substantial disruption.
e. Is a congenital anomaly/birth defect
f. Other situations:
• Medical or scientific judgment should be exercised in deciding whether SAE
reporting is appropriate in other situations such as important medical events that
may not be immediately life-threatening or result in death or hospitalization but may
jeopardize the participant or may require medical or surgical intervention to prevent
one of the other outcomes listed in the above definition. These events should
usually be considered serious.
• Examples of such events include invasive or malignant cancers, intensive treatment

in an emergency room or at home for allergic bronchospasm, blood dyscrasias or
convulsions that do not result in hospitalization, or development of drug dependency
or drug abuse.
• Suspected transmission via a Pfizer product of an infectious agent, pathogenic or

nonpathogenic, is considered serious. The event may be suspected from clinical
symptoms or laboratory findings indicating an infection in a patient exposed to a
Pfizer product. The terms “suspected transmission” and “transmission” are
considered synonymous. These cases are considered unexpected and handled as
serious expedited cases by pharmacovigilance personnel. Such cases are also
considered for reporting as product defects, if appropriate.
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10.3.3. Recording/Reporting and Follow-up of AEs and/or SAEs
AE and SAE Recording/Reporting
The table below summarizes the requirements for recording adverse events on the CRF and
for reporting serious adverse events on the Vaccines SAE Report Form to Pfizer Safety.
These requirements are delineated for 3 types of events: (1) SAEs; (2) nonserious adverse
events (AEs); and (3) exposure to the study intervention under study during pregnancy or
breastfeeding, and occupational exposure.
It should be noted that the Vaccines SAE Report Form for reporting of SAE information is
not the same as the AE page of the CRF. When the same data are collected, the forms must
be completed in a consistent manner. AEs should be recorded using concise medical
terminology and the same AE term should be used on both the CRF and the Vaccines SAE
Report Form for reporting of SAE information.
Safety Event Recorded on the CRF Reported on the Vaccines

SAE Report Form to
Pfizer Safety Within 24
Hours of Awareness
SAE All All

Nonserious AE All None
Exposure to the study All AEs/SAEs associated All (and EDP supplemental
intervention under study with exposure during form for EDP)
during pregnancy or pregnancy or breastfeeding Note: Include all SAEs
breastfeeding, and associated with exposure
occupational exposure Occupational exposure is not during pregnancy or
recorded. breastfeeding. Include all
AEs/SAEs associated with
occupational exposure.
• When an AE/SAE occurs, it is the responsibility of the investigator to review all

documentation (eg, hospital progress notes, laboratory reports, and diagnostic
reports) related to the event.
• The investigator will then record all relevant AE/SAE information in the CRF.
• It is not acceptable for the investigator to send photocopies of the participant’s

medical records to Pfizer Safety in lieu of completion of the Vaccines SAE Report
Form/AE/SAE CRF page.
• There may be instances when copies of medical records for certain cases are
requested by Pfizer Safety. In this case, all participant identifiers, with the
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exception of the participant number, will be redacted on the copies of the medical
records before submission to Pfizer Safety.
• The investigator will attempt to establish a diagnosis of the event based on signs,
symptoms, and/or other clinical information. Whenever possible, the diagnosis
(not the individual signs/symptoms) will be documented as the AE/SAE.
Assessment of Intensity
The investigator will make an assessment of intensity for each AE and SAE reported during
the study and assign it to 1 of the following categories:
GRADE If required on the AE page of the CRF, the investigator will use the
adjectives MILD, MODERATE, SEVERE, or LIFE-THREATENING to
describe the maximum intensity of the AE. For purposes of consistency,
these intensity grades are defined as follows:
1 MILD Does not interfere with participant's usual

function.
2 MODERATE Interferes to some extent with participant's usual

function.
3 SEVERE Interferes significantly with participant's usual

function.
4 LIFE-THREATENING Life-threatening consequences; urgent

intervention indicated.
Assessment of Causality
• The investigator is obligated to assess the relationship between study intervention
and each occurrence of each AE/SAE.
• A “reasonable possibility” of a relationship conveys that there are facts, evidence,

and/or arguments to suggest a causal relationship, rather than a relationship cannot
be ruled out.
• The investigator will use clinical judgment to determine the relationship.
• Alternative causes, such as underlying disease(s), concomitant therapy, and other

risk factors, as well as the temporal relationship of the event to study intervention
administration, will be considered and investigated.
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• The investigator will also consult the IB and/or product information, for marketed
products, in his/her assessment.
• For each AE/SAE, the investigator must document in the medical notes that he/she
has reviewed the AE/SAE and has provided an assessment of causality.
• There may be situations in which an SAE has occurred and the investigator has
minimal information to include in the initial report to the sponsor. However, it is
very important that the investigator always make an assessment of causality for
every event before the initial transmission of the SAE data to the sponsor.
• The investigator may change his/her opinion of causality in light of follow-up

information and send an SAE follow-up report with the updated causality
assessment.
• The causality assessment is one of the criteria used when determining regulatory
• If the investigator does not know whether or not the study intervention caused the
event, then the event will be handled as “related to study intervention” for reporting
purposes, as defined by the sponsor. In addition, if the investigator determines that
an SAE is associated with study procedures, the investigator must record this causal
relationship in the source documents and CRF, and report such an assessment in the
dedicated section of the Vaccines SAE Report Form and in accordance with the
SAE reporting requirements.
Follow-up of AEs and SAEs

• The investigator is obligated to perform or arrange for the conduct of supplemental
measurements and/or evaluations as medically indicated or as requested by the
sponsor to elucidate the nature and/or causality of the AE or SAE as fully as
possible. This may include additional laboratory tests or investigations,
histopathological examinations, or consultation with other healthcare providers.
• If a participant dies during participation in the study or during a recognized

follow-up period, the investigator will provide Pfizer Safety with a copy of any
postmortem findings including histopathology.
• New or updated information will be recorded in the originally completed CRF.
• The investigator will submit any updated SAE data to the sponsor within 24 hours of
receipt of the information.
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10.3.4. Reporting of SAEs
SAE Reporting to Pfizer Safety via Vaccines SAE Report Form

• Facsimile transmission of the Vaccines SAE Report Form is the preferred method to
transmit this information to Pfizer Safety.
• In circumstances when the facsimile is not working, notification by telephone is

acceptable with a copy of the Vaccines SAE Report Form sent by overnight mail or
courier service.
• Initial notification via telephone does not replace the need for the investigator to
complete and sign the Vaccines SAE Report Form pages within the designated
reporting time frames.
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10.4. Appendix 4: Contraceptive Guidance

10.4.1. Male Participant Reproductive Inclusion Criteria
Male participants are eligible to participate if they agree to the following requirements during
the intervention period and for at least 28 days after the last dose of study intervention, which
corresponds to the time needed to eliminate reproductive safety risk of the study
intervention(s):
• Refrain from donating sperm.
PLUS either:
• Be abstinent from heterosexual intercourse with a female of childbearing potential as

their preferred and usual lifestyle (abstinent on a long-term and persistent basis) and
agree to remain abstinent.
OR
• Must agree to use a male condom when engaging in any activity that allows for passage
of ejaculate to another person.
• In addition to male condom use, a highly effective method of contraception may be

considered in WOCBP partners of male participants (refer to the list of highly effective
methods below in Section 10.4.4).
10.4.2. Female Participant Reproductive Inclusion Criteria

A female participant is eligible to participate if she is not pregnant or breastfeeding, and at
least 1 of the following conditions applies:
• Is not a WOCBP (see definitions below in Section 10.4.3).
OR
• Is a WOCBP and using an acceptable contraceptive method as described below during

the intervention period (for a minimum of 28 days after the last dose of study
intervention). The investigator should evaluate the effectiveness of the contraceptive
method in relationship to the first dose of study intervention.
The investigator is responsible for review of medical history, menstrual history, and recent
sexual activity to decrease the risk for inclusion of a woman with an early undetected
pregnancy.
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10.4.3. Woman of Childbearing Potential

A woman is considered fertile following menarche and until becoming postmenopausal
unless permanently sterile (see below).
If fertility is unclear (eg, amenorrhea in adolescents or athletes) and a menstrual cycle cannot
be confirmed before the first dose of study intervention, additional evaluation should be
considered.
Women in the following categories are not considered WOCBP:
1. Premenopausal female with 1 of the following:
• Documented hysterectomy;
• Documented bilateral salpingectomy;
• Documented bilateral oophorectomy.
For individuals with permanent infertility due to an alternate medical cause other than the
above, (eg, mullerian agenesis, androgen insensitivity), investigator discretion should be
applied to determining study entry.
Note: Documentation for any of the above categories can come from the site personnel’s
review of the participant’s medical records, medical examination, or medical history
interview. The method of documentation should be recorded in the participant’s medical
record for the study.
2. Postmenopausal female:
• A postmenopausal state is defined as no menses for 12 months without an alternative

medical cause. In addition, a
• high FSH level in the postmenopausal range must be used to confirm a

postmenopausal state in women under 60 years of age and not using hormonal
contraception or HRT.
• Female on HRT and whose menopausal status is in doubt will be required to use
one of the nonestrogen hormonal highly effective contraception methods if they
wish to continue their HRT during the study. Otherwise, they must discontinue
HRT to allow confirmation of postmenopausal status before study enrollment.
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10.4.4. Contraception Methods

Contraceptive use by men or women should be consistent with local availability/regulations
regarding the use of contraceptive methods for those participating in clinical trials.
1. Implantable progestogen-only hormone contraception associated with inhibition of

ovulation.
2. Intrauterine device.
3. Intrauterine hormone-releasing system.
4. Bilateral tubal occlusion.
5. Vasectomized partner:
• Vasectomized partner is a highly effective contraceptive method provided that the

partner is the sole sexual partner of the woman of childbearing potential and the
absence of sperm has been confirmed. If not, an additional highly effective method
of contraception should be used. The spermatogenesis cycle is approximately
90 days.
6. Combined (estrogen- and progestogen-containing) hormonal contraception associated

with inhibition of ovulation:
• Oral;
• Intravaginal;
• Transdermal;
• Injectable.
7. Progestogen-only hormone contraception associated with inhibition of ovulation:
• Oral;
• Injectable.
8. Sexual abstinence:
• Sexual abstinence is considered a highly effective method only if defined as

refraining from heterosexual intercourse during the entire period of risk associated
with the study intervention. The reliability of sexual abstinence needs to be evaluated
in relation to the duration of the study and the preferred and usual lifestyle of the
participant.
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9. Progestogen-only oral hormonal contraception where inhibition of ovulation is not the

primary mode of action.
10. Male or female condom with or without spermicide.
11. Cervical cap, diaphragm, or sponge with spermicide.
12. A combination of male condom with either cervical cap, diaphragm, or sponge with
spermicide (double-barrier methods).
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10.5. Appendix 5: Liver Safety: Suggested Actions and Follow-up Assessments

Potential Cases of Drug-Induced Liver Injury
Humans exposed to a drug who show no sign of liver injury (as determined by elevations in
transaminases) are termed “tolerators,” while those who show transient liver injury, but adapt
are termed “adaptors.” In some participants, transaminase elevations are a harbinger of a
more serious potential outcome. These participants fail to adapt and therefore are
"susceptible" to progressive and serious liver injury, commonly referred to as DILI.
Participants who experience a transaminase elevation above 3 × ULN should be monitored
more frequently to determine if they are an “adaptor” or are “susceptible.”
LFTs are not required as a routine safety monitoring procedure for all participants in this
study. However, should an investigator deem it necessary to assess LFTs because a
participant presents with clinical signs/symptoms, such LFT results should be managed and
followed as described below.
In the majority of DILI cases, elevations in AST and/or ALT precede TBili elevations
(>2 × ULN) by several days or weeks. The increase in TBili typically occurs while
AST/ALT is/are still elevated above 3 × ULN (ie, AST/ALT and TBili values will be
elevated within the same laboratory sample). In rare instances, by the time TBili elevations
are detected, AST/ALT values might have decreased. This occurrence is still regarded as a
potential DILI. Therefore, abnormal elevations in either AST OR ALT in addition to TBili
that meet the criteria outlined below are considered potential DILI (assessed per Hy’s law
criteria) cases and should always be considered important medical events, even before all
other possible causes of liver injury have been excluded.
The threshold of laboratory abnormalities for a potential DILI case depends on the
participant’s individual baseline values and underlying conditions. Participants who present
with the following laboratory abnormalities should be evaluated further as potential DILI
(Hy’s law) cases to definitively determine the etiology of the abnormal laboratory values:
• Participants with AST/ALT and TBili baseline values within the normal range who
subsequently present with AST OR ALT values >3 × ULN AND a TBili value >2 × ULN
with no evidence of hemolysis and an alkaline phosphatase value <2 × ULN or not
available.
• For participants with baseline AST OR ALT OR TBili values above the ULN, the
following threshold values are used in the definition mentioned above, as needed,
depending on which values are above the ULN at baseline:
• Preexisting AST or ALT baseline values above the normal range: AST or ALT values
>2 times the baseline values AND >3 × ULN; or >8 × ULN (whichever is smaller).
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• Preexisting values of TBili above the normal range: TBili level increased from
baseline value by an amount of at least 1 × ULN or if the value reaches >3 × ULN
(whichever is smaller).
Rises in AST/ALT and TBili separated by more than a few weeks should be assessed
individually based on clinical judgment; any case where uncertainty remains as to whether it
represents a potential Hy’s law case should be reviewed with the sponsor.
The participant should return to the investigator site and be evaluated as soon as possible,
preferably within 48 hours from awareness of the abnormal results. This evaluation should
include laboratory tests, detailed history, and physical assessment.
In addition to repeating measurements of AST and ALT and TBili for suspected cases of
Hy’s law, additional laboratory tests should include albumin, CK, direct and indirect
bilirubin, GGT, PT/INR, total bile acids, and alkaline phosphatase. Consideration should
also be given to drawing a separate tube of clotted blood and an anticoagulated tube of blood
for further testing, as needed, for further contemporaneous analyses at the time of the
recognized initial abnormalities to determine etiology. A detailed history, including relevant
information, such as review of ethanol, acetaminophen/paracetamol (either by itself or as a
coformulated product in prescription or over-the-counter medications), recreational drug,
supplement (herbal) use and consumption, family history, sexual history, travel history,
history of contact with a jaundiced person, surgery, blood transfusion, history of liver or
allergic disease, and potential occupational exposure to chemicals, should be collected.
Further testing for acute hepatitis A, B, C, D, and E infection and liver imaging (eg, biliary
tract) and collection of serum samples for acetaminophen/paracetamol drug and/or protein
adduct levels may be warranted.
All cases demonstrated on repeat testing as meeting the laboratory criteria of AST/ALT and
TBili elevation defined above should be considered potential DILI (Hy’s law) cases if no
other reason for the LFT abnormalities has yet been found. Such potential DILI (Hy’s law)
cases are to be reported as SAEs, irrespective of availability of all the results of the
investigations performed to determine etiology of the LFT abnormalities.
A potential DILI (Hy’s law) case becomes a confirmed case only after all results of
reasonable investigations have been received and have excluded an alternative etiology.
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10.6. Appendix 6: Abbreviations

The following is a list of abbreviations that may be used in the protocol.
Abbreviation Term
2019-nCoV novel coronavirus 2019
Abs absolute (in Appendix 2)
AE adverse event
-hCG beta-human chorionic gonadotropin
BMI body mass index
CBER Center for Biologics Evaluation and Research
CDC Centers for Disease Control and Prevention (United States)
CFR Code of Federal Regulations
CIOMS Council for International Organizations of Medical Sciences
CLIA Clinical Laboratory Improvement Amendments
CONSORT Consolidated Standards of Reporting Trials
CRO contract research organization
CSR clinical study report
CT computed tomography
DBP diastolic blood pressure
DILI drug-induced liver injury
DNA deoxyribonucleic acid
DU dosing unit
EC ethics committee
ECMO extracorporeal membrane oxygenation
ECG electrocardiogram
eCRF electronic case report form
EDP exposure during pregnancy
EMA European Medicines Agency
EU European Union
EUA emergency use application
EudraCT European Clinical Trials Database
FDA Food and Drug Administration
FiO2 fraction of inspired oxygen
FSH follicle-stimulating hormone
GCP Good Clinical Practice
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Abbreviation Term
GGT gamma-glutamyl transferase
HBc Ab hepatitis B core antibody
HBe hepatitis B e
HBeAg hepatitis B e antigen
HBsAg hepatitis B surface antigen
HBV hepatitis B virus
HCV hepatitis C virus
HCV Ab hepatitis C virus antibody
HIPAA Health Insurance Portability and Accountability Act
HIV human immunodeficiency virus
HR heart rate
HRT hormone replacement therapy
IA interim analysis
IB investigator’s brochure
ICH International Council for Harmonisation
ICU intensive care unit
ID identification
Ig immunoglobulin
IgM immunoglobulin M
IMP investigational medicinal product
IND investigational new drug
INR international normalized ratio
IP manual investigational product manual
IPAL Investigational Product Accountability Log
IRB institutional review board
IRR illness rate ratio
IRT interactive response technology
ISO International Organization for Standardization
IV intravenous(ly)
LFT liver function test
LL lower limit
LNP lipid nanoparticle
LPX lipoplex
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Abbreviation Term
MAR missing at random
MERS Middle East respiratory syndrome
modRNA nucleoside-modified messenger ribonucleic acid
MRI magnetic resonance imaging
N SARS-CoV-2 nucleoprotein
N/A not applicable
non-S nonspike protein
P2 S SARS-CoV-2 full-length, P2 mutant, prefusion spike glycoprotein
PaO2 partial pressure of oxygen, arterial
PCR polymerase chain reaction
PI principal investigator
POS probability of success
PPE personal protective equipment
PT prothrombin time
RBC red blood cell
RR respiratory rate
RSV respiratory syncytial virus
S1 spike protein S1 subunit
saRNA self-amplifying messenger ribonucleic acid
SARS severe acute respiratory syndrome
SBP systolic blood pressure
SoA schedule of activities
SpO2 oxygen saturation as measured by pulse oximetry
SRSD single reference safety document
SUSAR suspected unexpected serious adverse reaction
TBD to be determined
TBili total bilirubin
ULN upper limit of normal
uRNA unmodified messenger ribonucleic acid
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Abbreviation Term
US United States
vax vaccination
VE vaccine efficacy
WOCBP woman/women of childbearing potential
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10.7. Appendix 7: Stopping and Alert Rules for Enhanced COVID-19

In Phase 2/3, the unblinded team supporting the DMC (reporting team), including an
unblinded medical monitor, will review cases of severe COVID-19 as they are received, and
will review AEs at least weekly for additional potential cases of severe COVID-19 and will
contact the DMC in the event that the stopping rule or an alert is met. Specifically, the
unblinded reporting team will contact the DMC chair, who will then convene the full DMC
as soon as possible. The DMC will review all available safety and/or efficacy data at the
time of the review. The DMC will make one of the following recommendations to Pfizer:
withhold final recommendation until further information/data are provided, continue the
study as designed, modify the study and continue, or stop the study. The final decision to
accept or reject the committee’s recommendation resides with Pfizer management and will be
communicated to the committee chairperson in writing.
At any point the unblinded team may discuss with the DMC chair whether the DMC should
review cases for an adverse imbalance of cases of COVID-19 and/or severe COVID-19
between the vaccine and placebo groups (see Section 9.6). In addition, at the time of the IAs
at 32, 62, 92, and 120 cases, the number of severe COVID-19 cases in the vaccine and
placebo groups will be assessed.
Stopping and alert rules will be applied as follows. The stopping rule will be triggered when
the 1-sided probability of observing the same or a more extreme case split is 5% or less when
the true incidence of severe disease is the same for vaccine and placebo participants, and alert
criteria are triggered when this probability is less than 11%. In addition, when the total
number of severe cases is low (15 or less), the unblinded team supporting the DMC will
implement the alert rule when a reverse case split of 2:1 or worse is observed. For example,
at 3 cases 2:1, at 4 cases 3:1, etc. Below 15 cases, this rule is more rigorous than requiring
the probability of an observed adverse split or worse be <11%.
The stopping rule and alert rules are illustrated in Table 9 and Table 10, respectively, when
the total number of severe cases is 20 or less. For example, when there are 7 severe cases,
the adverse split has to be 7:0 to stop the study, but a split of 5:2 would trigger the alert rule.
Similarly, when there is a total of 9 severe cases, an adverse split of 9:0 triggers the stopping
rule, while a split of 6:3 or worse triggers the alert rule. The alert rule may be triggered with
as few as 2 cases, with a split of  2:0.
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Table 9. Stopping Rule: Enrollment Is Stopped if the Number of Severe Cases in

the Vaccine Group Is Greater Than or Equal to the Prespecified Stopping
Rule Value (S)
Total Severe Cases Prespecified Stopping Rule Value If the True Ratio of Severe Cases
(S): Number of Severe Cases in the Between Vaccine and Placebo
Vaccine Group to Stop Groups Is 1:1, Probability of S or
More Being Observed in the Vaccine
Group
4 4 N/A
5 5 3.13%
6 6 1.56%
7 7 0.78%
8 7 3.52%
9 8 1.95%
10 9 1.07%
11 9 3.27%
12 10 1.93%
13 10 4.61%
14 11 2.87%
15 12 1.76%
16 12 3.84%
17 13 2.45%
18 13 4.81%
19 14 3.18%
20 15 2.07%
Abbreviation: N/A = not applicable.
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Table 10. Alert Rule: Further Action Is Taken if the Number of Severe Cases in the
Vaccine Group Is Greater Than or Equal to the Prespecified Alert Rule
Value (A)
Total Prespecifie If the True If the True If the True If the True If the True
Severe d Alert Ratio of Ratio of Ratio of Ratio of Ratio of
Cases Rule Value Severe Cases Severe Cases Severe Cases Severe Cases Severe Cases
(A): Between the Between the Between the Between the Between the
Number of Vaccine and Vaccine and Vaccine and Vaccine and Vaccine and
Severe Placebo Placebo Placebo Placebo Placebo
Cases in the Groups Is Groups Is Groups Is Groups Is Groups Is
Vaccine 1:1, 1:1, 2:1, 3:1, 4:1,
Group to Probability Probability Probability Probability Probability
Trigger of A Being of A or More of A or More of A or More of A or More
Further Observed in Being Being Being Being
Action the Vaccine Observed in Observed in Observed in Observed in
Group the Vaccine the Vaccine the Vaccine the Vaccine
Group Group Group Group
2 2 25.00% 25.00% 44.49% 56.25% 64.00%
3 2 37.50% 50.00% 74.12% 84.38% 89.60%
4 3 25.00% 31.25% 59.32% 73.83% 81.92%
5 4 15.63% 18.75% 46.16% 63.28% 73.73%
6 4 23.44% 34.38% 68.10% 83.06% 90.11%
7 5 16.41% 22.66% 57.14% 75.64% 85.20%
8 6 10.94% 14.45% 46.90% 67.85% 79.69%
9 6 16.41% 25.39% 65.11% 83.43% 91.44%
10 7 11.72% 17.19% 56.02% 77.59% 87.91%
11 8 8.06% 11.33% 47.35% 71.33% 83.89%
12 8 12.08% 19.38% 63.25% 84.24% 92.74%
13 9 8.73% 13.34% 55.31% 79.40% 90.09%
14 10 6.11% 8.98% 47.66% 74.15% 87.02%
15 10 9.16% 15.09% 61.94% 85.16% 93.89%
16 11 6.67% 10.51% 54.81% 81.03% 91.83%
17 12 4.72% 7.17% 47.88% 76.53% 89.43%
18 13 3.27% 4.81% 41.34% 71.75% 86.71%
19 13 5.18% 8.35% 54.43% 82.51% 93.24%
20 14 3.70% 5.77% 48.06% 78.58% 91.33%
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10.8. Appendix 8: Criteria for Allowing Inclusion of Participants With Chronic Stable
HIV, HCV, or HBV Infection
Potential participants with chronic stable HIV, HCV, or HBV infection may be considered
for inclusion if they fulfill the following respective criteria.
Known HIV infection
• Confirmed stable HIV disease defined as documented viral load <50 copies/mL and CD4
count >200 cells/mm3 within 6 months before enrollment, and on stable antiretroviral
therapy for at least 6 months.
Known HCV infection
• History of chronic HCV with evidence of sustained virological response (defined as

undetectable HCV RNA) for ≥12 weeks following HCV treatment or without evidence
of HCV RNA viremia (undetectable HCV viral load).
Known HBV infection
Confirmed inactive chronic HBV infection, defined as HBsAg present for ≥6 months and
the following:
• HBeAg negative, anti-HBe positive
• Serum HBV DNA <2000 IU/mL
• Persistently normal ALT and/or AST levels
• In those who have had a liver biopsy performed, findings that confirm the absence of
significant necroinflammation.
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11. REFERENCES
1
World Health Organization. WHO Director-General's opening remarks at the media
briefing on COVID-19. Available from: https://www.who.int/dg/speeches/detail/who-
director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-
2020. Published: 11 Mar 2020. Accessed: 01 Apr 2020.
2
World Health Organization. Coronavirus disease 2019 (COVID-19) situation report - 70.
In: Data as reported by national authorities by 10:00 CET 30 March 2020. Geneva,
Switzerland: World Health Organization; 2020.
3
Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19):
information for clinicians on investigational therapeutics for patients with COVID-19.
Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-
options.html. Updated: 25 Apr 2020. Accessed: 26 Jun 2020.
4
Rauch S, Jasny E, Schmidt KE, et al. New vaccine technologies to combat outbreak
situations. Front Immunol 2018;9:1963.
5
Sahin U, Karikó K, Türeci Ö. mRNA-based therapeutics—developing a new class of
drugs. Nat Rev Drug Discov 2014;13(10):759-80.
6
BioNTech RNA Pharmaceuticals GmbH. CorVAC/BNT162 Investigator’s Brochure.
Mainz, Germany: BioNTech RNA Pharmaceuticals GmbH; 25 Mar 2020.
7
Feldman RA, Fuhr R, Smolenov I, et al. mRNA vaccines against H10N8 and H7N9
influenza viruses of pandemic potential are immunogenic and well tolerated in healthy
adults in phase 1 randomized clinical trials. Vaccine 2019;37(25):3326-34.
8
US Food and Drug Administration. Guidance for industry: toxicity grading scale for
healthy adult and adolescent volunteers enrolled in preventive vaccine clinical trials.
Rockville, MD: Center for Biologics Evaluation and Research; September 2007.
9
Agresti A. Introduction: distributions and inference for categorical data. In: Agresti A,
ed. Categorical data analysis. 2nd ed. Hoboken, NJ: John Wiley & Sons; 2002:1-35.
10
Miettinen O, Nurminen M. Comparative analysis of two rates. Stat Med
1985;4(2):213-26.
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Protocol Amendment Summary of Changes Table
Document History

Protocol amendment 6 08 September 2020 • Reordered some procedures in the Phase 2/3
schedule of activities for consistency with the
main body of the protocol.
• Corrected the window for the 6-month follow-up
visit to be approximately 6 months after
Vaccination 2.
• Reduced the volume of blood draws to ~20 mL.
• Removed the need to have safety data reported for
participants to be included in the safety objective
assessment.
• Added an exploratory objective to describe safety,
immunogenicity, and efficacy in participants with
stable HIV disease.
• Increased the sample size for Phase 2/3 to
~43,998.
• Clarified that inclusion criterion 4 (ie, participants
at higher risk for acquiring COVID-19) is
applicable for Phase 2/3 only, and provided some
examples.
• Removed exclusion criterion 2 (ie, known
infection with HIV, HCV, or HBV) for Phase 3
and added criteria for HIV-positive participants.
• Decreased the lower age limit and removed the
upper age limit for inclusion in Phase 2/3 in order
to evaluate BNT162b2 30 µg in older adolescents
and those over 85 years of age; updated the title
and other references to adults to align with this
change.
• Renamed the immunological assays to align with
other program-level documents.
• Removed reference to the SARS-CoV-2 full-
length, P2 mutant, prefusion spike glycoprotein
(P2 S) being “heads up.”
• Clarified that a positive SARS-CoV-2 NAAT
result without symptoms should not result in
discontinuation of study intervention.
• Added clarification that potential COVID-19
illnesses that are consistent with the clinical
endpoint definition should not be recorded as AEs.
• Updated the analysis population descriptions to
align with the study SAP.
Protocol amendment 5 24 July 2020 Following regulatory feedback:
• Renamed Stage 1 to Phase 1, removed Stage 2,
and renamed Stage 3 to Phase 2/3.
• Clarified that a single vaccine candidate,
administered as 2 doses 21 days apart, will be
studied in Phase 2/3.
Document History

• Stated that the vaccine candidate selected for
Phase 2/3 evaluation is BNT162b2 at a dose of
30 µg.
• Removed the potential to study BNT162b3.
• Immunogenicity data will be summarized for the
first 360 participants through 1 month after Dose
2, rather than through 21 days after Dose 1.
• Provided further details of sponsor staff that will
be unblinded in Phase 2/3.
• Clarified which stopping rules apply to which
phase of the study.
In addition:
• Clarified the AE reporting requirements for
potential COVID-19 illnesses.
• Updated that Visit 1 may be conducted across 2
consecutive days in Phase 2/3.
• Moved the immunogenicity objectives in
Phase 2/3 to become exploratory.
• Added an additional inclusion criterion to enroll
participants who, in the judgment of the
investigator, are at risk for acquiring COVID-19.
• Modified exclusion criterion 5, so that participants
with a previous clinical or microbiological
diagnosis of COVID-19 are excluded from all
phases of the study.
• Clarified that there will be 2 all-available efficacy
populations.
• Clarified that immunogenicity samples will be
drawn for all participants; analyses will be based
upon results from subsets of samples, according to
the purpose.
• Updated that the 3-tier approach to summarizing
AEs will only be performed in Phase 2/3.
• Updated that at each interim analysis for efficacy,
only the first primary objective will be evaluated.
• Changed to use the same posterior probability
(99.5%) for all interim analyses, resulting in case
split changes in Tables 5, 6, and 7.
• Updated the stopping and alert rule parameters for
enhanced COVID-19.
Protocol amendment 4 30 June 2020 Given the rapidly evolving pandemic situation, and the
need to demonstrate VE as soon as possible, the
protocol has been amended to be powered to meet new
efficacy objectives. These new efficacy objectives and
corresponding endpoints have been added to Section 3.
Further nonclinical data are available to support the

study of the BNT162b3 candidate in humans, and the
candidate has been added to the protocol.
Document History

The 6-month safety follow-up telephone contact has
been changed to an in-person visit for Stage 3
participants, to allow collection of an immunogenicity
blood sample.
The COVID-19 illness visit has now added flexibility

to permit a remote or in-person visit.
The COVID-19 illness symptoms have been updated to

align with the FDA-accepted definitions; this change is
also reflected in the criteria for temporary delay of
enrollment.
AEs that occur between consent and dosing will now

be reported on the AE (rather than Medical History)
CRF, to align with the latest Pfizer protocol template.
Changes have been made to the headings to align with

the latest Pfizer protocol template.
Clarified that only an unblinded site staff member may

obtain the participant’s randomization number and
study intervention allocation.
Additional interim analyses have been added to

evaluate VE and futility during the study.
As a result of regulatory feedback, an appendix has

been added to outline the stopping and alert rules to
monitor for potential enhanced COVID-19.
Protocol amendment 3 10 June 2020 As data have become available from this study and the
BNT162-01 study in Germany, the following decisions
were made:
• Not to study the BNT162a1 and BNT162c2
vaccine candidates at this time. Therefore, these
candidates have been removed from the protocol.
• To study further lower dose levels of the modRNA
candidates. Therefore, a 20-µg dose level is
formally included for BNT162b1 and BNT162b2.
• To permit individual and group dosing alterations
for the second dose of study intervention.
Following regulatory feedback, the BNT162b3 vaccine

candidate has been removed from the protocol until
further nonclinical data are available to support study
in humans.
Given the rapidly evolving pandemic situation,

additional blood draws for exploratory COVID-19
research, intended to establish an immunological
Document History

surrogate of protection, will be taken from selected
participants who consent.
In order to increase flexibility enrolling participants, an

extended screening window (increased from 14 to 28
days) for sentinel participants in Stage 1 has been
added. This is considered acceptable since eligible
participants are expected to be either healthy or have
stable medical conditions.
To increase the number of doses that can be obtained

from available vaccine vials, not all dose levels will
result in a dosing volume of 0.5 mL. Precise dosing
instructions will be provided in the IP manual.
To facilitate the reporting of COVID-19 illness

diagnoses and potential symptoms to the investigator,
participants may utilize a COVID-19 illness e-diary.
Protocol amendment 2 27 May 2020 Given the urgent nature of the pandemic situation, the
following changes allow determination of the
appropriate human dose level for both younger and
older adults to move speedily into the next phase of
clinical evaluation:
• Added a new vaccine candidate, BNT162b3,
modRNA encoding a membrane-anchored RBD
• Added a 50-µg dose level for vaccine candidates
based on the modRNA platform (ie, BNT162b1,
BNT162b2, and BNT162b3)
• Modified the criteria required for the IRC to
determine dose escalation in the 18- to 55-year age
cohort and advancement to groups of participants
65 to 85 years of age
In addition:
• Removed hemoglobin change-from-baseline
abnormalities from the laboratory abnormality
grading scale as abnormalities should be graded
based upon absolute values
Protocol amendment 1 13 May 2020 • Following regulatory feedback:
• Modified exclusion criteria and prohibited
inhaled/nebulized corticosteroids for sentinel
participants in Stage 1
• Clarified that the rapid test for prior COVID-19
infection for sentinel participants in Stage 1 will be
used only for screening purposes
• Removed time frames for stopping rules
• Stated that data supporting the selection of vaccine
candidate(s)/dose level(s) and schedule(s) for
Stages 2 and 3 will be submitted to the FDA for
review
Document History

• Following preliminary experience in the
BioNTech study conducted in Germany (BNT162-
01):
• Decreased the dose levels for BNT162a1 and
BNT162c2
Additionally:
• Clarified the roles of BioNTech and Pfizer
• Amended text so that the IRC decision to progress
group(s) into Stages 2 and 3 can be based upon
safety and immunogenicity data after Dose 1 or 2
• Clarified safety data requirements to permit dose
escalation
• Amended text so that the progression to
participants 65 to 85 years of age can be based
upon data from the same RNA platform
• Incorporated a protocol administrative change to
correct the variant designation and the encoded
antigen to BNT162c2
• Clarified that the SARS-CoV-2 neutralizing assay
does not employ wild-type virus
• Clarified that the SARS-CoV-2 spike protein–
binding antibody assay is specific for the S1
subunit
• Clarified that efficacy against COVID-19 is based
upon illness (not infection) rate ratio
state that the study placebo may be supplied in a
glass or plastic vial
• Corrected a typographical error in Section 6.5.1
regarding the time frame for prior receipt of
blood/plasma products or immunoglobulins
• Corrected a typographical error in Table 2
regarding the lower limit of diameter (cm) for mild
redness and swelling
• Updated the °C fever scale in Table 4 to ensure
that all potential °F values are correctly assigned
clarify that a rapid test for prior COVID-19
infection will be performed for sentinel
participants in Stage 1, and a serum sample will be
drawn for potential future assessment
• Clarified that, after screening, physical
examinations in sentinel participants in Stage 1
will be directed
• Clarified the descriptions of the populations for
analysis to align with the statistical analysis plan
• Added a complete safety and immunogenicity
analysis approximately 6 months after Dose 2 for
all participants in Stage 3
Document History

• Amended text so that the stopping rules apply to
an RNA platform rather than a specific vaccine
candidate
Original protocol 15 April 2020 N/A
This amendment incorporates all revisions to date, including amendments made at the request of
country health authorities and IRBs/ECs.
Protocol C4591001 (PF-07302048) Statistical Analysis Plan
Protocol C4591001
A PHASE 1/2, PLACEBO-CONTROLLED, RANDOMIZED, OBSERVER-BLIND,

DOSE-FINDING STUDY TO DESCRIBE THE SAFETY, TOLERABILITY,
IMMUNOGENICITY, AND POTENTIAL EFFICACY OF SARS-COV-2 RNA
VACCINE CANDIDATES AGAINST COVID-19 IN HEALTHY ADULTS
Statistical Analysis Plan

(SAP)
Version: 1
Date: 20 May 2020
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TABLE OF CONTENTS
LIST OF TABLES .....................................................................................................................5
APPENDICES ...........................................................................................................................5
1. VERSION HISTORY ............................................................................................................6
2. INTRODUCTION .................................................................................................................6
2.1. Study Objectives, Endpoints, and Estimands ............................................................6
2.2. Study Design .............................................................................................................9
2.2.1. Overall Design ..............................................................................................9
2.2.2. Stage 1 ..........................................................................................................9
2.2.3. Stage 2 ........................................................................................................13
2.2.4. Stage 3 ........................................................................................................13
3. ENDPOINTS AND BASELINE VARIABLES: DEFINITIONS AND
CONVENTIONS ................................................................................................................14
3.1. Primary Endpoints ...................................................................................................14
3.1.1. Local Reactions ..........................................................................................14
3.1.2. Systemic Events (Systemic Event Symptoms and Fever) ..........................17
3.1.3. Use of Antipyretic Medication ...................................................................19
3.1.4. Adverse Events ...........................................................................................19
3.1.5. Serious Adverse Events ..............................................................................20
3.1.6. Hematology and Chemistry Laboratory Parameters in Sentinel
Cohorts From Stage 1 ......................................................................................20
3.2. Secondary Endpoints ...............................................................................................22
3.2.1. Immunogenicity Endpoints .........................................................................22
3.2.1.1. Serum Neutralizing Titers .........................................................22
3.2.1.2. IgG Concentrations ...................................................................22
3.2.2. Vaccine Efficacy Endpoint .........................................................................22
3.3. Tertiary/Exploratory Endpoints...............................................................................22
3.4. Baseline and Other Variables ..................................................................................22
3.4.1. Demographics, Medical History, and Physical Examination .....................23
3.4.2. E-Diary Completion....................................................................................23
3.4.3. Prior/Concomitant Vaccines and Concomitant Medications ......................23
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3.5. Safety Endpoints .....................................................................................................24

4. ANALYSIS SETS (POPULATIONS FOR ANALYSIS) ...................................................24
5. GENERAL METHODOLOGY AND CONVENTIONS ....................................................25
5.1. Hypotheses and Decision Rules ..............................................................................25
5.1.1. Vaccine Efficacy Hypothesis ......................................................................25
5.1.2. Sample Size ................................................................................................26
5.1.3. Multiplicity Considerations ........................................................................26
5.2. General Methods .....................................................................................................27
5.2.1. Analyses for Binary Data............................................................................27
5.2.2. Analyses for Continuous Data ....................................................................27
5.2.2.1. Geometric Means ......................................................................27
5.2.2.2. Geometric Mean Fold Rises ......................................................27
5.2.2.3. Geometric Mean Ratios .............................................................28
5.2.2.4. Geometric Mean Fold Rise Ratios ............................................28
5.2.2.5. Reverse Cumulative Distribution Curves ..................................28
5.3. Methods to Manage Missing Data ..........................................................................28
6. ANALYSES AND SUMMARIES ......................................................................................29
6.1. Primary Endpoint(s) ................................................................................................29
6.1.1. Local Reactions ..........................................................................................29
6.1.1.1. Main Analysis ...........................................................................29
6.1.1.2. Supplementary Analyses ...........................................................29
6.1.2. Systemic Events ..........................................................................................30
6.1.2.1. Main Analysis ...........................................................................30
6.1.3. Adverse Events ...........................................................................................31
6.1.3.1. Main Analysis ...........................................................................31
6.1.4. Serious Adverse Events ..............................................................................32
6.1.4.1. Main Analyses ...........................................................................32
6.1.5. Hematology and Chemistry Parameters in Sentinel Cohorts From
Stage 1 ..............................................................................................................32
6.1.5.1. Main Analyses ...........................................................................32
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6.2. Secondary Endpoints ...............................................................................................33

6.2.1. Immunogenicity Endpoints .........................................................................33
6.2.1.1. SARS-CoV-2 Serum Neutralizing Titers ..................................33
6.2.1.2. SARS-CoV-2-S1–Specific Binding Antibody Levels and
RBD-Specific Binding Antibody Levels ...........................................34
6.2.1.3. GMR of SARS-CoV-2 Serum Neutralizing Titer to
SARS-CoV-2-S1–Specific Binding Antibody Levels and RBD-
Specific Binding Antibody Levels ....................................................36
6.2.2. Vaccine Efficacy Endpoints .......................................................................37
6.2.2.1. COVID-19 Incidence per 1000 Person-Years of Follow-
up .......................................................................................................37
6.3. Tertiary/Exploratory Endpoints...............................................................................38
6.3.1. Relationship Between SARS-CoV-2 Serological Parameters and
NAAT-Confirmed COVID-19, Symptomatic SARS-CoV-2 Infection,
and Asymptomatic SARS-CoV-2 Infection.....................................................38
6.3.2. Additional Analysis ....................................................................................38
6.4. Subgroup Analysis ..................................................................................................38
6.5. Baseline and Other Summaries and Analyses .........................................................39
6.5.1. Baseline Summaries....................................................................................39
6.5.1.1. Demographic Characteristics ....................................................39
6.5.1.2. Medical History .........................................................................39
6.5.1.3. Physical Examination ................................................................39
6.5.2. Study Conduct and Participant Disposition ................................................39
6.5.2.1. Participant Disposition ..............................................................39
6.5.2.2. Blood Samples for Assay ..........................................................39
6.5.2.3. E-Diaries ....................................................................................39
6.5.3. Study Vaccination Exposure.......................................................................40
6.5.3.1. Vaccination Timing and Administration ...................................40
6.5.4. Prior/Concomitant Vaccination and Concomitant Medications .................40
6.6. Safety Summaries and Analyses .............................................................................40
7. ANALYSES TIMING .........................................................................................................40
7.1. Introduction .............................................................................................................40
7.2. Interim Analyses and Summaries ............................................................................40
7.2.1. Data Monitoring Committee .......................................................................41
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8. REFERENCES ....................................................................................................................41
9. APPENDICES .....................................................................................................................42
LIST OF TABLES
Table 1. Summary of Changes ..............................................................................................6
Table 2. List of Primary, Secondary, and Tertiary/Exploratory Objectives,
Estimands, and Endpoints .......................................................................................7
Table 3. Potential Groups in Stage 1 ..................................................................................10
Table 4. Derived Variables for Presence of Each and Any Local Reaction Within
7 Days for Each Dose ...........................................................................................15
Table 5. Local Reaction Grading Scale ..............................................................................16
Table 6. Systemic Event Grading Scale..............................................................................18
Table 7. Scale for Fever ......................................................................................................18
Table 8. Laboratory Abnormality Grading Scale ...............................................................20
Table 9. Probability of Observing at Least 1 AE by Assumed True Event Rates
With Different Sample Sizes ................................................................................26
APPENDICES
Appendix 1. List of Abbreviations...........................................................................................42
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1. VERSION HISTORY
Table 1. Summary of Changes

Version/ Associated Protocol Rationale Specific Changes
Date Amendment
1/ Protocol amendment N/A N/A
20 May 2020 1 13 May 2020
2. INTRODUCTION
This SAP provides the detailed methodology for summary and statistical analyses of the data
collected in Study C4591001. This document may modify the plans outlined in the protocol;
however, any major modifications of the primary endpoint definition or its analysis will also
be reflected in a protocol amendment.
2.1. Study Objectives, Endpoints, and Estimands

The estimands corresponding to each primary, secondary, and tertiary/exploratory objective
are described in Table 2 below.
In the primary safety objective evaluations, missing e-diary data will not be imputed.
Missing AE dates will be imputed according to Pfizer safety rules. No other missing
information will be imputed in the safety analysis.
for immunogenicity (see Section 4 for definition). These estimands estimate vaccine effect
in the hypothetical setting where participants follow the study schedules and protocol
requirements as directed. Missing antibody results will not be imputed. Immunogenicity
results that are below the LLOQ will be set to 0.5 × LLOQ in the analysis. However, this
calculation may be adjusted based upon additional data from the assay.
efficacy (see Section 4 for definition). These estimands estimate vaccine effect in the
as directed. Missing laboratory results to confirm COVID-19 infection will not be imputed
for the primary analysis, but imputation of missing data for the efficacy endpoint may be
performed as a sensitivity analysis.
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Estimands, and Endpoints
Primary Objective Estimands Primary Endpoints
To describe the safety and In participants receiving at least • Local reactions (pain at the
tolerability profiles of prophylactic 1 dose of study intervention and injection site, redness, and
BNT162 vaccines in healthy adults having safety data reported after any swelling).
after 1 or 2 doses. vaccination, the percentage of • Systemic events (fever,
participants reporting: fatigue, headache, chills,
• Local reactions for up to 7 days vomiting, diarrhea, new or
following each dose. worsened muscle pain, and
• Systemic events for up to 7 days new or worsened joint pain).
following each dose.
• AEs from Dose 1 to 1 month • AEs
after the last dose.
• SAEs
• SAEs from Dose 1 to 6 months
after the last dose.
In addition, in sentinel cohorts from

Stage 1, the percentage of
participants with:
Hematology and chemistry
chemistry laboratory values 1
laboratory parameters detailed in
and 7 days after Dose 1; and 7
the protocol, Section 10.2.
days after Dose 2.
• Grading shifts in hematology
and chemistry laboratory
assessments between baseline
and 1 and 7 days after Dose 1;
and before Dose 2 and 7 days
after Dose 2.
Secondary Objectives Estimands Secondary Endpoints
To describe the immune responses In participants complying with the
elicited by prophylactic BNT162 key protocol criteria (evaluable
vaccines in healthy adults after 1 or participants) at the following time
2 doses. points after receipt of study
intervention:
21 days after Dose 1; 7 and 14 days
and 1, 6, 12, and 24 months after
Dose 2.
Stage 1 Nonsentinel Cohorts and
Stage 2 Cohorts: 21 days after Dose
1; 14 days and 1, 6, 12, and 24
months after Dose 2.
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Estimands, and Endpoints
Stage 3 Cohort(s): 1, 12, and
24 months after Dose 2.
• GMTs at each time point. SARS-CoV-2 serum neutralizing
• GMFR from before vaccination titers.
to each subsequent time point
after vaccination.
achieving ≥4-fold rise from
before vaccination to each
vaccination.
• GMCs at each time point. SARS-CoV-2-S1–specific binding
• GMFR from before vaccination antibody levels and RBD-specific
to each subsequent time point binding antibody levels.
after vaccination.
achieving ≥4-fold rise from
before vaccination to each
vaccination.
• GMR, estimated by the ratio of SARS-CoV-2 serum neutralizing

the GM of SARS-CoV-2 serum titers.
neutralizing titers to the GM of
SARS-CoV-2–specific binding SARS-CoV-2-S1–specific binding
antibody levels at each time antibody levels.
point.
SARS-CoV-2 RBD-specific
binding antibody levels.
prophylactic BNT162 vaccines key protocol criteria (evaluable person-years of follow-up.
against confirmed COVID-19. participants) following receipt of the
last dose of study intervention:
vaccine to placebo].
Tertiary/Exploratory Objectives Estimands Tertiary/Exploratory Endpoints
To describe the relationship Nonvaccine-antigen SARS-CoV-2
between SARS-CoV-2 serological antibody levels.
parameters and:
• NAAT-confirmed COVID-19.
• Symptomatic SARS-CoV-2
infection.
• Asymptomatic SARS-CoV-2
infection.
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2.2. Study Design

2.2.1. Overall Design
• As a 2-dose (separated by 21 or 60 days) or single-dose schedule.
• At up to 3 different dose levels.
• In 3 age groups (18 through 55 years of age, 65 through 85 years of age, and
18 through 85 years of age [stratified as ≤55 or >55 years of age])
expanded-cohort stage; and Stage 3; a final-candidate/dose large-scale stage. These stages,
and the progression between them, are detailed in the schema (protocol, Section 1.2).

unblinded.
allocation for the participants in Stage 1 and Stage 2.
2.2.2. Stage 1
Each group (vaccine candidate/dose level/age group/number of doses) will comprise
15 participants; 12 participants will be randomized to receive active vaccine and 3 to receive
placebo. On Day 22, those in 2-dose groups will receive the same vaccine they received on
Day 1; for those in single-dose groups, all will receive placebo. Full details of all potential
groups in Stage 1 may be found in Table 3.
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Groups N Age Group Dose 1 Dose 2
(Years)
2-Dose Groups (Sentinel Cohorts) Day 1 Day 22
a-0.1-2-Y (Sentinel) 15 18 to 55 BNT162a1 0.1 µg (n=12) BNT162a1 0.1 µg (n=12)
[uRNA 0.1 µg (2 doses)] Placebo (n=3) Placebo (n=3)
a-0.3-2-Y (Sentinel) 15 18 to 55 BNT162a1 0.3 µg (n=12) BNT162a1 0.3 µg (n=12)


c-0.1-2-Y (Sentinel) 15 18 to 55 BNT162c2 0.1 µg (n=12) BNT162c2 0.1 µg (n=12)

[saRNA 0.1 µg (2 doses)] Placebo (n=3) Placebo (n=3)
c-0.3-2-Y (Sentinel) 15 18 to 55 BNT162c2 0.3 µg (n=12) BNT162c2 0.3 µg (n=12)
a-0.1-2-O (Sentinel) 15 65 to 85 BNT162a1 0.1 µg (n=12) BNT162a1 0.1 µg (n=12)

a-0.3-2-O (Sentinel) 15 65 to 85 BNT162a1 0.3 µg (n=12) BNT162a1 0.3 µg (n=12)


c-0.1-2-O (Sentinel) 15 65 to 85 BNT162c2 0.1 µg (n=12) BNT162c2 0.1 µg (n=12)

c-0.3-2-O (Sentinel) 15 65 to 85 BNT162c2 0.3 µg (n=12) BNT162c2 0.3 µg (n=12)
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(Years)
Single-Dose Groups Day 1 Day 22

a-x-1-Y 15 18 to 55 BNT162a1 TBD (n=12) Placebo (n=15)
[uRNA dose level(s) selected Placebo (n=3)
for Stage 2 (1 dose)]
selected for Stage 2 (1 dose)]
c-x-1-Y 15 18 to 55 BNT162c2 TBD (n=12) Placebo (n=15)
a-x-1-O 15 65 to 85 BNT162a1 TBD (n=12) Placebo (n=15)

[uRNA dose level(s) selected Placebo (n=3)
for Stage 2 (1 dose)]
c-x-1-O 15 65 to 85 BNT162c2 TBD (n=12) Placebo (n=15)
2-Dose Groups (Longer Schedule) Day 1 Day 61

a-x-2L-Y 15 18 to 55 BNT162a1 TBD (n=12) BNT162a1 TBD (n=12)
[uRNA dose level(s) selected Placebo (n=3) Placebo (n=3)
for Stage 2 (2 doses)]
(2 doses)]
(2 doses)]
c-x-2L-Y 15 18 to 55 BNT162c2 TBD (n=12) BNT162c2 TBD (n=12)
(2 doses)]
a-x-2L-O 15 65 to 85 BNT162a1 TBD (n=12) BNT162a1 TBD (n=12)

[uRNA dose level(s) selected Placebo (n=3) Placebo (n=3)
for Stage 2 (2 doses)]
(2 doses)]
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(Years)
(2 doses)]
c-x-2L-O 15 65 to 85 BNT162c2 TBD (n=12) BNT162c2 TBD (n=12)
(2 doses)]
Abbreviations: modRNA = nucleoside-modified messenger ribonucleic acid; saRNA = self-amplifying messenger
ribonucleic acid; TBD = to be determined; uRNA = unmodified messenger ribonucleic acid.
For each vaccine candidate/dose level/age group, the 15 participants randomized into each
2-dose group will comprise a sentinel cohort, to which the following apply:
• Additional safety assessments (see protocol, Section 8.2)
• Controlled enrollment:
• No more than 5 participants (4 active, 1 placebo) can be vaccinated on the first day.
• The first 5 participants must be observed by blinded site staff for at least 4 hours
after vaccination for any acute reactions.
• Vaccination of the remaining participants will commence no sooner than 24 hours

after the fifth participant received his or her vaccination.
• Application of stopping rules.
• IRC review of safety data to determine escalation to the next dose level.
• Escalation between dose levels in the 18- through 55-year age cohort will be
based on IRC review of at least 7-day post–Dose 1 safety data in this study and/or
the BioNTech study conducted in Germany (BNT162-01).
• Escalation between dose levels in the 65- through 85-year age cohort will be based
on IRC review of:
• At least 4-week post–Dose 1 safety data for the corresponding dose level in
the 18- through 55-year age cohort in this study and/or the BioNTech study
conducted in Germany (BNT162-01) and,
• At least 24-hour post–Dose 1 safety data in this study for the prior dose level
in the 65- through 85-year age cohort.
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• Note that, for candidates based upon the same RNA platform (eg, BNT162b1 and
BNT162b2), the stated observation periods may be shortened to 24 hours for the
second candidate studied, if the safety profile of the first candidate studied was
deemed acceptable at the same dose level by the IRC.
Groups of participants 65 through 85 years of age will not be started until safety and
immunogenicity data for the same RNA platform/dose level have been deemed acceptable in
the 18- through 55-year age cohort by the IRC.
Once the IRC has selected a vaccine candidate/dose level to proceed into Stage 2, for each
age cohort, 2 additional groups will be enrolled into Stage 1 for that vaccine candidate/dose
level:
• A 2-dose group, with the 2 doses administered 60 days apart rather than 21 days.
• A 1-dose group.
In this stage, assuming 2 dose levels are selected following the initial dose escalation, up to
56 potential groups are foreseen; if all groups are fully enrolled, this corresponds to a total of
840 participants.
2.2.3. Stage 2
and/or the BioNTech study conducted in Germany (BNT162-01), 1 or more groups (vaccine
candidate/dose level) may be selected to proceed into Stage 2. Participants in this stage will
be 18 through 85 years of age, stratified equally: 18 through 55 or 56 through 85 years.
Commencement of each age stratum will be dependent upon satisfactory safety and
immunogenicity data from the 18- through 55-year and 65- through 85-year groups from
Stage 1, respectively. It is therefore possible that the 2 age strata may not start concurrently.
In each group selected for Stage 2, it is intended that 225 participants will be randomized in a
4:1 ratio to receive active vaccine (180 participants) or placebo (45 participants).
2.2.4. Stage 3
and/or the BioNTech study conducted in Germany (BNT162-01), 1 group may be selected to
proceed into Stage 3. Participants in this stage will be 18 through 85 years of age, stratified
equally: 18 through 55 years or 56 through 85 years. As in Stage 2, it is possible that the
2 age strata may not start concurrently.
The group receiving the vaccine candidate/dose level selected for Stage 3 will comprise
3000 participants. An equal number of participants will receive placebo, ie, randomized in a
1:1 ratio.
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3. ENDPOINTS AND BASELINE VARIABLES: DEFINITIONS AND

CONVENTIONS
3.1. Primary Endpoints
For participants receiving at least 1 dose of study intervention and having safety data
reported after any vaccination, below are the primary safety endpoints:
• Local reactions (pain at the injection site, redness, and swelling) within 7 days after
each dose in each vaccine group.
• Systemic events (fever, fatigue, headache, chills, vomiting, diarrhea, new or worsened
muscle pain, and new or worsened joint pain) within 7 days after each dose in each
vaccine group.
For participants receiving at least 1 dose of study intervention, below are the primary safety
endpoints:
• AEs from Dose 1 to 1 month after the last dose.
• SAEs from Dose 1 to 6 months after the last dose.
For participants in sentinel cohorts from Stage 1, below are the additional primary safety
endpoints:
• Abnormal hematology and chemistry laboratory values 1 and 7 days after Dose 1; and
7 days after Dose 2.
• Grading shifts in hematology and chemistry laboratory assessments between baseline

and 1 and 7 days after Dose 1; and before Dose 2 and 7 days after Dose 2.
3.1.1. Local Reactions

The local reactions assessed and reported in the e-diary are redness, swelling, and pain at the
injection site, from Day 1 through Day 7 after each dose, where Day 1 is the day of each
dose. This section describes derivations with details for the assessment of local reactions:
presence, severity level, duration, and onset day.
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Presence or Absence
For the data summary of the presence (yes or no) of a local reaction during the interval from
Day 1 through Day 7 for each dose, where Day 1 is the day of each dose, the following
variables are required in order to compute the proportions:
• Presence (yes or no) of each severe/Grade 4 local reaction on each day and any day
(Day 1 through Day 7);
• Presence (yes or no) of each local reaction by maximum severity on any day (Day 1
through Day 7).
For each local reaction and any local reaction on any day, Table 4 explains the algorithm to
derive the presence of a reaction (yes or no) during the interval from Day 1 through Day 7,
where Day 1 is the day of each dose.
7 Days for Each Dose
Variablea Yes (1) No (0) Missing (.)
Presence of each local Participant reports the Participant reports the Participant does not report any
reaction. reaction as “yes” on any reaction as “no” on all 7 data on all 7 days (Day 1
day (Day 1 through days (Day 1 through through Day 7) for the
Day 7). Day 7) or as a reaction.
combination of “no” and
missing on all 7 days
(Day 1 through Day 7).
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7 Days for Each Dose
Variablea Yes (1) No (0) Missing (.)
Presence of any local Participant reports any For all 3 local reactions, Participant does not report any
reaction. local reaction as “yes” on participant reports “no” data for all 3 local reactions on
any day (Day 1 through on all 7 days (Day 1 all 7 days (Day 1 through
Day 7). through Day 7) or as a Day 7).
combination of “no” and
missing on all 7 days
(Day 1 through Day 7).
a. The variables will be derived for each and any of the local reactions (redness, swelling, and pain at the
injection site) and for each and any of the severe local reactions within the interval from Day 1 through
Day 7 after each dose.
Severity and Maximum Severity

(Grade 4)
Pain at the Does not interfere Interferes with Prevents daily Emergency room
injection site with activity. activity. activity. visit or
hospitalization for
severe pain.
Redness 2.0 cm to 5.0 cm >5.0 cm to 10.0 cm >10 cm Necrosis or
(5 to 10 measuring (11 to 20 measuring (≥21 measuring exfoliative
device units). device units). device units). dermatitis.
Swelling 2.0 cm to 5.0 cm >5.0 cm to 10.0 cm >10 cm Necrosis.
device units). device units). device units).
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For each local reaction reported for each dose, the maximum severity grade will be derived
for the e-diary collection period (Day 1 through Day 7, where Day 1 is the day of each dose)
as follows:
maximum severity grade = highest grade (maximum severity) within 7 days after
vaccination (Day 1 through Day 7) among severity grades where the answers are
neither “no” nor missing for at least 1 day during the interval from Day 1 through
Day 7.
Duration (First to Last Day Reported)
For participants experiencing any local reactions (or those with a derived reaction as
described in Table 5), the maximum duration (last day of reaction – first day of reaction + 1)
will be derived for each study vaccination. Resolution of the event is the last day on which
the event is recorded in the e-diary or the date the event ends if it is unresolved during the
participant diary recording period (end date collected on the CRF), unless chronicity is
established. If there is no known end date, the duration will be considered unknown and set
to missing. However, if an event is ongoing to the time of a subsequent vaccination, the end
date/day for the ongoing event would be the date/day that the next vaccine is administered,
which will be used for the duration computation. Participants with no reported reaction have
no duration.
Onset Day
The onset day of each local reaction will be derived. Onset day is defined as the first day of
reporting any severity.
For the onset day of each local reaction, if participants report change in severity of the local
reaction, only the first day of reporting that specific local reaction will be counted.
3.1.2. Systemic Events (Systemic Event Symptoms and Fever)

The systemic events assessed and recorded in the e-diary are vomiting, diarrhea, headache,
fatigue/tiredness, chills, new or worsened muscle pain, and new or worsened joint pain from
Day 1 through Day 7, where Day 1 is the day of each dose. The derivations for systemic
events will be handled in a way similar to the way local reactions are handled for presence of
event, severity level, duration, and onset day.
The variables associated with the systemic events will be computed in a way similar to the
way local reactions are computed (see Section 3.1.1). Maximum temperature range over the
period from Day 1 through Day 7 will be mapped into the ranges described in Table 7 for
summary of maximum temperature.
The symptoms will be assessed by the participant as absent, mild, moderate, or severe
according to the grading scale in Table 6.
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(Grade 4)
Vomiting 1-2 times in >2 times in Requires IV Emergency room visit
24 hours. 24 hours. hydration. or hospitalization for
hypotensive shock.
Diarrhea 2 to 3 loose stools 4 to 5 loose stools 6 or more loose Emergency room visit
in 24 hours. in 24 hours. stools in 24 hours. or hospitalization for
severe diarrhea.
Headache Does not interfere Some interference Prevents daily Emergency room visit
with activity. with activity. routine activity. or hospitalization for
severe headache.
Fatigue/tiredness Does not interfere Some interference Prevents daily Emergency room visit
severe fatigue.
Chills Does not interfere Some interference Prevents daily Emergency room visit
severe chills.
New or worsened Does not interfere Some interference Prevents daily Emergency room visit
muscle pain with activity. with activity. routine activity. or hospitalization for
severe new or worsened
muscle pain.
New or worsened Does not interfere Some interference Prevents daily Emergency room visit
joint pain with activity. with activity. routine activity. or hospitalization for
severe new or worsened
joint pain.
Oral temperature will be collected in the evening, daily, for 7 days following each dose
(Days 1 through 7, where Day 1 is the day of each dose) and at any time during the 7 days
that fever is suspected. Fever is defined as an oral temperature of ≥38.0°C (100.4°F). The
highest temperature for each day will be recorded in the e-diary. Temperature will be
measured and recorded to 1 decimal place and then categorized during analysis according to
the scale shown in Table 7. Temperatures recorded in degrees Fahrenheit will be
programmatically converted to degrees Celsius first for reporting. Fever will be grouped into
ranges for the analysis according to Table 7 below.

≥38.0°C to 38.4°C (100.4°F to 101.1°F)
>38.4°C to 38.9°C (101.2°F to 102.0°F)
>38.9°C to 40.0°C (102.1°F to 104.0°F)
>40.0°C (>104.0°F)
Note: Fever is defined as temperature ≥38.0°C (≥100.4°F).
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3.1.3. Use of Antipyretic Medication

The use of antipyretic medication is also recorded in the e-diary from Day 1 through Day 7,
where Day 1 is the day of each dose. For the use of antipyretic medication from Day 1
through Day 7 after each dose, the following endpoints and variables will be derived for
analysis following the same rules as for local reactions (see Section 3.1.1), where applicable.
• Presence (yes or no) of use of antipyretic medication on each day (Day 1 through Day 7);
• Presence (yes or no) of use of antipyretic medication on any day (Day 1 through Day 7);
• Duration (first to last day reported) of use of antipyretic medication;
• Onset day of use of antipyretic medication.
The use of antipyretic medication will be summarized and included in the systemic event
summary tables but will not be considered a systemic event.
3.1.4. Adverse Events

AEs will be assessed from the time of informed consent through 1 month after the last dose.
The primary endpoint “AEs from Dose 1 through 1 month after the last dose” and other AE
endpoints will be summarized by SOC and PT at the participant level.
This primary endpoint will be supported by summaries and listings of related AEs, severe
AEs, and immediate AEs (within the first 30 minutes after each dose).
AE reporting will be based on the specific reporting period. Standard algorithms for handling
missing AE dates will be applied as described in the Pfizer Vaccine data standard rules.
A 3-tier approach will be used to summarize AEs. Under this approach, AEs are classified
into 1 of 3 tiers. Different analyses will be performed for different tiers:
• Tier 1 events: These are prespecified events of clinical importance and are identified
in a list in the product’s Safety Review Plan.
• Tier 2 events: These are events that are not Tier 1 but are considered “relatively
common.” A MedDRA PT is defined as a Tier 2 event if there are at least 1%
participants with the AE term in at least 1 vaccine group.
• Tier 3 events: These are events that are neither Tier 1 nor Tier 2.
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3.1.5. Serious Adverse Events

approximately 6 months after the last dose of study intervention (Visit 8 for Stage 1
sentinel-cohort participants, Visit 5 for Stage 1 nonsentinel-cohort participants and Stage 2
participants, and Visit 4 for Stage 3 participants).
The safety endpoint “SAEs from Dose 1 to 6 months after the last dose” will be summarized
by SOC and PT at the participant level.
3.1.6. Hematology and Chemistry Laboratory Parameters in Sentinel Cohorts From

Stage 1
The following safety laboratory tests will be performed at the times defined in the protocol,
Section 1.3 (schedule of activities). Additional laboratory results may be reported on these
samples as a result of the method of analysis or the type of analyzer used by the clinical
laboratory, or as derived from calculated values. These additional tests would not require
additional collection of blood. Unscheduled clinical laboratory measurements may be
obtained at any time during the study to assess any perceived safety issues.
Hematology Chemistry
Hemoglobin BUN and creatinine
Hematocrit AST, ALT
RBC count Total bilirubin
MCV Alkaline phosphatase
MCH
MCHC
Platelet count
WBC count
Eosinophils (Abs)
Monocytes (Abs)
Basophils (Abs)
Lymphocytes (Abs)

accordance with the following grading scale (Table 8). Additionally, the primary criterion
for abnormality will follow the Pfizer safety rule book.

Hematology Mild Moderate Severe Potentially Life
(Grade 4)
Hemoglobin 11.0 – 12.0 9.5 – 10.9 8.0 – 9.4 <8.0
(Female) - g/dL
(Female)
change from
baseline
value - g/dL
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Hematology Mild Moderate Severe Potentially Life
(Grade 4)
Hemoglobin 12.5 – 13.5 10.5 – 12.4 8.5 – 10.4 <8.5
(Male) - g/dL
(Male)
change from
baseline
value - g/dL
WBC increase - 10,800 – 15,000 15,001 – 20,000 20,001 – 25,000 >25,000
cells/mm3
WBC decrease - 2500 – 3500 1500 – 2499 1000 – 1499 <1000
cells/mm3
Lymphocytes 750 – 1000 500 – 749 250 – 499 <250
Neutrophils decrease 1500 – 2000 1000 – 1499 500 – 999 <500
- cells/mm3
Eosinophils - 650 – 1500 1501 – 5000 >5000 Hypereosinophilic
cells/mm3
cells/mm3
(Grade 4)
BUN - mg/dL 23 – 26 27 – 31 >31 Requires dialysis
Creatinine - mg/dL 1.5 – 1.7 1.8 – 2.0 2.1 – 2.5 >2.5 or requires
dialysis
Alkaline phosphate - 1.1 – 2.0 × ULN 2.1 – 3.0 × ULN 3.1 – 10 × ULN >10 × ULN
increase by factor
Liver function tests - 1.1 – 2.5 × ULN 2.6 – 5.0 × ULN 5.1 – 10 × ULN >10 × ULN
ALT, AST
increase by factor
Bilirubin - when 1.1 – 1.25 × ULN 1.26 – 1.5 × ULN 1.51 – 1.75 × ULN >1.75 × ULN
accompanied
by any increase in
increase by factor
Bilirubin - when 1.1 – 1.5 × ULN 1.6 – 2.0 × ULN 2.0 – 3.0 × ULN >3.0 × ULN
factor
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3.2. Secondary Endpoints

3.2.1. Immunogenicity Endpoints
• SARS-CoV-2 serum neutralizing titers.
• SARS-CoV-2-S1–specific binding antibody levels.
• SARS-CoV-2 RBD-specific binding antibody levels.
To support the secondary immunogenicity endpoints, the GMTs or concentrations at all time
points, GMFR from before vaccination to each subsequent time point after vaccination, and
proportion of participants achieving ≥4-fold rise from before vaccination to each subsequent
time point after vaccination will be calculated and summarized by vaccine group.
3.2.1.1. Serum Neutralizing Titers

Titers above the LLOQ are considered accurate and their quantitated values will be reported.
Values below the LLOQ, denoted as BLQ, will be set to 0.5 × LLOQ for analysis. However,
this calculation may be adjusted based upon additional data from the assay. LLOQ results
will be included in the analysis specification once they are available.
3.2.1.2. IgG Concentrations

Results will be reported as IgG concentrations. IgG concentrations above the LLOQ are
considered accurate and their quantitated values will be reported. Values below the LLOQ,
denoted as BLQ, will be set to 0.5 × LLOQ for analysis. However, this calculation may be
adjusted based upon additional data from the assay. LLOQ results will be included in the
analysis specification once they are available.
3.2.2. Vaccine Efficacy Endpoint

• COVID-19 incidence per 1000 person-years of follow-up 14 days after receipt of the
last dose of study intervention onwards.
3.3. Tertiary/Exploratory Endpoints

• Nonvaccine-antigen SARS-CoV-2 antibody levels.
3.4. Baseline and Other Variables

Measurements or samples collected prior to Dose 1 are considered the baseline data for the
assessments.
The following variables will be summarized as part of the baseline characteristics:
• Demographics
• Medical history
• Physical examination
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• Vital signs
Other variables to be summarized include the following:
• E-diary completion
• Prior/concomitant vaccines
• Concomitant medications
3.4.1. Demographics, Medical History, and Physical Examination

The demographic variables are age at Dose 1 (in years), sex (male or female), race
(black/African American, American Indian or Alaskan native, Asian, Native Hawaiian or
other Pacific Islander, white), and ethnicity (Hispanic/Latino, non-Hispanic/non-Latino, not
reported). In cases where more than 1 category is selected for race, the participant would be
counted under the category “multiracial” for analysis.
Age at the time of vaccination (in years) will be derived based on the participant’s birthday.
For example, if the vaccination day is 1 day before the participant’s 19th birthday, the
participant is considered to be 18 years old. For participants who were randomized but not
vaccinated, the randomization date will be used in place of the date of vaccination at Dose 1
for the age calculation. If the randomization date is also missing, then the informed consent
date will be used for the age calculation.
Medical history will be categorized according to MedDRA.
A physical examination will be performed. It will evaluate any clinically significant

abnormalities within the following body systems: general appearance; skin; head, eyes, ears,
nose, and throat; heart; lungs; abdomen; musculoskeletal; extremities; neurological; and
lymph nodes. Clinically significant abnormal results will be recorded in the CRF.
3.4.2. E-Diary Completion

An e-diary will be considered transmitted if any data for the local reactions, systemic events,
or use of antipyretic medication are present for any day. If all data are missing for all items
on the e-diary for all 7 days after vaccination, then the e-diary will be considered not
transmitted. An e-diary will be considered completed if all expected data for all 7 days are
available (ie, not missing). Otherwise, the e-diary will be considered incomplete. For any
given day, an e-diary will be considered complete if all expected data are available.
3.4.3. Prior/Concomitant Vaccines and Concomitant Medications

• All vaccinations received from 28 days prior to study enrollment until the 6-month
follow-up visit (Visit 8 for Stage 1 sentinel cohorts, Visit 5 for Stage 1 nonsentinel
cohorts and Stage 2 participants, and Visit 4 for Stage 3 participants).
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• Prohibited medications listed in the protocol, Section 6.5.1, will be recorded, to include
start and stop dates, name of the medication, dose, unit, route, and frequency.
• In addition, for participants enrolled in the Stage 1 sentinel cohorts, all current
medication at baseline will be recorded, to include start date, name of the medication,
dose, unit, route, and frequency.
Concomitant and prior vaccines, and concomitant medications will be coded using the WHO
Drug Dictionary.
3.5. Safety Endpoints

Local reactions, systemic events, AEs, and SAEs have been described above in the primary
safety endpoints.
4. ANALYSIS SETS (POPULATIONS FOR ANALYSIS)

Data for all participants will be assessed to determine if participants meet the criteria for
inclusion in each analysis population prior to unblinding and releasing the database and
classifications will be documented per SOPs.
Randomized All participants who are assigned a randomization number in the IWR system.
Dose 1 evaluable All eligible randomized participants who receive the vaccine to which they are
immunogenicity randomly assigned at the first dose, have at least 1 valid and determinate
immunogenicity result 21 days after Dose 1, have blood collection within an
appropriate window after Dose 1, and have no other major protocol deviations as
determined by the clinician.
Dose 2 evaluable All eligible randomized participants who receive 2 doses of the vaccine to which
immunogenicity they are randomly assigned, within the predefined window, have at least 1 valid and
determinate immunogenicity result after Dose 2, have blood collection within an
appropriate window after Dose 2, and have no other major protocol deviations as
determined by the clinician.
Dose 1 all-available All participants who receive at least 1 dose of the study intervention with at least 1
immunogenicity valid and determinate immunogenicity result after Dose 1 but before Dose 2.
Dose 2 all-available All participants who receive at least 1 dose of the study intervention with at least 1
immunogenicity valid and determinate immunogenicity result after Dose 2.
Evaluable efficacy All eligible randomized participants who receive vaccination(s) as randomized
within the predefined window, have the efficacy measurement after the last dose of
study intervention, and have no other major protocol deviations as determined by
the clinician.
All-available efficacy All eligible randomized participants who receive at least 1 vaccination and have the
efficacy measurement at any time after Dose 1.
Safety All randomized participants who receive at least 1 dose of the study intervention.
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The major protocol deviations will be determined by the medical monitor. A major protocol
deviation is a protocol deviation that, in the opinion of the sponsor’s clinician, would
materially affect assessment of immunogenicity/efficacy, eg, participant receipt of a
prohibited vaccine or medication that might affect immune response or a medication error
with suspected decrease in potency of the vaccine. The sponsor’s clinician will identify
those participants with major protocol deviations before any unblinded analysis in Stage 3 is
carried out.
Both evaluable and all-available populations will be used for immunogenicity analyses.
5. GENERAL METHODOLOGY AND CONVENTIONS

unblinded. Sponsor staff will be unblinded to vaccine allocation for the participants in
Stage 1 and Stage 2. Laboratory personnel performing the assays will remain blinded until
all assays are completed. The timing for statistical analyses is specified in Section 7.
5.1. Hypotheses and Decision Rules

5.1.1. Vaccine Efficacy Hypothesis
At the end of Stage 3, the VE will be evaluated. VE is defined as VE = 100 × (1 – IRR),
where IRR is the calculated ratio of the COVID-19 illness rate in the active vaccine group to
the illness rate in the placebo group. The efficacy hypothesis is:
H0: VE ≤20% vs Ha: VE >20%
where H0 and Ha represent the null hypothesis and alternative hypothesis. For participants
with multiple illnesses, only the first COVID-19 confirmed case will contribute to the VE
calculation in the hypothesis test.
The main efficacy endpoint will be confirmed by SARS-CoV-2 NAAT-positive results at a

central laboratory, ie, centrally confirmed COVID-19, with the presence of at least 1
symptom described in the protocol, Section 8.13.
Efficacy will be demonstrated if the null hypothesis VE ≤20% is rejected at the 0.025
significance level, that is, when the lower limit of the 2-sided 95% CI for VE is >20%, which
is derived using the Clopper-Pearson method as described by Agresti.1
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5.1.2. Sample Size

hypothesis testing. Stage 1 will comprise 15 participants (randomization ratio of 4:1 so that
12 receive active vaccine and 3 receive placebo) per group; up to 56 potential groups are
foreseen; if all groups are fully enrolled, assuming 2 dose levels are selected following the
initial dose escalation, this corresponds to a total of 840 participants. Stage 2 will include 1
or more vaccine groups selected from Stage 1, and 225 participants will be randomized per
selected vaccine candidate in a 4:1 ratio to receive active vaccine (180 participants) or
placebo (45 participants).
For Stage 3, for the selected vaccine candidate/dose level, with assumptions of a true VE of
70%, 53 cases of COVID-19 will provide 90% power to conclude true VE >20%. This
would be achieved with 3000 participants per group (1:1 randomization ratio), based on the
assumption of a 1.7% incidence rate in the placebo group, and 20% of the participants being
nonevaluable.
1 AE.
Table 9. Probability of Observing at Least 1 AE by Assumed True Event Rates With

Different Sample Sizes
Assumed True Event N=12 N=45 N=180 N=3000
Rate of an AE
0.10% 0.01 0.04 0.16 0.95
0.50% 0.06 0.20 0.59 >0.99
1.00% 0.11 0.36 0.84 >0.99
2.00% 0.22 0.60 0.97 >0.99
3.00% 0.31 0.75 >0.99 >0.99
5.00% 0.46 0.90 >0.99 >0.99
7.00% 0.58 0.96 >0.99 >0.99
10.00% 0.72 0.99 >0.99 >0.99
5.1.3. Multiplicity Considerations

Since there is only 1 hypothesis with regard to VE at Stage 3, and no interim analysis is
planned for efficacy evaluation, no multiplicity adjustment is required to control the type I
error rate.
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5.2. General Methods

Time points for local reactions and systemic events refer to data within 7 days after each
dose.
CIs for all endpoints in the statistical analysis will be presented as 2-sided at the 95% level
unless specified otherwise.
5.2.1. Analyses for Binary Data

Descriptive statistics for categorical variables (eg, proportions) are the percentage (%), the
numerator (n) and the denominator (N) used in the percentage calculation, and the 95% CIs
where applicable.
The exact 95% CI for binary endpoints for each group will be computed using the
F distribution (Clopper-Pearson).1 The 95% CI for the between-group difference for binary
endpoints will be calculated using the Miettinen and Nurminen method.2
The 3-tier approach will be used to summarize AEs. For both Tier 1 (if any are identified
during the study) and Tier 2 events, a 95% CI for the between-group difference in
proportions will be calculated based on the Miettinen and Nurminen2 method. In addition,
for Tier 1 events (if any), the asymptotic p-values will also be presented for the difference in
proportions, based on the same test statistic and under the assumption that the test statistic is
asymptotically normally distributed. For Tier 3 events, counts and percentages for each
vaccine group will be provided.
5.2.2. Analyses for Continuous Data

Unless otherwise stated, descriptive statistics for continuous variables are n, mean, median,
standard deviation, minimum, and maximum.
5.2.2.1. Geometric Means

For immunogenicity results of SARS-CoV-2 serum neutralizing titers, the GMTs will be
computed along with associated 95% CIs. The GM will be calculated as the mean of the
assay results after making the logarithm transformation and then exponentiating the mean to
express results on the original scale. Two-sided 95% CIs will be obtained by taking log
transforms of concentrations, calculating the 95% CI with reference to the t-distribution, and
then exponentiating the confidence limits. Similarly, GMCs and 95% CIs will be calculated
for SARS-CoV-2-S1–specific binding antibody levels and RBD-specific binding antibody
levels.
5.2.2.2. Geometric Mean Fold Rises

GMFRs will be defined as the result after vaccination divided by the result before
vaccination. GMFRs are limited to participants with nonmissing values at both time points.
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GMFRs will be calculated as the mean of the difference of logarithmically transformed

neutralization titers or antibody levels (later result minus earlier result) and exponentiating
the mean. The associated 2-sided 95% CIs are obtained by constructing CIs using Student’s
t-distribution for the mean difference on the natural log scale and exponentiating the
confidence limits.
5.2.2.3. Geometric Mean Ratios

For SARS-CoV-2 serum neutralizing titers and SARS-CoV-2-S1–specific binding antibody
levels and RBD-specific binding antibody levels, the GMRs will be provided along with
associated 95% CIs.
GMRs will be limited to participants with nonmissing values for both SARS-CoV-2 serum
neutralizing titers and SARS-CoV-2-S1–specific binding antibody/SARS-CoV-2
RBD-specific binding antibody at each time point. The GMR will be calculated as the mean
of the difference of logarithmically transformed assay results (eg, SARS-CoV-2 serum
neutralizing titers minus SARS-CoV-2-S1–specific binding antibody for each participant)
and exponentiating the mean. Two-sided CIs will be obtained by calculating CIs using
Student’s t-distribution for the mean difference of the logarithmically transformed assay
results and exponentiating the confidence limits.
5.2.2.4. Geometric Mean Fold Rise Ratios

The ratios of GMFR A to GMFR B and GMFR A to GMFR C may be explored, where
GMFR A is the GM of the ratio of the SARS-CoV-2 serum neutralizing titer at the time point
after vaccination to the corresponding titer at the time point before vaccination, GMFR B is
the GM of the ratio of the SARS-CoV-2-S1–specific binding antibody level at the time point
after vaccination to the corresponding antibody level at the time point before vaccination, and
GMFR C is the GM of the ratio of the SARS-CoV-2 RBD-specific binding antibody level at
the time point after vaccination to the corresponding antibody level at the time point before
vaccination.
5.2.2.5. Reverse Cumulative Distribution Curves

Empirical RCDCs will plot proportions of participants with values equal to or exceeding a
specified assay value versus the indicated assay value, for all observed assay values. Data
points will be joined by a step function with data points on the left side of the step.
5.3. Methods to Manage Missing Data

For endpoints, the missing data handling rules are described in the corresponding endpoint
sections.
For the missing dates, the sponsor data standard rules for imputation will be applied
(eg, partial dates for AEs will be imputed according to Pfizer standard algorithms).
Missing COVID-19 test data in Stage 3 for computing VE will be imputed in the sensitivity
analysis. Details are included in Section 6.2.2.1.3.
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6. ANALYSES AND SUMMARIES

6.1. Primary Endpoint(s)
The safety analyses are based on the safety population. Participants will be summarized by
vaccine group according to the study interventions they actually received. Missing e-diary
data will not be imputed; missing AE dates will be handled according to the Pfizer safety
rules.
6.1.1. Local Reactions
6.1.1.1. Main Analysis

• Estimand: The percentage of participants reporting local reactions (redness, swelling, and
pain at the injection site) within 7 days after each dose (Section 2.1).
• Analysis set: Safety population (Section 4).
• Analysis time point: Within 7 days after each dose.
• Analysis methodology: Descriptive statistics (Section 5.2.1).
• Intercurrent events and missing data: The participants without any e-diary data
throughout the 7 days after vaccination will be excluded from the analysis at that
particular vaccination; missing values will not be imputed.
• Reporting results: Descriptive statistics for each and any local reaction after each dose in
each vaccine group will be presented by maximum severity across severity levels.
Confirmed e-diary errors will be excluded from the analysis. Descriptive summary
statistics will include counts and percentages of participants with the indicated endpoint
and the associated 2-sided Clopper-Pearson 95% CIs.
6.1.1.2. Supplementary Analyses

To support the assessment of local reactions, the following endpoints (as defined in
Section 3.1.1) will be summarized with the same analysis time point and analysis population,
analysis methodology, and appropriate reporting results. Confirmed e-diary errors will be
excluded from these analyses.
• Duration (days) of each local reaction after each dose.
• Onset day of each local reaction after each dose.
These continuous endpoints will be summarized by displaying n, mean, median, standard

deviation, minimum, and maximum for each vaccine group.
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Figures:
Bar charts with the proportions of participants for each local reaction throughout 7 days will
be plotted for each vaccine group. The bars will be divided into severity to highlight the
proportions of participants by maximum severity.
6.1.2. Systemic Events

• Estimand: The percentage of participants reporting systemic events (fever, fatigue,
headache, chills, vomiting, diarrhea, new or worsened muscle pain, and new or worsened
joint pain) within 7 days after each dose (Section 2.1).
• Analysis time point: Within 7 days after each dose.
• Intercurrent events and missing data: The participants without any e-diary data
throughout the 7 days after vaccination will be excluded from the analysis at that
particular vaccination; missing values will not be imputed.
• Reporting results: Descriptive statistics for each systemic event after each dose in each
vaccine group will be presented by maximum severity across severity levels. Descriptive
summary statistics will include counts and percentages of participants with the indicated
endpoint and the associated 2-sided Clopper-Pearson 95% CIs.

The following endpoints for assessment of systemic events will be summarized similarly to
the assessment of local reactions:
• Duration of each systemic event after each dose.
• Onset day of each systemic event after each dose.
These continuous endpoints will be summarized by displaying n, mean, median, standard

deviation, minimum, and maximum for each vaccine group.
The use of antipyretic medication (see Section 3.1.3) will be summarized similarly to
systemic events, except that there is no severity level associated with the use of antipyretic
medication.
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Figures:
Bar charts with the proportions of participants reporting each systemic event throughout
7 days after each dose will be plotted for each vaccine group. The bars will be divided into
severity subgroups to highlight the proportions of participants by severity.
6.1.3. Adverse Events

• Estimand: The percentage of participants reporting AEs from Dose 1 to 1 month after the
last dose (Section 2.1).
• Analysis time point: Dose 1 to 1 month after the last dose.
• Analysis methodology: 3-Tiered approach (Section 3.1.4).
• Intercurrent events and missing data: Partial AE dates will be imputed using the Pfizer
standard algorithm.
• Reporting results: AEs will be categorized according to MedDRA terms. A 3-tier

approach will be used to summarize AEs. Under this approach AEs are classified into
1 of 3 tiers (Section 3.1.4). For both Tier 1 and Tier 2 events, 2-sided 95% CIs for the
difference between the vaccine and placebo groups in the percentage of participants
reporting the events based on the Miettinen and Nurminen2 method will be provided. In
addition, for Tier 1 events, the asymptotic p-values will also be presented for the
difference between groups in the percentage of participants reporting the events, based on
the same test statistic and under the assumption that the test statistic is asymptotically
normally distributed. AE displays will be sorted in descending order of point estimates
of risk difference within SOC. Descriptive summary statistics (counts, percentages, and
associated Clopper-Pearson 95% CIs) will be provided for any AEs for each vaccine
group.

Immediate AEs (within the first 30 minutes after each dose) will also be summarized for each
vaccine group. All AEs after informed consent and prior to the first vaccination will not be
included in the analyses but will be listed.
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6.1.4. Serious Adverse Events

6.1.4.1. Main Analyses
• Estimand: The percentage of participants reporting SAEs from Dose 1 to 6 months after
the last dose (Section 2.1).
• Analysis time point: Dose 1 to 6 months after the last dose.
• Intercurrent events and missing data: Partial SAE dates will be imputed using the Pfizer
standard algorithm.
• Reporting results: SAEs will be categorized according to MedDRA terms. Counts,

percentages, and the associated Clopper-Pearson 95% CIs of SAEs from Dose 1 to
6 months after the last dose will be provided for each vaccine group.
6.1.5. Hematology and Chemistry Parameters in Sentinel Cohorts From Stage 1

6.1.5.1. Main Analyses
• Estimands: The percentage of participants with abnormal hematology and chemistry
laboratory values 1 and 7 days after Dose 1; and 7 days after Dose 2 (Section 2.1).
• The percentage of participants with grading shifts in hematology and chemistry

laboratory assessments between baseline and 1 and 7 days after Dose 1; and before Dose
2 and 7 days after Dose 2 (Section 2.1).
• Analysis time point: 1 and 7 days after Dose 1; and 7 days after Dose 2.
• Analysis methodology: Descriptive statistics including counts and percentage

(Section 5.2.1).
• Intercurrent events and missing data: Missing values will not be imputed.
• Reporting results: Descriptive summary statistics will be provided including counts and
percentages of participants with the indicated endpoint and the associated
Clopper-Pearson 2-sided 95% CIs.
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6.2. Secondary Endpoints

6.2.1. Immunogenicity Endpoints
For all immunogenicity analyses, the same analysis methods will be applied to the
immunogenicity endpoints in Stages 1, 2, and 3. For all the immunogenicity endpoints, the
analysis will be based on the Dose 1 and Dose 2 evaluable immunogenicity populations. An
additional analysis will be performed based on the all-available immunogenicity populations
if there is a large enough difference in sample size between the all-available immunogenicity
populations and the evaluable immunogenicity populations (Section 4). Participants will be
summarized according to the vaccine group to which they were randomized. The missing
serology data will not be imputed. The summary for additional immunogenicity assay results
will be provided, if any.
6.2.1.1. SARS-CoV-2 Serum Neutralizing Titers

6.2.1.1.1. Main Analyses
• Estimands:
• GMTs (Section 2.1).
• GMFR from before vaccination to each subsequent time point after vaccination
(Section 2.1).
• Proportion of participants achieving ≥4-fold rise from before vaccination to each

subsequent time point after vaccination (Section 2.1).
• Analysis set: Dose 1 and Dose 2 evaluable and all-available immunogenicity populations
(Section 4).
• Analysis time points:
• Stage 1 sentinel cohorts: 7 and 21 days after Dose 1; 7 and 14 days and 1, 6, 12, and
• Stage 1 nonsentinel cohorts and Stage 2 cohorts: 21 days after Dose 1; 14 days and 1,
6, 12, and 24 months after Dose 2.
• Stage 3 cohort(s): 1, 12, and 24 months after Dose 2.
• Analysis methodology: GMs and the associated 2-sided CIs will be derived by
calculating means and CIs on the natural log scale based on the t-distribution, and then
exponentiating the results Section 5.2.2.1). GMFRs will be limited to participants with
nonmissing values prior to the first dose and at the postvaccination time point. The
GMFR will be calculated as the mean of the difference of logarithmically transformed
assay results (later time point – earlier time point) and transformed back to the original
scale. Two-sided CIs will be obtained by calculating CIs using Student’s t-distribution
for the mean difference of the logarithmically transformed assay results and transforming
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the limits back to the original scale (Section 5.2.2.2). Percentages of participants with
≥4-fold rise will be calculated with the associated 2-sided 95% CIs (Clopper-Pearson
method).
• Intercurrent events and missing data: Serology data deemed unevaluable because of
noncompliance with the key protocol criteria will be excluded. Titers below the LLOQ
or denoted as BLQ will be set to 0.5 × LLOQ for analysis. However, this calculation
may be adjusted based upon additional data from the assay. Missing data will not be
imputed.
• Reporting results: the GMTs at each time point, GMFRs from before vaccination to each
subsequent time point after vaccination, and the percentages of participants achieving
≥4-fold rise and the associated 2-sided 95% CIs from before vaccination to each time
point after vaccination.
Figures:
Empirical RCDCs will be provided for SARS-CoV-2 serum neutralizing titers after Dose 1
and after Dose 2 (Section 5.2.2.5).
6.2.1.1.2. Additional Exploratory Analyses

Similar analysis for SARS-CoV-2 serum neutralizing titers will be performed by baseline
serostatus (< LLOQ and ≥ LLOQ).
6.2.1.2. SARS-CoV-2-S1–Specific Binding Antibody Levels and RBD-Specific Binding

Antibody Levels
• Estimands:
• GMCs (Section 2.1).
• GMFR from before vaccination to each subsequent time point after vaccination
(Section 2.1).
• Proportion of participants achieving ≥4-fold rise from before vaccination to each

subsequent time point after vaccination (Section 2.1).
(Section 4).
• Stage 1 sentinel cohorts: 7 and 21 days after Dose 1; 7 and 14 days and 1, 6, 12,
and 24 months after Dose 2.
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• Stage 1 nonsentinel cohorts and Stage 2 cohorts: 21 days after Dose 1; 14 days
and 1, 6, 12, and 24 months after Dose 2.
• Analysis methodology: GMs and the associated 2-sided CIs will be derived by
calculating means and CIs on the natural log scale based on the t-distribution, and then
exponentiating the results (Section 5.2.2.1). GMFRs will be limited to participants with
nonmissing values prior to the first dose and at the postvaccination time point. The
GMFR will be calculated as the mean of the difference of logarithmically transformed
assay results (later time point – earlier time point) and transformed back to the original
scale. Two-sided CIs will be obtained by calculating CIs using Student’s t-distribution
for the mean difference of the logarithmically transformed assay results and transforming
the limits back to the original scale (Section 5.2.2.2). Percentages of participants with
≥4-fold rise will be calculated with the associated 2-sided 95% CIs (Clopper-Pearson
method).
noncompliance with the key protocol criteria will be excluded. Concentrations below the
LLOQ or denoted as BLQ will be set to 0.5 × LLOQ for analysis. However, this
calculation may be adjusted based upon additional data from the assay. Missing data will
not be imputed.
• Reporting results: the GMCs, GMFRs, and percentages of participants with ≥4-fold rise
and the associated 2-sided 95% CIs will be provided for each study intervention
(active/placebo) within each group before vaccination and at each time point.
Figures:
Empirical RCDCs will be provided for SARS-CoV-2-S1–specific binding antibody levels

and RBD-specific binding antibody levels after Dose 1 and after Dose 2 (Section 5.2.2.5).

Similar analysis for SARS-CoV-2-S1–specific binding antibody levels and RBD-specific
binding antibody levels will be performed by baseline serostatus.
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6.2.1.3. GMR of SARS-CoV-2 Serum Neutralizing Titer to SARS-CoV-2-S1–Specific

Binding Antibody Levels and RBD-Specific Binding Antibody Levels
• Estimands:
• GMR of SARS-CoV-2 serum neutralizing titers to SARS-CoV-2-S1–specific binding

antibody levels (Section 2.1).
• GMR of SARS-CoV-2 serum neutralizing titers to SARS-CoV-2 RBD-specific

binding antibody levels (Section 2.1).
(Section 4).
• Stage 1 sentinel cohorts: 7 and 21 days after Dose 1; 7 and 14 days and 1, 6, 12, and
• Stage 1 nonsentinel cohorts and Stage 2 cohorts: 21 days after Dose 1; 14 days and 1,
6, 12, and 24 months after Dose 2.
• Analysis methodology: GMRs will be limited to participants with nonmissing values for
both SARS-CoV-2 serum neutralizing titers and SARS-CoV-2-S1–specific binding
antibody/SARS-CoV-2 RBD-specific binding antibody at each time point. The GMR
will be calculated as the mean of the difference of logarithmically transformed assay
results (eg, SARS-CoV-2 serum neutralizing titers minus SARS-CoV-2-S1–specific
binding antibody levels for each participant) and transformed back to the original scale
(Section 5.2.2.3). Two-sided CIs will be obtained by calculating CIs using the Student’s
t-distribution for the mean difference of the logarithmically transformed assay results and
transforming the limits back to the original scale (Section 5.2.2.3).
noncompliance with the key protocol criteria will be excluded. Concentrations below the
LLOQ or denoted as BLQ will be set to 0.5 × LLOQ for analysis. However, this
calculation may be adjusted based upon additional data from the assay. Missing data will
not be imputed.
• Reporting results: The GMRs and the associated 2-sided 95% CIs will be provided for
each study intervention (active/placebo) within each group before vaccination and at each
time point.
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6.2.2. Vaccine Efficacy Endpoints

6.2.2.1. COVID-19 Incidence per 1000 Person-Years of Follow-up
• Estimand: 100 × (1 – IRR) [ratio of active vaccine illness rate to placebo illness rate]
(Section 2.1).
• Analysis set: Evaluable efficacy and all-available efficacy populations (Section 4).
• Analysis time point: End of the surveillance period (ie, 53 COVID-19 cases were
observed).
• Analysis methodology: Assessment of VE will be performed for centrally confirmed

COVID-19 from 14 days after the receipt of the last dose of study intervention onwards,
and will be estimated by 100 × (1 – IRR), where IRR is the calculated ratio of COVID-19
illness rate per 1000 person-years of follow-up in the active vaccine group to the
corresponding illness rate in the placebo group after 2 doses. The 2-sided 95% CI for VE
will be derived using the Clopper-Pearson method.
• Intercurrent events and missing data: COVID-19 test data deemed unevaluable because
of noncompliance with the key protocol criteria will be excluded. Missing efficacy data
will not be imputed in the main analyses.
• Reporting results: VE and the associated 2-sided 95% CIs will be provided.

The same methodology described in Section 6.2.2.1.1 for VE assessment will be applied to
the following exploratory endpoints to evaluate:
• VE for centrally confirmed COVID-19 from 1 day after the receipt of the first dose of
study intervention onwards.
• VE for centrally confirmed COVID-19 from 1 day after the receipt of the first dose and
14 days after the receipt of the last dose of study intervention onwards by baseline
serostatus based on SARS-CoV-2-S1–specific binding antibody levels.
• VE for locally confirmed COVID-19 from 1 day after the receipt of the first dose and
14 days after the receipt of the last dose of study intervention onwards.
• VE for locally confirmed COVID-19 from 1 day after the receipt of the first dose and
14 days after the receipt of the last dose of study intervention onwards by baseline
serostatus based on SARS-CoV-2-S1–specific binding antibody levels.
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• VE for centrally confirmed symptomatic seroconversion to SARS-CoV-2 from 1 day

after the receipt of the first dose and 14 days after the receipt of the last dose of study
intervention onwards: presence of at least 1 symptom described in the protocol,
Section 8.13, and a positive nonvaccine-antigen SARS-CoV-2 antibody result in a
participant whose most recent prior nonvaccine-antigen SARS-CoV-2 antibody result
was negative.
• VE for centrally confirmed asymptomatic seroconversion to SARS-CoV-2 from 1 day

after the receipt of the first dose and 14 days after the receipt of the last dose of study
intervention onwards: positive nonvaccine-antigen SARS-CoV-2 antibody result in a
participant with a prior nonvaccine-antigen SARS-CoV-2 antibody result that was
negative.
6.2.2.1.3. Sensitivity and Supplemental Analyses

With MAR assumption, a missing efficacy endpoint may be imputed based on predicted
probability using the fully conditional specification method.3 The imputation will run
multiple times (up to 1000) and summary statistics (eg, average VE, number and percentage
of lower limit of 95% CI for VE >20%, etc, from the imputation runs) across the imputations
will be tabulated.
COVID-19 disease-related information may be summarized or listed.
6.3. Tertiary/Exploratory Endpoints

6.3.1. Relationship Between SARS-CoV-2 Serological Parameters and NAAT-
Confirmed COVID-19, Symptomatic SARS-CoV-2 Infection, and Asymptomatic
SARS-CoV-2 Infection
If sufficient data are collected, the correlation of RT-PCR–confirmed COVID-19 and
seropositivity or seroconversion measured by nonvaccine-antigen SARS-CoV-2 antibody
levels, percentages (and 2-sided 95% CIs) of participants with confirmed COVID-19, and
nonvaccine-antigen SARS-CoV-2 antibody levels after Dose 1 and after Dose 2 will be
provided.
6.3.2. Additional Analysis

The ratios of GMFRs may be explored (Section 5.2.2.4).
6.4. Subgroup Analysis

Subgroup analyses based on race, ethnicity, and sex will be performed on all primary safety
and secondary immunogenicity and efficacy endpoints (as supplemental analyses).
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6.5. Baseline and Other Summaries and Analyses

6.5.1. Baseline Summaries
6.5.1.1. Demographic Characteristics
Demographic characteristics, including sex, race, and ethnicity, will be summarized for the
safety population for each vaccine group and overall.
6.5.1.2. Medical History

Each reported medical history term will be mapped to a SOC and PT according to MedDRA.
The number and percentage of participants with an assigned vaccine having at least 1
diagnosis, overall and at each SOC and PT level, will be summarized by vaccine group and
overall by cohort for the overall safety population.
6.5.1.3. Physical Examination

Significant physical examination findings will be recorded on medical history or AE CRF
pages, as relevant, and reporting will be done under those endpoints for the overall safety
population.
6.5.2. Study Conduct and Participant Disposition

6.5.2.1. Participant Disposition
The number and percentage of randomized participants will be included in the participant
disposition summary. In addition, the numbers and percentages of participants who received
vaccinations (Doses 1 and 2), who completed the follow-up visits (1 month after the last
dose), and who withdrew before each follow-up visit along with the reasons for withdrawal
will be tabulated by vaccine group (according to randomized group assignment) and overall
by each cohort. The reasons for withdrawal will be those as specified in the database.
Participants excluded from each analysis population will also be summarized separately
along with the reasons for exclusion, by vaccine group.
6.5.2.2. Blood Samples for Assay

The number and percentage of randomized participants providing blood samples within and
outside of protocol-specified time frames will be tabulated separately for each time point.
6.5.2.3. E-Diaries
The participants who were vaccinated and completed e-diaries after each dose will be
summarized according to the vaccine actually received. Besides the analysis described in
Section 6.1.1 and Section 6.1.2, the summary will also include the numbers and percentages
of vaccinated participants not transmitting the e-diary, transmitting the e-diary, and
completing the e-diary for any day in the required reporting period, by assigned vaccine
group for each dose.
The safety population will be used.
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6.5.3. Study Vaccination Exposure

6.5.3.1. Vaccination Timing and Administration
For each dose, the number and percentage of participants randomized and receiving each
study intervention within the protocol-specified time frame, as well as before and after the
specified time frame, will be tabulated for each vaccine group and overall for all randomized
participants. The denominator for the percentages is the total number of participants in the
given vaccine group or overall.
In addition, the relation of randomized vaccine to actual vaccine received will be presented
as a cross tabulation of the actual vaccine received versus the randomized vaccine.
A listing of participants showing the randomized vaccine and the vaccine actually received at
each dose will be presented.
6.5.4. Prior/Concomitant Vaccination and Concomitant Medications

Each prior/concomitant vaccine will be summarized according to the ATC 4th-level
classification. All vaccines received before Dose 1 will be listed. The number and
percentage of randomized participants receiving each concomitant vaccine after Dose 1 will
be tabulated according to assigned vaccine schedule. Summarization will be done for the
interval between Dose 1 and 1 month after the last dose. The safety population will be used.
Concomitant medications will be summarized in a similar way as concomitant vaccines.
6.6. Safety Summaries and Analyses

Local reaction, systemic event, AE, and SAE summaries and analyses are described under
Primary Endpoint(s) (Section 6.1).
7. ANALYSES TIMING
7.1. Introduction
No formal interim analysis is planned in this study. As this is a sponsor open-label study
during Stages 1 and 2, the sponsor may conduct unblinded reviews of the data during the
course of the study for the purpose of safety assessment, facilitating dose escalation
decisions, and/or supporting clinical development.
7.2. Interim Analyses and Summaries

• Complete safety and immunogenicity analysis approximately 3 weeks after Dose 2

for Stage 1.
• Complete safety and immunogenicity analysis approximately 3 weeks after Dose 2

for Stage 2.
• Complete safety and immunogenicity analysis approximately 6 months after Dose 2

for all participants in Stage 3.
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• Complete efficacy and persistence-of-immunogenicity analysis after complete data

are available at the end of the study.
7.2.1. Data Monitoring Committee

This study will use an IRC and a DMC. The IRC is independent of the study team and
includes only internal members. The DMC is independent of the study team and includes
only external members. The IRC and DMC charters describe the roles of the IRC and DMC
in more detail.
8. REFERENCES
1. Agresti A. Introduction: distributions and inference for categorical data. In: Agresti A, ed.
Categorical data analysis. 2nd ed. Hoboken, NJ: John Wiley & Sons; 2002:1-35.
2. Miettinen O, Nurminen M. Comparative analysis of two rates. Stat Med

1985;4(2):213-26.
3. van Buuren S. Multiple imputation of discrete and continuous data by fully conditional
specification. Stat Methods Med Res 2007;16(3):219-42.
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9. APPENDICES
Appendix 1. List of Abbreviations
Abbreviation Term
Abs absolute
AE adverse event
ATC Anatomic Therapeutic Chemical
BLQ below the level of quantitation
GM geometric mean
IRR illness rate ratio
MAR missing at random
N/A not applicable
PT preferred term
RBC red blood cell
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Abbreviation Term
SOC system organ class
VE vaccine efficacy
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Protocol

3. Summary of protocol amendments………………………………………….page 265

A PHASE 1/2, PLACEBO-CONTROLLED, RANDOMIZED, OBSERVER-BLIND,

Study Intervention Number: PF-07302048

EudraCT Number: N/A

Protocol Amendment Summary of Changes Table

Document Version Date Summary and Rationale for Changes

Original protocol 15 April 2020 N/A

2.3.1. Risk Assessment .........................................................................................27

5.4. Screen Failures ........................................................................................................36

6.5. Concomitant Therapy..............................................................................................44

8.2.2.1. Grading Scales...........................................................................52

8.3.2. Method of Detecting AEs and SAEs ..........................................................58

8.11.1. Stage 1 Sentinel Cohorts...........................................................................63

8.11.1.10. Visit 9 – 12-Month Follow-up Visit: (350 to 378 Days

8.11.3.2. Visit 2 – Vaccination 2: (19 to 23 Days or 56 to 70 Days

9. STATISTICAL CONSIDERATIONS ................................................................................90

10.1.1.1. Reporting of Safety Issues and Serious Breaches of the

10.3.4. Reporting of SAEs..................................................................................116

Table 6. Laboratory Abnormality Grading Scale .................................................108

A pneumonia of unknown cause detected in Wuhan, China, was first reported in

BNT162a1 (variant RBL063.3): a uRNA encoding the RBD;

BNT162b1 (variant RBP020.3): a modRNA encoding the RBD;

BNT162b2 (variant RBP020.2): a modRNA encoding P2 S;

BNT162c2 (variant RBP020.3): an saRNA encoding the RBD.

Objectives, Estimands, and Endpoints

Objectives Estimands Endpoints

to 6 months after the last dose

Stage 1 Sentinel Cohorts: 7 and

Objectives Estimands Endpoints

SARS-CoV-2–specific binding binding antibody levels

This is a Phase 1/2, randomized, placebo-controlled, observer-blind, dose-finding, and

 As a 2-dose (separated by 21 or 60 days) or single-dose schedule

 At up to 3 different dose levels

Intervention Groups and Duration

Participants are expected to participate for up to a maximum of approximately 26 months.

Data Monitoring Committee or Other Independent Oversight Committee

The secondary immunogenicity objectives will be evaluated descriptively by GMT, GMC,

IRC choice of group(s) for Stage 2

Stage 2 (4:1 randomization active:placebo)

IRC choice of group(s) for Stage 3

Stage 3 (1:1 randomization active:placebo)

1.3. Schedule of Activities

assessments required to protect the well-being of the participant.

1.3.1. Stage 1 Sentinel Cohorts

Visit Number Screening 1 2 3 4 5 6 7 8 9 10 Unplanned Unplanned

Visit Window (Days) 0 to 14 Day 1 1 to 3 6 to 8 19 to 23 6 to 8 12 to 16 28 to 35 154 to 350 to 714 to Optimally 28 to 35 Days

Visit Number Screening 1 2 3 4 5 6 7 8 9 10 Unplanned Unplanned

Visit Window (Days) 0 to 14 Day 1 1 to 3 6 to 8 19 to 23 6 to 8 12 to 16 28 to 35 154 to 350 to 714 to Optimally 28 to 35 Days

Visit Number Screening 1 2 3 4 5 6 7 8 9 10 Unplanned Unplanned

Visit Window (Days) 0 to 14 Day 1 1 to 3 6 to 8 19 to 23 6 to 8 12 to 16 28 to 35 154 to 350 to 714 to Optimally 28 to 35 Days

Visit Number Screening 1 2 3 4 5 6 7 8 9 10 Unplanned Unplanned

Visit Window (Days) 0 to 14 Day 1 1 to 3 6 to 8 19 to 23 6 to 8 12 to 16 28 to 35 154 to 350 to 714 to Optimally 28 to 35 Days

1.3.2. Stage 1 Nonsentinel Cohorts and Stage 2 Cohorts

Visit Number 1 2 3 4 5 6 7 Unplanned Unplanned

Follow-up Follow-up Follow-up Follow-up Follow-up COVID-19 COVID-19

Visit Number 1 2 3 4 5 6 7 Unplanned Unplanned

1.3.3. Stage 3 Cohort(s)

Visit Number 1 2 3 4 5 6 Unplanned Unplanned