125742 S1 M5 5351 c4591001 interim mth6 protocol

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PF-07302048 (BNT162 RNA- Based COVID- 19 Vaccines)
Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 1A PHASE 1/2 /3, PLACEBO -CONTROLLED , RANDOMIZED, OBSERV ER-BLIND, 
DOSE -FINDING STUDY T O EVALUATE THE SAFETY, TOLERABI LITY, 
IMMUNOGENICITY, AND EFFICACY OF SARS -COV -
2RNA VACCINE 
CANDIDATES AGAINST C OVID -19 IN HEALTHY INDIVIDUALS
Study Sponsor: BioNTech
Study Conducted By: Pfizer
Study Intervention Number: PF-07302048
Study Intervention Name: RNA -Based COVID -19 Vaccine s
US IND Number: 19736
EudraCT Number: 2020- 002641- 42
Protocol Number: C4591001
Phase: 1/2/3
Short Title: A Phase 1/2 /3Study  to Evaluate the Safety , Tolerabilit y, Immunogenicity, and 
Efficacy  of RNA Vaccine Candidates Against C OVID-19 in Healthy  Individuals
This document and accompanying materials contain confidential information belonging to Pfizer.  Except as 
otherwise agreed to in writing, by accepting or reviewing these document s, you agree to hold this 
information in confidence and not copy or disclose it to others (except where required by app licable law ) or 
use it for unauthorized purposes.  In the event of any actual or suspected breach of this obligation, Pfizer 
must be promptly notified.
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Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 2Protocol Amendment Summary of Changes Table
Document History
Document Version Date Summary and Rationale for Changes
Protocol amendment 14 02March 2021 In order to further describe duration of 
protection, and heterologous/homologous 
protection against the emerging VOCs, an 
additional dose of BNT162b2 or BNT162b2 SA
will be given to approximatel y 600 Phase 3
participants approximately 5 to 7months after 
their second dose of BNT162b2 ;a further dose 
of BNT162b2 SAwill be given to approximately 
30of those participants who receive 
BNT162b2 SA: 
Added corresponding objectives, 
estimands, and endpoints
Added corresponding SoA and 
procedures
Added details in the s tatistical methods
sections .
Approximately 300 BNT162b2 -naïve 
participants will be enrolled and receive 2 doses 
of BNT162b2 SAto describe 
heterologous/homologous protection against the 
emerging VOCs and reference strains:
Added corresponding objectives, 
estimands, and endpoints
Added corresponding SoA and 
procedures
Added details in the s tatistical methods
sections .
Cell-mediated immune responses will also be 
described follow ing isolatio ns of PBMCs in a 
subset of both the Phase 3 participants who 
receive a single booster vaccination and the
BNT162b2 -naïve group who receive 
BNT162b2 SA.
Added the asymptomatic case definitions in 
Section 8.1and further clarified the secondary 
definition for asymptomatic case based on 
seroconversion of N-binding antibody.
Defined the analysis populations used for 
evaluation of asymptomatic infection based on 
seroconversion of N -binding antibody and based 
on NAAT from participants who consent to 
active surveillance.
Clarified that unblinding for a nonemergency 
reason should be conducted outside of the IRT 
system .
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Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 3Document History
Document Version Date Summary and Rationale for Changes
Clarified that ifmultiple visits occur on the same 
day, all procedures for all visits must be 
conducted (including collection of all blood 
samples).
Clarified the plan for stepwise unblinding of the 
sponsor in the study.
Protocol amendment 13 12February 2021 In order to describe the boostability of BNT162, 
an additional dose of BNT162b2 at 30 µg w ill be 
given to Phase 1 participants approximately 6 to 
12 months after their second dose of BNT162 b1 
or BNT162b2 : 
Added corresponding objectives, 
estimands, and endpoints
Added c orresponding SoA and 
procedures
Added d etails in the s tatistical methods
sections .
Clarified the population used for analysis of 
reactogenicity endpoints.
To align with current recommendations, 
investigators may exercise judgment on review 
of inclusio n and exclusion c riteria ahead of 
vaccination with BNT162b2 for participants 
who originally received placebo.
Clarified that i f a participant has previously 
withdrawn consent and wishes to receive a 
COVID -19 vaccine outside the study, they may 
request to know which study intervention they 
received for Vaccination (s)1/2 w ithout needing 
to reconsent.
Participants who provide biw eekly swab sfor 
surveillance of asymptomatic infection should 
now continue to swab even after unblinding if 
they originally received BNT162b2 , to 
maximize the numbers of swabs to be collected .
Clarified the procedures for unscheduled visits 
to administer a second dos e in the event a 
participant received only 1 dose of BNT162b2.
Protocol amendment 12 14January 2021 Because of a formatting error in protocol 
amendment 11, exclusion criterion 4 w as 
inadvertently added to exclusion criterion 3 and 
the subsequent criteria renumbered. This 
amendment corrects that error.
Because of a change in the pace w ith which 
participants ≥16 years of age who originally 
received placebo wi llbecom e eligible for receipt 
of BNT162b2 , text w as updated throughout the 
protocol to reflect that this will happen in a 
phased manner ,with recommendations detailed 
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Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 4Document History
Document Version Date Summary and Rationale for Changes
separately and available in the electronic study 
reference portal .
Clarified that p articipants who are unblinded 
because they becomepotentially eligible for 
receipt of BNT162b2 w ill not p articipate in 
surveillance for asymptomatic SARS CoV- 2 
infection .
Corrected the exploratory objective to describe 
non-S seroconversion to SARS -CoV- 2 to clarify 
that this will only include participants who 
received BNT162b2 at initial randomization 
(since t hose who received it subsequently do not 
have blood drawn).
In line with current recommendations, removed 
the requirement to discontinue study 
intervention because of a diagnosis of 
COVID -19 during the study.
Protocol amendment 11 04January 2021 Added approaches to evaluate efficacy against
asymptomatic SAR S-CoV -2 infection :
Added objective s, estimand s,and endpoint s, 
and statistical methods, for assessment via 
N-binding antibody seroconversion ;
Added a potential intensive surveillance 
period for nasal swabbing, for assessment via 
NAAT:
Corresponding objectives, estimands ,and 
endpoints added
Corresponding SoA and procedures 
added
Details added in the statistical methods
sections .
Added the possibility of assessing f ull-length 
S-binding , instead of S1-binding ,IgG levels in 
Phase 2/3.
Clarified in Section 4.1.1 that any Phase 1 
placebo recipient w ho has not already been 
offered the opportunity to receive BNT162b2 
will be given this opportunity at the approximate 
time participants in Phase 2/3 reach Visit 4, for 
consistency with other sections.
Added a sentence to reflect that assent is 
obtained from participants <18 y ears of age .
Protocol amendment 10 01 Dec ember 2020 Added the possibility of administering 
BNT162b2 to participants who originally 
received placebo, following any local or national 
recommendations .
Added the possibility of administering 
BNT162b2 to participants who originally 
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Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 5Document History
Document Version Date Summary and Rationale for Changes
received placebo, following completion of the 
active safety surveillance period .
Added corresponding exploratory objec tives and 
statistical analysis details.
Removed immunogenicity analyses of titers 
greater than defined threshold(s).
Removed the need for blinded COVID -19case 
review after the final efficacy analysis.
Included thepossibility , due to local 
circumstances r elated to the COVID -19 
pandemic, that study procedures that do not 
require in -person participant contact may be 
performed by telehealth .
In light of additional information to better 
estimate the standard deviation of SARS -CoV- 2 
neutralizing titers , increas ed the sample size for 
the noninferiority immunogenicity analysis in 
adolescents 12 to 15 years of age.
Protocol amendment 9 29October 2020 To better align with the natural history of 
SARS -CoV- 2 infection , added Phase 2/3 
secondary efficacy objectives, estimand s,and 
endpoint sto include COVID -19 cases that occur 
from 14 days after the second dose ; also 
modified the existing secondary efficacy 
objectives, estimands, and endpoints to include 
COVID -19 cases that occur from 14 days , as 
well as 7 days ,after the second dose;
Made corresponding changes to the study 
design, study assessments and procedures, 
andstatistical analysis section s.
For operational reasons ,removed the interim 
analysis planned after accrual of 32 cases.
Clarified that interim analyses will be conducted 
after accrual of at least 62, 92, and 120 cases .
Included any participants 16 through 17 years of 
age enrolled under this amendment in the 
reactogenicity subset .
Added an unblinded clinical scientist to su pport 
DMC activities.
Clarified that s erology data after a postbaseline 
positive SARS -CoV- 2 test result will not be 
included in the analysis based on theevaluable 
immunogenicity population s.
Protocol amendment 8 15 October 2020 Removed “N-binding antibody ”and 
“SARS -CoV- 2 detection by NAAT ”as 
endpoints from the third exploratory objective , 
as these results are used for the determination of 
the population, and are not endpoints.
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Protocol Amendment 14, 02March 2021
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 6Document History
Document Version Date Summary and Rationale for Changes
Clarified that the “Process 1” participants 
included in the descriptiv e analysis of 
“Process 1”-and “Process 2”- manufactured 
study intervention swill be selected randomly .
Clarified that surveillance of potential 
COVID -19 symptoms should continue even if a 
participant has a positive SARS -CoV- 2 test 
earlier in the study.
Further modified the circumstances in which a 
local NAAT result may be used in the 
COVID -19 case definition.
Clarified that f or participants who are not in the 
reactogenicity subset, local reactions and 
systemic events following vaccination should be 
detected and reported as AEs .
Clarified that premenarchal females are not 
WOCBP.
Made various editorial changes .
Protocol amendment 7 06 October 2020 Reduced the lower age range to include 
adolescents 12 to 15 years of age and added 
corresponding objectives.
Removed reference to COVID -19 antibody 
testing in Section 2.3.2 .
Clarified w ith efficacy estimands and endpoints 
that last dose refers to second dose.
Added an additional exploratory objective to 
describe safety and immunogenicity in 
participants 16 to 55 years of age vaccinated 
with study intervention produced by 
manufacturing “Process 1” or “Process 2.”
Clarified exclusion criterion 5.
Added Section 6.1.1 to describe manufacturing 
“Process 1” and “Process 2.”
Clarified the degree of unblinding on the 
unblinded submissions team in Section 6.3.3 .
Made provision for a second dose of BNT162b2 
in participants who were affected by a 
medication error at Visit 2 in Section 6.6.
Provided further clarification regarding 
discontinuation of study intervention in 
Section 7.1.
Modified the circumstances in which a local 
NAAT result may be used in the COVID -19 
case definition.
Added that 2 periods of potential COVID -19 
symptoms within 4 days will be considered as a 
single illness.
Provided guidance in Section 8.13 regard ing 
circumstances in which a SARS -CoV -2 test 
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Protocol Amendment 14, 02March 2021
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 7Document History
Document Version Date Summary and Rationale for Changes
might be required even if symptoms within 7 
days following each vaccination are considered 
more likely due to vaccine reactogenicity.
Made allow ance in Section 8.13 for a second 
SARS -CoV- 2 test to be performed w ithin the 
same potential COVID -19 illness if it is in 
accordance w ith routine practice.
Added Section 8.15 to describe the reporting of 
SARS -CoV- 2 test results and their implications 
for participants receiving a second vaccine dose.
Added statistical hypot hesis and pow er analysis 
for evaluation of noninferiority of the immune 
response to BNT162b2 in participants 12 to 15 
years of age to the response in participants 16 to 
25 years of age.
Amended scope of analyses of safety data in 
Section 9.5.1 .
Made variou s editorial changes.
Protocol amendment 6 
(Germ any-specific)23 September 2020 According to regulatory request, inclusion 
criterion 1 now  specifies that participants less 
than 18 years of age will not be enrolled in the 
EU.
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 w indow  for the 6 -month follow -up 
visit to be approximately 6 months after 
Vaccination 2.
Reduced the volume o f blood draw s 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 disea se.
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 low er 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; 
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Protocol Amendment 14, 02March 2021
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 8Document History
Document Version Date Summary and Rationale for Changes
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 p otential COVID -19 
illnesses that are consistent with the clinical 
endpoint definition should notbe recorded as 
AEs.
Updated the analysis population descriptions to 
align with the study SAP.
Protocol amendment 5 24 July 2020 Follow ing 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.
Stated that the vaccine candidate selected for 
Phase 2/3 evaluation is BNT162b2 at a dose of 
30µg.
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 unblinde d 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 
participa nts with a p revious clinical or 
microbiological diagnosis of COVID -19are 
excluded from all phases of the study.
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Protocol Amendment 14, 02March 2021
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Page 9Document History
Document Version Date Summary and Rationale for Changes
Clarified that there will be 2 all -available 
efficacy populations.
Clarified that immunogenicity samples will be 
draw n for all participants; an alyses 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 objecti ve w ill be 
evaluated.
Changed to use the same posterior probability 
(99.5%) for all interim analyses, resulting in 
case split changes in T ables 5, 6, and 7 .
Updated the s topping and alert ruleparameter s 
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 pow ered 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.
The 6 -month safety follow -up telephone contact has 
been changed to an in -person visit for Sta ge 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 definitio ns; 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 ha ve been made to the headings to align 
with the latest Pfizer protocol template.
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Protocol Amendment 14, 02March 2021
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
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Document Version Date Summary and Rationale for Changes
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 low er 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.
Follow ing 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 a n immunological 
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 
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investigator, participants may utilize a COVID -19 
illness e -diary.
Protoco l amendment 2 27 May 2020 Given the urgent nature of the pandemic situation, 
the following changes allow determin ation 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 Follow ing 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 d ata supporting the selection of 
vaccine candidate(s)/dose level(s) and 
schedule(s) for Stages 2 and 3 will be submit ted 
to the FDA for review
Follow ing 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 d ecision 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
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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 th at 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
Incorporated a protocol administrative change to 
state that the study placebo ma y 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 diamete r (cm ) for 
mild redness and swelling
Updated the °C fever scale in Table 4 to ensure 
that all potential °F values are correctly assigned
Incorporated a protocol administrative change to 
clarify that a rapid test for prior COVID -19 
infection will be performed for s entinel 
participants in Stage 1 , and a serum sample will 
be drawn for potential future assessment
Clarified that, after screening, physical 
examinations in s entinel participants in Stage 1
will be directed
Clarified the descriptions of the populations for 
analysis to align with the statistical analysis plan
Added a com plete safety and immunogenicity 
analysis approximately 6 months after Dose 2 
for all participants inStage 3
Amended text so that the stopping rules apply to 
an RNA pla tform  rather than a specific vaccine 
candidate
Original protocol 15April 2020 N/A
This amendment incorporates all revisions to date, including amendments made at the 
request of country  health authorities and IRBs/ECs.
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Page 13TABLE OF CONTENTS
LIST OF TABLES ................................ ................................ ................................ ................... 20
LIST OF FIGURES ................................ ................................ ................................ ................. 21
1. PROTOCOL  SUMMARY ................................ ................................ ................................ ...22
1.1. Sy nopsis ................................ ................................ ................................ .................. 22
1.2. Schema ................................ ................................ ................................ .................... 36
1.3. Schedule of Activities ................................ ................................ ............................. 37
1.3.1. Phase 1 ................................ ................................ ................................ ........ 37
1.3.2. Phase 2/3................................ ................................ ................................ .....44
1.3.3. Administration of BNT162b2 to Those Originall y Assigned to 
Placebo ................................ ................................ ................................ ............. 48
1.3.4. Administration of an Additional Dose of BNT162b2 or BNT162b2 SA......50
1.3.5. Administration of BNT162b2 SAto BNT162b2 -Naïve Participants ........... 53
1.3.6. Surveillance for As ymptomatic SARS -CoV -2 Infection ........................... 56
2. INTRODUCTION ................................ ................................ ................................ ............... 57
2.1. Study  Rationale ................................ ................................ ................................ .......57
2.2. Background .............................................................................................................57
2.2.1. Clinical Overview ................................ ................................ ....................... 59
2.3. Benefit/Risk Assessment................................ ................................ ......................... 59
2.3.1. Risk Assessment ................................ ................................ ......................... 61
2.3.2. Benefit Assessment ................................ ................................ ..................... 63
2.3.3. Overall Benefit/R isk Conclusion ................................ ................................ 63
3. OBJECTI VES, ESTIMANDS, AND ENDPOINTS ...........................................................63
3.1. For Phase 1 ................................ ................................ ................................ .............. 63
3.2. For Phase 2/3 ................................ ................................ ................................ ........... 65
4. STUDY DESIGN ................................ ................................ ................................ ................. 72
4.1. Overall Design ................................ ................................ ................................ ......... 72
4.1.1. Phase 1 ................................ ................................ ................................ ........ 73
4.1.2. Phase 2/3................................ ................................ ................................ .....74
4.2. Scientific Rationale for Study  Design ................................ ................................ .....77
4.3. Justification for Dose ................................ ................................ .............................. 77
4.4. End of Study  Definition ................................ ................................ .......................... 78
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Page 145. STUDY POPUL ATION ................................ ................................ ................................ ......79
5.1. I nclusion Criteria ................................ ................................ ................................ .....79
5.2. Exclusion Criteria ................................ ................................ ................................ ....80
5.3. L ifesty le Considerations ................................ ................................ .......................... 82
5.3.1. Contraception ................................ ................................ .............................. 82
5.4. Screen Failures ................................ ................................ ................................ ........ 83
5.5. Criteria for Temporarily  Delay ing Enrollment/Randomization/Study  
Intervention Administration ................................ ................................ ...................... 83
6. STUDY INTERVENTIO N................................ ................................ ................................ ..84
6.1. Study  Intervention(s) Administered ................................ ................................ ........ 84
6.1.1. Manufacturing Process ................................ ................................ ............... 85
6.1.2. Administration ................................ ................................ ............................ 85
6.2. Preparation/Handling/Storage/Accountability ................................ ........................ 86
6.2.1. Preparation and Dispensing ................................ ................................ ........ 87
6.3. Measures to Minimize Bias: Randomization and Blinding ................................ .....88
6.3.1. Allocation to Study Intervention ................................ ................................ 88
6.3.2. Blinding of Site Personnel ................................ ................................ .......... 88
6.3.3. Blinding of the Sponsor................................ ................................ .............. 88
6.3.4. Breaking the Blind ................................ ................................ ...................... 90
6.4. Study  Intervention Compliance ................................ ................................ ............... 90
6.5. Concomitant Therapy ................................ ................................ .............................. 91
6.5.1. Prohibited During the Study ................................ ................................ .......91
6.5.2. Permitted During the Study ................................ ................................ ........ 92
6.6. Dose Modification ................................ ................................ ................................ ...92
6.7. I ntervention After the End of the Study ................................ ................................ ..93
7. DI SCONTINUATION O F STUDY INTERVENTION AND PARTI CIPANT 
DISCONTINUATION/WI THDRAWAL ................................ ................................ ........... 93
7.1. Discontinuation of Study  Intervention ................................ ................................ ....93
7.2. Participant Discontinuation/Withdrawal From the Study ................................ .......94
7.2.1. Withdrawal of Consent ................................ ................................ ............... 94
7.3. L ost to Follow -up ................................ ................................ ................................ ....95
8. STUDY ASSESSMENTS AND PROCEDURES ................................ ............................... 95
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Page 158.1. Efficacy  and/or Immunogenicity Assessments ................................ ....................... 97
8.1.1. Efficacy  Against COVID -19 ................................ ................................ ......97
8.1.2. Efficacy  Against Asy mptomatic SARS -CoV -2 Infection .......................... 99
8.1.2.1. Seroconversion of N -Binding Antibod y ................................ ...99
8.1.2.2. NAAT -Confirmed SARS -CoV -2 Infection .............................. 99
8.1.3. Vaccine -Induced Immunogenicit y................................ ............................ 100
8.1.4. Biological Samples ................................ ................................ ................... 100
8.1.5. Surveillance for Asy mptomatic SARS -CoV -2 Infection ......................... 100
8.2. Safet y Assessments ................................ ................................ ............................... 101
8.2.1. C linical Safety  Laboratory  Assessments (Phase 1 Participants Onl y).....101
8.2.2. Electronic Diary ................................ ................................ ........................ 102
8.2.2.1. Grading Scales ................................ ................................ ......... 103
8.2.2.2. L ocal Reactions ................................ ................................ .......103
8.2.2.3. Systemic Events ................................ ................................ ......104
8.2.2.4. Fever ................................ ................................ ........................ 105
8.2.2.5. Antipy retic Medication ................................ ........................... 105
8.2.3. Phase 1 Stopping Rules ................................ ................................ ............ 105
8.2.4. Surveillance of Events That Could Represent Enhanced COVID -19 
and Phase 2/3 Stopping Rule ................................ ................................ ......... 107
8.2.5. Randomization and Vaccination After a Stopping Rule Is Met ............... 107
8.2.6. Pregnancy  Testing ................................ ................................ .................... 108
8.3. Adverse Events and Serious Adverse Events................................ ........................ 108
8.3.1. Time Period and Frequency  for Collecting AE and SAE Information .....108
8.3.1.1. Reporting SAEs to Pfizer Safety ................................ ............. 109
8.3.1.2. Recording Nonserious AEs and SAEs on the CRF ................. 110
8.3.2. Method of Detecting AEs and SAEs ................................ ........................ 110
8.3.3. Follow -up of AEs and SAEs ................................ ................................ .....110
8.3.4. Regulatory Reporting Requirements for SAEs ................................ ......... 110
8.3.5. Exposure During Pregnancy  or Breastfeeding, and Occupational 
Exposure ................................ ................................ ................................ ........ 111
8.3.5.1. Exposure During Pregnancy ................................ .................... 111
8.3.6. Exposure During Breastfeeding ................................ ................................ 112
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Page 168.3.6.1. Occupational Exposure ................................ ........................... 113
8.3.7. Cardiovascular and Death Events ................................ ............................. 113
8.3.8. Disease -Related Events and/or Disease -Related Outcomes Not 
Qualifying as AEs or SAEs ................................ ................................ ............ 113
8.3.9. Adverse Events of Special Interest ................................ ........................... 114
8.3.9.1. Lack of Efficacy ................................ ................................ ......114
8.3.10. Medical Device Deficiencies ................................ ................................ ..114
8.3.11. Medication Errors ................................ ................................ ................... 114
8.4. Treatment of Overdose................................ ................................ .......................... 115
8.5. Pharmacokinetics ................................ ................................ ................................ ..116
8.6. Pharmacod ynamics ................................ ................................ ................................ 116
8.7. Genetics ................................ ................................ ................................ ................. 116
8.8. Biomarkers ................................ ................................ ................................ ............ 116
8.9. I mmunogenicit y Assessments ................................ ................................ ............... 116
8.10. Health Economics ................................ ................................ ............................... 116
8.11. Stud y Procedures ................................ ................................ ................................ .116
8.11.1. Phase 1 ................................ ................................ ................................ ....116
8.11.1.1. Screening: (0 to 28 Day s Before Visit 1) .............................. 116
8.11.1.2. Visit 1 – Vaccination 1: (Day  1) ................................ ........... 118
8.11.1.3. Visit 2 – Next -Day Follow -up Visit (Vaccination 1): (1 
to 3 Day s After Visit 1) ................................ ................................ ...120
8.11.1.4. Visit 3 – 1- Week Follow -up Visit (Vaccination 1): (6 to 
8 Day s After Visit 1) ................................ ................................ .......121
8.11.1.5. Visit 4 – Vaccination 2: (19 to 23 Day s After Visit 1) ......... 122
8.11.1.6. Visit 5 – 1- Week Follow -up Visit (Vaccination 2): (6 to 
8 Day s After Visit 4) ................................ ................................ .......124
8.11.1.7. Visit 6 – 2- Week Follow -up Visit (Vaccin ation 2): (12 to 
16 Day s After Visit 4) ................................ ................................ .....126
8.11.1.8. Visit 7 – 1- Month Follow -up Visit: (28 to 35 Day s After 
Visit 4) ................................ ................................ ............................. 127
8.11.1.9. Visit 8 – 6- Month Follow -up Visit: (175 to 189 Day s 
After Visit 4) ................................ ................................ .................... 127
8.11.1.10. Between Visits 8 and 9 ................................ ........................ 128
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Page 178.11.1.11. Visit 8a –Vaccination 3: (175 to 315 Day s After 
Vaccination 2) ................................ ................................ ................. 128
8.11.1.12. Visit 8b – 1- Week Follow -up Visit (After Vaccination 
3): (6 to 8 Day s After Visit 8a) ................................ ........................ 130
8.11.1.13. Visit 8c – 1 -Month Follow -up Visit (After Vaccination 
3): (28 to 35 Days After Visit 8a) ................................ .................... 130
8.11.1.14. Visit 9 – 12- Month Follow -up Visit: (350 to 378 Day s 
After Visit 4): Onl y for Those Participants Who Originall y 
Receive d BNT162b1 or BNT162b2 or Placebo Recipients Who 
Decline BNT162b2 ................................ ................................ .......... 131
8.11.1.15. Visit 10 – 24- Month Follow -up Visit: (714 to 742 Day s 
After Visit 4):  Onl y for Those Participants Who Originall y 
Received BNT162b1 or BNT162b2 or Placebo Recipients Who 
Decline BNT162b2 ................................ ................................ .......... 132
8.11.2. Phase 2/3................................ ................................ ................................ .132
8.11.2.1. Visit 1 – Vaccination 1: (Day  1) ................................ ........... 132
8.11.2.2. Visit 2 – Vaccination 2: (19 to 23 Day s After Visit 1) ......... 135
8.11.2.3. Visit 3 – 1- Month Follow -up Visit (After Vaccination 2): 
(28 to 35 Day s After Visit 2) ................................ ........................... 137
8.11.2.4. Visit 4 – 6- Month Follow -up Visit: (175 to 189 Day s 
After Visit 2) ................................ ................................ .................... 138
8.11.2.5. Visit 5 – 12- Month Follow -up Visit: (350 to 378 Day s 
After Vis it 2): Onl y for Those Participants Who Originall y 
Received BNT162b2 or Placebo Recipients Who Decline 
BNT162b2 ................................ ................................ ....................... 138
8.11.2.6. Visit 6 – 24- Month Follow -up Visit: (714 to 742 Day s 
After Visit 2) ): Onl y for Those Participants Who Originall y 
Received BNT162b2 or Placebo Recipients Who Decline 
BNT162b2 ................................ ................................ ....................... 139
8.12. Unscheduled Visit for a Grade 3 or Suspected Grade 4 Reaction ...................... 140
8.13. COVID -19 Surveillance (All Participants) ................................ ......................... 141
8.13.1. Potential COVI D-19 Illness Visit: (Optimally Within 3 Day s After 
Potential COVI D-19 Illness Onset) ................................ ............................... 142
8.13.2. Potential COVI D-19 Convalescent Visit: (28 to 35 Day s After 
Potential  COVI D-19 Illness Visit) ................................ ................................ 143
8.14. Communication and Use of Technology ................................ ............................. 144
8.15. SARS -CoV -2 NAAT Results ................................ ................................ .............. 144
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Page 188.16. Procedures for Administration of BNT162b2 to Those Originally  Assigned 
to Placebo ................................ ................................ ................................ ................ 145
8.16.1. Visit 101 – Vaccination 3: (From Recommendation or at Least 175 
Days After Vaccination 2) ................................ ................................ ............. 145
8.16.2. Visit 102 – Vaccination 4: (19 to 23 Day s After Visit 101) ................... 147
8.16.3. Visit 103 – 1- Month Follow -up Telephone Contact (After 
Vaccination 4): (28 to 35 Days After Visit 102) ................................ ............ 148
8.16.4. Visit 104 – 6- Month Follow -up Telephone Contact (After 
Vaccination 4): (175 to 189 Days After Visit 102) ................................ ........ 148
8.16.5. Visit 105 – 18- Month Follow -up Telephone Contact (After 
Vaccination 4): (532 to 560 Days After Visit 102) ................................ ........ 149
8.17. Administration of an Additional Dose of BNT162b2 or BNT162b2 SA.............. 149
8.17.1. Visit 301 – Vaccination 3: (150 to 210 Days After Visit 2) ................... 149
8.17.2. Visit 302 – 1- Week Follow -up Visit (After Vaccination 3): (6 to 8 
Days After Visit 301) ................................ ................................ ..................... 152
8.17.3. Visit 303 – 1- Month Follow -up Visit (After Vaccination 3): (28 to 
35 Day s After Visit 301) ................................ ................................ ................ 152
8.17.4. Visit 304 – 1- Week Follow -up Visit (Vaccination 4): (6 to 8 Day s 
After Visit 303): Onl y for Those Participants Who Received a fourth 
dose of BNT162b2 SA................................ ................................ ..................... 154
8.17.5. Visit 305 – 1- Month Follow -up Visit (Vaccination 4): (28 to 35 
Days After Visit 303): Only  for Those Participants Who Received a 
fourth dose of BNT162 b2SA................................ ................................ ........... 155
8.17.6. Visit 306 – 6- Month Follow -up Visit: (175 to 189 Day s After Visit 
301): ................................ ................................ ................................ ............... 155
8.17.7. Visit 307 – 18- Month Follow -up Visit: (532 to 560 Day s After 
Visit 301): ................................ ................................ ................................ ......156
8.18. Administration of BNT162b2 SAto BNT162b2 -naïve Participants ..................... 156
8.18.1. Visit 401 – Vaccination 1: (Day  1)................................ ......................... 156
8.18.2. Visit 402 – Vaccination 2: (19 to 23 Day s After Visit 401)................... 159
8.18.3. Visit 403 – 1- Week Follow -up Visit (After Vaccination 2): (6 to 8 
Days After Visit 402) ................................ ................................ ..................... 161
8.18.4. Visit 404 – 1- Month Follow -up Visit (After Vaccination 2): (28 to 
35 Day s After Visit 402) ................................ ................................ ................ 161
8.18.5. Visit 405 – 6- Month Follow -up Visit: (175 to 189 Day s After Visit 
402) ................................ ................................ ................................ ................ 162
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Page 198.18.6. Visit 406 – 18- Month Follow -up Visit: (532 to 560 Day s After 
Visit 402) ................................ ................................ ................................ .......163
8.19. Surveillance for Asy mptomatic SARS -CoV -2 Infection ................................ ....163
8.19.1. Visit 201 –Asymptomatic SARS -CoV -2 Infection Surveillance 
Consen t: From Approval of Protocol Amendment 11 ................................ ...163
8.19.2. Visit 202 Onward –Asymptomatic SARS -CoV -2 Infection 
Surveillance Swab: Repeating Every  10 to 18 Days After Each Previous 
Surveillance Swab Collection ................................ ................................ ........ 164
9. STATI STICAL CONSI DERATIONS ................................ ................................ .............. 165
9.1. Estimands and Statistical Hy potheses ................................ ................................ ...165
9.1.1. Estimands ................................ ................................ ................................ ..165
9.1.2. Statistic al Hy potheses ................................ ................................ ............... 166
9.1.2.1. Statistical Hy pothesis Evaluation for Efficacy ........................ 166
9.1.2.2. Statistical Hy pothesis Evaluation for Immunogenicity ........... 166
9.2. Sample Size Determination ................................ ................................ ................... 168
9.2.1. Phase 1 ................................ ................................ ................................ ......168
9.2.2. Efficacy  Against COVID -19 ................................ ................................ ....168
9.2.3. Efficacy  Agains t Asy mptomatic Infection ................................ ............... 169
9.2.4. I mmunogenicit y Bridging of 12 to 15 Years to 16 to 25 Years ............... 169
9.2.5. Boostability  and Protection Against Emerging SARS -CoV -2 VOCs ......169
9.2.6. Safet y ................................ ................................ ................................ ........ 170
9.3. Analy sis Sets ................................ ................................ ................................ ......... 172
9.4. Statistic al Analy ses................................ ................................ ............................... 174
9.4.1. I mmunogenicit y Analyses ................................ ................................ ........ 174
9.4.2. Efficacy  Anal yses................................ ................................ ..................... 184
9.4.3. S afety Anal yses................................ ................................ ........................ 189
9.4.4. Other Anal yses................................ ................................ .......................... 191
9.5. I nterim Anal yses................................ ................................ ................................ ...191
9.5.1. Analy sis Timing ................................ ................................ ........................ 194
9.6. Data Monitoring Committee or Other Independent Oversight Committee...........195
10. SUPPORTING DOCUM ENTATION AND OPERATI ONAL 
CONSI DERATIONS ................................ ................................ ................................ ........ 197
10.1. Appendix 1: Regulatory , Ethical, and Study  Oversight Considerations ............. 197
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Page 2010.1.1. Regulatory and Ethical Considerations ................................ .................. 197
10.1.1.1. Reporting of Safety  Issues and Serious Breaches of the 
Protocol or I CH GCP ................................ ................................ .......197
10.1.2. I nformed Consent Proce ss................................ ................................ ......198
10.1.3. Data Protection ................................ ................................ ....................... 199
10.1.4. Dissemination of Clinical Study  Data ................................ .................... 199
10.1.5. Data Qualit y Assurance ................................ ................................ .......... 200
10.1.6. Source Documents ................................ ................................ .................. 202
10.1.7. Study  and Site Start and Closure ................................ ............................ 202
10.1.8. Sponsor’s Qualified Medical Personnel ................................ ................. 203
10.2. Appendix 2: Clinical Laboratory  Tests ................................ ............................... 204
10.3. Appendix 3: Adverse Events: Definitions and Procedures for Recor ding, 
Evaluating, Follow -up, and Reporting ................................ ................................ ....206
10.3.1. Definition of AE ................................ ................................ ..................... 206
10.3.2. Definition of SAE ................................ ................................ ................... 207
10.3.3 . Recording/Reporting and Follow- up of AEs and/or SAEs ..................... 209
10.3.4. Reporting of SAEs................................ ................................ .................. 212
10.4. Appendix 4: Contraceptive Guidance ................................ ................................ .213
10.4.1. Male Participant Reproductive Inclusion Criteria ................................ ..213
10.4.2. Female Participant Reproductive Inclusion Criteria ............................... 213
10.4.3. Woman of Childbearing Potential ................................ .......................... 214
10.4.4. Contraception Methods ................................ ................................ ........... 215
10.5. Appendix 5: L iver Safety : Suggested Actions and Follow -up Assessments ......217
10.6. Appendix 6: Abbreviations ................................ ................................ ................. 219
10.7. Appendix 7: Stopping and Alert Rules for Enhanced COVID -19 ...................... 223
10.8. Appendix 8: Criteria for A llowing Inclusion of Participants With Chronic 
Stable HIV, HCV, or HBV Infection ................................ ................................ ......226
11. REFERENCES ................................ ................................ ................................ ................ 227
LIST OF TABLES
Table 1. Local Reaction Grading Scale ................................ ................................ 103
Table 2. Systemic Event Grading Scale ................................ ................................ 104
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Page 21Table 3. Scale for Fever ................................ ................................ ........................ 105
Table 4. Power Anal ysis for Noninferiorit y Assessment ................................ .....169
Table 5. Probability  of Observing at Least 1 AE by  Assumed True Event 
Rates With D ifferent Sample Sizes ................................ ........................ 171
Table 6. Interim Anal ysis Plan and Boundaries for Efficacy  and Futility ............ 192
Table 7. Statistical Design Operating Characteristics: Probability  of Success 
or Failure for Interim Analy ses................................ ............................... 193
Table 8. Statistical Design Operating Characteristics: Probability  of Success 
for Final Anal ysis and Overall ................................ ................................ 193
Table 9. Laboratory  Abnormality  Grading Scale ................................ ................. 204
Table 10. Stopping Rule: Enrollment I s Stopped if the Number of Severe 
Cases in the Vaccine Group I s Greater Than or Equal to the 
Prespecified Stopping Rule Value (S) ................................ .................... 224
Table 11. Alert Rule: Further Action I s Taken if the Number of Severe Cases 
in the Vaccine Group Is Greater Than or Equal to the Prespecified 
Alert Rule Value (A) ................................ ................................ .............. 225
LIST OF FIGURES
Figure 1. Multiplicity  Schema ................................ ................................ ................ 168
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Page 221.PROTOCOL SUMMARY
1.1.Synopsis
Short Title: A Phase 1/2 /3Study  to Evaluate the Safety , Tolerabilit y, 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 officiall y 
named as se vere acute respiratory  syndrome corona virus 2 (SARS -CoV -2), and the WHO 
officiall y named the disease caused by SARS -CoV -2 as coronavirus disease 2019 
(COVID -19). On11 March 2020 , the WHO upgraded the status of the COVID- 19 outbreak 
from epidemic to pande mic, which is now spreading globall y at high speed.
There are currently  no licensed vaccines to prevent infection with SARS -CoV -2or 
COVID -19. Given the rapid transmission of COV ID-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 aplatform ofnucleoside -modified 
messenger RNA (modRNA , BNT162b ). Each vaccine candidate expresses 1 of 3 antigen s:
BNT162b1 (variant RBP020.3) : a modRNA encoding the trimerized SARS -CoV -2 spike 
glycoprotein receptor -binding domain ( RBD ) (version 5) ;
BNT162b 2 (variant RBP020.2) :a modRNA encoding the SARS -CoV -2 full- length, P2 
mutant, prefusion spike gly coprotein ( P2 S) (version 9);
BNT162b2s01 (variant RBP020.11 ): amodRNA encoding the P2 S containing South Africa 
B.1.351 variant –specific mutations, hereafter referred to as BNT162b2 SA, as a representative 
variant of concern (VOC).
All candidates are formulated in the same lipid nanoparticle (LNP) composition . This study  
is intended to investigate the safet y, immunogenicity , and /orefficacy  of these proph ylactic 
BNT162 vaccines against COVI D-19 .
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Page 23Objectives , Estimands, and Endpoints
For Phase 1
Objectives Estimands Endpoints
Primary: Primary: Primary: 
To describe the safety and tolerability 
profiles of prophylactic BNT162 
vaccines in healthy adults after 1or 2 
dosesIn participants receiving at least 1 dose 
of study intervention, the percentage of 
participants reporting:
 Local reactions for up to 7 days 
following each dose
 Systemic events for up to 7 days 
following each dose
 Adverse events (AE s) from 
Dose 1 to1 month after the last 
dose
 Serious AEs (SAE s) from Dose 1 
to 6 months after the last dose Local reactions (pain at the 
injection site , rednes s, and 
swelling )
 Systemic events (fever, fatigue, 
headache, chills, vomiting, 
diarrhea, new or worsened muscle 
pain, and new or worsened joint 
pain)
 AEs
 SAEs
In addition, the percentage of 
participants 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 2Hematology and chemistry laboratory 
parame tersdetailed in Section 10.2
Secondary: Secondary: Secondary: 
To describe the immune responses 
elicited by prophylactic BNT162 
vaccines in healthy adults after 1or 2 
dosesIn participants complying with the key 
protocol criteria (evaluable 
participants) at the following time 
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 
each time point
 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 vaccinationSARS -CoV -2neutralizing titers
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Page 24Objectives Estimands Endpoints
 Geometric mean concentrations 
(GMCs) at each time point
 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 vaccinationS1-binding IgGlevels and 
RBD -binding IgG levels
 Geometric mean ratio (GMR) , 
estimated by the ratio of the 
geometric mean of SARS -CoV -2
neutralizing titers to the geometric 
mean of binding IgGlevels at each 
time point SARS -CoV -2neutralizing titers
 S1-binding IgGlevels
 RBD -binding IgGlevels
Exploratory : Exploratory : Exploratory : 
To describe the immune responses 
elicited by a third dose of prophylactic 
BNT162b2 administered tohealthy 
adults 6 to 12 months after the second 
dose of either BNT162b1 or 
BNT162b2 GMC/GMT and GMFR at the 
time of Dose 3 and 7days and 
1month after Dose 3. SARS -CoV -2 reference -strain 
neutralizing titers
 SARS -CoV -2 SA-variant
neutralizing titers
 Full-length S -binding or 
S1-binding IgG levels
 GMR of SARS-CoV -2reference -
strain neutralizing titers 1 month 
after Dose 3 to 1 month after 
Dose 2 SARS -CoV -2 reference -strain 
neutralizing titers
 GMR of SARS-CoV -2SA-variant
neutralizing titers 1 month after 
Dose 3 to SARS -CoV -2reference -
strain neutralizing titers 1 month 
after Dose 2 SARS -CoV -2 reference -strain 
neutralizing titers
 SARS -CoV -2 SA-variant
neutralizing titers
To de scribe the safety profile of a third 
dose of prophylactic BNT162 b2
administered to healthy adults 6 to 
12months after the second dose of 
either BNT162b1 or BNT162b2In participants receiving a third dose of 
BNT162b2 , the percentage of 
participants reporting:
 Local reactions for up to 7 days 
after Dose 3
 Systemic events for up to 7 days 
after Dose 3
 AEs and SAEs from Dose 3to 
1month after Dose 3 Local reactions (pain at the 
injection site, redness, and 
swelling)
 Systemic events (fever, fatigue, 
headache, chills , vomiting, 
diarrhea, new or worsened muscle 
pain, and new or worsened joint 
pain)
 AEs
 SAEs
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PF-07302048 (BNT162 RNA- Based COVID- 19 Vaccines)
Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 25For Phase 2/3
ObjectivesaEstimands Endpoints
Prim ary Efficacy
To evaluate the efficac yof 
prophylactic BNT162 b2against 
confirmed COVID -19occurring from 
7 days after the second dose in 
participants without evidence of 
infection before vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) at least 7 days after 
receipt of the second dose of study 
intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of follow -up based on 
central laboratory or locally 
confirmed NAAT in participants with 
no serological or virological evidence 
(up to 7 days after receipt of the 
second dose) of past SARS -CoV -2 
infection
To evaluate the efficac yof 
prophylactic BNT162 b2against 
confirmed COVID -19 occurring from 
7 days after the second dose in 
participants with and without 
evidence of infection before 
vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) at least 7 days after 
receipt of the second dose of study 
intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of follo w-up based on 
central laboratory or locally 
confirmed NAAT
Prim ary Safety
To define the safety profile of 
prophylactic BNT162 b2in the first 
360 participants randomized (Phase 2)In participants receiving at least 1 
dose of study intervention, the 
percentage of participants reporting:
 Local reactions for up to 7 days 
following each dose
 Systemic events for up to 7 days 
following each dose
 AEs from Dose 1 to 7 days after 
the second dose
 SAEs from Dose 1 to 7 days
after the second dose Local reactions (pain at the 
injection site, redness, and 
swelling)
 Systemic events (fever, fatigue, 
headache, chills, vomiting, 
diarrhea, new or worsened 
muscle pain, and new or 
worsened joint pain)
 AEs
 SAEs
To define the safety profile of 
prophylactic BNT162 b2in all 
participants randomized in Phase 2/3In participants receiving at least 
1 dose of study intervention, the 
percentage of participants reporting:
 Local reactions for up to 7 days 
following each dose
 Systemic events for up to 7 days 
following each dose
 AEs fr om Dose 1 to 1 month 
after the second dose
 SAEs from Dose 1 to 6 months 
after the second dose AEs
 SAEs
 In a subset of at least 6000 
participants:
o Local reactions (pain at the 
injection site, redness, and 
swelling)
o Systemic events (fever, 
fatigue, headache, chills, 
vomiting, diarrhea, new or 
worsened muscle pain, and 
new or worsened joint pain )
To define the safety profile of 
prophylactic BNT162 b2in 
participants 12 to 15 years of age in 
Phase 3In participants receiving at least 
1dose of study intervention, the 
percentage of participants reporting:
 Local reactions for up to 7 days 
following each dose
 Systemic events for up to 7 days 
following each dose
 AEs from Dose 1 to 1 month 
after the second dose
 SAEs from Dose 1 to 6 months 
after the second dose Local reactions (pain at the 
injection site, redness, and 
swelling)
 Systemic events (fever, fatigue, 
headache, chills, vomiting, 
diarrhea, new or worsened 
muscle pain, and new or 
worsened joint pain)
 AEs
 SAEs
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PF-07302048 (BNT162 RNA- Based COVID- 19 Vaccines)
Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 26ObjectivesaEstimands Endpoints
To describe the safety and tolerability 
profile of BNT162 b2SAgiven as 1 or 
2 doses to BNT162b2 -experienced
participants , or as 2 doses to 
BNT162b2 -naïve participants
To describe the safety and tolerability 
profile of BNT162 b2given as a third
dose to BNT162b2-experienced
participantsIn partic ipants receiving at least 
1dose of study intervention , the 
percentage of participants reporting:
Local reactions for up to 7 days 
following each dose 
Systemic events for up to 7 days 
following each dose
AEs from Dose 1 to 1 month after 
the last dose
SAEs from Dose 1 to 5 or 
6 months after the last doseLocal reactions (pain at the 
injection site , redness , and 
swelling )
Systemic events (fever, fatigue, 
headache, chills, vomiting, 
diarrhea, new or worsened muscle 
pain, and new or worsened joint 
pain)
AEs
SAEs
Prim ary Immunogenicity
BNT162b2 -experienced participants 
Todemonstrate the noninferiority of 
the anti –reference strain immune 
response after a third dose of 
BNT162b2 compared to after 2 doses 
of BNT162b2, in the same individualsGMR of reference strain NT 1 month 
after the third dose of BNT162b2 to 
1month after thesecond dose of 
BNT162b2
The d ifference inpercentage sof 
participants with seroresponse tothe 
reference strain at1 month after the 
third dose of BNT162b2 and 1 month 
after the second dose of BNT162b2SARS -CoV -2 reference strain NTs in 
participants with no serological or 
virological evidence (up to 1 month
after receipt of the third dose of 
BNT162b2 ) of past SARS -CoV -2 
infection
Todemonstrate the noninferiority of 
the anti -SA immune response after 
1dose of BNT162b2 SAcompared to 
the anti –reference strain immune 
response after 2 doses of BNT162b2, 
in the same individualsGMR of SA NT 1month after 1 dose 
of BNT162b2 SAto the reference strain 
NT 1 month after the second dose of 
BNT162b2
The difference in percentage sof 
participants with seroresponse to the 
SAstrain at 1 month after 1 dose of 
BNT162b2 SAand seroresponse to the 
reference strain at 1 month after the 
second dose of BNT162b2SARS -CoV -2 SA and reference strain 
NTs in participants with no 
serological or virological evidence 
(upto 1 month after receipt of 1dose
of BNT162b2 SA) of past SARS -CoV -
2 infection
BNT162b2 -naïve participants 
Todemonstrate the noninferiority of 
the anti-SA immune response after 2 
doses of BNT162b2 SAcompared to 
the anti –reference strain immune 
response after 2 doses of BNT162b2 GMR of SA NT 1month after the 
second dose of BNT162b2 SAto the 
reference strain NT 1 month after the 
second dose of BNT162b2
The difference in percentages of 
participants with seroresponse to the
SAstrain at 1 month after the second 
dose of BNT162b2 SAand 
seroresponse to the reference strain at 
1 month after the second dose of 
BNT162b2SARS -CoV -2 SA and reference strain 
NTs in participants with no 
serological or virological evidence 
(upto 1 month after receipt of the 
second dose of BNT162b2 SAor 
BNT162b2 as appropriate ) of past 
SARS -CoV -2 infection
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PF-07302048 (BNT162 RNA- Based COVID- 19 Vaccines)
Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 27ObjectivesaEstimands Endpoints
Secondary Efficacy
To evaluate the efficac yof 
prophylactic BNT162 b2against 
confirmed COVID -19 occurring from 
14days after the second dose in 
participants without evidence of 
infection before vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) at least 14days after 
receipt of the second dose of study 
intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of follow -up based on 
central laboratory or locally 
confirmed NAAT in participants with 
no serological or virological evidence 
(up to 14days after receipt of the 
second dose) of past SARS -CoV -2 
infection
To evaluate the efficac yof 
prophylactic BNT162 b2against 
confirmed COVID -19 occurring from 
14days after the second dose in 
participants with and without 
evidence of infection before 
vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) at least 14days after 
receipt of the second dose of study 
intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of follow -up based on 
central laboratory or locally 
confirmed NAAT
To evaluate the efficac yof 
prophylactic BNT162 b2against 
confirmed severe COVID -19
occurring from 7days and from 
14days after the second dose in 
participants without evidence of 
infection before vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) 
 at least 7 days 
and
at least 14 days
after receipt of the second dose of 
study intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]Confirmed s evere COVID -19 
incidence per 1000 person -years of 
follow -up in participants with no 
serological or virological evidence (up 
to 7 days and up to 14 days after 
receipt of the secon d dose) of past 
SARS -CoV -2 infection
To evaluate the efficac yof 
prophylactic BNT162 b2against 
confirmed severe COVID -19
occurring from 7 days and from 
14days after the second dose in 
participants with and without 
evidence of infection before 
vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) 
at least 7 days 
and
at least 14 days
after receipt of the second dose of 
study intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]Confirmed severe COVID -19
incidence per 1000 person -years of 
follow -up
To describe the efficac yof 
prophylactic BNT162 b2against 
confirmed COVID -19 (according to 
the CDC -defined symptoms) 
occurring from 7 days and from 
14days after the second dose in 
participants without evidence of 
infection before vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) 
at least 7 days 
and
at least 14 days
after receipt of the second dose of 
study intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of follow -up based on 
central laboratory or locally 
confirmed NAAT in participants with
no serological or virological evidence 
(up to 7days and up to 14 days after 
receipt of the second dose) of past 
SARS -CoV -2 infection
To describe the efficac yof 
prophylactic BNT162 b2against 
confirmed COVID -19 (according to 
the CDC -defined symptoms) 
occurring from 7 days and from 
14days after the second dose in 
participants with and without 
evidence of infection before 
vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) 
at least 7 days 
and
at least 14 days
after receipt of the second dose of 
study intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placeb o]COVID -19 incidence per 1000 
person -years of follow -up based on 
central laboratory or locally 
confirmed NAAT
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PF-07302048 (BNT162 RNA- Based COVID- 19 Vaccines)
Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 28ObjectivesaEstimands Endpoints
To evaluate the efficacy of 
prophylactic BNT162b2 against 
non-S seroconversion to 
SARS -CoV -2 in participants without 
evidence of infection or confirmed 
COVID -19In participants complying with the 
key protocol criteria (evaluable 
participants):
100 × (1 –IRR) [ratio of active 
vaccine to placebo]Incidence of asymptomatic 
SARS -CoV -2 infection per 1000 
person -years of follow -up based on 
N-binding antibody seroconversion in 
participants with no serological or 
virological evidence of past 
SARS -CoV -2 infection or confirmed 
COVID -19 
To evaluate the efficacy of 
prophylactic BNT162b 2against 
asymptomatic SARS -CoV -2 infection 
in participants without evidence of 
infection up to the start of the
asymptomatic surveillance periodIn participants complying with the 
key protocol criteria (evaluable 
participants):
100 × (1 –IRR) [ratio of active 
vaccine to placebo]Incidence of asymp tomatic 
SARS -CoV -2 infection per 1000 
person -years of follow -up based on 
central laboratory –confirmed NAAT 
in participants with no serological or 
virological evidence (up to the start of 
the asymptomatic surveillance period ) 
of past SARS -CoV -2 infection
Secondary Immunogenicity
Todemonstrate the noninferiority of 
the immune response to prophylactic 
BNT162b2 in participants 12 to 15 
years of age compared to participants 
16 to 25 years of ageGMR, estimated by the ratio of the 
geometric mean of SARS -CoV -2 
neutralizing titers in the 2 age groups 
(12-15 years of age to 16 -25 years of 
age) 1 month after completion of 
vaccinationSARS -CoV -2 neutralizing titers in 
participants with no serological or 
virological evidence (up to 1 month
after receipt of the seconddose) of 
past SARS -CoV -2 infection
BNT162b2 -experienced participants 
Todemonstrate the noninferiority of 
the anti-SA immune response after a 
third dose of BNT162b2 compared to 
the anti –reference strain immune 
response after 2 doses of BNT162b2, 
in the same individuals GMR of SA NT 1month after the 
third dose of BNT162b2 to the 
reference strain NT 1 month after the 
second dose of BNT162b2
The difference in percentages of 
participants w ith seroresponse to the
SAstrain at 1 month after the third 
dose of BNT162b 2and seroresponse 
to the reference strain at 1 month after 
the second dose of BNT162b2SARS -CoV -2 SA and reference strain 
NTs in participants with no 
serological or virological ev idence 
(upto 1 month after receipt of the 
third dose of BNT162b2 ) of past 
SARS -CoV -2 infection
Todemonstrate the noninferiority of 
the anti –reference strain immune 
response after 1 dose of BNT162b2 SA
compared to after 2 doses of 
BNT162b2, in the same individuals GMR of reference strain NT 1 month 
after 1 dose of BNT162b2 SAto 
1month after the second dose of 
BNT162b2
The difference in percentages of 
participants with seroresponse to the 
reference strainat 1 month after 1 
dose of BNT162b2 SAand 1 month 
after the second dose of BNT162b2SARS -CoV -2 reference strain NTs in 
participants with no serological or 
virological evidence (up to 1 month
after receipt of 1 dose of 
BNT162b2 SA) of past SARS -CoV -2 
infection
To descriptively compare the anti-SA
immune response after 1 dose of 
BNT162b2 SAanda third dose of 
BNT162b2GMR of SANT 1 month after 1 dose 
of BNT162b2 SAto1month after the 
third dose of BNT162b2
The difference in percentages of 
participa nts with seroresponse to the 
SAstrain at 1 month after 1 dose of 
BNT162b2 SAand 1 month after the 
third dose of BNT162b2SARS -CoV -2 SA NT in participants 
with no serological or virological 
evidence (up to 1 month after receipt 
of 1dose of BNT162b2 SAor the third
dose of BNT162b2 ) of past 
SARS -CoV -2 infection
090177e19668af9a\Approved\Approved On: 02-Mar-2021 14:41 (GMT) 
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FDA-CBER-2021-5683-0015554
PF-07302048 (BNT162 RNA- Based COVID- 19 Vaccines)
Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 29ObjectivesaEstimands Endpoints
Todescriptively compare the anti-SA 
immune response after 2 doses of 
BNT162b2 SAand the anti –reference 
strain immune response after 2 doses 
of BNT162b2, in the same individuals GMR of SA NT 1month after the 
second dose of BNT162b2 SAto the 
reference strain NT 1 month after the 
second dose of BNT162b2
The difference in percentages of 
participants with seroresponse to the 
SA strain at 1 month after the second 
dose of BNT162b2 SAand 
seroresponse to the reference strain at 
1 month after the second dose of 
BNT162b2SARS -CoV -2 SA and reference strain 
NTs in participants with no 
serological or virological evidence 
(upto 1 month after receipt of the 
second dose of BNT162b2 SA) of past 
SARS -CoV -2 infection
BNT162b2 -naïve participants 
Todemonstrate a statistically greater 
anti-SA immune response after 2 
doses of BNT162b2 SAcompared to 
after 2 doses of BNT162b2 GMR of SA NT 1month after the 
second dose of BNT162b2 SAto 
1month after the second dose of 
BNT162b2
The difference in percentages of 
participants with seroresponse to the 
SA strain at 1 month after the second 
dose of BNT162b2 SAand 1 month 
after the second dose of BNT162b2SARS -CoV -2 SANTs in participants 
with no serological or virological 
evidence (up to 1 month after receipt 
of the second dose of BNT162b2 SAor 
BNT162b2 as appropriate) of past 
SARS -CoV -2 infection
Todescriptively compare the anti–
reference strain immune response 
after 2 doses of BNT162b2 SAand 
after 2 doses of BNT162b2 GMR of reference strain NT 1 month 
after the second dose of BNT162b2 SA
to 1month after the second dose of 
BNT162b2
The difference in percentages of 
participants with seroresponse to the 
refere ncestrain at 1 month after th e 
second dose of BNT162b2 SAand 1 
month after the second dose of 
BNT162b2SARS -CoV -2 reference strain NTs in 
participants with no serological or 
virological evidence (up to 1 month
after receipt of the second doseof 
BNT162b2 SAor BNT162b2 as 
appropriate ) of past SARS -CoV -2 
infection
Exploratory
To describe the efficac yof 
prophylactic BNT162b 2against 
confirmed COVID -19 occurring from 
7 days after the second dose through 
the blinded follow -up period in 
participants without, and with and 
without ,evidence of infection before 
vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) after receipt of the 
second dose of study intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of blinded follow -up 
based on central laboratory or locally 
confirmed NAAT
To describe the incidence of 
confirmed COVID -19 through the 
entire study follow -up period in 
participants who received BNT162b2 
at initial randomization or 
subseq uentlyIn participants who received 
BNT162b2 (at initial randomization 
or subsequently):
Incidence per 1000 person-ye ars of 
follow -upCOVID -19 incidence per 1000 
person -years of follow -up based on 
central laboratory or locally 
confirmed NAAT
090177e19668af9a\Approved\Approved On: 02-Mar-2021 14:41 (GMT) 
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FDA-CBER-2021-5683-0015555
PF-07302048 (BNT162 RNA- Based COVID- 19 Vaccines)
Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 30ObjectivesaEstimands Endpoints
To evaluate the immune response 
over time to prophylactic BNT162 b2
and persistence of immune response 
in participants with and without 
serological or virological evidence of 
SARS -CoV -2infection before 
vaccinationGMC/ GMT and GMFR at baseline 
and 1, 6, 12, and 24 months after 
completion of vaccination Full-length S -binding or 
S1-binding IgGlevels
 SARS -CoV -2 neutralizing titers
To describe the incidence of non-S 
seroconversion to SARS -CoV -2
through the entire study follow-up 
period in participants who received 
BNT162b2 at initial randomizationIn participants who received 
BNT162b2 at initial randomization:
Incidence per 1000 person-ye ars of 
follow -upIncidence of asymptomatic 
SARS -CoV -2 infection per 1000 
person -years of follow -up based on 
N-binding antibody seroconversion in 
participants with no serological or 
virological evidence of past 
SARS -CoV -2 infection or confirmed 
COVID -19 
To describe the efficac yof 
prophylactic BNT162b 2against 
asymptomatic SARS -CoV -2 infection 
in participants with evidence of 
infection up to the start of the 
asymptomatic surveillance periodIn participants complying with the 
key protocol criteria (evaluable 
participants):
100 × (1 –IRR) [ratio of active 
vaccine to placebo]Incidence of asymptomatic 
SARS -CoV -2 infection per 1000 
person -years of follow -up based on 
central laboratory –confirmed NAAT
in participants with serological or 
virological evidence (up to the start of 
the asymptomatic surveillance period) 
of past SARS -CoV -2 infection
To describe the serological responses 
to the BNT vaccine candidate and 
characterize the SARS -CoV -2 isolate 
in cases of :
 Confirmed COVID-19
 Confirmed severe COVID -19
 SARS -CoV -2 infection without 
confirmed COVID -19 Full-length S -binding or 
S1-binding IgGlevels
 SARS -CoV -2 neutralizing titers
 Identification of SARS -CoV -2 
variant(s)
To describe the safety, 
immunogenicity ,and efficacy of 
prophylactic BNT162b2 in 
individuals with confirmed stable HIV 
disease All safety, immunogenicity, and 
efficacy endpoints described 
above
To describe the safety and
immunogenicity of prophylactic 
BNT162b2 in individuals 16 to 55 
years of age vaccinated with study 
intervention produced by 
manufacturing “Process 1” or 
“Process 2”b AEs
 SAEs
 SARS -CoV -2 neutralizing titers
To describe the immune response to 
any VOCs not already specifiedGeometric mean NT for any VOC s
not already specified, after any dose 
of BNT162b2 SAor BNT162b2 SARS -CoV -2NTs for any VOCs
not already specified
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FDA-CBER-2021-5683-0015556
PF-07302048 (BNT162 RNA- Based COVID- 19 Vaccines)
Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 31ObjectivesaEstimands Endpoints
To describe thecell-mediated immune 
response , and additional humoral 
immune response parameters, to the 
reference strain and SA in a subset of 
participants:
7 Daysand1and 6month safter
BNT162 b2SAgiven as 1 or 2 
doses to BNT162b2 -experienced
participa nts
7 Daysand1and 6month safter 
BNT162 b2SAgiven as 2 doses to 
BNT162b2 -naïve participants
7 Daysand1and 6month safter 
BNT162b2 given as a third dose 
to BNT162b2 -experienced
participants
a.HIV-positive participants in Phase 3 will not be included in analyses of the objectives, with the 
exception of the specific exploratory objective.
b.See Section 6.1.1 for a description of the manufacturing process.
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.  Th ese parts, and the progression 
between them, are detailed in the schema ( Section 1.2).
The study  will evaluate the safet y, tolerability , and immunogenicit yof 3 different 
SARS -CoV-2 R NAvaccine candidate s against C OVID -19and the efficacy  of 1 candidate :
As a 2 -dose (separa ted by  21 day s) schedule ;
At various different dose levels in Phase 1;
As a booster;
In 3 age groups ( Phase 1: 18 to 55 y ears of age, 65 to 85 y ears of age ; Phase 2/3: ≥12 
years of age[stratified as 12-15, 16 -55,or >55years of age] ).
Dependent upon safet y and/or immunogenicit y data generated during the course of this 
study , or the BioNTech study  conducted in Germany  (BNT162 -01), it is possible that groups 
in Phase 1 may  be started at the next highest dose, g roups may  not be started, groups may  be 
terminated early , and /orgroups may  be added with dose levels below the lowest stated dose 
or intermediate between the lowest and highest stated doses.
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Protocol C4591001
Protocol Amendment 14, 02March 2021
 CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 32The vaccine candidate selected for Phase 2/3 evaluation is BNT162b 2at a dose of 30µg.
Participants ≥16 y ears of age who originall y received placebo will be offered the opportunity  
to receive BNT162b2 at defined points as part of the study .
An intensive period of surveillance to evaluate the efficacy  of BNT162b2 against
asymptomatic SARS -CoV-2 infection may be conducted at selected sites among Phase 2/3 
participants following approval of protocol amendment 11. After an initial in -person visit 
where a blood sample will be collected and a nasal (midturbinate) swab obtained, n asal  
swab s will be obtained from consented participants every  2 weeks until Visit 4 , or a 
sufficient number of cases of SARS -CoV -2 infection have accrued to evaluate this objective, 
whichever is sooner . The swabs will be tested at a central laboratory  using NAAT to detect 
SARS -CoV -2.Participants who originall y received placebo and become eligible for receipt 
of BNT162b2 according to local or national recommendations and then receive BNT162b2 
as part of the stud y will not participate in surveillance for as ymptomatic SARS -CoV-2
infection ; if they  become eligible during the surveillance period, the swabbing every  2 weeks 
will cease .
In order to describe the boostability  of BNT162, and potential heterologous protection 
against emerging SARS -CoV -2 VOC s, an additional dose of BNT 162b2 at 30 µg will be 
given to Phase 1 participants approximately  6to 12 months after their second dose of 
BNT162b1 or BNT162b2. This will provide an early  assessment of the safety  of a third dose 
of BNT162, as well as its immunogenicit y.  The assessmen t of boostability  will be further 
expanded in a subset of Phase 3 participants who will receive a third dose of BNT162b2 or a 
third and potentially  a fourth dose of protot ype BNT162b2 VOC(based upon the South African 
variant and hereafter referred to as BNT162b2 SA).
To further describe potential homologous and heterologous protection against emerging 
SARS -CoV -2 VOCs, a new cohort of participants will be enrolled who are COVID-19 
vaccine –naïve ( ie, BNT162b2 -naïve) and have not experienced COVID-19. They  will 
receive BNT162b2 SAgiven as a 2- dose series, separated by  21 day s.
Number of Participants
Each group in Phase 1 will comprise 15 participants (12 receiving active vaccine and 
3receivi ng placebo). In this phase , 13groups will be studied, correspond ingto a total of 
195participants.
The vaccine candidate selected for Phase 2/ 3, BNT162b 2at a dose of 30 µg,will comprise 
21,999 vaccine recipients .The 12- to 15 -year stratum will comprise up to approximately
2000 participants ( 1000 vaccine recipients) enrolled at selected investigational sites. It is 
intended that a minimum of 40% of participants will be in the >55-year stratum. An equal 
number of participants will receive placeb o, ie, randomized in a 1:1 ratio.
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Page 33For evaluation of boostability  and protection against emerging VOCs, 600 existing Phase 3 
participants 18 to 55 y ears of age will be rerandomized in a 1:1 ratio to receive either a third 
dose of BNT162b2 or a third dose of BNT162b2 SA.
An additional group of 30existing Phase 3 participants 18 to 55 y ears of age will be enrolled 
to receive a third and fourth dose of BNT162b2 SA.For these 30 participants, through 1 
month after their first dose of BNT162b2 SAthe participant swill be blinded to their vaccine 
allocation ,but the investigator and sponsor will not be. Serum samples from these 
participants may  be used for assay  development purposes and, except for objectives relating 
to response to a fourth dose, their results wi ll be analy zed separately  from the main 
immunogenicit y anal yses.
Three hundred participants 18 to 55 y ears of age who are COVID -19 vaccine –naïve 
(ie,BNT162b2 -naïve) and have not experienced COVID-19 will be enrolled as a new cohort 
of participants toreceive BNT162b2 SAgiven as a 2- dose series .
Intervention Groups and Duration
The study  will evaluate a 2-dose (separated b y 21 days) schedule of various different dose 
levels of 3 investigational RNA vaccine candidate s for active immunization against 
COVID -19in 3 age groups ( Phase 1: 18 to 55 years of age ,65 to 85 y ears of age ; Phase 2/3:
≥12years of age [stratified as 12-15, 16 -55,or >55 years of age] ):
BNT162b1 (BNT162 RNA -LNP vaccine utilizing modRNA and encoding the RBD ): 
10µg, 20 µg, 30µg, 100 µg
BNT162b2 (BNT162 RNA -LNP vaccine utilizing modRNA and encoding the P2 S ): 
10µg, 20µg,30µg
BNT162b2 SA(BNT162 RNA -LNP vaccine utilizing modRNA and encoding the P2 S
containing South Africa B.1.351 variant –specific mutations): 30µg
The vaccine candidate selected for Phase 2/3 evaluation is BNT162b 2at a dose of 30µg.
Participants are expected to participate for up to a maximum of approximately  26 months. 
The duration of stud y follow -up may  be shorter among participants enrolled in Phase 1 
dosing arms that are not evaluated in Phase 2/ 3.
Phase 1 participants who originall y received BNT162b1 or BNT162b2 at dose levels of 10, 
20, or 30 µg at Doses 1 and 2 will be offered an additional dose of BNT162b2 at 30 µg 
approximately  6to 12 mon ths after their second dose of BNT162.
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Page 34Data Monitoring Committee or Other Independent Oversight Committee
The study  will utilize an IRC, an internal Pfizer committee thatwill 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
Thesample size for Phase 1of the stud y is not based on an y statistical h ypothesis testing.
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 r ate 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 -19cases 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 y earincidence 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 underly ing 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 secondary  objectives regarding VE against asy mptomatic SARS -CoV -2(determined b y 
asymptomatic seroconversion of N -binding antibody  and/or asymptomatic SARS -CoV -2 
infection based on central laboratory –confirmed NAAT) will be evaluated. VE will be
demonstrated if the lower bound of the 95% CI for VE is>20% .
In Phase 3, up to approximately  2000 participants are anticipated to be 12 to 15 y ears of age. 
Noninferiorit y of immune response to proph ylactic BNT162b2 in participants 12 to 15 years 
of age to response in participants 16 to 25years of age will be assessed based on the GM Rof 
SARS -CoV -2 neutralizing titers using a 1.5 -fold margin. A sample size of 225 evaluable 
participants (or 280 vaccine recipients) per age group will provide a power of 90.4% to 
declare the noninferiority in terms of GM R(lower limit of 95% CI for GMR>0.67).
Theboostability  and protection against emerging VOCs for BNT162b2-experienced 
participants and BNT162b2 -naïve participants will be assessed based on GMRs of 
SARS -CoV -2 SA -neutralizing and/orreference strain– neutralizing titers using a 2-fold 
noninferiority  margin and the difference in percentages of participants with seroresponse 
using a 10% noninferiority  margin.
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Page 35The primary  safet y objective will be evaluated b y descriptive summary  statistics for local 
reactions, s ystemic events ,AEs/SAEs ,and abnormal hematology  and chemistry  laboratory  
parameters (Phase 1 only), for each vacci ne group. A 3-tier approach will be used to 
summarize AEs in Phase 2/3.
Except for the objective sto assess the noninferiority  of immune response in parti cipants 12
to 15 years of age compared to participants 16 to 25 years of age and evaluation of 
boostability  and protection against emerging VOCs by BNT162b2 andBNT162b2 SAin 
Phase 3, the other immunogenicity  objectives will be evaluated descriptively  by GMT, GMC, 
GMFR, percentage of participants with ≥4-fold rise, and GMR,and the associated 95% CIs, 
for SARS -CoV -2neutralizing titers, f ull-length S -binding or S1 -binding IgGlevels ,and/or
RBD- binding IgGlevels (Phase 1 only )at the various time points.
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Page 361.2.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 Dose s1 and 2)
Phase 2/ 3 Single vaccine candidate (1:1 randomization active:placebo)
Safety and immunogenicity analysis of 
Phase 2 data (first 360 participants) 
by unblinded team (these participants
will also be included in Phase 3 
analyses)Age: ≥12
(Stratified 12-15, 16-55 ,or >55)
BNT162b 230µgor placebo 2doses
(n~21,999 per group , total n~ 43.998 )
Abbreviation: IRC = internal review committee.
Note: Participants ≥16 years of age who originally received placebo w ill be offered the opportunity to receive 
BNT162b2 at defined points as part of the study.
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 371.3. S chedule of Activ ities
The SoA table sprovide 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  sche dule visits (unplanned visits) in additi on 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 
Anunplanned potential COVID-19 illness visit and unplanned potential COVID-19 
convalescent visit are requi red at an y time between Visit 1 (Vaccination 1) and Visit 10
(24-month follow -up visit) that COVID- 19 is suspected.
Administration of BNT162b2 to Those Originally Assigned to Placebo: If a participant 
becomes eligible for receipt of BNT162b2 or another COV ID-19 vaccine according to 
recommendations detailed separately , and available in the electronic study reference portal , 
theparticipant will be advised to contact the site to determine whether he or she can receive 
BNT162b2 in a phased manner as part of the study . When contacted, the site will conduct a 
phone visit to confirm eligibility  and, if eligible and wanting to receive BNT162b2 if the
participant originally  received placebo, will unblind study  intervention allocation to 
determine wheth er the participant received BNT162b1, BNT162b2, or placebo. If he or she
originall y received placebo and wants to receive BNT162b2 ,the participant will move to the 
SoA in Section 1.3.3 for his or her remaining visits. Participants who received BNT162b1 or 
BNT162b2 (at an y dose level) will continue in the study  as originall y planned.
All other participants will be advised to contact the site to determine whether they  can 
receive BNT162b2 as part of the study no later than at the approximate time participants in 
Phase 2/3 reach Visit 4. When contacted, the site will unblind study  intervention allocation 
to determine whether the partic ipant received BNT162b1, BNT162b2 ,or placebo. If he or 
sheoriginally  received placebo and want sto receive BNT162b2 ,the participant will move to 
the SoA in Section 1.3.3 for his or her remaining visits.
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 38Visit Number Screening 1 2 3 4 5 6 7
Study 
procedures 
for Visit 8 
onwards 
continue on 
the next 
tableUnplanned Unplanned
Visit Description Screening Vax 1 Next -Day 
Follow -up 
Visit 
(Vax 1) 1-Week
Follow -up 
Visit 
(Vax 1)Vax 2 1-Week
Follow -up 
Visit 
(Vax 2)2-Week
Follow -up 
Visit 
(Vax 2) 1-Month 
Follow -up 
VisitPotential 
COVID -19 
Illness 
VisitaPotential 
COVID -19 
Convalesce
ntVisit
Visit Window (Days) 0 to 28
Days 
Before 
Visit 1Day 1 1 to 3 
Days After 
Visit 16 to 8 
Days After 
Visit 119 to 23 
Days After 
Visit 16 to 8 
Days After 
Visit 412 to 16 
Days After 
Visit 4 28 to 35 
Days After 
Visit 4Optimally 
Within 3 
Days After 
Potential 
COVID -19 
Illness 
Onset28 to 35 
Days After 
Potential 
COVID -19 
Illness Visit
Obtain informed consent XContinued on table belowAssign participant number X
Obtain demography and medical 
history dataX
Obtain details of medications 
currently takenX
Perform physical examination X X X X X X X
Measure vital signs 
(including body temperature)X X X X X X X
Collect blood sample for hematology 
and chemistry laboratory testsb~10 mL ~10 mL ~10 mL ~10 mL ~10 mL
Collect screening blood sample for 
HIV, HBsAg, HBc Ab, and HCV Ab 
tests~10 mL
Serological test for p rior COVID- 19 
infection~20 mL
Perform urine pregnancy test (if 
appropriate)X X X
Obtain nasal (midturbinate) swab(s)cX X X
Collect nonstudy vaccine information X X X X X X X X
Confirm eligibility X X X
Collect prohibited medication use X X X X X X X X
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 39Visit Number Screening 1 2 3 4 5 6 7
Study 
procedures 
for Visit 8 
onwards 
continue on 
the next 
tableUnplanned Unplanned
Visit Description Screening Vax 1 Next -Day 
Follow -up 
Visit 
(Vax 1) 1-Week
Follow -up 
Visit 
(Vax 1)Vax 2 1-Week
Follow -up 
Visit 
(Vax 2)2-Week
Follow -up 
Visit 
(Vax 2) 1-Month 
Follow -up 
VisitPotential 
COVID -19 
Illness 
VisitaPotential 
COVID -19 
Convalesce
ntVisit
Visit Window (Days) 0 to 28
Days 
Before 
Visit 1Day 1 1 to 3 
Days After 
Visit 16 to 8 
Days After 
Visit 119 to 23 
Days After 
Visit 16 to 8 
Days After 
Visit 412 to 16 
Days After 
Visit 4 28 to 35 
Days After 
Visit 4Optimally 
Within 3 
Days After 
Potential 
COVID -19 
Illness 
Onset28 to 35 
Days After 
Potential 
COVID -19 
Illness Visit
Review hematology and chemistry
resultsX X X X XContinued on table belowReview temporary delay criteria X X
Confirm use of contraceptives 
(ifappropriate)X X X X X X X X
Obtain randomization number and 
study intervention allocationX
Collect blood sample for 
immunogenicity assessment ~50 mL ~50 mL ~50 mL ~50 mL
+ optionale
~170 mL~50 mL
+ optionale
~170 mL~50 mL
+ optionale
~170 mL~20 mL
Administer study intervention X X
Assess acute reactions for at least 30 
minutes after study intervention 
administrationdX X
Explain participant communication 
methods (including for e -diary 
completion), assist the participant
with downloading the app, or issue 
provisioned device, if requiredX
Provide thermometer and measuring 
deviceX X
Review reactogenicity e-diary data 
(daily review is optimal during the 
active diary period)
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 40Visit Number Screening 1 2 3 4 5 6 7
Study 
procedures 
for Visit 8 
onwards 
continue on 
the next 
tableUnplanned Unplanned
Visit Description Screening Vax 1 Next -Day 
Follow -up 
Visit 
(Vax 1) 1-Week
Follow -up 
Visit 
(Vax 1)Vax 2 1-Week
Follow -up 
Visit 
(Vax 2)2-Week
Follow -up 
Visit 
(Vax 2) 1-Month 
Follow -up 
VisitPotential 
COVID -19 
Illness 
VisitaPotential 
COVID -19 
Convalesce
ntVisit
Visit Window (Days) 0 to 28
Days 
Before 
Visit 1Day 1 1 to 3 
Days After 
Visit 16 to 8 
Days After 
Visit 119 to 23 
Days After 
Visit 16 to 8 
Days After 
Visit 412 to 16 
Days After 
Visit 4 28 to 35 
Days After 
Visit 4Optimally 
Within 3 
Days After 
Potential 
COVID -19 
Illness 
Onset28 to 35 
Days After 
Potential 
COVID -19 
Illness Visit
Review ongoing reactogenicity e-
diary symptoms and obtain stop dates X XContinued on table 
belowCollect AEs and SAEs as appropriate X X X X X X X X X X
Collect e -diary or assist the participant 
to delete application
Collection of 
COVID -19–related clinical and 
laboratory information (including 
local diagnosis)X X
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.TheCOVID -19 illness visit may be conducted as an in -person or telehealth visit.
b.Hem atology: hemoglobin, complete blood count with differential, and platelets.  Blood chemistry: alanine aminotransferase (AL T), aspartate 
aminotransferase (AST), alkaline pho sphatase, 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 w ill 
only proceed if it i sNAAT -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 administ ration. Fu rther 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 res earch .
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 41Continuation of table above
Visit Number 8 8a 8b 8c 9 10 Unplanned Unplanned
Visit Description 6-Month
Follow -up VisitVax 3 1-Week
Follow -up Visit 
(After Vax 3)1-Month 
Follow -up Visit
(After Vax 3)12-Month 
Follow -up Visit24-Month 
Follow -up VisitPotential 
COVID -19 Illness 
VisitaPotential 
COVID -19 
Convalescent Visit
Visit Window (Days) 175to 189Days 
After Visit 4175to 315 Days 
After Visit 46 to 8 Days 
After Visit 8a28 to 35 Days 
After Visit 8a350 to 378 Days 
After Visit 4714 to 742 Days 
After Visit 4Optimally Within 
3Days After 
Potential 
COVID -19 Illness 
Onset28 to 35 Days After 
Potential 
COVID -19 Illness 
Visit
ONLY FOR THOSE PARTICIPANTS 
ORIGINALLY ASSIGNED TO BNT162 at 
10µg, 20 µg, or 30 µg
Those participants who decline to receive a third 
dose of BNT162 m ove directly from Visit 8 to 
Visit 9ONLY FOR THOSE 
PARTICIPANTS 
ORIGINALLY ASSIGNED TO 
BNT162 OR PLACEBO 
RECIPIENTS WHO D ECLINE
BNT162b2 (ie, those 
participants who do not
transition from  placebo to 
BNT162b2)
Obtain informed consent X
Confirm participant originally 
received 10to 30µg of 
BNT162b1 or BNT162b2X
Perform urine pregnancy test 
(if appropriate)X
Confirm use of contraceptives 
(ifappropriate)X X X
Collect prohibited medication 
useX X X X X X X X
Collect nonstudy vaccine 
information X X X X
Measure body temperature X
Confirm eligibility X
Review temporary delay 
criteriaX
Collect blood sample for 
immunogenicity assessment ~20 mL ~20 mL ~20 mL ~20 mL ~20 mL ~20 mL ~20 mL
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 42Continuation of table above
Visit Number 8 8a 8b 8c 9 10 Unplanned Unplanned
Visit Description 6-Month
Follow -up VisitVax 3 1-Week
Follow -up Visit 
(After Vax 3)1-Month 
Follow -up Visit
(After Vax 3)12-Month 
Follow -up Visit24-Month 
Follow -up VisitPotential 
COVID -19 Illness 
VisitaPotential 
COVID -19 
Convalescent Visit
Visit Window (Days) 175to 189Days 
After Visit 4175to 315 Days 
After Visit 46 to 8 Days 
After Visit 8a28 to 35 Days 
After Visit 8a350 to 378 Days 
After Visit 4714 to 742 Days 
After Visit 4Optimally Within 
3Days After 
Potential 
COVID -19 Illness 
Onset28 to 35 Days After 
Potential 
COVID -19 Illness 
Visit
ONLY FOR THOSE PARTICIPANTS 
ORIGINALLY ASSIGNED TO BNT162 at 
10µg, 20 µg, or 30 µg
Those participants who decline to receive a third 
dose of BNT162 m ove directly from Visit 8 to 
Visit 9ONLY FOR THOSE 
PARTICIPANTS 
ORIGINALLY ASSIGNED TO 
BNT162 OR PLACEBO 
RECIPIENTS WHO D ECLINE
BNT162b2 (ie, those 
participants who do not
transition from  placebo to 
BNT162b2)
Obtain nasal (midturbinate) 
swab(s)X X
Obtain the participant’s 
vaccine vial allocation using 
the IRT systemX
Administer 30-µ g dose of 
BNT162b2X
Assess acute reactions for at 
least 30 minutes after study 
intervention administrationX
Provide thermometer and 
measuring deviceX
Remind participant of  e-diary 
technologiesX
Review reactogenicity e-diary 
data (daily review is optimal 
during the active diary period)
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 43Continuation of table above
Visit Number 8 8a 8b 8c 9 10 Unplanned Unplanned
Visit Description 6-Month
Follow -up VisitVax 3 1-Week
Follow -up Visit 
(After Vax 3)1-Month 
Follow -up Visit
(After Vax 3)12-Month 
Follow -up Visit24-Month 
Follow -up VisitPotential 
COVID -19 Illness 
VisitaPotential 
COVID -19 
Convalescent Visit
Visit Window (Days) 175to 189Days 
After Visit 4175to 315 Days 
After Visit 46 to 8 Days 
After Visit 8a28 to 35 Days 
After Visit 8a350 to 378 Days 
After Visit 4714 to 742 Days 
After Visit 4Optimally Within 
3Days After 
Potential 
COVID -19 Illness 
Onset28 to 35 Days After 
Potential 
COVID -19 Illness 
Visit
ONLY FOR THOSE PARTICIPANTS 
ORIGINALLY ASSIGNED TO BNT162 at 
10µg, 20 µg, or 30 µg
Those participants who decline to receive a third 
dose of BNT162 m ove directly from Visit 8 to 
Visit 9ONLY FOR THOSE 
PARTICIPANTS 
ORIGINALLY ASSIGNED TO 
BNT162 OR PLACEBO 
RECIPIENTS WHO D ECLINE
BNT162b2 (ie, those 
participants who do not
transition from  placebo to 
BNT162b2)
Review ongoing 
reactogenicity e-diary 
symptoms and obtain stop 
dates X
Collect AEs and SAEs as 
appropriateX X X X XbXb X X
Collect e -diary or assist the 
participant to delete 
applicationX
Collection of 
COVID -19–related clinical 
and laboratory information 
(including local diagnosis)X X
Abbreviation s: IRT = interactive response technology; vax = vaccination.
a. The COVID- 19 illness visit may be conducted as an in -person or telehealth visit.
b.Any AEs occurring up to 48 hours after the blood draw must be recorded (see Section 8.3.1 ).
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 441.3.2. Phase 2/ 3
An unplanned potential COVID-19 illness visit and unplanned potential COVID-19 
convalescent visit are required at an y time between Visit 1 (Vaccination 1) and Visit 6
(24-month follow -up visit) that potential COVID -19symptoms are reported, including 
MIS-C.
Administration of BNT162b2 to Those Originally Assigned to Placebo: If a participant 
≥16 years of age becomes eligible for receipt of BNT162b2 or another COVID -19 vaccine 
according to recommendations detailed separatel y, and available in the electronic study 
reference portal, theparticipant will be advised to contact the site to determine whether he or 
shecan receive BNT162b2 in a phased manner aspart of the stud y.When contacted, the s ite 
will conduct aphone visit to confirm eligibility  and, if eligible and wanting to receive 
BNT162b2 if the participant originall y received placebo, will unblind study intervention 
allocation to determine whether theparticipant received BNT162b2 or placebo .If he or she
originall y received placebo and want sto receive BNT162b2 ,the participant will move to the
SoA in Section 1.3.3 for his or her remaining visits. Participants who received BNT162b2 
will continue in the study as originally  planned.
All other participants ≥16 y earsof age who have not already  been offe red the opportunity  to 
receive BNT162b2 will be given this opportunity  no later than 6 months after Vaccination 2 
(at the time of the originally  planned Visit 4). If they  want to receive BNT162b2 ,theywill 
be unblinded and those who did originall y receive placebo will move to the SoA in 
Section 1.3.3 for their remaining visits.
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 45Visit Number 1 2 3 4 5 6 Unplanned Unplanned
Visit Description Vaccination 1 Vaccination 2 1-Month
Follow -up 
Visit6-Month
Follow -up 
Visit12-Month 
Follow -up 
Visit24-Month 
Follow -up 
VisitPotential 
COVID -19 
Illness VisitaPotential 
COVID -19 
Convalescent 
Visit
Visit Window (Days) Day 1b 19 to 23 Days 
After Visit 128 to 35 Days 
After Visit 2175to 189
Days After 
Visit 2350 to 378 
Days After 
Visit 2714 to 742 
Days After 
Visit 2Optimally 
Within 3 
Days After 
Potential 
COVID -19 
Illness Onset28 to 35 Days 
After 
Potential 
COVID -19 
Illness VisitONLY FOR THOSE 
PARTICIPANTS 
ORIGINALLY ASSIGNED 
TO BNT162b2 OR 
PLACEBO RECIPIENTS 
WHO DECLINE
BNT162b2
Obtain informed consent X
Assign participant number X
Obtain demography and medical history data X
Perform clinical assessmentc X
For participants who are HIV-positive, record latest 
CD4 count and HIV viral loadX X X X X
Measure height and weight X
Measure temperature (body) X 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
Confirm eligibility X X
Review temporary delay criteria X X
Collect blood sample for immunogenicity 
assessmentd~20mL/
~10mL~20mL/
~10mL~20mL/
~10mL~20mL/
~10mL~20 mL/
~10mL~20mL/
~10mL
Obtain  nasal (midturbinate) swab X X X
Obtain randomization number and study 
intervention allocationX
Administer study intervention X X
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Protocol Amendment 14, 02March 2021
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 46Visit Number 1 2 3 4 5 6 Unplanned Unplanned
Visit Description Vaccination 1 Vaccination 2 1-Month
Follow -up 
Visit6-Month
Follow -up 
Visit12-Month 
Follow -up 
Visit24-Month 
Follow -up 
VisitPotential 
COVID -19 
Illness VisitaPotential 
COVID -19 
Convalescent 
Visit
Visit Window (Days) Day 1b 19 to 23 Days 
After Visit 128 to 35 Days 
After Visit 2175to 189
Days After 
Visit 2350 to 378 
Days After 
Visit 2714 to 742 
Days After 
Visit 2Optimally 
Within 3 
Days After 
Potential 
COVID -19 
Illness Onset28 to 35 Days 
After 
Potential 
COVID -19 
Illness VisitONLY FOR THOSE 
PARTICIPANTS 
ORIGINALLY ASSIGNED 
TO BNT162b2 OR 
PLACEBO RECIPIENTS 
WHO DECLINE
BNT162b2
Assess acute reactions for at least 30 minutes after 
study intervention administrationX X
Explain p articipant communication methods 
(including for e -diary completion), assist the 
participant with downloading the app, or issue 
provisioned device, if requiredX
Provide /ensure the participant has a thermometer
(all participants) and measuring device
(reactogenicity subset participants only)X X
Review reactogenicity e -diary data (daily review is 
optimal during the active diary period)e
Review ongoing reactogenicity e -diary symptoms 
and obtain stop dateseX X
Collect AEs and SAEs as appropriate X X X XfXfXf X Xf
According to eligibility, a scertain willingness to 
receive BNT162b2 if or iginally received placebo ;if 
willing, u nblind the participant’s study intervention
assignment (if not already done), and move placebo 
recipients to the SoA in Section 1.3.3X X
Collect e -diary or assist the participant to delete 
applicationX
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 47Visit Number 1 2 3 4 5 6 Unplanned Unplanned
Visit Description Vaccination 1 Vaccination 2 1-Month
Follow -up 
Visit6-Month
Follow -up 
Visit12-Month 
Follow -up 
Visit24-Month 
Follow -up 
VisitPotential 
COVID -19 
Illness VisitaPotential 
COVID -19 
Convalescent 
Visit
Visit Window (Days) Day 1b 19 to 23 Days 
After Visit 128 to 35 Days 
After Visit 2175to 189
Days After 
Visit 2350 to 378 
Days After 
Visit 2714 to 742 
Days After 
Visit 2Optimally 
Within 3 
Days After 
Potential 
COVID -19 
Illness Onset28 to 35 Days 
After 
Potential 
COVID -19 
Illness VisitONLY FOR THOSE 
PARTICIPANTS 
ORIGINALLY ASSIGNED 
TO BNT162b2 OR 
PLACEBO RECIPIENTS 
WHO DECLINE
BNT162b2
Collection of COVID -19–related clinical and 
laboratory information (including local diagnosis)X X
Abbreviation s: 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 conse cutive 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.20mL is to be collected from participants ≥16 years of age; 10 mL is to be collected from participants 12 to 15 years of age. 
e.Reactogenicity subset participants only.
f.Any AEs occurring up to 48 hours after the blood draw  must be recorded (see Section 8.3.1 ).
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 481.3.3. Administration of BNT162b2 to Those Originally Assigned to Placebo
Participants ≥16 years of age who originall y received placebo and become eligible for receipt of BNT162b2 according to
recommendations detailed separately , and available in the electronic study reference portal ,will have the opportunity  to receive 
BNT162b2 in a phased manner as part of the study . Any placebo recipient ≥16 years of age who has not alread y been offered the 
opportunity  to receive BNT162b2 will be given this opportunity  no later than 6 months after Vaccination 2.
Visit Number 101 102 103 104 105 Unplanned Unplanned
Visit Description Vaccination 3 Vaccination 4 1-Month
Telephone 
Contact6-Month
Telephone 
Contact18-Month
Telephone 
ContactPotential 
COVID -19 
Illness VisitPotential 
COVID -19 
Convalescent 
Visit
Visit Window (Days) From 
Recommendationa
or
At Least 17 5Days 
After Vaccination 2b19 to 23 Days 
After Visit 10128 to 35 Days 
After Visit 102175to 189
Days After 
Visit 102532 to 560 Days 
After Visit 102Optimally 
Within 3 Days 
After Potential 
COVID -19 
Illness Onset28 to 35 Days 
After Potential 
COVID -19 
Illness Visit
Confirm participant meets local/national 
recommending criteria or is at least 175 days 
after Vaccination 2 (Visit 4 /Visit 2)X
Obtain informed consent X
Confirm participant originally received placebo X
Perform urine pregnancy test (if appropriate) X X
Confirm use of contraceptives (if appropriate) X X
Collect prohibited medication use X X X X X X X
For participants who are HIV-positive, record 
latest CD4 count and HIV viral loadX X X X
Review and consider eligibility X X
Review temporary delay criteria X X
Collect blood sample for immunogenicity 
assessmentc~20mL ~20mL
Obtain nasal (midturbinate) swab X X X
Obtain vaccine vial allocation via IRT X X
Administer BNT162b2 X X
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CONFIDENTIAL
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Page 49Visit Number 101 102 103 104 105 Unplanned Unplanned
Visit Description Vaccination 3 Vaccination 4 1-Month
Telephone 
Contact6-Month
Telephone 
Contact18-Month
Telephone 
ContactPotential 
COVID -19 
Illness VisitPotential 
COVID -19 
Convalescent 
Visit
Visit Window (Days) From 
Recommendationa
or
At Least 17 5Days 
After Vaccination 2b19 to 23 Days 
After Visit 10128 to 35 Days 
After Visit 102175to 189
Days After 
Visit 102532 to 560 Days 
After Visit 102Optimally 
Within 3 Days 
After Potential 
COVID -19 
Illness Onset28 to 35 Days 
After Potential 
COVID -19 
Illness Visit
Assess acute reactions for at least 30 minutes 
after study intervention administrationX X
Collect AEs and SAEs as appropriate X X X X XdXd
Contact the participant by telephone X X X
Request the participant return the e -diary or 
assist the participant to delete the applicationX
Collection of COVID -19–related clinical and 
laboratory information (including local 
diagnosis)X X
Abbreviation s:HIV = human immunodeficiency virus; IRT = interactive response technology.
a.For participants whobecom e eligible according to recommenda tions detailed separately and available in the electronic study reference portal .
b.For any remaining Phase 2/3 placebo recipients who wish to receive BNT162b2 ;may be combined with Visit 4 for Phase 2/3 participants .
c.Only if the participant has no blood sample collected in the previous 7 days .
d.AEs need only be recorded if the participant remains in the AE reporting period (see Section 8.3.1 ).
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Page 501.3.4. Administration of an Additional Dose of BNT162b2 or BNT162b2 SA
Select participant s in Phase 3 at select sites who originall y received 2 doses of BNT162b2 will be offered the opportunity to receive a 
third (and potentially  fourth) dose of BNT162b2 or BNT162b2 SA.
Visit Number 301 302 303 304 305 306 307 Unplanned Unplanned
Visit Description Vax 3a 1-Week
Follow -up 
Visit (After 
Vax 3)1-Month 
Follow -up 
Visit
(After Vax 
3)1-Week
Follow -up 
Visit (After 
Vax 4)b1-Month 
Follow -up 
Visit
(After Vax 
4)b6-Month 
Follow -up 
Visit18-Month 
Follow -up VisitPotential 
COVID -19 
Illness VisitcPotential 
COVID -19 
Convalescent 
Visit
Visit Window (Days) 150 to 2 10
Days After 
Visit 26 to 8 Days 
After Visit 
30128 to 35 Days 
After Visit 
3016 to 8 Days 
After Visit 
30328 to 35 Days 
After Visit 
303175to 189
Days After 
Visit 301532to 560Days 
After Visit 301Optimally 
Within 3 Days 
After Potential 
COVID -19 
Illness Onset28 to 35 Days 
After 
Potential 
COVID -19 
Illness Visit ONLY FOR SELECT PARTICIPANTS 
AT SELECT SITES WHO ORIGINALLY 
RECEIVED BNT162b2 AT DOSE 1 AND 
DOSE 2ONLY FOR THE SUBSET 
OF PARTICIPANTS WHO 
RECEIVE DOSE 4
Obtain informed consent X
Confirm participant originally 
received BNT162b2 at Dose 1 
and Dose 2X
Perform urine pregnancy test (if 
appropriate)X Xb
Confirm use of contraceptives 
(ifappropriate)X X X X X
Collect prohibited medication 
useX X X X X X X X X
Collect nonstudy vaccine 
information X X X X X X
For participants who are HIV -
positive, record latest CD4 
count and HIV viral loadX X X X
Measure body temperature X Xb
Confirm eligibility X Xb
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 51Visit Number 301 302 303 304 305 306 307 Unplanned Unplanned
Visit Description Vax 3a 1-Week
Follow -up 
Visit (After 
Vax 3)1-Month 
Follow -up 
Visit
(After Vax 
3)1-Week
Follow -up 
Visit (After 
Vax 4)b1-Month 
Follow -up 
Visit
(After Vax 
4)b6-Month 
Follow -up 
Visit18-Month 
Follow -up VisitPotential 
COVID -19 
Illness VisitcPotential 
COVID -19 
Convalescent 
Visit
Visit Window (Days) 150 to 2 10
Days After 
Visit 26 to 8 Days 
After Visit 
30128 to 35 Days 
After Visit 
3016 to 8 Days 
After Visit 
30328 to 35 Days 
After Visit 
303175to 189
Days After 
Visit 301532to 560Days 
After Visit 301Optimally 
Within 3 Days 
After Potential 
COVID -19 
Illness Onset28 to 35 Days 
After 
Potential 
COVID -19 
Illness Visit ONLY FOR SELECT PARTICIPANTS 
AT SELECT SITES WHO ORIGINALLY 
RECEIVED BNT162b2 AT DOSE 1 AND 
DOSE 2ONLY FOR THE SUBSET 
OF PARTICIPANTS WHO 
RECEIVE DOSE 4
Review temporary delay criteria X Xb
Collect blood sample for 
immunogenicity assessment ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~50 mL ~20 mL
Collect blood sample for PBMC 
isolationd~120 mL ~120 mL ~120 mL ~120 mL
Collect blood sample for HLA 
typingd~5mL
Obtain nasal (midturbinate) 
swab(s)X Xb X
Obtain randomization number 
and study intervention 
allocation using the IRT systemX
Administer study intervention X Xb
Assess acute reactions for at 
least 30 minutes after study 
intervention administrationX Xb
Provide thermometer and 
measuring deviceX
Remind participant of  e-diary 
technologiesX Xb
Review reactogenicity e-diary 
data (daily review is optimal 
during the active diary period)
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CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 52Visit Number 301 302 303 304 305 306 307 Unplanned Unplanned
Visit Description Vax 3a 1-Week
Follow -up 
Visit (After 
Vax 3)1-Month 
Follow -up 
Visit
(After Vax 
3)1-Week
Follow -up 
Visit (After 
Vax 4)b1-Month 
Follow -up 
Visit
(After Vax 
4)b6-Month 
Follow -up 
Visit18-Month 
Follow -up VisitPotential 
COVID -19 
Illness VisitcPotential 
COVID -19 
Convalescent 
Visit
Visit Window (Days) 150 to 2 10
Days After 
Visit 26 to 8 Days 
After Visit 
30128 to 35 Days 
After Visit 
3016 to 8 Days 
After Visit 
30328 to 35 Days 
After Visit 
303175to 189
Days After 
Visit 301532to 560Days 
After Visit 301Optimally 
Within 3 Days 
After Potential 
COVID -19 
Illness Onset28 to 35 Days 
After 
Potential 
COVID -19 
Illness Visit ONLY FOR SELECT PARTICIPANTS 
AT SELECT SITES WHO ORIGINALLY 
RECEIVED BNT162b2 AT DOSE 1 AND 
DOSE 2ONLY FOR THE SUBSET 
OF PARTICIPANTS WHO 
RECEIVE DOSE 4
Review ongoing reactogenicity 
e-diary symptoms and obtain 
stop dates X X
Collect AEs and SAEs as 
appropriateX X X X X XeXe X Xe
Collect e -diary or assist the 
participant to delete applicationX
Collection of 
COVID -19–related clinical and 
laboratory information 
(including local diagnosis)X X
Abbreviations: e-diary = electronic diary ; HIV = human immunodeficiency virus; HLA = human leukocyte antigen; IRT = interactive response technology; PBMC = peripheral 
blood mononuclear cell; vax = vaccination.
a.Visit 301 can occur on the same day as Visit 4, but all procedures for both visits must be conducted (including collection of all blood samples) .
b.Only for those participants who willreceive Dose 4 .
c. The COVID- 19 illness visit may be conducted as an in -person or telehealth visit.
d.Additional 120 mL for PBMC isolation and 5 mL for HLA typing is for select participants who w ill receive a third (but not fourth) dose of BNT162b2 or 
BNT16 2b2SAat select sites 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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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 531.3.5. Administration of BNT162b2 SAto BNT162b2-N aïve Participants
As part of Amendment 14, an additional cohort of BNT162b2 -naïve participants will be enrolled to receive BNT162b2 SA per the 
following SoA.
Visit Number 401 402 403 404 405 406 Unplanned Unplanned
Visit Description Vaccination 1 Vaccination 2 1-Week
Follow -up 
Visit1-Month
Follow -up 
Visit6-Month
Follow -up 
Visit18-Month 
Follow -up 
VisitPotential 
COVID -19 
Illness VisitbPotential 
COVID -19 
Convalescent 
Visit
Visit Window (Days) Day 1a 19 to 23 Days 
After Visit 
4016to 8Days 
After Visit 
40228 to 35 Days 
After Visit 
402175to 189
Days After 
Visit 402532to 560
Days After 
Visit 402Optimally 
Within 3 Days 
After 
Potential 
COVID -19 
Illness Onset28 to 35 Days 
After 
Potential 
COVID -19 
Illness Visit
Obtain informed consent X
Assign participant number X
Obtain demography and medical history data X
Perform clinical assessmen tc X
Measure height and weight X
Measure temperature (body) X X
Perform urine pregnancy test (if appropriate) X X
Confirm use of contraceptives (if appropriate) X X X X
Collect nonstudy vaccine information X X X X X
Collect prohibited medication use X X X X X X X
For participants who are HIV-positive, record 
latest CD4 count and HIV viral loadX X X X
Confirm eligibility X X
Review temporary delay criteria X X
Collect blood sample for immunogenicity 
assessment~50mL ~50mL ~50mL ~50mL ~50 mL ~20mL
Collect blood sample for PBMC isolationd ~120 mL ~120 mL ~120 mL ~120 mL
Collect blood sample for HLA typingd ~5mL
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Page 54Visit Number 401 402 403 404 405 406 Unplanned Unplanned
Visit Description Vaccination 1 Vaccination 2 1-Week
Follow -up 
Visit1-Month
Follow -up 
Visit6-Month
Follow -up 
Visit18-Month 
Follow -up 
VisitPotential 
COVID -19 
Illness VisitbPotential 
COVID -19 
Convalescent 
Visit
Visit Window (Days) Day 1a 19 to 23 Days 
After Visit 
4016to 8Days 
After Visit 
40228 to 35 Days 
After Visit 
402175to 189
Days After 
Visit 402532to 560
Days After 
Visit 402Optimally 
Within 3 Days 
After 
Potential 
COVID -19 
Illness Onset28 to 35 Days 
After 
Potential 
COVID -19 
Illness Visit
Obtain  nasal (midturbinate) swab X X X
Obtain the participant’s vaccine vial allocation 
using the IRT systemX X
Administer BNT162b2 SA X X
Assess acute reactions for at least 30 minutes 
after study intervention administrationX X
Explain p articipant communication methods 
(including for e -diary completion), assist the 
participant with downloading the app, or issue 
provisioned device, if requiredX
Provide /ensure the participant has a
thermometer (all participants) and measuring 
device (reactogenicity subset participants only)X X
Review reactogenicity e -diary data (daily 
review is optimal during the active diary 
period)
Review ongoing reactogenicity e -diary 
symptoms and obtain stop datesX X
Collect AEs and SAEs as appropriate X X X X XeXe X Xe
Collect e -diary or assist the participant to delete 
applicationX
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 55Visit Number 401 402 403 404 405 406 Unplanned Unplanned
Visit Description Vaccination 1 Vaccination 2 1-Week
Follow -up 
Visit1-Month
Follow -up 
Visit6-Month
Follow -up 
Visit18-Month 
Follow -up 
VisitPotential 
COVID -19 
Illness VisitbPotential 
COVID -19 
Convalescent 
Visit
Visit Window (Days) Day 1a 19 to 23 Days 
After Visit 
4016to 8Days 
After Visit 
40228 to 35 Days 
After Visit 
402175to 189
Days After 
Visit 402532to 560
Days After 
Visit 402Optimally 
Within 3 Days 
After 
Potential 
COVID -19 
Illness Onset28 to 35 Days 
After 
Potential 
COVID -19 
Illness Visit
Collection of COVID -19–related clinical and 
laboratory information (including local 
diagnosis)X X
Abbreviation s: e-diary = electronic diary ; HIV = human immunodeficiency virus; HLA = human leukocyte antigen; IRT = interactive response technology; PBMC = peripheral 
blood mononuclear cell; vax = vaccination .
a.The visit may be conducted across 2 consecutive days; if so, all steps from assessing the inclusion and exclusion criteria on wards must be conducted on the 
same day.
b.The COVID- 19 illness visit may be conducted as an in -person or telehealth visit.
c.Including, if indicated, a physical examination.
d.Additional 120 mL for PBMC isolation and 5 mL for HLA typing is for select participants at select sites 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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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 561.3.6. Surveillance for Asymptomatic SARS -CoV -2 Infection
An intensive period of surveillance for as ymptomatic SARS -CoV-2 infection may be conducted at selected sites among Phase 2/3 
participants following approval of protocol amendment 11. After an initial in -person visit where a blood sample will be collected and 
a nasal (midturbinate) swab obtained, n asal (midturbinate) swab s will be obtained from consented participants every  2 weeks until 
Visit 4 or a sufficient number of cases of SARS- CoV -2 infection have accrued to evaluate this objective, whichever is sooner.
Participants who are unblinded because they becom epotentially eligible for receipt of BNT162b2 according to recommendations 
detailed separatel y, and available in the electronic study  reference portal, will not participate in surveillance for asy mptomatic 
SARS -CoV-2 infection. However, participants who provided additional consent to conduct biweekly  swabbing for surveillance of 
asymptomatic infection should continue to swab even after unblinding if they  originally  received BNT162b2 .
Surveillance for asymptomatic SARS -CoV -2 infection (swabbing) should cease in partici pants enrolled in to the subset of participants 
who will receive an additional dose of BNT162b2 or BNT162b2 SA.
Visit Number 201 202Onward
Visit Description Asymptomatic SARS -CoV -2 
Infection Surveillance ConsentAsymptomatic SARS -CoV -2 
Infection 
Surveillance Swab
Visit Window (Days) From  Approval of Protocol 
Amendment 11 Repeating Every 10 to 18 Days 
After Each Previous Surveillance 
Swab Collection
Obtain informed consent for asymptomatic SARS -CoV -2 infection surveillance X
Collect prohibited medication use X
Collect blood sample for immunogenicity assessmenta~20mL/~10 mL
Obtain nasal (midturbinate) swab (self-swab at home or by site staff at an in -
person visit)X X
Collect AEs and SAEs as appropriatebX
a.Only if the participant has no blood sample collected in the previous 7 days. 20 mL is to be collected from participants ≥16 years of age; 10 mL is to be 
collected from participants 12 to 15 years of age .
b.AEs need only be recorded if the participant remains in the AE reporting period (see Section 8.3.1 ).
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CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 572.INTRODUCTION
The BNT162 RNA -based COVID -19 vaccine sare 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 safet y, tolerabilit y, and immunogenicit y of 
2 BNT162 RNA -based COVID -19 vaccine candidates against COVID-19 , and the efficacy  
of 1 candidate, in healthy individuals. There are currentl y no licensed vaccines to prevent 
infection with SARS -CoV -2or COVID -19. Given the g lobal crisis of COVID -19 and fas t 
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.  
InJanuary  2020, it became c lear that a novel coronavirus (2019 -nCoV) was the underl ying 
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 Betacoronavir ussubfamily .  By  sequence analy sis, the phy logenetic 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 globall y, 
affecting a growing number of countries.
On 11 March 2020 ,the WHO characterized the COVID -19 outbreak as a pandemic.1  
TheWHO Situation Update Report dated 30March 2020 not ed 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 re ported cases globall y. At the time of 
this communication, the number of confirmed case s continues to rise globally . There are 
currentl y no licensed vaccines or effective antiviral drugs to treat SARS -CoV -2 infections or 
the disease it causes, COVID -19.3
As more data about COVID -19 continue to accrue, the potential duration of protection 
afforded after a wild -type SARS -CoV -2 infection, and by  vaccination, remains unknown. In 
addition, mutated SARS -CoV -2 VOC s have started to emerge, for example in the UK 
(known as 20I/501Y.V1, VOC 202012/01, or B.1.1.7) , SA (known as 20H/501Y.V2 or 
B.1.351) ,and Brazil (known as P.1) .4
A proph ylactic, RNA -based SARS -CoV -2 vaccine provides one of the most flexible and 
fastest approaches available to immunize against the emerging virus.5,6
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 associ ated with infection and may  
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Page 58be 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 eas y and rapid pro duction and the prospect of 
producing high numbers of vaccination doses within a shorter time period than achieved with 
traditional vaccine approaches.  This capability  is pivotal to enable the most effective 
response in outbreak scenarios.
Three SARS -CoV -2–RNA lipid nanoparticle (RNA -LNP) vaccines based on aplatform of
nucleoside -modified messenger RNA (modRNA , BNT162b )will be evaluated in this study . 
Each vaccine candidate expresses 1 of 3 antigens: 
BNT162b1 (variant RBP020.3) : nucleoside -modified messenger RNA (modRNA) with 
blunted innate immune sensor –activating capacit y and augmented expression encoding 
the trimerized SARS -CoV -2 spike gly coprotein receptor- binding domain (RBD) 
(version 5);
BNT162b2 (variant RBP020.2 ): nucleoside -modified messenger RNA (modRNA) as 
above ,but encoding the SARS -CoV -2 full -length, P2 mutant, prefusion spike 
glycoprotein (P2 S) (version 9);
BNT162b2s01 (variant RBP020.11): nucleoside -modified messenger RNA (modRNA) 
as above ,but encoding the P2Sconta ining South Africa B.1.351 variant –specific 
mutations, hereafter referred to as BNT162b2 SA, as a representative variant of concern 
(VOC) .
The vaccine candidate selected for Phase 2/3 evaluation is BNT162b 2.
In light of the unknowns regarding duration of protection, as well as the emerging VOCs, it is 
important to understand the boostability  of BNT162, and potential heterologous protection 
against emerging VOC(s). A first step to address this will be to study an additional dose of 
BNT162b2 at 30 µg given to Phase 1 participants approximately  6to 12 months after their 
second dose of BNT162 b1 or BNT162b2. This will provide an early  assessment of the safet y 
of a third dose of BNT162, as well as its immunogenici ty.The assessment of boostability  
will be further expanded in a subset of Phase 3 participants who will receive a third dose of 
BNT162b2 or a third and potentially  a fourth dose of prototy pe BNT162b2 VOC(based upon 
the South African variant and hereafter referred to as BNT162b2 SA).
To further describe potential homologous and heterologous protection against emerging 
SARS -CoV -2 VOCs, a new cohort of participants will be enrolled who are COVID-19 
vaccine –naïve ( ie, BNT162b2 -naïve) and have not experienced C OVID-19. They  will 
receive BNT162b2 SAgiven as a 2- dose series, separated by  21 day s.
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Page 592.2.1. Clinical Overview
Prior to this study , given clinical data from other similarly  formulated uRNA liposomal 
vaccines from BioNTech in oncology  trials7and recent published results from clinical trials 
using modRNA influenza vaccines by Moderna ,8the BNT162 vaccines we re expected to 
have a favorable safet y profile with mild, localized ,and transient effects. BNT162 vaccines 
based on modRNA have now been administered to huma ns for the first time in this study  and 
the BNT162 -01study conducted in German y by BioNTech, at doses between 1 µg and 
100µg. The currently  availa blesafety  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, support eda favorable risk /benefit profile. Anticipated AEs after 
vaccination were expected to be manageable using routine symptom -driven standard of care 
as determined b y the investigators and,as a result, the profile of these vaccine candidate s
support edinitiation of this Phase 1/2 /3clinical study .
Updates as part of protocol amendment 6:
In order for the overall Phase 3 study  populati on 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 diseas e. In addition, with the currently  available 
therapies for the irtreatment, many  individuals with chronic stable HIV, HCV, and HBV 
infections are unlikel y to be at higher safet y 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 reactogenicit y 
subset (see Section 8.2.2).
Updates as part of protocol amendment 7:
The minimum age for inclusion in Phase 3 is lowered to 12 y ears, therefore allowing the 
inclusion of participants 12 to 15 years of age.
For individuals 12 to 15 years of age, the immune responses in this age group may  be 
higher and reactogenicity is expected to be similar to y ounger adults 18 t o 25 y ears of 
age. Inclusion of individuals 12 to 15 y ears of age was based upon a satisfactory  blinded 
safet y profile in participants 18 to 25 years of age .
All participants 12 to 15 years of age will be included in the reactogenicit y subset (see 
Section 8.2.2 ).
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Page 60More detailed information about the known and expected benefits and risks and reasonabl y 
expected AEs of BNT162 RNA -based COVID -19 vaccine smay be found in the IB, which is 
the SRSD for t his study . 
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Page 612.3.1. Risk Assessment
Potential Risk of Clinical 
SignificanceSummary of Data/Rationale for Risk Mitigation Strategy
Study Intervention : BNT162 RNA -Based COVID -19 Vaccine
Potential for local reactions (injection 
site redness,  injection site swelling, 
and injection site pain) and systemic 
events (fever, fatigue, headache, 
chills, vomiting, diarrhea, muscle 
pain, and joint pain) following 
vaccination.These are c ommo n adverse reactions seen 
with other vaccines, as noted in the FD A 
Center for Biologics Evaluation and 
Research (CBER) guidelines on toxicity 
grading scales for healthy adult volunteers 
enrolled in preventive vaccine clinical 
trials.9The Phase 1 study design includes the use of controlled vaccination and 
dose escalatio n to closely monitor and limit the rate of enrollment to ensure 
participant safety. The study employs the u se of a reactogenicity e-diary to 
monitor local reactions and systemic events in real time. Stopping rules are 
also in place. The first 5 participant s 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.
Unknown AEs and laboratory 
abnormalities with a novel vaccine.This study is one of the first 2 
parallel -running clinical studies with the 
BNT162 vaccine candidates and as such 
there areno clinical data available for t his 
vaccine.The Phase 1 study design includes the use of controlled vaccination and 
dose escalation to c losely monitor and limit the rate of enrollment to ensure 
participant safety. An IRC (in Phase 1) and DMC (throughout the study) 
will also review safety data. Stopping rules are also in place. The first 5 
participants in each group in Phase 1 will be obser ved 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
enhancement.Disease enhancement has been seen 
following vaccination with respiratory 
syncytial virus (RSV ),feline coronavirus ,
and Dengue virus vaccines .Phase 1 excludesparticipant s with likely previous or current COVID -19.In 
Phase 2/ 3, temporary delay criteria defer vaccination of participants with 
symptoms of potential COVID -19.All participants are follow ed for any 
potential COVID -19 illness ,including markers of severity , and have blood 
samples taken for potential measurement of SARS -CoV -2 antigen -specific 
antibody and SARS -CoV -2 neutralizing titers .
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Page 62Potential Risk of Clinical 
SignificanceSummary of Data/Rationale for Risk Mitigation Strategy
Study Procedures
Participant s will be required to attend 
healthcare facilities during the g lobal 
SARS -CoV-2 pandemic.Without appropriate social distancing and 
PPE, there is a potential for increased 
exposure to SARS -CoV -2.Pfizer w ill work with sites to ensure an appropriate COVID -19 prevention 
strategy. Potential COVID -19 illness visits can be conducted via t elehealth , 
without the need for an in -person visit, if required, w ith the participant 
performing a self -swab.
Venipuncture will be performed 
during the study .There is the risk of bleeding, bruising, 
hematoma formation, and infection at the 
venipuncture site.Only appropriately qualified personnel would obtain the blood draw .
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Page 632.3.2. Benefit Assessment
Benefit s to individual participants may include:
Receipt of an efficacious COVID- 19 vaccine during a global pandemic
Access to COVID -19 diagnostic 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 t o minimize risk to participants participating in this 
study , the potential risks identified in association with BNT162 RNA -based COVID -19 
vaccine are justified b y the anticipated benefits that may  be afforded to healthy  participants.
3.OBJECTIVES , ESTIMANDS ,AND ENDPOINTS
3.1.For Phase 1
Objectives Estimands Endpoints
Primary: Primary: Primary: 
To describe the safety and tolerability 
profiles of prophylactic BNT162 
vaccines in healthy adults after 1or 2 
dosesIn participants receiving at least 1 dose 
of study intervention , the percentage of 
participants reporting:
 Local reactions for up to 7 days 
following each dose 
 Systemic events for up to 7 days 
following each dose
 Adverse events (AE s) from 
Dose 1 to1 month after the last 
dose
 Serious AEs (SAE s) from Dose 1 
to 6 months after the last dose Local reactions (pain at the 
injection site , redness , and 
swelling )
 Systemic events (fever, fatigue, 
headache, chills, vomiting, 
diarrhea, new or worsened muscle 
pain, and new or worsened joint 
pain)
 AEs
 SAEs
In addition, the percentage of 
participants 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 2Hematology and chemistry laboratory 
parameters detailed in Section 10.2
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Secondary: Secondary: Secondary: 
To describe the immune responses 
elicited by prophylactic BNT162 
vaccines in healthy adults after 1or 2 
dosesIn participants complying with the key 
protocol criteria (evaluable 
participants) at the following time 
points after receipt of study 
intervention :7 and 21 days after Dose 
1; 7and 14 days and1, 6, 12 ,and 24
months after Dose 2
 Geometric mean titers (GMTs) at 
each time point
 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 vaccinationSARS -CoV -2neutralizing titers
 Geometric mean concentrations 
(GMCs) at each time point
 GMFR from prior to first dose of 
study intervention to each 
subsequent time point
 Proportion of participants 
achieving ≥4-fold rise from before 
vaccination to each subsequent 
time point after vaccinationS1-binding IgGlevels and RBD -
binding IgG levels
 Geometric mean ratio (GMR) , 
estimated by the ratio of the
geometric mean of SARS -CoV -2
neutralizing titers to the geometric 
mean of binding IgGlevels at each 
time point SARS -CoV -2neutralizing titers
 S1-binding IgGlevels
 RBD -binding IgGlevels
Exploratory : Exploratory : Exploratory : 
To describe the immune responses 
elicited by a third dose of prophylactic 
BNT162 b2administered to healthy 
adults 6 to 12 months after the second 
dose of either BNT162 b1 or 
BNT162 b2 GMC/ GMT and GMFR at the 
time of Dose 3and7days and 1
month after Dose 3. SARS -CoV -2 reference -strain 
neutralizing titers
 SARS -CoV -2 SA-variant
neutralizing titers
 Full-length S -binding or 
S1-binding IgGlevels
 GMR of SARS-CoV -2reference -
strain neutralizing titers 1 month 
after Dose 3 to 1 month after 
Dose 2 SARS -CoV -2 reference -strain 
neutralizing titers
 GMR of SARS-CoV -2SA-variant
neutralizing titers 1 month after 
Dose 3 to SARS -CoV -2reference -
strain neutralizing titers 1 month 
after Dose 2 SARS -CoV -2 reference -strain 
neutralizing titers
 SARS -CoV -2 SA-variant
neutralizing titers
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To de scribe the safety profile of a third 
dose of prophylactic BNT162 b2
administered to healthy adults 6 to 12 
months after the second dose of either 
BNT162 b1 or BNT162 b2In participants receiving a third dose of 
BNT162b2 , the percentage of 
participants reporting:
 Local reactions for up to 7 days 
after Dose 3
 Systemic events for up to 7 days 
after Dose 3
 AEs and SAEs from Dose 3to 
1month after Dose 3 Local reactions (pain at the 
injection site, redness, and 
swelling)
 Systemic events (fever, fatigue, 
headache, chills, vomiting, 
diarrhea, new or worsened muscle 
pain, and new or worsened joint 
pain)
 AEs
 SAEs
3.2.For Phase 2/3
ObjectivesaEstimands Endpoints
Prim ary Efficacy
To evaluate the efficac yof 
prophylactic BNT162 b2against 
confirmed COVID -19 occurring from 
7 days after the second dose in 
participants without evidence of 
infection before vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) at least 7 days after 
receipt of the second dose of study 
intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of follow -up based on 
central laboratory or locally 
confirmed NAAT in participants with 
no serological or virological evidence 
(up to 7days after recei pt of the 
second dose) of past SARS -CoV -2 
infection
To evaluate the efficac yof 
prophylactic BNT162 b2  against 
confirmed COVID -19occurring from 
7 days after the second dose in 
participants with and without 
evidence of infection before 
vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) at least 7 days after 
receipt of the second dose of study 
intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of follo w-up based on 
central laboratory or locally 
confirmed NAAT
Prim ary Safety
To define the safety profile of 
prophylactic BNT162b 2in the first 
360 participants randomized (Phase 2)In participants receiving at least 1 
dose of study intervention, the 
percentage of participants reporting:
 Local reactions for up to 7 days 
following each dose
 Systemic events for up to 7 days 
following each dose
 AEs from Dose 1 to 7 days after 
the second dose
 SAEs from Dose 1 to 7 days
after the second dose Local reactions (pain at the 
injection site, redness, and 
swelling)
 Systemic events (fever, fatigue, 
headache, chills, vomiting, 
diarrhea, new or worsened 
muscle pain, and new or 
worsened joint pain)
 AEs
 SAEs
To define the safety profile of 
prophylactic BNT162b 2in all 
participants randomized in Phase 2/ 3In participants receiving at least 
1 dose of study intervention, the 
percentage of participants reporting:
 Local reactions for up to 7 days 
following each dose
 Systemic events for up to 7 days 
following each dose
 AEs fr om Dose 1 to 1 month 
after the second dose
 SAEs from Dose 1 to 6 months 
after the second dose AEs
 SAEs
 In a subset of at least 6000 
participants:
o Local reactions (pain at the 
injection site, redness, and 
swelling)
o Systemic events (fever, 
fatigue, headache, chills, 
vomiting, diarrhea, new or 
worsened muscle pain, and 
new or worsened joint pain)
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To define the safety profile of 
prophylactic BNT162 b2in 
participants 12 to 15 years of age in 
Phase 3In participants receiving at least 
1dose of study intervention, the 
percentage of participants reporting:
 Local reactions for up to 7 days 
following each dose
 Systemic events for up to 7 days 
following each dose
 AEs from Dose 1 to 1 month 
after the second dose
SAEs from Dose 1 to 6 
months after the second dose Local reactions (pain at the 
injection site, redness, and 
swelling)
 Systemic events (fever, fatigue, 
headache, chills, vomiting, 
diarrhea, new or worsened 
muscle pain, and new or 
worsened joint pain)
 AEs
 SAEs
To describe the safety and tolerability 
profile of BNT162 b2SAgiven as 1 or 
2 doses to BNT162b2 -experienced
participants , or as 2 doses to 
BNT162b2 -naïve participants
To describe the safety and tolerability 
profile of BNT162 b2given as a third
dose to BNT162b2-experienced
participantsIn participants receiving at least 
1dose of study intervention , the 
percentage of participants reporting:
Local reactions for up to 7 days 
following each dose 
Systemic events for up to 7 days 
following each dose
AEs from Dose 1 to 1 month after 
the last dose
SAEs from Dose 1 to 5 or 6 
months after the last doseLocal reactions (pain at the 
injection site , redness , and 
swelling )
Systemic events (fever, fatigue, 
headache, chills, vomiting, 
diarrhea, new or worsened muscle 
pain, and new or worsened joint 
pain)
AEs
SAEs
Prim ary Immunogenicity
BNT162b2 -experienced participants
Todemonstrate the noninferiority of 
the anti –reference strain immune 
response after a third dose of 
BNT162b2 compared to after 2 doses 
of BNT162b2, in the same individualsGMR of reference strain NT 1 month 
after the third dose of BNT162b2 to 
1month after the second dose of 
BNT162b2
The difference in percentages of 
participants with seroresponse to the 
reference strain at 1 month after the 
third dose of BNT162b2 and 1 month 
after the second dose of BNT162b2SARS -CoV -2 reference strain NTs in 
participants with no serological or 
virological evidence (up to 1 month
after receipt of thethird dose of 
BNT162b2 ) of past SARS -CoV -2 
infection
Todemonstrate the noninferiority of 
the anti -SA immune response after 
1dose of BNT162b2 SAcompared to 
the anti –reference strain immune 
response after 2 doses of BNT162b2, 
in the same individualsGMR of SA NT 1month after 1 dose 
of BNT162b2 SAto the reference strain 
NT 1 month after the second dose of 
BNT162b2
The difference in percentages of 
participants with seroresponse to the 
SAstrain at 1 month after 1 dose of 
BNT162b2 SAand seroresponse to the 
reference strain at 1 month after the 
second dose of BNT162b2SARS -CoV -2 SA and reference strain 
NTs in participants with no 
serological or virological evidence (up 
to 1 month after receipt of 1dose of 
BNT162b2 SA) of past SARS -CoV -2 
infection
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BNT162b2 -naïve participants
Todemonstrate the noninferiority of 
the anti-SA immune response after 2 
doses of BNT162b2 SAcompared to 
the anti –reference strain immune 
response after 2 doses of BNT162b2 GMR of SA NT 1month after the 
second dose of BNT162b2 SAto the 
reference strain NT 1 month after the 
second dose of BNT162b2
The difference in percentages of 
participants with seroresponse to the 
SAstrain at 1 month after the second 
dose of BNT162b2 SAand 
seroresponse to thereference strain at 
1 month after the second dose of 
BNT162b2SARS -CoV -2 SA and reference strain 
NTs in participants with no 
serological or virological evidence (up 
to 1 month after receipt of the second
dose of BNT162b2 SAor BNT162b2 as 
appropriate ) of past SARS -CoV -2 
infection
Secondary Efficacy
To evaluate the efficac yof 
prophylactic BNT162 b2against 
confirmed COVID -19 occurring from 
14 days after the second dose in 
participants without evidence of 
infection before vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) at least 14days after 
receipt of the second dose of study 
intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of follow -up based on 
central laboratory or locally 
confirmed NAAT in participants with 
no serological or virological evidence 
(up to 14days after receipt of the 
second dose) of past SARS -CoV -2 
infection
To evaluate the efficac yof 
prophylactic BNT162 b2against 
confirmed COVID -19 occurring from 
14 days after the second dose in 
participants with and without 
evidence of infection before
vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) at least 14days after 
receipt of the second dose of study 
intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of follow -up based on 
central laboratory or locally 
confirmed NAAT
To evaluate the efficac yof 
prophylactic BNT162b 2against 
confirmed severe COVID -19
occurring from 7 days and from 14 
days after the second dose in 
participants without evidence of 
infection before vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) 
at least 7 days 
and
at least 14 days
after receipt of the second dose of 
study intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]Confirmed severe COVID -19 
incidence per 1000 person -years of 
follow -up in participants with no 
serological or virological evidence (up 
to 7 days and up to 14 days after 
receipt of the second dose) of past 
SARS -CoV -2 infection
To evaluate the effi cacyof 
prophylactic BNT162b 2against 
confirmed severe COVID -19
occurring from 7 days and from 14 
days after the second dose in 
participants with and without 
evidence of infection before 
vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) 
at least 7 days 
and
at least 14 days
after receipt of the second dose of 
study intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]Confirmed s evere COVID -19 
incidence per 1000 person -years of 
follow -up
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To describe the efficac yof 
prophylactic BNT162b 2against 
confirmed COVID -19 (according to 
the CDC -defined symptoms) 
occurring from 7 days and from 14 
days after the second dose in 
participants without evidence of 
infection before vaccinationIn participants complyin g with the 
key protocol criteria (evaluable 
participants) 
at least 7 days 
and
at least 14 days
after receipt of the second dose of 
study intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of follow -up based on 
central laboratory or locally 
confirmed NAAT in participants with
no serological or virological evidence 
(up to 7 days and up to 14 days after 
receipt of the second dose) of past 
SARS -CoV -2 infection
To describe the efficac yof 
prophylactic BNT162b 2against 
confirmed COVID -19 (according to 
the CDC -defined symptoms) 
occurring from 7 days and from 14 
days after the second dose in 
participants with and without 
evidence of infection before 
vaccinationIn participants complying wi th the 
key protocol criteria (evaluable 
participants) 
at least 7 days 
and
at least 14 days
after receipt of the second dose of 
study intervention:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of follow -up based on 
central laboratory or locally 
confirmed NAAT
To evaluate the efficacy of 
prophylactic BNT162b2 against 
non-S seroconversion to 
SARS -CoV -2 in participants without 
evidence of infection or confirmed 
COVID -19 In participants complying with the 
key protocol criteria (evaluable 
participants):
100 × (1 –IRR) [ratio of active 
vaccine to placebo]Incidence of asymptomatic 
SARS -CoV -2 infection per 1000 
person -years of follow -up based on 
N-binding antibody seroconversion in 
participants with no serologica l or 
virological evidence of past 
SARS -CoV -2 infection or confirmed 
COVID -19 
To evaluate the efficacy of 
prophylactic BNT162b 2against 
asymptomatic SARS -CoV -2 infection 
in participants without evidence of 
infection up to the start of the 
asymptomatic sur veillance periodIn participants complying with the 
key protocol criteria (evaluable 
participants):
100 × (1 –IRR) [ratio of active 
vaccine to placebo]Incidence of asymptomatic 
SARS -CoV -2 infection per 1000 
person -years of follow -up based on 
central laboratory –confirmed NAAT 
in participants with no serological or 
virological evidence (up to the start of 
the asymptomatic surveillance period ) 
of past SARS -CoV -2 infection
Secondary Immunogenicity
Todemonstrate the noninferiority of 
the immune response to prophylactic 
BNT162b2 in participants 12 to 15 
years of age compared to participants 
16 to 25 years of ageGMR, estimated by the ratio of the 
geometric mean of SARS -CoV -2 
neutralizing titers in the 2 age groups 
(12-15 years of age to 16 -25 years of 
age) 1 month after completion of 
vaccinationSARS -CoV -2 neutralizing titers in 
participants with no serological or 
virological evidence (up to 1 month
after receipt of the second dose) of 
past SARS -
CoV -2 infection
BNT162b2 -experienced participants
Todemonstrate the noninferiority of 
the anti-SA immune response after a 
third dose of BNT162b2 compared to 
the anti –reference strain immune 
response after 2 doses of BNT162b2, 
in the same individuals GMR of SA NT 1month after the 
third dose of BNT162b2 to the 
reference strain NT 1 month after the 
second dose of BNT162b2
The difference in percentages of 
participants with seroresponse to the
SAstrain at 1 month after the third 
dose of BNT162b2 and seroresponse 
to the reference strain at 1 month after 
the second dose of BNT162b2SARS -CoV -2 SA and reference strain 
NTs in participants with no 
serological or virological evidence (up 
to 1 month after receipt of the third
dose of BNT162b2 ) of past 
SARS -CoV -2 infection
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Todemonstrate the noninferiority of 
the an ti–reference strain immune 
response after 1 dose of BNT162b2 SA
compared to after 2 doses of 
BNT162b2, in the same individuals GMR of reference strain NT 1 month 
after 1 dose of BNT162b2 SAto 
1month after the second dose of 
BNT162b2
The difference in percentages of 
participants with seroresponse to the 
reference strain at 1 month after 1 
dose of BNT162b2 SAand 1 month 
after the second dose of BNT162b2SARS -CoV -2 reference strain NTs in 
participants with no serological or 
virological e vidence (up to 1 month
after receipt of 1 dose of 
BNT162b2 SA) of past SARS -CoV -2 
infection
To descriptively compare the anti-SA
immune response after 1 dose of 
BNT162b2 SAanda third dose of 
BNT162b2GMR of SANT 1 month after 1 dose 
of BNT162b2 SAto1month after the 
third dose of BNT162b2
The difference in percentages of 
participants with seroresponse to the
SA strain at 1 month after 1 dose of 
BNT162b2 SAand 1 month after the 
third dose of BNT162b2SARS -CoV -2 SA NT in participants 
with no serological or virological 
evidence (up to 1 month after receipt 
of 1dose of BNT162b2 SAor the third
dose of BNT162b2 ) of past 
SARS -CoV -2 infection
Todescriptively compare the anti-SA 
immune response after 2 doses of 
BNT162b2 SAand the anti –reference 
strain immune response after 2 doses 
of BNT162b2, in the same individuals GMR of SA NT 1month after the 
second dose of BNT162b2 SAto the 
reference strain NT 1 month after the 
second dose of BNT162b2
The difference in percentages of 
participants with seroresponse to the 
SA strain at 1 month after the second 
dose of BNT162b2 SAand 
seroresponse to the reference strain at 
1 month after the second dose of 
BNT162b2SARS -CoV -2 SA and reference strain 
NTs in participants with no 
serological or virological evidence (up 
to 1 month after receipt of the second
dose of BNT162b2 SA) of past 
SARS -CoV -2 infection
BNT162b2 -naïve participants 
Todemonstrate a statistically greater 
anti-SA immune response after 2 
doses of BNT162b2 SAcompared to 
after 2 doses of BNT162b2 GMR of SA NT 1month after the 
second dose of BNT162b2 SAto 
1month after the second dose of 
BNT162b2
The difference in percentages of 
participants with seroresponse to the 
SA strain at 1 month after the second 
dose of BNT162b2 SAand 1 month 
after the second dose of BNT162b2SARS -CoV -2 SANTs in participants 
with no serological or virological 
evidence (up to 1 month after receipt 
of the second dose of BNT162b2 SAor 
BNT162b2 as appropriate) of past 
SARS -CoV -2 infection
Todescript ively compare the anti –
reference strain immune response 
after 2 doses of BNT162b2 SAand 
after 2 doses of BNT162b2 GMR of reference strain NT 1 month 
after the second dose of BNT162b2 SA
to 1month after the second dose of 
BNT162b2
The difference in percentages of 
participants with seroresponse to 
refere nce strain at 1 month after the 
second dose of BNT162b2 SAand 1 
month after the second dose of 
BNT162b2SARS -CoV -2 reference strain NTs in 
participants with no serological or 
virological evidence (up t o 1 month
after receipt of the second doseof 
BNT162b2 SAor BNT162b2 as 
appropriate ) of past SARS -CoV -2 
infection
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Page 70ObjectivesaEstimands Endpoints
Exploratory
To describe the efficac yof 
prophylactic BNT162b 2against 
confirmed COVID -19 occurring from 
7 days after the second dose through 
the blinded follow -up period in 
participants without, and with and 
without ,evidence of infection before 
vaccinationIn participants complying with the 
key protocol criteria (evaluable 
participants) after receipt of the 
second dose of study interve ntion:
100 × (1 –IRR) [ratio of active 
vaccine to placebo]COVID -19 incidence per 1000 
person -years of blinded follow -up 
based on central laboratory or locally 
confirmed NAAT
To describe the incidence of 
confirmed COVID -19 through the 
entire study follow -up period in 
participants who received BNT162b2 
at initial randomization or 
subsequentlyIn participants who received 
BNT162b2 (at initial randomization 
or subsequently):
Incidence per 1000 person-ye ars of 
follow -upCOVID -19 incidence per 1000 
person -year s of follow -up based on 
central laboratory or locally 
confirmed NAAT
To evaluate the immune response 
over time to prophylactic BNT162b2 
and persistence of immune response 
in participants with and without 
serological or virological evidence of 
SARS -CoV -2infection before 
vaccinationGMC/ GMT andGMFR at baseline 
and 1, 6, 12, and 24 months after 
completion of vaccination Full-length S -binding or 
S1-binding IgGlevels
 SARS -CoV -2 neutralizing titers
To describe the incidence of non-S 
seroconversion to SARS -CoV -2
through the entire study follow-up 
period in participants who received 
BNT162b2 at initial randomization In participants who received 
BNT162b2 at initial randomization:
Incidence per 1000 person-ye ars of 
follow -upIncidence of asymptomatic 
SARS -CoV -2 infection per 1000 
person -years of follow -up based on 
N-binding antibody seroconversion in 
participants with no serological or 
virological evidence of past 
SARS -CoV -2 infection or confirmed 
COVID -19 
To describe the efficac yof 
prophylactic BNT162b 2against 
asymptomatic SARS -CoV -2 infection 
in participants with evidence of 
infection up to the start of the 
asymptomatic surveillance periodIn participants complying with the 
key protocol criteria (evaluable 
participants):
100 × (1 –IRR) [ratio of acti ve 
vaccine to placebo]Incidence of asymptomatic 
SARS -CoV -2 infection per 1000 
person -years of follow -up based on 
central laboratory –confirmed NAAT
in participants with serological or 
virological evidence (up to the start of 
the asymptomatic surveillance p eriod) 
of past SARS -CoV -2 infection
To describe the serological responses 
to the BNT vaccine candidate and 
characterize the SARS -CoV -2 isolate 
in cases of :
 Confirmed COVID-19
 Confirmed severe COVID -19
 SARS -CoV -2 infection without 
confirmed COVID -19 Full-length S -binding or 
S1-binding IgGlevels
 SARS -CoV -2 neutralizing titers
 Identification of SARS -CoV -2 
variant(s) 
To describe the safety, 
immunogenicity ,and efficacy of 
prophylactic BNT162b2 in 
individuals with confirmed stable HIV 
disease All safety, immunogenicity, and 
efficacy endpoints described 
above
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Page 71ObjectivesaEstimands Endpoints
To describe the safety and 
immunogenicity of prophylactic 
BNT162b2 in individuals 16 to 55 
years of age vaccinated with study 
intervention produced by 
manufacturing “Process 1” or 
“Process 2”b AEs
 SAEs
 SARS -CoV -2 neutralizing titers
To describe the immune response to 
any VOCs not already specifiedGeometric mean NT for any VOC snot 
already specified, after any dose of 
BNT162b2 SAor BNT162b2 SARS -CoV -2NTs for any VOCs
not already specified
To describe the cell-mediated immune 
response , and additional humoral 
immune response parameters, to the 
reference strain and SA in a subset of 
participants:
 7 Daysand1and 6month safter
BNT162 b2SAgiven as 1 or 2 
doses to BNT162b2 -experienced
participants
 7 Daysand 1 and 6month safter 
BNT162 b2SAgiven as 2 doses to 
BNT162b2 -naïve participants
 7 Daysand1and 6month safter 
BNT162b2 given as a third dose 
to BNT162b2 -experienced 
participants
a.HIV-positive participants in Phase 3 will not be included in analyses of the objectives, with the 
exception of the specific exploratory objective.
b.SeeSection 6.1.1 for description of the manufacturing process .
Up until the final efficacy anal ysis, 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. 
For those AEs that are handled as disease -related efficacy  endpoints (which may  include 
death), a DMC will conduct unblinded reviews on a regula r basis throughout the trial
(seeSection 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 an y such AE that meets the criteria for seriousness to Pfizer Safet y.
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Page 724.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  
indiv idual s.
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 safet y, tolerability ,andimmunogenicit y of 3 different 
SARS -CoV-2 R NAvaccine candidate s against C OVID -19and the efficacy  of 1 candidate :
As a 2 -dose (separated by  21 day s) schedule ;
At various different dose levels in Phase 1;
As a booster;
In 3 age groups ( Phase 1: 18 to 55 y ears of age, 65 to 85 y ears of age ; Phase 2/3: ≥12 
yearsof age [stratified as 12-15, 16 -55,or >55 years of age] ).
Dependent upon safet y and/or immunogenicit y data generated during the course of this 
study , or the BioNTech study  conducted in Germany (BNT162 -01), it is possible that groups 
in Phase 1 may  be sta rted at the next highest dose, g roups may  not be started, groups may  be 
terminated early , and /orgroups may  be added with dose levels below the lowest stated dose 
or intermediate between the lowest and highest stated doses.
The study  is observer -blinded, a s the ph ysical 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 Phase 1.
In order to describe the boostability  of BNT162, an additional dose of BNT162b2 at 30 µg 
will be given to Pha se 1 participants approximately  6to 12 months after their second dose of 
BNT162 b1 or BNT162b2. This will provide an early  assessment of the safety  of a third dose 
of BNT162, as well as its immunogenicit y.The assessment of boostability  will be further 
expanded in a subset of Phase 3 participants who will receive a third dose of BNT162b2 or a 
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Page 73third and potentially  a fourth dose of protot ype BNT162b2 VOC(based upon the South African 
variant and hereafter referred to as BNT162b2 SA).
To further describe pote ntial homologous and heterologous protection against emerging 
SARS -CoV -2 VOCs, a new cohort of participants will be enrolled who are COVID-19 
vaccine -naïve ( ie, BNT162b2 -naïve) and have not experienced COVID-19. They  will 
receive BNT162b 2SAgiven as a 2-dose series, separated by  21 day s.
4.1.1. Phase 1
Each group (vaccine candidate/dose level/ age group ) will comprise 15 participant s; 
12participants will be randomized to receive active vaccine and 3 to receive placebo.
For each vaccine candidate/ dose level /age group , the following apply :
Additional safet y 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
Thefirst 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 24hours 
after the fifth participant received his or her vaccination
Application of stopping rules
IRC review of safet y 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 safet y data in this study  and/or the BioNTech stud y conducted in 
German y (BNT162 -01)
Note that, since both candidates arebased upon the same RNA platform, dose 
escalation for the second candidate studied may be based upon the safet y profile of 
the first candidate studied being deeme d acceptable at the same , or a higher, dose 
level by  the IRC
Groups of participants 65 to 85 y ears of age will not be started until safet y 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 I RC.
In this phase , 13groups will be studied, corresponding to a total of 195participants.
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Page 74The I RC 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
progress ion into Phase 2/ 3.
Participants who originally  received placebo and become eligible for receipt of BNT162b2 or 
another CO VID-19 vaccine according to recommendations detailed separately , and available 
in the electronic stud y reference portal ,will have the opportunity  to receive BNT162b2 in a 
phased manner as part of the study . The investigator will ensure the participant me ets at least 
1of the recommendation criteria. 
Any Phase 1placebo recipient who has not already  been offered the opportunity  to receive 
BNT162b2 will be given this opportunity  no later than at the approximate time participants in 
Phase 2/3 reach Visit 4.
Any participant who originally  received placebo but then goes on to receive BNT162b2 will 
move to a new visit schedule ( Section 1.3.3 ).
In order to describe the boostability  of BNT162, and potential heterologous protection 
against emerging SARS -CoV -2 VOC s, an additional dose of BNT162b2 at 30 µg will be 
given to Phase 1 p articipants approximately  6to 12 months after their second dose of 
BNT162 b1 or BNT162b2.
Phase 1 participants who originally received BNT162b1 or BNT162b2 at dose levels of 10, 
20, or 30 µg at Doses 1 and 2 will be offered an additional dose of BNT162b2 a t 30 µg
approximately  6to 12 months after their second dose of BNT162. 
Participants are expected to participate for up to a maximum of approximately  26 months.  
4.1.2. Phase 2/ 3
On the basis of safet y and/or immunogenicit y data generated during the course of this study, 
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 ≥12 years of age, 
stratified as follows : 12 to 15 y ears, 16to 55 years,or >55 years. The 12- to 15 -year stratum 
will comprise up to approximately  2000 participants enrolled at selected investigational sites.
It is intended that a minimum of 40% of participants will be in the >55-year stratum.
Commencement of each age strat um w ill be based upon satisfactory  post–Dose 2 safety  and 
immunogenicit y data from the 18 -to 55 -year and 65 -to 85 -yearagegroups in Phase 1, 
respectivel y.  The vaccine candidate selected for Phase 2/3 evaluation is BNT162b 2at a dose 
of 30µg.
Phase 2/ 3 is event -driven. Under the assumption of a true VE rate of ≥60%, after the second
dose of investigational product, a target of 164primary -endpoint cases of confirmed 
COVID -19 due to SARS -CoV -2 occurring at least 7days following the second 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 
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Page 75may vary depending on the incidence of COVID -19 at the time of the enrollment, the true 
underly ing VE, and a potential earl y stop for efficacy  or futility .
Assuming a COVID -19 attack rate of 1. 3%per y earin the placebo group , accrual of 164 first
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 t he number of participants 
initially  targeted for Phase 2/ 3 and may be adjusted based on advice from DMC analy ses 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 >55to 85 y ears) will comprise the “Phase 2 ”portion. 
Safety  data through 7 day s after D ose 2 and immunogenicity  data through 1 month after 
Dose 2 from these 360 participants will be anal yzed by  the unblinded statistical team, 
reviewed b y the DMC, and submitted to appropriate regulatory  authorities for review. 
Enrol lment may continue during this period and these participants would be included in the 
efficacy  evaluation in the “Phase 3” portion of the study .
In Phase 3, up to approximately  2000 participants , enrolled at selected sites, are anticipated 
to be 12 to 15 y ears of age. Noninferiority  of immune response to proph ylactic BNT162b2 
in participants 12to 15 years of age to response inparticipants 16 to 25years of ag e will be 
assessed based on the GM Rof SARS -CoV -2 neutralizing titers using a 1.5 -fold margin. A 
sample size of 225 evaluable participants (or 280vaccine recipients) per age group will 
provide a power of 90.4 % to declare the noninferiority in terms of GM R(lower limit of 95%
CIforGMR>0.67) . A random sample of 280 participant s from each of the 2age group s
(12to 15 y ears and 16 to 25 y ears) will be selected as an immunogenicity  subset for the 
noninferiority  assessment.
The initial BNT162b2 was manufac tured using “Process 1”; however, “Process 2” was 
developed to support an increased scale of manufacture. In the stud y, each lot of
“Process 2”-manufactured BNT162b2 will be administered to approximately  250participants
16 to 55 y ears of age . The safet y and immunogenicity  of prophy lactic BNT162b2 in 
individuals 16 to 55 y ears of age vaccinated with “Process 1” and each lot of “Process 2” 
study  intervention will be described. A random sample of 250 participants from those 
vaccinated with study  intervention produced by  manufacturing “Process 1” will be selected 
for this descriptive analysis .
For evaluation of boostability  and protection against emerging VOCs, 600 existing Phase 3 
participants 18 to 55 y ears of age will be rerandomized in a 1:1 ra tio to receive either a third 
dose of BNT162b2 or a third dose of BNT162b2 SA.
An additional group of 30existing Phase 3 participants 18 to 55 y ears of age will be enrolled 
to receive a third and fourth dose of BNT162b2 SA. For these 30 participants, throug h 1 month 
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Page 76after their first dose of BNT162b2 SAthe participant will be blinded to their vaccine allocation 
but the investigator and Sponsor will not be. Serum samples from these participants may  be 
used for assay  development purposes and, except for objectives relating to response to a 
fourth dose, their results will be anal yzed separately  from the main immunogenicity  anal yses.
Three hundred participants 18 to 55 y ears of age who are COVID -19 vaccine –naïve ( ie, 
BNT162b2 -naïve) and have not experienced COVID-19 will be enrolled as a new cohort of 
participants toreceive BNT162b2 SAgiven as a 2 -dose series .
Participants are expected to participate for up to a maximum of approximately 26 months. 
The duration of stud y follow -up may  be shorter among participants enrolled in Phase 1 
dosing arms that are not evaluated in Phase 2/ 3.
Participants ≥16 y ears of age who originall y received placebo and become eligible for receipt 
of BNT162b2 according to recommendations detailed separa tely, and available in the 
electronic stud y reference portal ,will have the opportunity  to receive BNT162b2 in a phased 
manner as part of the study . The investigator will ensure the participant meets at least 1of 
the recommendation criteria.
Any Phase 2/3 placebo recipient ≥16 y ears of age who has not alread y been offered the 
opportunity  to receive BNT162b2 will be given this opportunity  no later than 6 months after 
Vaccination 2 (at the time of the originall y planned Visit 4).
Any participant who originally  received placebo but then goes on to receive BNT162b2 will 
move to a new visit schedule ( Section 1.3.3 ).
Thechanges to the protocol as part of protocol a mendment 14 to assess boostability  and 
homologous/heterologous protection against emerging VOCs allow the evaluation of safet y 
and immunogenicit y of BNT162b2 SA:
When given as a third dose to C4591001 Phase 3 pa rticipants who received a second dose 
of BNT162b2 approximately  6 months previousl y (ie, BNT162b2- experienced) and have 
not experienced COVID -19. 
In a small separate group of individuals who previously  received 2 doses of BNT162b2 
followed b y 1 dose of BN T162b2 SA, a second BNT162b2 SAdose will also be given 1 
month after Dose 1 of BNT162b2 SA.
When given as a 2 -dose series, separated b y 21 days, in newl y recruited participants who 
are COVID -19 vaccine– naïve ( ie, BNT162b2 -naïve) and have not experienced 
COVID -19.
In addition, a group of C4591001 Phase 3 participants who received a second dose of 
BNT162b2 approximately  6 months previousl y will receive a third dose of BNT162b2.
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CONFIDENTIAL
CT02- GSOP Clinical Protocol Template Phase 1 2 3 4 (05 December 2019)
Page 77This approach will allow an evaluation of immunogenicity  against the reference a ncestral 
SARS -CoV -2strain (Wuhan -Hu-1/USA -WA1) and the selected South African VOC, using a 
noninferiority  approach based on neutralizing antibody  titers in prior BNT162b2 vaccinees 
who receive either a homologous boost (with BNT162b2) or a heterologous bo ost (with 
BNT162b2 SA), as well as new vaccinees receiving 2 doses of BNT162b2 SA.
An intensive period of surveillance to evaluate the efficacy  of BNT162b2 against 
asymptomatic SARS -CoV -2 infection may be conducted at selected sites among Phase 2/3 
participa nts following approval of protocol amendment 11. After an initial in -person visit 
where a blood sample will be collected and a nasal (midturbinate) swab obtained, n asal 
(midturbinate) swab s will be obtained from consented participants every 2 weeks until 
Visit 4, or a sufficient number of cases of SARS -CoV -2 infection have accrued to evaluate 
this objective, whichever is sooner, per the SoA in Section 1.3.6 . The swabs will be tested at 
a central laboratory  using NAAT to detect SARS -CoV -2.Participants who are unblinded 
because they becom epotentially eligible for receipt of BNT162b2 according to 
recommendations detailed separately , and available in the electronic study  reference portal, 
will not participate in surveillance for as ymptomatic SARS -CoV -2 infection. However, 
participants who provided additional consent to conduct biweekl y swabbing for surveillance 
of as ymptomatic infection should continue to swab even after unblinding if they  originall y 
received BNT162b2 .
Surveillance for asymptomatic SARS -CoV -2 infection (swabbing) should cease in 
participants enrolled into the subset of participa nts who will receive an additional d ose of 
BNT162b2 or BNT162b2 SA.
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 s ymptoms, 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 
vaccine s,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 newl y emerged COVID -19 pandemic, 
sufficient data were not available to experimentally  validate the dose selection and in itial 
starting dose. Therefore, the original planned starting dose of10 µg (for both BNT162b1 and 
BNT162b2) in this study wasbased on nonclinical experience with the same RNAs encoding 
other viral antigens (such as influenza and HIV antigens). The gene ral safety  and 
effectiveness of uRNA and modRNA platforms have been demonstrated in oncological 
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