This study is a large-scale investigation (Phase 3) into a new booster shot designedspecifically for teenagers. The booster targets a particular variant of COVID-19, OmicronXBB.1.5. The main focus is on safety: researchers want to see if this new booster is safefor teenagers who have already received two doses of the Pfizer or Moderna mRNA COVID-19vaccines. To ensure a fair comparison, the study will use a double-blind approach. Thismeans two groups of teenagers will receive booster shots, but neither the teenagers northe researchers giving the shots will know beforehand which version of the booster eachperson gets. The study will also assess how well the body fights the virus after thebooster shot.
This is a Phase 3, randomized, double-blinded study to evaluate the safety and
immunogenicity of booster doses of Omicron subvariant severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) recombinant (r) spike (S) protein nanoparticle vaccines
(SARS-CoV-2 rS) adjuvanted with Matrix-M™ adjuvant (NVX-CoV2601 [Omicron XBB.1.5]) and
bivalent (NVX-CoV2373 [prototype] + NVX CoV2601) in previously vaccinated adolescent
participants ≥ 12 to < 18 years of age.
Approximately 400 adolescents who have received a regimen of ≥ 2 doses of the Moderna
and/or Pfizer-BioNTech monovalent and/or bivalent COVID-19 vaccines ≥ 90 days previously
will be randomized 1:1 to Group A or Group B:
- Group A: 1 dose of NVX-CoV2601 (1 on Day 0)
  -  Group B: 1 dose of bivalent NVX-CoV2373 + NVX-CoV2601 (1 on Day 0) All participants
     will remain on study for immunogenicity and safety data collection through Day 180.
Biological: NVX-CoV2601 co-formulated Omicron XBB.1.5 SARS-CoV-2 rS vaccine
Coformulated Omicron XBB.1.5 SARS-CoV-2 rS vaccine with Matrix-M adjuvant: supplied as a
solution for preparation for injection, at a concentration of 10 µg antigen and 100 µg
adjuvant per mL. All injections will be administered in a 0.5 mL injection volume at a
dose of 5 µg antigen with 50 µg Matrix-M adjuvant.
Other Name: NVX-CoV2601
Biological: Prototype/XBB.1.5 Bivalent Vaccine (5 µg)
A site-mixed bivalent vaccine prepared by combining 0.25 mL of NVX-CoV2373 and 0.25 mL
NVX-CoV2601. All injections will be administered in a 0.5 mL injection volume at a dose
of 5 µg total antigen (2.5 µg prototype antigen + 2.5 µg Omicron XBB.1.5 antigen) with 50
µg Matrix-M adjuvant.
Other Name: Omicron XBB.1.5 (sub-variant)SARS-CoV-2 rS /Matrix-M Adjuvant
Inclusion Criteria:
1. Adolescents ≥ 12 to < 18 years of age at screening
  2. Participant and parent(s)/caregiver(s) or legally acceptable representative willing
     and able to give in-formed consent and assent, as required, prior to study
     enrollment and to comply with study procedures.
  3. Participants of childbearing potential (defined as any participant who has
     experienced menarche and who is NOT surgically sterile [ie, hysterectomy, bilateral
     tubal ligation, or bilateral oophorectomy] or post-menopausal [defined as amenorrhea
     ≥ 12 consecutive months]) must agree to be heterosexually inactive from at least 28
     days prior to enrollment and through the end of the study OR agree to consistently
     use a medically acceptable method of contraception listed below from ≥ 28 days prior
     to enrollment and through the end of the study.
  4. Is medically stable, as determined by the investigator (based on review of health
     status, vital signs [to include body temperature], medical history, and targeted
     physical examination [to include body weight]). Vital signs must be within medically
     acceptable ranges prior to the vaccination.
  5. Agrees to not participate in any other SARS-CoV-2 prevention or treatment trials for
     the duration of the study.
  6. Have previously received ≥ 2 doses of the Moderna and/or Pfizer-BioNTech monovalent
     and/or bivalent COVID-19 vaccines with the last dose having been given ≥ 90 days
     previously prior to study vaccination.
Exclusion Criteria:
  1. Received COVID-19 vaccines other than Moderna and/or Pfizer-BioNTech in the past,
     inclusive of clinical trial COVID-19 vaccines.
  2. Participation in research involving receipt of investigational products
     (drug/biologic/device) within 90 days prior to study vaccination.
3. Received influenza vaccination within 14 days prior to study vaccination.
  4. Received any vaccine ≤ 45 days prior to study vaccination, except for rabies, human
     papilloma virus (HPV), tetanus-diphtheria (Td), tetanus, diphtheria, and pertussis
     (TDaP/DTap), hepatitis B virus (HBV), and meningococcal vaccines which may be given
     as medically indicated.
5. Any known allergies to products contained in the investigational product.
6. Any history of anaphylaxis to any prior vaccine.
  7. Autoimmune or immunodeficiency disease/condition (iatrogenic or congenital)
     requiring ongoing immunomodulatory therapy.
  8. Chronic administration (defined as > 14 continuous days) of immunosuppressant,
     systemic glucocorticoids, or other immune-modifying drugs within 90 days prior to
     study vaccination.
     An immunosuppressant dose of glucocorticoid is defined as a systemic dose ≥ 10 mg of
     prednisone per day or equivalent. The use of topical or intranasal glucocorticoids
     is permitted. Topical tacrolimus and ocular cyclosporin are permitted.
  9. Received immunoglobulin, blood-derived products, or immunosuppressant drugs within
     90 days prior to study vaccination, except for rabies immunoglobulin which may be
     given if medically indicated.
 10. Active cancer (malignancy) on therapy within 3 years prior to study vaccination
     (with the exception of adequately treated non-melanomatous skin carcinoma or lentigo
     maligna and uterine cervical carcinoma in situ without evidence of disease, at the
     discretion of the investigator).
 11. Participants who are breastfeeding, pregnant, or who plan to become pregnant prior
     to the end of study.
 12. Suspected or known history of alcohol abuse or drug addiction within 2 years prior
     to the study vaccine dose that, in the opinion of the investigator, might interfere
     with protocol compliance.
 13. Any other condition that, in the opinion of the investigator, would pose a health
     risk to the participant if enrolled or could interfere with evaluation of the study
     vaccine or interpretation of study results (including neurologic or psychiatric
     conditions likely to impair the quality of safety reporting).
 14. Study team member or immediate family member of any study team member (inclusive of
     Sponsor, clinical research organization [CRO], and study site personnel involved in
     the conduct or planning of the study).
15. Participants with a history of myocarditis or pericarditis.
 16. Respiratory symptoms in the past 3 days (ie, cough, sore throat, difficulty
     breathing).
 17. Temperature of > 38°C within 24 hours of planned study vaccination (site measured or
     participant measured).
18. Blood pressure of ≥ 160/100 mmHg.
Alfa Medical Research
Davie	4152820, Florida	4155751, United States
Westside Center for Clinical Research
Jacksonville	4160021, Florida	4155751, United States
ITB Research
Miami	4164138, Florida	4155751, United States
Velocity Clinical Research
Meridian	5600685, Idaho	5596512, United States
DM Clinical Research - Chicago
River Forest	4907637, Illinois	4896861, United States
Johnson County Clinical Trials
Lenexa	4274356, Kansas	4273857, United States
Alliance for Multispecialty Research, LLC (AMR)
Newton	4276248, Kansas	4273857, United States
AMR
Wichita	4281730, Kansas	4273857, United States
Velocity Clinical Research
Lafayette	4330145, Louisiana	4331987, United States
Velocity Clinical Research
Vestal	5142296, New York	5128638, United States
Velocity Clinical Research
Cincinnati	4508722, Ohio	5165418, United States
Tekton Research
Tulsa	4553433, Oklahoma	4544379, United States
Clinical Research Associates, Inc
Nashville	4644585, Tennessee	4662168, United States
Benchmark Research
Austin	4671654, Texas	4736286, United States
South Texas Clinical Research
Corpus Christi	4683416, Texas	4736286, United States
DM Clinical Research
Houston	4699066, Texas	4736286, United States
Medical Colleagues of Texas, LLP
Katy	4702732, Texas	4736286, United States
Research Your Health
Plano	4719457, Texas	4736286, United States
Tekton Research
San Antonio	4726206, Texas	4736286, United States
Mountain View CCT Research
Pleasant View	5779833, Utah	5549030, United States
Clinical Development, Study Director
 Novavax