Pfizer beat third-quarter expectations and raised its 2021 forecast again even as sales of its top product, the COVID-19 vaccine Comirnaty, slipped in the U.S.

Soaring international sales of the preventive shots helped pushed total Comirnaty revenue close to $13 billion in the quarter, and the drugmaker said Tuesday that it now expects to book about $36 billion in sales from the vaccine this year.

That’s up from a second-quarter forecast for $33.5 billion and more than twice what Pfizer expected at the start of the year, shortly after distribution of the shots began.

Pfizer shares profits from the vaccine and costs to make and distribute it with German development partner BioNTech.

In the U.S., third-quarter sales of the vaccine fell to $1.59 billion from a little over $2 billion the previous quarter.

Analysts expected that, as demand fell following the rush to get shots shortly after vaccine eligibility expanded in the spring. But demand appears to be picking up again and will be helped by booster shots and an expansion of the vaccine for use in children.

Late last week, the Food and Drug Administration cleared kid-size doses of Pfizer’s two-shot COVID-19 vaccine — just a third of the amount given to teens and adults — for emergency use. Up to 28 million more American children could become eligible for the vaccinations later this week.

Pfizer’s vaccine is the first cleared by the FDA for use in children. The U.S. government has already purchased 115 million pediatric doses of the shots, or enough to vaccinate every U.S. child, Pfizer Chairman and CEO Albert Bourla said in a statement posted on the company’s website.

Outside Comirnaty, Pfizer products include several cancer treatments, other vaccines and internal medicine drugs like Eliquis, for preventing blood clots and strokes. Sales of that drug climbed 21% to $1.35 billion in the quarter.

Sales of the breast cancer drug Ibrance climbed 9% outside the U.S., excluding foreign exchange rates, as diagnosis and treatment that had slowed during the pandemic began picking up again. But sales slipped in the U.S. as more people got the drug through Pfizer’s patient assistance program, Bourla said.

U.S. sales of the company’s Prevnar vaccines, which guard against pneumonia and related bacterial diseases, also slipped 2% in the quarter as people prioritized COVID-19 shots.

Overall, COVID-19 vaccine sales to emerging markets appeared to be the main factor behind Pfizer’s better-than-expected performance in the quarter, Mizuho Securities USA analyst Dr. Vamil Divan said in a research note. He said the rest of the business performed close to expectations.

Pfizer earned a total of $8.15 billion in the third quarter, or more than five times what it earned in last year’s third quarter before its COVID-19 vaccine was approved by regulators. Adjusted results in the latest quarter totaled $1.34 per share. The company’s total revenue more than doubled to $24.09 billion.

Analysts expected, on average, third-quarter earnings of $1.08 per share from Pfizer on about $22.58 billion in revenue, according to FactSet.

New York-based Pfizer Inc. now expects 2021 adjusted earnings of $4.13 to $4.18 per share on revenue ranging from $81 billion to $82 billion.

For 2021, analysts forecast earnings of $4.04 per share on $78.77 billion in revenue.

Shares of Pfizer climbed nearly 3% to $44.82 in early-morning trading before markets opened.

In August, the stock had topped a previous all-time high price of $47.40, a mark that stood for 22 years.

(AP)