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When Your Second Vaccine Dose Packs a Punch
It's not your imagination: The second dose of the COVID-19 vaccine can produce stronger side effects
February 22, 2021

A few hours after getting the second dose of her COVID-19 vaccine one morning in mid-February, Wendy Reiter's arm was a bit sore, just as it was after her first shot. But by evening, she felt flu-like, with body aches, a headache and serious fatigue.
“I felt like I was hit by a truck. I was essentially laid up for a day and a half, sleeping on an off all day and feeling out of it,” Reiter, 75, an educational administrator in Westchester County, New York, recalls. “Then the veil lifted, and I felt like my old self again.”

Meanwhile, her husband, who is 89, felt fine after getting his second dose. When Reiter asked friends about their experiences, they were “all over the map,” ranging from intense to nonexistent.

So it goes with the Pfizer and Moderna COVID-19 vaccines. These are reactogenic vaccines, which means they're expected to produce side effects or reactions.

Even after the first dose, some people can get local reactions such as soreness or tenderness in the injected arm, or they may feel slightly out of sorts for a day or two, explains William Schaffner, M.D., a professor of preventive medicine and infectious diseases at the Vanderbilt University School of Medicine in Nashville.

But the second dose of both vaccines has quickly gained a reputation for packing a punch, with side effects that may include fatigue, chills, headache, muscle aches and pains, and even a fever.

“More people — 40 to 50 percent — experience some of these symptoms to one degree or another after the second vaccine,” Schaffner says. This happens because “your immune system is starting to work and cope with the stimulus that comes from the vaccine — so in a sense it's a good thing.”

And because the second dose builds upon the first, the immune system's response can be more emphatic. The more intense side effects with the second dose of the COVID-19 vaccines are similar to the second Shingrix shingles vaccine, which is also reactogenic, Schaffner says.

How age plays a role in the shot's effects

That said, the responses to the COVID-19 vaccines are highly variable. Some people don't experience any symptoms, while others have mild-to-moderate side effects, and some get more severe symptoms, experts say.

Interestingly, younger adults tend to experience more intense symptoms after the second dose than older adults do.

“The immune response is more robust if you're young and healthy,” says Wilbur Chen, M.D., a professor of medicine at the University of Maryland School of Medicine. “I've seen health care workers in their 20s and 30s who think they're bulletproof be surprised by their response to the vaccine.
I'm aware of these reactions because I have to go into lengthy counseling about these reactions.” Chen, who is in his 50s, says he experienced fatigue and body aches after his second dose of the Pfizer vaccine. His message: “A reaction means it's working — your body is responding to the vaccine.”

By contrast, older adults tend to have a milder response because “their immune systems are not responding as vigorously as a young person's, but they still get 95 percent protection from the virus,” Schaffner says. Aside from age, experts don't know why some people have more intense reactions than others do.

Laurie Douglas, 65, a graphic designer in New York City, had no problem with the first dose of the COVID-19 vaccine but ended up having a tough time after the second. After staying up late to try to make some deadlines, she started feeling achy and tired and spiked a fever of 100.5.
The next day, the symptoms continued. “I could not stay awake,” recalls Douglas, who has type 1 diabetes, which compromises her immune function.
“I took a nap for an hour in the morning. Then I took another nap in the early afternoon and slept from 3 p.m. until 8 p.m.”
The next day, Douglas still had a slight headache and felt tired. Even though her symptoms lasted two and a half days, she says, “I was thankful; I was expecting it to be way worse."

What you can take to ease the ache

If you experience intense side effects from the second dose, it's safe to take acetaminophen or ibuprofen after the vaccine, as Reiter and Douglas did.
While some people have been taking pain relievers before they get the shot (in an effort to prevent a reaction), that's not a good idea because some studies suggest that taking medicine to prevent vaccine-related symptoms may blunt the immune response to the vaccine, Schaffner says.

That's not something you want to risk.

https://www.aarp.org/health/conditions-treatments/info-2021/second-dose-vaccine-side-effects.html

https://www.aarp.org/health/conditions-treatments/info-2021/second-dose-vaccine-side-effects.html