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Aging for Amateurs: What to expect when you're expecting your 2nd COVID-19 vaccine

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COVID-19 shots might be tweaked if variants get worse (copy) (copy)

Empty vials of the Pfizer-BioNTech COVID-19 vaccine are seen at a vaccination center at the University of Nevada, Las Vegas. File/John Locher/AP

After my most recent column, a reader chided me for not talking about possible risks of transmission of the coronavirus even after having had the second vaccine dose. I was so busy talking about the likely next pandemic (antibiotic resistance) that I didn’t even mention that risk. Well, here’s a full column just about the second vaccine dose, what to expect after the shot itself, and what to do next after the second shot is in your arm.

If you had little or no reaction to the first dose, you were not alone. Less than one in 10 had a fever after the first dose, but after the second, nearly a third had a fever, some with shaking chills. Most had pain at the injection site after the first, widespread aches were more common after the second. In general, the older the patient, the less likely these symptoms were. Despite this fact, most authorities recommend against making any big plans for the day after your second vaccine dose.

An issue related to these aches and fever is what to do about them. You might be tempted to take a dose of a pain reliever prior to your shot to head off the discomfort. Don’t! The U.S. Centers for Disease Control and Prevention says that you shouldn’t unless you’ve been told to do so by your doctor. Pain relievers might decrease the effectiveness of the vaccine. If you need to treat severe symptoms with a dose or two of acetaminophen, or a non-steroidal anti-inflammatory drug like Motrin or Advil, that’s OK, but not before the injection.

Another mild and relatively rare problem is an itchy rash or “COVID arm,” developed three to 10 days after the shot, at the injection site. The CDC says this is likely a mild allergic reaction — that can be treated with an oral antihistamine like diphenhydramine (Benadryl) —that doesn’t indicate a risk for a more severe one with the second dose. The CDC does suggest having the second injection in the other arm.

Recent severe weather events have played havoc with getting vaccines to vaccination sites, causing supply issues and difficulties meeting needs for second shots when they are scheduled. The bottom line is, don’t get the second dose early, but don’t worry about getting it late — just be sure to get it. With currently available vaccines (Pfizer and Moderna), you need that second dose to develop the strongest immunity. Don’t “switch horses in the middle of the stream.” Stay with the same vaccine manufacturer if possible. Studies haven’t been done to prove that mixing vaccine types is either safe or effective.

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In general, avoid other vaccinations for at least two weeks after your COVID-19 vaccination. Mixing vaccines may interfere with the development of immunity to whatever diseases you are trying to prevent.

Remember that two-week interval after your second vaccine dose for another reason. It takes about two weeks for your body to develop full protection from the virus, perhaps even a little longer. After that time, your risk of developing severe disease if you are exposed to someone with COVID-19 is almost zero! The CDC says you don’t have to quarantine if you are exposed to someone with COVID-19, as long as you don’t have symptoms yourself and it hasn’t been more than three months since your second vaccine dose (because we don’t yet have data on how long immunity lasts but studies are continuing to find out).

Now, what about wearing the mask? And what about physical distancing? Even with the vaccine, there’s still a very small chance that you could get sick from the virus (they’re 90 percent to 95 percent effective), so wear the mask and keep your distance when you’re outside your bubble. In addition, if you do get what’s called a “breakthrough” infection, you might be able to transmit it to another person. So wear your mask and keep your distance.

Two very recent studies, both published just this month, shed light on the risk of transmission of COVID-19. The first found a direct correlation between COVID-19 viral load in the back of the nose and transmissibility of the virus. The higher the viral load, the greater the transmissibility of the virus. The second found that in people who became infected after only the first dose of the Pfizer vaccine, viral load in the nose was markedly diminished compared with unvaccinated people. That’s very encouraging to have lower viral load, even shortly after getting your first dose!

Dr. Anthony Fauci’s bottom line is mine, too: “When your turn to get vaccinated comes up, get vaccinated. It’s not only good for you and your family and community, it will have a very important impact on the dynamics of the outbreak in our country.”

Bert Keller and Bill Simpson write the occasional column, “Aging for Amateurs.” Simpson, a retired physician, wrote this installment. Comments, questions and suggestions are welcome at

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