Booster Doses: Frequently Asked Questions

Eligibility

Why do I need a booster dose?

"Booster doses" will provide a boost in the fight against COVID-19 so New Yorkers have continued protection against the virus. That's why New York State encourages all eligible New Yorkers to get their booster dose.

Our federal health and medical experts have been analyzing the scientific data closely from New York, the United States and around the world to understand how long the vaccine's protection will last and how we might maximize this protection. Although COVID-19 vaccines remain highly effective in preventing severe disease and hospitalization, the available data suggest that protection of authorized and approved COVID-19 vaccines against COVID-19 infection begins to decrease over time. A booster dose will help eligible New Yorkers maximize their protection, prolong the vaccine's durability and continue to safeguard our communities against the virus.

 

Am I eligible for a booster dose?

The following groups of New Yorkers are currently eligible for their booster dose:

  • New Yorkers ages 5 to 17 are only eligible for a Pfizer-BioNTech booster dose at least 5 months after completing their primary series;

  • New Yorkers 18 years and older who completed the Moderna initial vaccine series at least five months ago;
  • New Yorkers 18 years and older who are at least two months past the single-dose Janssen/Johnson & Johnson vaccine.

For New Yorkers 18 and older, Pfizer-BioNTech or Moderna (COVID-19 mRNA vaccines) are preferred. You may get Johnson & Johnson's Janssen COVID-19 vaccine in some situations.

For New Yorkers who are moderately to severely immunocompromised, see the questions below related to the recommendations for you.


Am I eligible for a second booster dose?

The following groups of New Yorkers are currently eligible for their second booster dose:

  • New Yorkers 12 years and older who are moderately – severely immunocompromised and completed their first booster dose at least four months ago;
  • New Yorkers 18 years and older who received Janssen (Johnson & Johnson) as both their primary (first dose) and first booster vaccine at least four months ago;
  • New Yorkers 50 years and older who are at least four months past their first booster vaccine.

New Yorkers 5 – 17 can only receive the Pfizer-BioNTech vaccine booster.

For New Yorkers 18 and older, Pfizer-BioNTech or Moderna (COVID-19 mRNA vaccines) are available for your second booster, if eligible.

For more Information on deciding about a second booster, visit the CDC website or talk to your healthcare provider.


If we need a booster dose, does that mean that the vaccines aren't working?

No. COVID-19 vaccines are working very well to prevent severe illness, hospitalization, and death, even against widely circulating variants. That's why CDC and NYSDOH encourage all eligible New Yorkers to get their booster dose.

It is normal for a vaccine's protection to wane over time, and a booster dose will help maximize New Yorkers' protection, prolong the vaccine's durability, and keep eligible New Yorkers healthy and safe.

 

Should I receive the same vaccine type I received for my initial vaccine series, or can I receive a different vaccine type ("mix and match")? In other words, can I decide which booster dose to get?

New Yorkers 5 – 17 can only receive the Pfizer-BioNTech vaccine booster.

For New Yorkers 18 and older, Pfizer-BioNTech or Moderna (COVID-19 mRNA vaccines) are preferred. You may get Johnson & Johnson's Janssen COVID-19 vaccine in some situations.

For New Yorkers eligible for a second booster dose, only Pfizer-BioNTech or Moderna (COVID-19 mRNA vaccines) are available.


If I already had COVID, should I still get my booster dose?

Yes, you should be vaccinated regardless of whether you already had COVID-19 because:

  • Research has not yet shown how long you are protected from getting COVID-19 again after you recover from COVID-19.
  • Vaccination helps protect you even if you've already had COVID-19.
  • If you were treated for COVID-19 with monoclonal antibodies or convalescent plasma, you no longer need to wait 90 days before getting a COVID-19 vaccine. If you are receiving Evushield, you should delay your next dose of treatment for 2 weeks after your vaccination. Talk to your primary health care provider if you are unsure what treatments you received or if you have more questions about getting a COVID-19 vaccine.
  • People who previously received antibody products (anti-SARS-CoV-2 monoclonal antibodies or convalescent plasma) as part of COVID-19 treatment, post-exposure prophylaxis, or pre-exposure prophylaxis can be vaccinated at any time; COVID-19 vaccination does not need to be delayed following receipt of monoclonal antibodies or convalescent plasma. For people who previously received a COVID-19 vaccine, administration of tixagevimab/cilgavimab (EVUSHELD™) for pre-exposure prophylaxis should be deferred for at least two weeks after vaccination. 
  • Individuals who have recently recovered from COVID-19 in the last 3 months (90 days) may wish to delay booster vaccination until 3 months after their positive test result.


What is the guidance for New Yorker’s who are moderately – severely immunocompromised?

New Yorkers who are 12 years of age or older and are moderately or severely immunocompromised may now receive 5 doses total (a primary series of 3 doses, plus 2 booster doses). New Yorkers who are moderately or severely immunocompromised—and who received a single Janssen (Johnson & Johnson) COVID-19 vaccine primary series—are able to receive a total of 4 vaccine doses: 1 Janssen (Johnson& Johnson) dose, 1 additional mRNA dose, and 2 booster doses.

New Yorkers who are 5 years of age to 11 years of age and are moderately or severely Immunocompromised may receive 4 doses total (a primary series of 3 doses, plus 1 booster dose).

In rare instances, a healthcare provider may recommend some individuals to repeat one or more doses of COVID-19 vaccines, and therefore an individual may have received more doses than identified above. It is always best to confirm with your designated health care team for what doses are most appropriate for you.


Can I get a booster and flu shot at same time?

Yes. You may receive a COVID-19 vaccine and other vaccines without regard to timing. This includes simultaneous administration of a COVID-19 vaccine and other vaccines (including vaccines such as the measles-mumps-rubella [MMR] vaccine) on the same day, as well as coadministration at any time interval.

 

Can I get a booster dose (first booster, or second booster) before I am eligible?

No. Individuals should only receive their booster dose (first booster, or second booster) if they are eligible.

Side Effects, Safety and Efficacy

What are the side effects of the booster dose (first booster, or second booster)?

Just like your COVID-19 initial vaccine series, you may not notice any changes in how you feel after your booster dose(s). But it's also possible to feel a little "under the weather." This can happen after any vaccine.

After the COVID-19 booster dose(s), you may have:

  • A sore arm where you got the shot
  • A headache
  • Chills
  • Fever
  • Tiredness
  • Nausea and vomiting

These side effects are not dangerous and are just a sign of your immune system doing its job. They are easily treatable with over-the-counter pain medicine and fever reducers, and usually only last for a short period of time. Serious or long-lasting side effects are extremely rare. If you still don't feel well after two or three days, contact your health care provider.

 

Are COVID-19 booster doses safe?

Yes. The booster doses are safe, effective.

 

Are there other non-COVID-19 vaccines that require more than two doses?

Yes, this is common. Many vaccines require more than one or two doses for long-lasting protection. For example, the life-saving polio vaccine requires four doses; the hepatitis vaccine requires three doses.

Other vaccines require occasional "boosts" like the tetanus-diphtheria (tetanus) vaccine, given to individuals every ten years. There are other vaccines that need to be administered even more often. For example, the influenza (flu) vaccine is recommended for individuals each year because of new strains emerging every season.
 

Can people who received Johnson & Johnson's Janssen (J&J/Janssen) COVID-19 Vaccine get a booster dose of an mRNA vaccine?

Eligible New Yorkers can receive any of the FDA-approved or authorized COVID-19 vaccines for their booster dose, including Pfizer-BioNTech, Moderna, or Janssen/Johnson & Johnson.  However, Pfizer-BioNTech and Moderna vaccines are preferred for booster doses. If you have questions, talk to your primary health care provider or vaccine administrator.


Can people who received Johnson & Johnson's Janssen (J&J/Janssen) COVID-19 Vaccine for their first booster dose receive a second booster dose?

New Yorkers who are eligible for their second booster can receive either Pfizer-BioNTech or Moderna for their second booster dose. If you have questions, talk to your primary health care provider or vaccine administrator.


How do I know if I should consider another COVID-19 vaccine type for my booster dose?

Eligible New Yorkers can receive any of the FDA-approved or authorized COVID-19 vaccines for their booster dose, including Pfizer-BioNTech, Moderna, or Janssen/Johnson & Johnson, although the Pfizer-BioNTech and Moderna vaccines are preferred for booster doses. The Janssen/Johnson and Johnson vaccine should be used in only limited situations and cannot be used for a second booster.  If you have questions, talk to your primary health care provider or vaccine administrator.

Cases of myocarditis related to Pfizer-BioNTech and Moderna's mRNA vaccines (mostly in young men), and cases of GBS (mostly in middle aged adults) and thrombosis with thrombocytopenia (mostly in young women) related to the Janssen/Johnson & Johnson vaccine continue to remain very rare.

If you have questions, talk to your primary health care provider or vaccine administrator.

 

What's the difference between a "booster dose" and an "additional dose" and a "second booster"?

An "additional dose" refers to another dose of vaccine that is given to someone who is immunocompromised and who may not have built enough protection after their initial COVID-19 vaccine series.

A "booster dose" refers to another dose of vaccine that is given to someone who built enough protection after vaccination, but then that protection decreased over time.

A “second booster dose” refers to another dose of vaccine for eligible New Yorker’s who have completed both their initial vaccine series and booster dose. These individuals have built up protection after vaccination, but may need more protection over time.

For Immunocompromised New Yorkers

If I am immunocompromised, am I eligible for my additional dose of the COVID-19 vaccine?

Moderately to severely immunocompromised people should receive an additional dose of the COVID-19 vaccine and a booster when eligible. People with moderately to severely compromised immune systems are especially vulnerable to COVID-19 and may not build the same level of immunity to the vaccine series compared to people who are not immunocompromised. This additional dose is intended to improve immunocompromised people's response to their initial vaccine series. Individuals who are moderately to severely immunocompromised and have received their additional dose and booster dose are also eligible for a second booster four months after their booster dose.

 

What qualifies a New Yorker as moderately or severely immunocompromised?

According to the CDC, having a weakened immune system can make you more likely to get severely ill from COVID-19. Many conditions and treatments can cause a person to be immunocompromised or have a weakened immune system. Primary immunodeficiency is caused by genetic defects that can be inherited. Prolonged use of corticosteroids or other immune weakening medicines can lead to secondary or acquired immunodeficiency.

These conditions and treatments include but are not limited to:

  • Active treatment for solid tumor and hematologic malignancies
  • Receipt of solid-organ transplant and taking immunosuppressive therapy
  • Receipt of CAR-T-cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
  • Moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Advanced or untreated HIV infection
  • Active treatment with high-dose corticosteroids (i.e., ≥20mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory.

Factors to consider in assessing the general level of immune competence in a patient include disease severity, duration, clinical stability, complications, comorbidities, and any potentially immunosuppressing treatment.

People should talk to their healthcare provider about their medical condition, and whether getting an additional dose is appropriate for them.

 

When should I receive my additional dose (third dose) of the COVID-19 vaccine?

New Yorkers with moderately to severely compromised immune systems who have completed either 2 doses of Pfizer BioNtech; 2 doses of Moderna; or 1 dose of Janssen can receive an additional dose at least 28 days after their final dose of their vaccine series. Pfizer-BioNTech or Moderna vaccine should be used for the additional dose. Children 5-17 years of age can only receive Pfizer-BioNTech vaccine.

Immunocompromised individuals should confer with their physicians regarding the appropriateness and timing for receiving an additional dose of COVID-19 vaccine. The New York State Department of Health also encourages physicians to proactively reach out to their immunocompromised patients to discuss the benefits of receiving an additional dose.

 

When should I receive my booster dose of the COVID-19 vaccine?

A booster dose of an FDA-approved or FDA-authorized COVID-19 vaccine is recommended for moderately to severely immunocompromised New Yorkers 5 and older who:

  • Received 3 doses of an mRNA vaccine as their primary series. A single booster dose should be administered 3 months after the third dose for a total of 4 doses.
  • Received a dose of Janssen COVID-19 vaccine followed by an mRNA COVID-19 vaccine (Pfizer or Moderna. A single booster dose should be administered 2 months after the second dose for a total of 3 doses of COVID-19 vaccine.

Pfizer COVID-19 vaccine is the only COVID-19 vaccine currently FDA-authorized for use in person 5-17 years old.


When should I receive my second booster dose of the COVID-19 vaccine?

A second booster dose of an FDA-approved or FDA-authorized mRNA COVID-19 vaccine (Pfizer BioNtech or Moderna) is recommended for moderately to severely immunocompromised New Yorkers 12 and older who:

  • Received 3 doses of an mRNA vaccine as their primary series and a single booster dose, can receive a second booster dose four months after their first booster dose.
  • Received a dose of Janssen COVID-19 vaccine followed by an mRNA COVID-19 vaccine (Pfizer or Moderna) and a single booster dose, can receive a second booster dose four months after their first booster dose.

Pfizer COVID-19 vaccine is the only COVID-19 vaccine currently FDA-authorized for use in person 5-17 years old.


What about children?

Children 5 – 11 who are at least 28 days past their initial Pfizer-BioNTech series may receive an additional (third) dose of the Pfizer-BioNTech vaccine. They may also receive a booster dose 3 months after their additional (third) dose.

 

What immunocompromising conditions currently qualify children 5 – 11-years-old to be eligible for an additional dose of the COVID-19 vaccine?

Children 5-11-years-old with certain immunocompromising conditions who received their Pfizer-BioNTech initial vaccine series at least 28 days ago are eligible for an additional dose of the Pfizer-BioNTech vaccine.

Consistent with CDC's guidance, this includes moderately or severely immunocompromised due to a medical condition or receipt of immunosuppressive medications or treatments. Specifically, immunocompromising conditions may include:

  • Been receiving active cancer treatment for tumors or cancers of the blood
  • Received an organ transplant and are taking medicine to suppress the immune system
  • Received a stem cell transplant within the last 2 years or are taking medicine to suppress the immune system
  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Advanced or untreated HIV infection
  • Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response

Because of the risk of COVID-19 infection in this population, immunocompromised people should continue to be counseled regarding the potential for a reduced immune response after vaccination and the importance of additional protective measures, regardless of the decision to receive an additional dose of the COVID-19 vaccine. Prevention measures include wearing a well-fitting mask, staying six feet apart from others they don't live with, and avoiding crowds and poorly ventilated indoor spaces until advised otherwise by their healthcare provider particularly in areas of increased transmission. Close contacts of immunocompromised people should be strongly encouraged to be vaccinated against COVID-19.

Parents or guardians with questions are encouraged to consult with their child's health care provider.

 

Why do immunocompromised individuals need an additional or booster dose of the vaccine?

According to the CDC, people who are moderately to severely immunocompromised make up about 3 percent of the adult population and are especially vulnerable to COVID-19 because they are more at risk of serious, prolonged illness.

Studies indicate some immunocompromised people don't always build the same level of immunity after vaccination the way non-immunocompromised people do and may benefit from an additional dose to ensure adequate protection against COVID-19. In small studies,  immunocompromised people who completed their primary vaccine series have accounted for a large proportion of hospitalized "breakthrough cases," and were more likely to transmit the virus to household contacts.

 

Can you mix and match the vaccines for my additional dose? For example, if I received the Pfizer-BioNTech for my initial vaccine series, can I receive Moderna's COVID-19 vaccine for my additional dose?

For people who received either Pfizer-BioNTech or Moderna's COVID-19 vaccine series, a third dose of the same mRNA vaccine should be used. If the mRNA vaccine product given for the first two doses is not available or is unknown, either mRNA COVID-19 vaccine product may be administered. For people who received Janssen’s COVID-19 vaccine series, an additional dose of an mRNA vaccine (Pfizer or Moderna) should be used.  The mRNA vaccines are preferentially recommended in most situations over the Janssen COVID-19 Vaccine.

Additional-dose eligible children 5 – 17 can only receive an additional dose of the Pfizer-BioNTech vaccine.

 

What are the risks of vaccinating individuals with an additional dose?

There is limited information about the risks of receiving an additional dose of vaccine, and the safety, efficacy, and benefit of additional doses of COVID-19 vaccine in immunocompromised people continues to be evaluated. So far, reactions reported after the additional dose were similar to that of the two-dose series: fatigue and pain at injection site were the most commonly reported side effects, and overall, most symptoms were mild to moderate.

However, as with any COVID-19 series, serious side effects are rare, but may occur.

Proof of Booster and Additional Dose

How should I expect to receive proof of my COVID-19 booster dose and/or my additional dose?

You should expect to receive proof of your booster dose on your original CDC COVID-19 vaccination card. If you lost your original vaccination card, please reach out to your health care provider to obtain a copy of your immunization record. New York State does not replace lost vaccination cards because they are issued through the CDC.

Additionally, New Yorkers who received their booster or additional dose at least 3 – 4 days ago can also retrieve their Excelsior Vaccination Pass Plus, which will have their booster or additional dose information included. As a secure, digital copy of an individual's COVID-19 vaccination record, your Excelsior Vaccination Pass Plus does not expire. Learn more: epass.ny.gov.

 

Do I need my COVID-19 booster and/or my additional dose to be considered "fully vaccinated"?

No. At this time, New Yorkers are still considered fully vaccinated two weeks after they complete their initial vaccine series – either two weeks after their second dose in a two-shot series such as the Pfizer-BioNTech or Moderna vaccines, or two weeks after a single-dose vaccine, such as the J&J/Janssen vaccine. However, we continue to urge New Yorkers to get fully vaccinated and to stay up to date with all recommended vaccine doses.

For more information visit the CDC HERE

Information for Healthcare Workers: COVID-19 New Booster Dose Requirement