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 12 years and older who completed the Pfizer-BioNTech initial vaccine series at least five months ago;
  • 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.

New Yorkers 12 – 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.

 

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 12 – 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.

 

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.
  • Evidence is emerging that people get better protection by being fully vaccinated compared with having had COVID-19. One study showed that unvaccinated people who already had COVID-19 are more than 2 times as likely than fully vaccinated people to get COVID-19 again.
  • If you were treated for COVID-19 with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine. 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.

 

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 before I am eligible?

No. Individuals should only receive their booster dose if they are eligible.

 

What proof of eligibility is required for New Yorkers who are currently eligible based on their health conditions or employment status?

In order to prove eligibility, eligible New Yorkers are required provide written self-attestation confirming eligibility, which providers must collect. At this time, providers administering the COVID-19 booster dose will not be required to confirm eligibility in order to enable speedy administration and lower barriers to access for patients.

Side Effects, Safety and Efficacy

What are the side effects of the booster dose?

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

After the COVID-19 booster dose, 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, and free for eligible New Yorkers.

 

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.

 

How long do we expect booster doses to protect us, and will I need another?

It is not fully clear at this time, which is why our federal and State health and medical experts have been, and continue to, monitor and analyze the scientific data closely from the United States and around the world. This enables us to analyze data as the virus evolves and continue to understand how long this protection will last, and how we might maximize this protection. We will continue to follow the science and communicate openly with New Yorkers as additional data becomes available.

 

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

Although 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, this information can be considered when determining your booster dose.

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"?

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.

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 third dose of the COVID-19 vaccine and a booster—or fourth dose—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 two-dose vaccine series compared to people who are not immunocompromised. This additional dose intended to improve immunocompromised people's response to their initial vaccine series.

 

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 can receive an additional third dose (5 and older for Pfizer-BioNTech recipients; 18 and older for Moderna recipients) at least 28 days after a second dose of the Pfizer-BioNTech COVID-19 vaccine or Moderna COVID-19 vaccines.

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 (fourth dose) of the COVID-19 vaccine?

A booster dose (fourth dose) of an mRNA COVID-19 vaccine is recommended for moderately to severely immunocompromised New Yorkers (12 and older for Pfizer-BioNTech recipients; 18 and older for Moderna recipients) five months following their additional dose (third dose) of an mRNA COVID-19 vaccine (Pfizer-BioNTech or Moderna).

 

What about children?

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

 

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, fully vaccinated immunocompromised people 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.

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

 

What should immunocompromised people who received the J&J/Janssen vaccine do?

The FDA's recent EUA amendment only applies to mRNA COVID-19 vaccines, as does CDC's recommendation. However, please note that all individuals who are 18 years and older and received the Janssen/Johnson & Johnson vaccine at least two months ago are eligible and encouraged to receive their COVID-19 booster dose, especially if you are immunocompromised.

 

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 third mRNA 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 the two-dose 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" for proof of business and venue entry, where applicable?

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.