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An illustration of three vaccine syringes laid on top of each other. On the top one are the words "1st Dose." On the middle one are the words "2nd Dose." On the bottom one are the words "3rd Dose."
Credit: Tatiana Ayazo

As Shelley Fritz pulled into the hospital parking lot on a rainy Saturday, she felt hopeful. The day before, after months of hearsay, the U.S. Centers for Disease Control and Prevention (CDC) finally recommended a third COVID-19 vaccine dose for immunocompromised people who had already received the two-dose mRNA COVID-19 vaccine series (Pfizer and Moderna). (As of now, the recommendation does not apply to people who received the Johnson & Johnson vaccine, though that may change.)

After the announcement, Shelley spent the next few hours searching her county’s website for any information on when the third dose would become available in her area. She lives in Kauai, Hawaii.

Finally, her husband came across a post on the county’s Facebook page that said the third dose was being offered the following morning at the local hospital on a first come, first serve basis.

“I felt like I better jump on this now and get it,” says Shelley, who has rheumatoid arthritis and fibromyalgia, noting that it took her months to schedule an appointment for her first vaccine dose. “The sooner that I could get this, the better I might feel about being out in the world.”

But there was a moment of pause: The day before the CDC made its recommendation, Shelley received an infusion of the biologic medication she takes to treat her rheumatoid arthritis — Inflectra, a biosimilar for infliximab (Remicade).

Immunosuppressive Medications and the COVID-19 Vaccine

Some medical organizations, like the American College of Rheumatology (ACR), recommend that people taking certain immunosuppressive medications temporarily stop or adjust the timing  of their treatment in order to help increase the effectiveness of the COVID-19 vaccine.

Inflectra, a TNF blocker, is not among the medications that the ACR recommends temporarily stopping.

However, it’s a good idea to speak to your doctor if you have any questions about your medications and the timing of when to get the COVID-19 vaccine.

Read more here about which medications you may want to temporarily stop before getting the vaccine.

Getting the Third Dose: What the Process Was Like

Shelley knew she wouldn’t be able to talk to rheumatologist until Monday and didn’t know when she’d be able to get a third dose again. She was slightly concerned about getting the third dose so soon after her infusion because she was already experiencing her usual post-infusion side effects — including aching joints and a headache — but she wanted to get the vaccine when it was readily available to her.

Despite lingering post-infusion side effects, Shelley made her way to the hospital that Saturday for her third COVID-19 vaccine dose. She thought the process would be similar to last time: Check in, get your shot, wait 15 minutes, leave. But when she saw the mile-long line of people, she knew it was going to be a “hot mess.”

“I was standing in the rain in a very long line outside the hospital doors,” Shelley recalls. “I didn’t feel great, but I didn’t have it as bad as others. There were people carrying oxygen tanks; people who I’d seen getting chemotherapy when I got my infusion. At one point, someone asked if I could save their spot so they could sit down and regain some energy.”

Finally — after two and a half hours — Shelley made it through the doors, one step closer to her extra dose; her extra layer of protection.

It would be another 30 minutes before she actually got the vaccine, and another 15 till she was able to leave. And when she left the hospital, Shelley didn’t feel any physical symptoms — just “enormous relief.”

“When I drove away, I started crying,” Shelley says. “I felt like I had some armor on. As time went by [after my first two vaccine doses], I felt I was becoming less protected. Now, I feel like I might stand a chance if I’m around people who aren’t masked or might have COVID.”

Navigating Side Effects After the Third Dose

When Shelley arrived home, she knew it was important to hydrate and rest. At that point, a few hours after her shot, she noticed a little soreness and swelling in her arm. Although she didn’t experience any arm pain the first time around, she knew it was a normal side effect, and went about her day. Eventually, she started to feel a little worse.

“As the night progressed, I just felt like I had the flu,” Shelley said. This flu-like feeling was quickly joined by a headache and pain in the spine, which she wasn’t expecting. “I really couldn’t tell if the side effects were from the vaccine, the infusion, or a combination of the two.”

Two days later, Shelley says she’s feeling better, though not at 100 percent. “I’m a bit achy and I still feel like I’m on fire, but my temperature is fine. I’m watching to make sure I don’t have any other weird symptoms.”

One thing that eased her concern was learning via social media that other people were experiencing similar side effects.

CreakyJoints Members on Getting the Third Vaccine Dose

CreakyJoints asked community members on Facebook, Twitter, and Instagram if they received their third COVID-19 vaccine dose over the weekend and, if so, what the experience was like. Many dealt with similar symptoms to Shelley, such as joint pain, fever, and headache.

Others said they were symptom-free after their third shot.

Here are some stories from CreakyJoints community members:

“I had the third shot on Saturday. With the first and second, I got a rash. [With] the third shot I ran a fever, had body aches, and got a terrible headache with nausea. I feel very hopeful that this response was so strong and am hopeful it is building some antibodies.” — Rebecca W.

“I got the third shot on Saturday, and I would say the reaction so far is a little worse than the first or second shots. I got Moderna and have the ‘COVID arm’ response, plus body aches for the first two days. My lymph nodes nearest the injection site are pretty painful, which didn’t happen at all with the first two. I’m also hoping it means that my body is mounting a successful (and long-lasting) response.” — Elizabeth P.

“After a year of frequent illnesses (not COVID) including a stint in the hospital on IV antibiotics, I was happy to hear of the third dose. I went to a local pharmacy Saturday to get mine. I had a slightly worse response this time but not bad. Just generally felt yucky and very tired.” — Krista K.

“Got it Saturday morning. I didn’t feel anything nor get sick from the first two shots. This one I didn’t feel well for about 48 hours. Saturday night was the worst. Sore joints, sore muscles, spine hurt. I couldn’t get comfortable. Today (Monday) I’m just tired. I’m so relieved though.” — Mary T.

“Got my third Pfizer injection on Saturday. As with the first two, the only side effect was a little injection site soreness. I don’t know if this is a good thing or a bad.” — Edna S.

“I had [third] Pfizer on Friday. Had sore arm, headache and felt tired. Pretty similar to how I felt after the second dose. Hoping I mount a good response.” — Kristen M.

“Made an appointment with my pharmacy. Got it Sunday, no problem and no wait. They know what medications I take so, no issues at all. Today my arm is sore but other than that nothing abnormal to report.” — Layne M.

“Not doing too great here. Chills, really hot, tummy issues, sore arm, and very sleepy. Doing what I can to endure. But I’d take side effects over the virus.” — Malia M.

“Just had my third shot yesterday. Had some fatigue for a few hours after. Slept good and woke up with a sore arm. Much better than my last two shots.” — Natalie G.

“I got mine Sunday afternoon. I woke up this morning with chills and a headache. Now I have a low-grade fever. Very similar to my second dose.” — Tricia

“I got my third Pfizer shot Friday. First shot was fine, second was sick for a week, third was fine the day of but the next day felt sick. Woke up today and feel fine.” — Alyzza D.

Continuing Precautions After the Third Dose

Remember that a third dose may help strengthen your immune response to the vaccine, but it’s still important to be cautious and minimize your risk and exposure to COVID-19.  The CDC still urges immunocompromised people to practice mitigation efforts, such as wearing a mask, maintaining social distance, and avoiding crowds and poorly ventilated indoor spaces, even after receiving their additional COVID-19 vaccine dose.

Additionally, per the CDC’s recent recommendations, if you are exposed to COVID-19, you should be tested three to five days after exposure and wear a mask in public indoor settings for 14 days or until they receive a negative test result.

For her part, Shelley says she will feel a little more comfortable going out in the world now that she has the third dose.

“I still have some concerns about getting COVID, but am not as concerned,” Shelley says, adding that she still plans to wear a mask in public, practice social distancing, and avoid those who are not taking precautions or are not vaccinated. “I know there are breakthrough cases happening, and I don’t want one of those. I just hope if I do get it, it would be a more mild case because I got the third dose.”

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COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases. American College of Rheumatology. May 24, 2021. https://www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf.

COVID-19 Vaccines for Moderately to Severely Immunocompromised People. U.S.Centers for Disease Control and Prevention. August 13, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html.

Interim Public Health Recommendations for Fully Vaccinated People. U.S. Centers for Disease Control and Prevention. July 28, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html.

Interview with Shelley Fitz, an immunocompromised patient with rheumatoid arthritis and fibromyalgia.

Stappenbeck T. Should You Be Worried About COVID Arm?. Cleveland Clinic. February 17, 2021. https://health.clevelandclinic.org/should-you-be-worried-about-covid-arm/.

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