COVID booster vaccine

Do I qualify?

The U.S. Food and Drug Administration has authorized a third dose of COVID-19 vaccines by Pfizer and Moderna Inc for people with a moderate to severely compromised immune systems. This category includes people with:

– Chronic renal disease (GFR less than 60mL/min)

– Solid tumor and hematologic malignancies

– Recipients of solid organ or hematopoietic stem cell transplant

– Severe primary immunodeficiencies (


– Large doses of immunosuppressive medications such as cancer chemotherapeutic agents, TNF blockers, dialysis, biologic agents (rituximab) or high doses of corticosteroids

Does everyone with FD, PD or MSA qualify right now?

No, this is dependent on your renal function and level of immunosuppression. The Dysautonomia Center recommends for the COVID-19 vaccine and booster to be completed as soon as it is available for you. At this time, if you are fully vaccinated and do not have the conditions listed above, you do not need an additional vaccine booster dose at this time.

How can I have my antibody levels checked?

People in these categories may have lower antibody levels due to medications or treatments which interact with the vaccine. Emerging data suggest that an additional COVID-19 vaccine dose in immunocompromised people enhances antibody response and increases the proportion of those who respond. Your degree of immunity is not completely predicted by antibody levels, as there are other components of immunity that you could still have, even when antibody levels are low, including T cells and memory B cells.

But if you are a patient at the Dysautonomia Center and would like to have your antibody levels checked, please email us at with your name, date of birth, and your lab of choice (NYU, Labcorp, or Quest).

When is the best time to get the booster shot?

The Pfizer-BioNTech COVID-19 Vaccine is currently authorized for emergency use in individuals ages 12 and older, and the Moderna COVID-19 Vaccine is authorized for emergency use in individuals ages 18 and older. Both vaccines are administered as a series of two shots: the Pfizer-BioNTech COVID-19 Vaccine is administered three weeks apart, and the Moderna COVID-19 Vaccine is administered one month apart. The authorizations for these vaccines have been amended to allow for an additional, or third, dose to be administered at least 28 days following the a two-dose regimen of the same vaccine to individuals 18 years of age or older (ages 12 or older for Pfizer-BioNTech).

How will I respond to the booster vaccine?

We are anticipating patients to have similar responses to the booster as the second dose of the vaccine.

Anticipating “flu-like symptoms” from the vaccine is very normal and commonly occurs from any vaccine. Those symptoms, which sometimes include fever, malaise, chills, body aches, or local site pain at the injection site, are all signs of our own bodies mounting good immune responses. So while that’s a good sign, we understand it can be very uncomfortable to most, and in FD may trigger an autonomic crisis.

Special Guidance for FD

For this reason, we have been recommending to everyone with FD for the second and third dose of the vaccine the following guidance that will help reduce all of those symptoms and therefore prevent an autonomic crisis.

The evening following the vaccination, we recommend starting taking ibuprofen around the clock (or acetaminophen if you have kidney or renal disease) and continue this for 2-3 days. To do this, we recommend taking the weight-appropriate dose (check the label of whichever medication you have) every 6 hours, including during periods of sleep. We recommend including periods of sleep, especially that first night following the dose because some people with FD have awakened with a fever and had autonomic crisis immediately from this. Likewise, some people have only wanted to take ibuprofen or acetaminophen once they measured or felt fever or otherwise felt bad, and in these cases, autonomic crises may have already started along with those other symptoms. But so far, everyone who has followed this advice and taken their antipyretic (antifever) medication every 4-6 hours, they have felt fine and had no issues with increased autonomic crisis.

How do I help protect my family member with FD, PD or MSA?

Close contacts and household members should get vaccinated to provide increased protection to their loved ones. People should continue to wear a mask, stay 6 feet apart from others they don’t live with, and avoid crowds and poorly ventilated indoor spaces.

Where can I get the booster dose?

New York State vaccinations sites are providing the 3rd dose for people who are immunocompromised on a walk-in basis. No proof of immunocompromise or medical letter is required. Please bring your COVID-19 vaccination card with you.

You can check with your local pharmacy if they are distributing COVID-19 booster doses. NYU Langone Health is not yet offering them, and we cannot order them here or outside pharmacies. The will likely be very similar to the first round of vaccines, being offered to people with certain conditions in stages.

If you have any further questions not answered here, please contact us.

The Dysautonomia Center