Medical Examiner

What You Need to Know About Allergic Reactions to the COVID-19 Vaccine

And all your other questions answered, too.

The Pfizer-BioNTech Covid-19 vaccination vial.
The Pfizer-BioNTech Covid-19 vaccination vial. Hugh Hastings/Getty Images

With one COVID-19 vaccine approved and distribution starting, we are all on the possible brink of getting access to the Pfizer COVID-19 vaccine. You probably have some questions about how everything is going to work, so we’re collecting answers as best we can. We’ll continue updating this page as more information becomes available. If you have a question you’d like answered, email us at tips@slate.com.

What’s going on with the side effects—and allergic reactions—I’ve been hearing about about?

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The first thing to know is that none of the side effects have been serious enough to override the benefits of this vaccine. And vaccines always have side effects. Headaches, chills, fatigue, and fever are pretty common in both Pfizer and Moderna’s formulations. “These reactions aren’t mild to people experiencing them, but they are expected, and pass quickly,” writes Maryn McKenna in Wired. McKenna explains that if we had more measured, accurate coverage and outreach explaining the expected mild side effects of this vaccine, we might be more prepared to take these stories in stride and not worry that the vaccines are doing something terrible to us, because they are not.

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So what about the more serious side effects? They’ve been rare—but also have passed without lasting incident, too. In Alaska, two health care workers developed allergic reactions after taking the vaccine that were so severe that they required hospital treatment, the New York Times reported Wednesday. Paul A. Offit, a member of the panel that makes recommendations about the vaccines to the Food and Drug Administration, pointed out that the reactions were caught by a protocol that suggests that people stay put for a bit after getting the shot, in case of something like this, and that these specific incidents should be further investigated. Which is all to say: It’s probably fine, but it’s also a good sign that we’re hearing about it. Transparency is key to vaccines being safe, though at the same time, as a lay person, it can feel worrying to hear about every single suspicious thing.

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It’s also worth remembering that this vaccine rollout is under a lot of scrutiny. It’s the most public vaccine rollout in history. That means we might end up hearing about fluke events, too.

Do we have two vaccines now?

Yes! The Pfizer vaccine was approved by the U.S. Food and Drug Administration on Dec. 11. On Dec. 18, the FDA granted an emergency use authorization for Moderna’s vaccine. Because Moderna’s vaccine does not need to be kept extremely cold, it will be easier to distribute, especially to rural place with small hospitals.

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Who got the first dose of an approved vaccine in the US.?

On Dec. 14, a nurse in New York became the first person in America to receive a dose of the Pfizer-BioNTech vaccine outside of a clinical trial. Hospitals around the country are currently vaccinating health care workers, and pop-up clinics at nursing homes are vaccinating residents.

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How will I know when it’s my turn to get the vaccine?

That’s still being worked out. It’s possible that you will receive messaging from your local government, or a message from your primary care doctor, when it’s time for you, specifically, to get the vaccine. (Or, let’s face it, you’ll see an Instagram post from someone in your demographic who got it, and you’ll know it’s time to ask.)

By now you’ve probably heard that the Centers for Disease Control and Prevention is recommending that most vulnerable people—like health care workers, the elderly, and people with risk factors—get access to COVID-19 vaccines first. Maybe you’ve “found your place in line” using the New York Times’ snazzy quiz thing. Getting the vaccine to those at the very front of the line will be somewhat straightforward, since distribution clinics can just be set up at those places, like hospitals and nursing homes. For the rest of us, the vaccine won’t come to our house or place of work. Instead, vaccine providers—meaning doctors or pharmacy workers—will need to submit a form saying that they’ll adhere to the order of groups laid out in order to get doses. It’s not yet clear how they’ll vet people to figure out the exact order.

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I get people in nursing homes and ER doctors going first. But how are they deciding the order of the line otherwise?

The CDC is still hashing out who to recommend in each stage of the rollout. The biggest ethical quandary right now is how to prioritize elderly people versus people deemed “essential workers.” The elderly are at higher risk of dying from the virus, but essential workers stand to spread it to more people, so who to put first “depends on what impact you’re trying to achieve,” former FDA Administration Scott Gottlieb said on Face the Nation.* Ultimately, it will be up to states, which have their own rubrics of how to prioritize different groups of people, and then to the clinics that give them out on how to enforce those, and to what extent.

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Are rich people going to be able to skip the line?

They’re sure trying. Based on the fact that there’s going to be some provider discretion in how strictly to enforce the vaccine line rules, and also the fact that even when it’s formally your turn there might be a scramble to get an appointment … it’s safe to say that billionaires will probably find a way to get vaccinated before their technical turn.

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Where will I get the vaccine?

Probably just a drug store or your doctor’s office. The CEO of CVS told Today that you’ll be able to book a vaccine appointment in the pharmacy’s app. “I don’t foresee there being long lines,” a Walgreens executive told CBS This Morning. “A lot of details are still being worked out.” Optimistic!

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Which vaccine should I get?

Whichever one you are offered. But if you could choose, yes, we have somewhat nonscientific opinions on that.

How do we know the vaccine is safe, given how quickly it’s been developed and tested?

One of the main reasons for the speed is because scientists were able to do the work that comes before testing a vaccine much, much faster than usual. They sequenced and shared the genome soon after the novel coronavirus was discovered. Then, there were people clamoring to participate in the trials. Another reason the rollout is happening so fast is because companies had vaccines manufactured and ready to go basically the second they had enough safety and efficacy data. That’s a big financial bet they were able to take because of all the money available to work on this.

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But in terms of safety specifically—it’s true that clinical trials have been relatively short compared with other vaccines’ testing. Researchers feel confident in the safety of the product partly because the mechanism they’re using to deliver the vaccine just doesn’t have very much in it that could cause issues. Also, this is a unique situation, because the cost of not having a vaccine has been so high, so it’s changed the calculus a little bit (technically the vaccine is not “approved” it is “authorized for emergency use”). But overall, early data suggest that the vaccine is very safe. Moreover, the U.K. approved the vaccine first, so we know the vaccine approval isn’t, say, a political move by a deranged president. While it’s understandable to be a little hesitant, so far everything seems to be going just fine.

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What politicians have gotten the vaccine?

Lots. A partial list: Mike Pence (and Mother) got the vaccine Friday morning, on live TV. Mitch McConnell and Nancy Pelosi got doses shortly after, as did Alexandria Ocasio-Cortez, who, obviously, did an informative Instagram story about the experience. Bernie Sanders and Elizabeth Warren got it this weekend. Joe Biden is scheduled to get it Monday. (Update, December 21st, 3:51 p.m.: He got it!).

Yes, they’re cutting the line, sort of. Take Biden, for example—according to the New York Times’ tool, a 78-year-old man from New Castle County, Delaware, with no risk factors for COVID, would be 118.5 millionth in line for the vaccine, even if he’s considered an essential worker.

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Why? “Continuity of government.” It’s a matter of national security that the people running the country don’t get sick, if possible. It’s also a public health move—getting the vaccine on camera helps ensure everyone else feels safe getting it, too.

What about Donald Trump?

He does not seem to have an appointment, yet, though he’s said he’ll get it at some point. Given that Trump has already had the virus, the necessity of him getting the vaccine is less urgent—he likely still has some immunity—but from a public health messaging standpoint, it probably makes sense for him to get the shot too.

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It seems unfair that members of the Trump White House have access first.

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Well, yes, it does not make a ton of sense justice-wise for a group of people in power who have flouted mask rules and held a superspreader event to get priority for the vaccine. But consider that it’s really, really good that the vaccine is not becoming a polarized, political thing, à la masks or basic social distancing measures.

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If I have already had COVID-19, should I get the vaccine?

The CDC’s official position is that the organization “cannot comment.” Reinfection from COVID-19 appears exceedingly rare, and there have not been many reported cases. However, that “may mean that either it is rare or it is rarely detected,” as virologist Angela Rasmussen has written in Slate. If we already had enough vaccines for everyone, it might be a no-brainer to get the COVID-19 vaccine, just in case, if you’ve already had COVID-19. Since there’s a limited supply, that makes the calculus a little tricker. But like all the aspects of who will get the vaccine when, this one’s a little murky: Some health officials are recommending that people who have already had COVID just go ahead and get the vaccine. This is a long answer to say: Yes, you still should get the vaccine, at some point.

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Why do you need two doses of the vaccine?

It’s not uncommon for immunizations to involve two jabs. “More than one dose means more opportunities for the immune system to figure out exactly how to counter a future infection,” explains Kait Sanchez in the Verge. You might still be somewhat protected after the first dose—that’s the case with Pfizer’s vaccine, data show. And while there’s a recommended number of days between doses (21, in the case of Pfizer’s), the exact timing of the second dose is something of an art. So you probably won’t have to worry about squeezing vaccinations into your calendar too precisely.

What will you be able to do once you are fully vaccinated?

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Not as much as you’d hope. The vaccines are good at preventing disease, but it is unclear how good they are at preventing infections. It’s possible that you could get the vaccine and be an asymptomatic carrier of the virus. “If vaccinated people are silent spreaders of the virus, they may keep it circulating in their communities,” writes Apoorva Mandavilli in the New York Times; the piece is headlined “Here’s Why Vaccinated People Still Need to Wear a Mask.” In the Atlantic, Sarah Zhang refers to the period we’re about to enter, where some people are vaccinated but many are not, as a “vaccine purgatory.”

We suggest looking at the delightful coverage of 90-year-old British people getting the vaccine.

Correction, Dec. 21, 2020: This post originally misspelled Scott Gottlieb’s last name.

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