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Most Common COVID Vaccine Side Effects in Older Adults

Some, but not all, report mild-to-moderate symptoms after the shot

Older man getting the COVID-19 vaccine

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En español | The majority of Americans 65 and older have been fully vaccinated against the coronavirus, but still nearly 20 percent have yet to get their first dose. Some plan to, some have no plans to and some are on the fence, according to the Kaiser Family Foundation (KFF) COVID-19 Vaccine Monitor project.

In fact, a significant share (24 percent) of adults ages 50-plus said in late March that they want to wait and see how the vaccines are working in others before they roll up their sleeves for the shot — and concern over potential side effects is a major reason for their delay, according to KFF's polling. A new AARP survey revealed a similar trend: It found that 59 percent of adults ages 50 and older who are somewhat or very unlikely to get a COVID-19 vaccine are concerned about the vaccine's side effects.

Experts say one way to help alleviate anxiety over vaccine side effects is to set expectations from the start. Here's what older adults can anticipate, based on the data collected so far.

Injection site pain, headache, fatigue are most common

Here's some good news: A key finding from clinical trial data and from the first few months of vaccine rollout is that older adults have fewer side effects from a COVID-19 vaccine compared to younger populations.

"If there's a little bit of a silver lining to this cloud, it's that we who have gray hair are less likely to experience these reactions,” says William Schaffner, an infectious disease expert and professor of preventive medicine and health policy at Vanderbilt University.

The likely reason has to do with a declining immune response that comes with age, experts say. However, a lack of reaction or a diminished one doesn't mean the body isn't building protection against COVID-19. Large-scale clinical trials and real-world data show that the three federally authorized vaccines — from Moderna, Pfizer-BioNTech and Johnson & Johnson (J&J) — are highly effective at preventing severe illness from a coronavirus infection across all age groups. “So these are very strong vaccines,” Schaffner says.

COVID-19 vaccine side effects by age

Data is for systemic reactions, collected from the clinical trials

For those who did have symptoms, pain at the injection site, fatigue, headache and muscle pain — the majority of which were mild to moderate — were the most common among older adults in clinical trials for the Moderna, Pfizer and J&J vaccines. Data collected by the Centers for Disease Control and Prevention's (CDC) v-safe surveillance system also lists these as the top symptoms experienced by people 65 and older who received the Moderna and Pfizer vaccines between Dec. 14, 2020, and Feb. 28, 2021.

Joint pain, fever, nausea and chills have also been reported among older adults after their shots. And CDC data collected during the first month of U.S. vaccinations found that dizziness was one of the most frequently noted symptoms, across all age groups.

Another key finding: The second shot tends to hit a little harder. Older adults reported more frequent and more intense side effects after their second dose of the Pfizer and Moderna vaccines, compared to the first dose. What's more, if you've already had COVID-19 “the inclination at the moment” is that you could feel stronger side effects from the vaccines, since your “immune system has been somewhat primed,” Schaffner says.

Side effects a result of ‘revved up’ immune system

Most common vaccine side effects in older adults

Data collected from the vaccine clinical trials

Side effects in adults 65+ after Moderna vaccine (second dose)

  1. Pain at injection site (83.4%)
  2. Fatigue (58.4%)
  3. Headache (46.4%)
  4. Muscle pain (46.9%)
  5. Joint pain (34.9%)
  6. Chills (30.6%)

Nausea/vomiting (11.8%) and fever (10.2%) were also reported.

Side effects in adults >55 after Pfizer-BioNTech vaccine (second dose)

  1. Pain at injection site (66.1%)
  2. Fatigue (50.5%)
  3. Headache (39.0%)
  4. Muscle pain (28.7%)
  5. Chills (22.7%)
  6. Joint pain (18.9%)

Fever (10.9%), diarrhea (8.3%) and vomiting (0.7%) were also reported.

Side effects in adults 60+ after Johnson & Johnson vaccine

  1. Pain at injection site (33.3%)
  2. Headache (30.4%)
  3. Fatigue (29.7%)
  4. Muscle pain (24.0%)
  5. Nausea (12.3%)
  6. Fever (3.1%)

Source: U.S. Centers for Disease Control and Prevention

However irritating and uncomfortable they may be, these short-lived side effects “are normal signs that your body is building protection,” the CDC says.

The headache, fatigue, aches and chills are a result of an inflammatory response that happens “as the immune system sends the soldiers in to encounter the vaccine and begin to respond to it,” Schaffner explains. So the systemic reactions “are already your immune system starting to rev up,” he adds.

Over-the-counter medications, such as ibuprofen, acetaminophen, aspirin or antihistamines can help with any post-vaccine pain or discomfort. The CDC says individuals can take these medications as long as there's no other medical reason that would prevent them from taking them normally, although it's always a good idea to check with your doctor.

Just be sure to wait until symptoms — if any — set in before you seek relief. Schaffner says there's some data that suggest taking a pain-relieving medication before your shot can weaken your immune response, so “out of an excess of caution” it's best to wait. And any irritation or discomfort in the arm where you got the shot can be eased with a clean, cool, wet washcloth, the CDC says.

Preparing for possible side effects

If you are prone to dizzy spells or have trouble with balance, go to your appointment with “someone who can hold your arm,” Schaffner says, referring to the CDC report that listed dizziness as a common side effect from the shots. Making sure you're well hydrated before your vaccine can also help offset any lightheadedness.

"And remember, one of the good things is you will be observed for at least 15 minutes afterward. So you'll be sitting down in an area just beyond where you were vaccinated, and you can compose yourself and relax,” he adds.

In most cases, vaccine-related side effects fade after a few days — typically one to three days after onset. However, if they linger or worry you, contact your doctor. The same goes if the redness or tenderness where you got the shot gets worse after 24 hours, the CDC advises.

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An important thing to keep in mind: In comparison to COVID, any side effects from the vaccines “are really very trivial,” Schaffner says. “It is a very modest price to pay if you do have some transient side effects, in order to protect ourselves against a virus that really could put any of us into the intensive care unit within 48 hours."

Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.