It's Okay to Mix and Match!

COVID-19 vaccine booster shots, who is eligible and what kind to get?

Yesterday I posted on Instagram about getting my COVID-19 vaccine booster and there were so many questions. Can you mix and match? Who should get boosted? Do you need to be a triple threat, or is double plenty awesome? So I thought it worthy of a post.

I am happy to say the FDA is embracing the plaids plus polka dots approach! I love mixing prints, I need to do it more often. There is no clashing, just enhancing. Just like the vaccines!

First off, who is eligible for a booster?

  • Anyone 65 years and older

  • Anyone age 18+ who lives in a long-term care setting

  • Anyone age 18+ with underlying medical conditions. Click here for a list from the CDC that reviews who is high risk. 

  • Anyone age 18+ who works in a high-risk setting. This includes healthcare workers, firefighters, police, staff in groups homes, education staff, food and agriculture workers, corrections workers, postal service workers, public transit workers, and grocery store workers. 

  • Anyone ages 18+ who lives in high-risk settings. This includes correctional facilities and being homeless.  

People who should get a booster are those who are more likely to be exposed to COVID-19 and/or if exposed more likely to get seriously ill from COVID-19. 

Recommending booster shots DOES NOT MEAN (I am speaking loudly here) that your one dose of Johnson & Johnson or two doses of Moderna or Pfizer-BioNTech aren’t good enough. I am a healthy 55 year old and if I didn’t work in a health care setting, I wouldn’t have chosen to get a booster.


How good are the vaccines? So glad you asked! Unvaccinated people are 11 times more likely to die from COVID-19 than those who are vaccinated.  

Here are great graphics from the CDC that show you exactly how effective the vaccines are:

This first one is cases of COVID-19 by vaccination status. 

And this next one is deaths from COVID-19 by vaccination status:

Think of vaccines like safety devices in a car. For those of us who drive on the highway, on country roads, and in cities, seatbelts and airbags are enough. However, if you are driving a race car on a race track at high speeds, then your car should be equipped with additional crash protection because you are at higher risk of crashing and have a greater risk of injury or death should you crash.

If you are eligible, WHEN can you get a booster?

If you received the Johnson & Johnson vaccine, you can get a booster two months or more after your initial vaccination. 

If you received the Moderna or Pfizer-BioNTech (the mRNA vaccines) you can get a booster six months or more after your initial vaccination series was completed. 

What booster should you get?

What is available and you feel comfortable getting! 

If you started in house Pfizer-BioNTech you don’t have to stay in that house for life. This isn’t Game of Thrones or Harry Potter. Some researchers have wondered if switching vaccines for the booster may induce an even more robust immune response, but we don’t know. I have received 3 doses of Pfizer.

The Johnson & Johnson vaccine has a small risk of blood clots for young women. The risk is 15.1 cases per million after dose 1 and 1.9 cases per million after a second dose. That is still very low, but you can eliminate the risk altogether with an mRNA vaccine booster. Then again, if there is a reason you can’t get an MRNA vaccine booster the risk of a blood clot is very, very rare.

The risk of myocarditis (inflammation of the heart) is very low after the mRNA vaccines. Here are some graphics that put the risk of myocarditis from the vaccine and hospitalizations from COVID-19 in perspective. The risk is highest in young men, but even then the risk is very low.


From Circulation. Myocarditis With COVID-19 mRNA Vaccines. 144: 6.

If you are eligible for a booster, get one. 

If you are not, don’t panic. You are very well protected. As we get more data, recommendations about who needs a booster may change. Understand that doesn’t reflect uncertainty, it is just the meandering path of science. 

Think of the changing science like a change in flight plans. It is was sunny and clear skies when you took off, so your pilot started with one flight plan. If unpredictable weather whips up and your pilot changes routes to avoid flying into a tropical storm you are happy, because with this new information adjustments can be made so you are safer. We all makes changes every day based on new information, it’s just somehow with COVID-19 that has been erroneously linked with originally being wrong. But you would never (hopefully) think that your pilot with one flight plan with clear skies who now switches to a safer plan based on new information was wrong to begin with!

Even though I am triple vaccinated, I am still wearing a mask most places. Look, I also like my seat belt and air bags to be functional. I accept that no method of protection is 100%. Too often we are used to absolutes, but a vaccine that reduces your risk of dying 11-fold from a disease is truly amazing.

So if you are eligible, go monochromatic or mix and match. It’s all good.


CDC Expands Eligibility for COVID-19 Booster Shots

Bozkurt B, Kamat I, Hotez PJ. Circulation. Myocarditis With COVID-19 mRNA Vaccines. 144: 6.

Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status — 13 U.S. Jurisdictions, April 4–July 17, 2021. Weekly / September 17, 2021 / 70(37);1284–1290