I was pleasantly surprised when the third dose became available and felt relieved when I received the dose with no unforeseen complications.

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Like many people with rheumatoid arthritis (RA), I take immunosuppressive medications to stop my immune system from attacking healthy cells in my joints (aka to control my disease activity).

The medications work to keep RA under control, but they also leave me at a slightly greater risk of infection.

So while I was incredibly happy to get my initial two doses of the COVID-19 vaccine back in the spring, I was also nervous that I might not experience the same protection as others.

This fear was further fed by research that immunocompromised people don’t necessarily experience the same levels of immunity post-vaccination as non-immunocompromised people.

I also have a 7-year-old son who is currently too young to get vaccinated. Due to both of us being at risk, my family has continued to be cautious about potential exposures to the coronavirus. This means missing out on opportunities or [not taking] risks others might feel more comfortable taking if they had full immunity.

In mid-August, after the Food and Drug Administration (FDA) announced its authorization, the Centers for Disease Control and Prevention (CDC) announced their recommendation of an additional dose of the mRNA vaccines for people with “moderately to severely compromised immune systems.”

This included people who’d received their second dose of the Pfizer-BioNTech COVID-19 vaccine or Moderna COVID-19 vaccine at least 28 days ago.

Since I had gotten the Pfizer-BioNTech vaccine months ago, I knew that this category potentially included me!

I quickly felt a rapid mixture of emotions: surprise and shock, then relief, and eventually elation.

It felt like such a huge change from earlier in the pandemic, when people with moderately compromised immune systems seemed forgotten or overlooked.

For example, I was not given any priority for a COVID-19 vaccine in my home state (Washington) when the vaccines first became available to the public.

Before scheduling the vaccine, I knew I needed to check in with my rheumatologist to confirm that I should get the dose and to discuss timing my medications.

With my initial two doses of the Pfizer vaccine, my doctor had recommended following the American College of Rheumatology’s vaccine clinical guidelines. These recommendations were incredibly helpful but hadn’t yet been updated to include the third dose.

I was able to get a message through to my rheumatologist on her secure email system, and she got back to me within 24 hours, which was a huge relief. She confirmed that I should get the third vaccine dose, and we came up with a plan for my medication timing so that I would be most likely to mount a good antibody response.

I wanted to get my third dose right away to minimize the risk of anything going wrong, like pharmacies running out of doses or other unexpected barriers coming up.

I went to Vaccines.gov to find the closest locations to me that had Pfizer doses in stock. Since I’ve had so many barriers to healthcare in the past, I also knew it would be in my best interest to call ahead to double check that the pharmacy had doses in stock and that they were giving the third vaccine.

The first two places I called said they were already out of Pfizer, but I was able to schedule online with the third pharmacy. My husband drove me there just in case I felt tired or unwell afterward.

When I got to the pharmacy, however, the pharmacist said that they were only doing first and second doses of Pfizer and not third doses because they were waiting for guidance from “the state.”

I’ll be honest, I actually got a little teary at this point because this pharmacy was located inside a large store and I was already nervous about the potential COVID-19 exposure just by entering the store. I was frustrated and sad that this exposure was in vain, and also mad at myself for not calling in addition to scheduling the appointment online, just to be sure they were actually doing the third dose.

Fortunately, my tech-savvy husband discovered that another pharmacy up the road was offering the dose already, so we drove a little further and successfully got the vaccine.

I’m not afraid of needles and barely felt the vaccine going in. I was especially relieved to get it given that I was denied at the first location.

After my third dose

In the week following my third dose, the main side effects (all of which were mild to moderate) included tiredness and a sore arm. They were more similar to my side effects after the first Pfizer vaccine than the second.

I knew that many other patients were nervous or fearful about vaccines, so I made a fun educational video about my experience getting the third dose.

I was happy to answer other people’s questions and bring awareness to the existence of a third dose. I was surprised how many folks hadn’t yet heard that a third vaccine dose was recommended for immunocompromised people.

Now that it’s been over 2 weeks since my third dose, I know that I’ve likely mounted the antibody and cell-mediated immune response I’m going to make.

I continue to feel relieved to have the chance to get more protection against COVID-19, but with the Delta variant surging, I will continue taking all necessary precautions to lessen risk to myself and others.


Cheryl Crow is an occupational therapist who’s lived with rheumatoid arthritis for 18 years. In 2019, Cheryl started Arthritis Life to help others thrive despite arthritis. She facilitates online courses and support groups to help people adjust to their conditions and live full and meaningful lives. Most days you can find Cheryl creating life hack videos, sharing patient stories on the Arthritis Life Podcast, or spreading the word about Acceptance and Commitment Therapy (ACT).