FDA Confirms IM Doc Concerns About Pharmacies Pushing Covid Boosters + Other Vaccines in Same Visit

We recently had a debate in the comments section about the (de)merits of getting multiple vaccinations at once (as in ones designed, safety-tested and approved as individual shots). Reader Daryl reported his contrasting experience with the positive reader reports about getting a Novavax booster, which should by virtue of its more traditional design, cause much less in the way of reactions than mRNA jabs:

I’m having my own novavax (+ flu) vaccine experience this morning… woke up with a headache, muscle aches and temperature dysregulation at 2:30 AM after a few hours of poor sleep. About the same effect as the moderna boosters had on me.

Your humble blogger was perhaps not as sympathetic as I should have been, pointing Novavax + flu vaccine is not the same as Novavax in isolation and that IM Doc has seen a lot of his patients having trouble after pharmacies pushed them to get other vaccines at the same time as their Covid booster. As IM Doc had reported by e-mail earlier that month:

Many patients getting all three at the same time flu, Covid and RSV. They are getting really sick with flu like illness. And the story is always the same. Medicare patients going to the pharmacy to get a flu shot and ending up with all 3 at the strong encouragement of the pharmacist. Why not? Patients are now considered “profit centers”. They turn that 85 dollar flu shot “sale” into a 400 something dollar sale with the other two shots…..

We added some additional advice from him:

I would tell you that any of the shingles vaxx should be taken by themselves in isolation for a month or so before or after any other vaccines. They can often be very harsh.

Readers pointed out that supposed informed sources, such as a site called Everyday Health, who in this case had an English major offering medical advice (with the article reviewed by a sole “expert”), that it was “safe” to get Covid and flu vaccine tout ensemble. Note the issue presented was not safety but discomfort. Recall the Covid mRNA shots are deemed safe even with causing many to have to skip a day or two of work after getting them, an outcome hourly laborers cannot afford.

There appear to have been enough people having bad outcomes from a flu + Covid jab combo that the FDA took the rare step of rousing itself to weigh in. And it didn’t result in this practice getting a clean bill of health. From CNN in Covid shots may slightly increase risk of stroke in older adults, particularly when administered with certain flu vaccines:

Vaccines for Covid-19 and influenza may slightly increase the risk of strokes caused by blood clots in the brains of seniors, particularly when the two vaccines are given at the same time and when they are given to adults who are age 85 and older, according to a new study.

The safety signal was detected by experts at the US Food and Drug Administration who analyzed data from Medicare claims.

It is the second study to find an elevated risk of stroke for seniors after Covid-19 and flu vaccinations given together. The US Centers for Disease Control and FDA issued a public communication in January explaining that one of their near real-time vaccine safety monitoring studies — called the Vaccine Safety Datalink — had picked up a small and uncertain risk of stroke for older adults who received a dose of Pfizer’s bivalent Covid-19 vaccine and a high-dose or adjuvanted flu shot on the same day. That study triggered the FDA’s broader look at strokes after vaccination noted in the medical records of seniors on Medicare.

That said, the risk identified in the FDA’s study appears to be very small — roughly 3 strokes or transient ischemic attacks for every 100,000 doses given — and the study found it may be primarily driven by the high-dose or adjuvanted flu vaccines, which are specially designed to rev up the immune system so it mounts a stronger response to the shot….

A few weeks ago, however, Dr. Peter Marks, head of FDA’s Center for Biologics Evaluation and Research, said he was planning to get his Covid-19 vaccine first, followed by his influenza vaccine about two weeks later.

“If you want to minimize the chance of interactions and minimize confusing the side effects from one with another, you wait about two weeks between the vaccines,” Marks said on an FDA stakeholder call in September.

Mind you, this report covered only getting the two vaccines, not Covid + flu shot + RSV vaccine, the new pharmacy trifecta. And it covered only stroke risk, not getting flu-like symptoms….when the whole point is not to get sick or be the functional equivalent of sick.

And that’s before flu vaccines having underwhelming efficacy. From a 2019 article in Vaccine:

Analysis included 20,022 adults aged ≥18 years enrolled during the 2011–12 through 2015–16 influenza seasons; 4,785 (24%) tested positive for influenza. VE among patients aged ≥65 years was not significantly lower than VE among patients aged 18–49 years against any subtype with no significant interaction of age and vaccination. VE against A(H3N2) viruses was 14% (95% confidence interval [CI]−14% to 36%) for adults ≥65 years and 21% (CI 9%-32%) for adults 18–49 years. VE against A(H1N1)pdm09 was 49% (95% CI 22%-66%) for adults ≥65 years and 48% (95% CI 41%-54%) for adults 18–49 years and against B viruses was 62% (95% CI 44%–74%) for adults ≥65 years and 55% (95% CI 45%-63%) for adults 18–49 years. There was no significant interaction of age and vaccination for separate strata of prior vaccination status.

GoodRx similarly notes that flu vaccines typically have 40% to 60% efficacy.

On the CNN article and the vogue for doubling or tripling up on vaccinations:

This is being done against all traditions and recommendations of the past. Now it is Covid + flu shots.

As far as I can tell, this is being done only in pharmacies. Those places where patients are called “profit centers”. An 85 year old walks into Walgreens for a 25$ flu shot, and then suddenly convinced to get a Covid booster at 185$ a pop and then an RSV vaccine for $300. A 25$ visit suddenly becomes 500$. Who cares about the strokes. Or the huge number of them flat on their back for 3 days.

What a joke our entire system has become. If people only knew how much of my day was taken up securing the cash flow for Pharma they would be shocked.

It is depressing the degree to which patients need to be their own advocates and not blindly follow the advice of supposed medical professionals.

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  1. IMOR

    My sister reported serious full-body aches after tripling up, which, when coupled with expected flu-like symptoms, lost her a full day.

    Off-topic, CVS is the only one of the Novavax outlets present in my area- and its pharmacy informed me two days ago they don’t have it and don’t know that they’ll be offering it at all.

    1. curlydan

      I read on Twitter/X that Costcos were pretty good about having Novavax. You might check there if one is in the area.

  2. Jen

    My 90 year old dad, who has long COVID, had all 3 vaccines simultaneously. Came down with COVID a few days later.

  3. Arizona Slim

    My mother got the flu from a flu shot. And that is one of the many reason why I’ve never gotten one myself. In my family, we have a history of horrendous reactions to drugs, so if one of us has a problem, the rest of us will too.

    As for that other shot, y’know, the one that’s been heavily promoted since 2020, I still haven’t gotten one. Once again, I thank NC for helping me to make that decision. I think I owe my good health to it.

    1. Tvc15

      I’ve had the flu once in my life and coincidentally or not, after receiving a flu shot. This was approximately 10 years ago. I mentioned to my PCP and he said, good thing you did otherwise it would have been much worse. Funny, where have I heard that same message recently. I will never get another flu shot and did not participate in the experimental Covid shots.

    2. Oakchair

      A randomized study that look at all infections found the flu vaccine increased all cause infectious by a risk ratio of 4.4.
      This was replicated by a prospective study that found similar results. Interesting these studies found that flu vaccines increased the chance of getting a Coronavirus infection which was replicated in the US military data.


  4. Jason Boxman

    I’ve never had a good reaction to the flu shot; Whenever I mention it, there’s the usual “you can’t get the flu…” nonsensical response, as if the flu shot doesn’t activate the immune system in some way, the entire point of it, and it is somehow a magic pony. It’s not the arm pain, I’d lie in bed unable to make it to REM sleep for the entire night, miserable feeling. Every time. I finally stopped getting the flu shot. And now with SARS2 I don’t leave the house and always wear a P100 when I do, so no more flu shot for me.

    I’m considering the Novavax pending how it performs in the real world based on anecdotal reports. We’ll see. My trust in public health for pharmaceuticals has never been lower.

    Vaccines for Covid-19 and influenza may slightly increase the risk of strokes caused by blood clots in the brains of seniors, particularly when the two vaccines are given at the same time and when they are given to adults who are age 85 and older, according to a new study.

    LOL. It’s a good thing a clinical trial was required before these multi-shots were allowed, oh wait…

    The safety signal was detected by experts at the US Food and Drug Administration who analyzed data from Medicare claims.

    Oh, silly me, using it on the population at large IS the clinical study!

  5. Laura in So Cal

    This was one of the steps we took when my infant son had bad vaccine reactions. From age 1 onwards, my son never got more than one shot at a time and they were spaced at least one month apart.

  6. RookieEMT

    I went from usually complying and taking the flu shot once a year to perhaps never taking a flu shot for the rest of my life. I don’t mind TDAP and MMR but anything out of the range of tried and true vaccines decades old, I don’t want to touch em’.

    I went from not really dallying in alternative medicine to having an Ayurvedic provider and suspicious that it’s more than just placebo. I don’t want to visit doctors, I want to see her.

    Doing so feels like rebellion and freedom…

    1. Paris

      Same here. Ever since the Covid vaccines I stopped taking the flu shot too. These people just want to make money out of my health. No way Jose I’m taking any other useless shot in my life.

  7. Heather

    I’m 69 years old and only got the flu shot this year, not Covid, RSV, or pneumonia. Next year I may not even get the flu shot. Wish I had been told it was only 40-60% effective, the flu shot, I mean. I will say, though, that Walgreens never tried to pressure me to get any of the other shots. Thank God for small favors, I guess. The only reaction I got was some fatigue for a day.

  8. Rick

    I appreciate the input of NC on this topic. I was inclined to only do one at a time as I have in the past with pneumonia and shingles vaccinations. It was easier when there was only one (flu) every year. With the added information here I will continue to wait between jabs with RSV next and flu last. I’ve never had much faith in the influenza immunization due to its low efficacy but don’t mind getting it. I never was ‘vax and relax’ for SARS, either. After reading some of the original Pfizer report and seeing that the high efficacy numbers came from not looking for disease in their population I could see it was the same inflated efficacy scam that was tried with the flu vaccine years ago. I got the J&J out of an abundance of caution about a new vaccine technology.

    For me, Novavax has been a no-problem at all event, not even a sore arm. I went to Costco and asked about it from hearing anecdotal reports online. The first worker I asked said they didn’t have it but a nearby person said, no, they had it. The person administering knew what they were giving me and I checked out the vial in the tray after hearing reports of being given something other than what was asked for.

    On the enshittification front, the Costco online appointment site never had any Novavax appointments available. When asked about it the response was, “Oh, that’s an external site and it’s broken.”

    1. Jay Ess

      Interesting. I used the Costco site to schedule the Novavax shot and the scheduling worked for me. My only confirmed side effect was a very slightly sore arm (not like the Pfizer shot, which caused serious soreness). I also went to bed 20 minutes early the next day, which may or may not have been vaccine related, but if so it was only very minor fatigue.

  9. Insouciant Iowan

    I got a Pfizer booster and flu shot at the same time at my neighborhood pharmacy where my wife and I have trade fpr 17 yrs. (I know the phatmacists by name.) Tje day following I had a sore arm where the COVID booster was injected, but no discomfort on the flu shoilder. I was also lethargic and slept through most of the afternoon. This is the first time I jave had after effects from COVID/ flu shots.
    I asked about getting the RSV shot at the same time. The pharmacist said I should wait a couple of weeks. It’s been a month. I’ll likely get it done this week or next.

  10. Dee

    In long term care homes here (Ontario, Canada) vaccines are often given to residents at vaccine clinics held by visitors from the local health unit. They typically double up the covid booster and flu vaccine on the same day. Staff at the home have never suggested spreading out the shots, so families are really left to their own knowledge and judgment.

  11. Pat

    I have had two significant flu bouts in thirty years, as in full battery of symptoms for almost a week. Both of them followed flu shots (call me naive). I have been told often about how it was all in my head and that couldn’t happen. But considering I haven’t been laid up like that with flu since, in my head or not, I see no reason to tempt fate. Efficacy matters. In this and in Covid.

    I understand that my good peasant stock, childhood dirt eating, and getting every childhood disease possible appears to have made me less vulnerable to illness than others of my acquaintance, but quite honestly much of the medical profession strikes me as a racket anymore. I have been lucky to have had a few IM Doc style doctors in my life. Unfortunately due to retirement and business changes I am without such trustworthy guidance at the moment. I can only hope I am lucky enough to find another.
    But in the meanwhile I will take anything CVS tells me with a boulder of salt.

  12. New_Okie

    Thanks for this important public service announcement.

    I have been disabled ever since receiving a battery of travel vaccinations in a compressed schedule. Whether it was having several vaccines at once, having the second shot too soon after the first, a bad batch with too much adjuvant (a neighbor who also became disabled following a vaccination was told this was the case) or some combination of the them I do not know. Hell, I don’t *know* that it was the vaccines at all. Inference is the best I can do.

    But I wish the doctor giving me the shots had sat down with me and said “hey, just so you know, if you do it this way the risk of adverse events–the kind that limit your whole life–really goes up. If you do it more slowly over three months it will be much safer”. Hindsight, of course, being 20/20.

  13. Rip Van Winkle

    Postcard reminder arrived from the Vet. 2 dogs here, 7 and 15 years. No health problems, ever. List of 9 shots. Hadn’t seen that before. Nope. Just what they need required by law (rabies), thank you very much – or we’ll go elsewhere.

  14. Adam

    Got both the latest Moderna shot plus the flu shot in the same arm a few weeks ago at Walgreens. Yes, they did try to talk us into more vaccines which my wife and I rejected. And luckily it was done over the weekend since we were both under the weather for a few days and boy did our arms hurt where they gave us the shots. Really wanted the Novavax shot instead; I should have waited!

  15. polar donkey

    Perhaps someone should tell NFL and Travis Kielce since they are blanketing game commercials with getting flu and covid shots at same time

  16. CanCyn

    Last week a friend had COVID and flu shots at the same time on Tuesday and then a shingles vaccine on Friday morning. She had to leave work early because she was starting to get really sleepy. She slept almost the entire weekend, eating only three times from Friday night to Sunday dinner.
    I always remember people saying they didn’t want to get the flu shot because it had given them the flu in the past. I asked my doc about it years ago. She said it was impossible, that people had just coincidentally contracted the flu around the same time as they got the vaccine. And I believed her! Our public health folks are doing drive through clinics and giving flu and COVID shots this week. No more MRNA COVID shots for me, maybe Novavax if available – not that is any way to through to our local public people to ask about Novovax. And no flu shot this year either. So grateful to IM Doc and NC for keeping us up to speed on this stuff.

  17. SES

    The autumn before Covid started, my partner, who was known by his doctor to have autoimmune problems, was given a flu shot and a pneumonia shot at the same appointment and in the same arm. The doctor looked at the instructions right after administering the pneumonia shot and said, “Oops, I shouldn’t have done that!”

    My partner developed a high fever that night, and then broke out in hives over his back, chest, and face that lasted nearly three years, until an extended course of prednisone apparently resolved it. While he had the hives, he was sensitive to a whole range of foods, which would exacerbate the hives and trigger intense itching.

    He’s had little reaction to the Pfizer vaccine and no reaction to Novavax.

  18. Dave K

    For what it’s worth, my doctor recommended RSV, then COVID, then flu vaccines in that order with several weeks between each. She was most adamant about RSV, somewhat less so about COVID and flu vaccines. Both my wife and I were given this recommendation; both of us are ‘older.’ But then our doctor works in a holistic health center and gives hour-plus consultations…not sure what we’ll do when she retires, as she, too, is ‘older.’

  19. Daryl

    Thanks for prompting the discussion and the writeup. I personally won’t be getting multiple vaccines at the same time going forward.

    In the end the novavax + flu combo ended up being milder for me than moderna or moderna + flu, which I had done previously.

  20. Ed S.

    In reference to the GoodRX reference, the statement in article is, “Experts never know ahead of time how effective flu vaccines will be. But on average, the flu vaccine is about 40% to 60% effective”.

    However, in the GoodRX article there is a link to the actual CDC data; the CDC data shows the average effectiveness from 2009/10 through 2022/23 is 43%. The range is a low of 19% to a high of 60% (once). Of the 13 data points available from the CDC, only four are above 50% VE . So the range quoted in the GoodRX article isn’t especially accurate. It’s a bit distressing that you need to go to the original source to validate most claims.

    A more accurate statement such as:

    The average effectiveness of the vaccine since the 2009/10 flu season is 43% and ranges from 19% to 60%

    isn’t particularly encouraging.

    And interestingly enough, there was “not enough data to compute” 2020/21″ due to low flu circulation.

  21. Oakchair

    And that 43% is the relative benefit. The absolute benefit is that for every 100 people to get a flu vaccine 1 case of the flu is prevented. That is the entire benefit according to studies done by the vaccine corporations.


    According to the vaccine manufacutring in their FDA documents the flu vaccine causes 0.7% more grade 3 adverse effects and over 65% more adverse advents of any grade compared to the non-vaccine group. Grade 3 events are defined as prevented work/school/normal activities, or caused a doctor’s visit. Short version: According to the drug companies clinical trials flu vaccines fail a cost-benefit analysis.


    1. Ed S.

      Thanks for the absolute benefit update; I looked at one of the studies of effectiveness but couldn’t figure out exactly what the actual benefit was. The true absolute benefit you cite (1 case prevented for every 100 vaccines) is part and parcel with IMDoc’s post several days ago about relative risk reduction versus absolute risk reduction. What these statistics purport to mean and what they actually mean are two different things.

    2. Objective Ace

      I particularly liked this quote from your source

      The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies.

      1. Oakchair

        That’s putting it lightly when it comes to medical research.

        Marcia Angell the former Editor of the New England Journal of Medicine stated “medical centers have become supplicants to the drug companies, deferring to them”

        “academic researchers are little more than hired hands who supply human subjects and collect data according to instructions from corporate paymasters”

        “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.”

        Richard Horton the former editor of the Lancet stated
        “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue.”

        Corporations have gone far further then capturing their regulators, they’ve captured every major institution in the country.


  22. Stubbins

    My wife got the Covid booster + flu shot at same time, and was wiped out for 3 days. I tried gently to talk her out of doing both at once but she insisted.

  23. castilleja

    I talked to a neighbor’s husband today. His wife (she’s around 75) got a flu and covid shot one day, earlier this month, then the next day got a shot for osteoporosis. He couldn’t remember the name of the osteoporosis shot. She had a stroke soon afterwards. He now knew that this was a big mistake. This all has me wondering about dog and cat vaccinations. Ma be not a good idea to get 3 or 4 shots in one visit? – for any critter???

    The neighbor’s wife was quite active, walked a couple times a day with a dog, was slender, etc.and healthy before this.

  24. Jack

    I only got the flu vaccine once. When I was a submariner in the Navy and they made us take it. I immediately came down with the flu. I have never had another flu shot in the 30 years since. As far as Covid, I got the J and J. I didn’t trust the mRNA. As it turns out rightly so. I don’t trust anything the government tells me anymore. I am 66 and will probably never get another shot of anything (except maybe bourbon, orally administered). On a different note, I read recently (believe it was in the WAPO) about Walgreens pharmacists and pharm techs going on strike. I specifically remember one of the pharmacists divulging how management made him give vaccines, and ignore the back order of thousands of Rx refills, because vaccines were such a profit center for Walgreens.

  25. The Rev Kev

    Suppose that I should add the obvious. If you have a shot and suffer a bad reaction, both you and your doctor can say let’s not do that one again. But if you are taking three shots in one go and suffer a bad reaction, which one was it? How do you find out? Wait a year and take each shot individually a month apart to find the cause of your reaction? That puts you at risk for a second time. My wife and I made sure that our kids go their vaccinations when they were babies but Covid vaccinations? Yeah, nah! Dodged a bullet with the Astrazeneca vaccination so won’t do that one again either.

  26. jackiebass

    I have my personal rule about getting vaccines. I will only get one at a visit and the next at least a month later.

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