Table of Contents
COVID-19 was one of the most significant healthcare disasters to strike humanity, with far-reaching consequences on virtually every aspect of life. Vaccination emerged as the antidote to prevent COVID symptoms from rising, but it too became controversial as users come to suspect its long-term effects on health and immunity.
This presented a unique challenge for those living with Postural Orthostatic Tachycardia or POTS, in terms of how it might affect their symptoms.
In this guide, we attempt to break down what research has shown through early 2025 to answer should people with dysautonomia get the COVID vaccine and explain how POTS patients can navigate vaccination safely and confidently.
“POTS patient discussing COVID-19 vaccination with a healthcare specialist in a calm clinical setting.”
Can the COVID-19 vaccine cause POTS?
A small number of case reports have documented POTS after COVID vaccination, especially in people with existing dysautonomia or a history of autoimmune activation. However, these were mostly rare, and most individuals receiving vaccines, including those with POTS, didn’t experience worsening of symptoms.
The insights from current medical literature suggest:
- Immune activation from a vaccine can temporarily stress the autonomic nervous system.
- People predisposed to autonomic dysfunction may experience short-term POTS-like symptoms.
- Long-term or permanent POTS after a vaccine remains uncommon.
According to the CDC, vaccines may produce short-lived side effects due to immune activation, but serious long-term complications hardly emerge. Similarly, NIH reports continue to explore why certain individuals develop dysautonomia or autonomic dysfunction after viral infections or immune triggers, including vaccines.
Why Some People Experience a POTS Flare After the COVID-19 Vaccine
The immune stimulation that occurs shortly after getting inoculated can induce a strong reaction in some patients. It’s crucial to see a doctor if you experience any of these symptoms:
- Increased heart rate
- Fatigue
- Dizziness upon standing
- Worsened brain fog
- Unstable temporary blood pressure
These symptoms can last a few days to several weeks, but patients with POTS should go for a proper diagnosis to reveal whether the symptoms are a result of COVID or POTS-related. This clarity would aid in managing POTS symptoms to help most people return to their baseline state.
Possible Mechanisms Behind a Post-Vaccine Flare
Research is still underway to unravel what might be driving post-vaccination flare-ups observed in some people. Different theories are advanced to explain why some people develop POTS after COVID vaccine.
1. Immune System Activation
This is the most widely accepted theory. When a person gets a vaccine, their immune system is triggered intentionally. This, in turn, may temporarily disrupt the autonomic regulation system or the body’s autopilot system that primarily functions to adjust blood flow when an individual stands up after sitting or lying.
Since the body is unable to maintain blood pressure, blood accumulates in the lower body, which spikes the heart rate to compensate.
2. Inflammation Affecting Blood Vessels
A vaccine can inflame blood vessels, which causes temporary vasodilation, or the widening of blood vessels. This can make orthostatic intolerance more prominent, which is why people with POTS experience common symptoms like dizziness, lightheadedness, and fainting in an upright position. Lying down can help relieve these symptoms.
3. Autonomic Oversensitivity
People with existing POTS may simply be more sensitive to physiological stressors than those who don’t.
4. Anxiety + Medical Stress
A population-based cohort study found that a considerable number of patients reported anxiety about COVID-19 vaccination, which can be an independent trigger for symptoms.
Our stress test can help assess your stress levels and how your heart responds to it.
POTS After COVID Infection vs. After COVID Vaccination
POTS can be divided into two key phases: one before the COVID infection and the other that follows a vaccination. Every POTS patient needs to understand between COVID-19-related effects and post-vaccine effects
Evidence from Medical studies on POTS and COVID vaccines reveal the following:
- A significant percentage of Long COVID patients develop new-onset POTS or dysautonomia as a potential long-term condition.
- COVID infection can damage autonomic fibers, alter blood volume, and dysregulate nervous system function.
- Post-infection dysautonomia tends to last longer and be more severe than post-vaccine flares.
All in all, while the COVID vaccine may trigger short-term symptoms in some, the risk of POTS developing from COVID infection is five times higher than developing POTS from the vaccine.
An observational study, published in the peer-reviewed journal Heart Rhythm, analyzed data from 10 patients treated at a multidisciplinary POTS clinic between July 2021 and June 2022. The study found that directing the right care resulted in positive outcomes in the study participants.
Is the COVID Vaccine Safe for People With POTS?
Considering the potential effects of COVID-19, it’s natural to ask: Is it safe for POTS patients to get the COVID vaccine? The majority opinion is yes. Numerous cardiologists, neurologists, and dysautonomia specialists reassure their patients that vaccines do not trigger a worsening of long-haul COVID. This means that most POTS patients can tolerate mRNA vaccines without trouble.
IT’s important to be mindful that COVID vaccination safety does not mean “symptom-free.” People with moderate to severe POTS often experience fatigue, tachycardia, or dizziness in the post-vaccine period that is similar to the body’s reaction to viral illness or dehydration.
What to Expect If You Get the COVID Vaccine With POTS
The possibility of new-onset POTS as a result of COVID-19 vaccination is a rare adverse event. In reality, an infection poses a bigger threat to worsen symptoms in individuals with pre-existing conditions, especially in autoimmune-driven POTS.
This is why personalized medical guidance is highly important to identify whether or not the POTS symptoms are associated with the vaccine or not. Most POTS patients fall into one of these three groups:
1. No change in symptoms
This group contains the vast majority of POTS patients who feel normal after getting vaccinated. The vaccine does not, in any way, affect the intensity or frequency of their symptoms.
2. Mild flare
Certain individuals can encounter milder symptoms that usually last 24–72 hours.
3. Moderate flare lasting days or weeks
In a few cases, a vaccine stimulates a more intense reaction with more long-lasting symptoms.The possibility of new-onset POTS as a result of COVID-19 vaccination is a rare adverse event. In reality, an infection poses a bigger threat to worsen symptoms in individuals with pre-existing conditions, especially in autoimmune-driven POTS.
This is why personalized medical guidance is highly important to identify whether or not the POTS symptoms are associated with the vaccine or not. Most POTS patients fall into one of these three groups:
1. No change in symptoms
This group contains the vast majority of POTS patients who feel normal after getting vaccinated. The vaccine does not, in any way, affect the intensity or frequency of their symptoms.
2. Mild flare
Certain individuals can encounter milder symptoms that usually last 24–72 hours.
3. Moderate flare lasting days or weeks
In a few cases, a vaccine stimulates a more intense reaction with more long-lasting symptoms.
Strategies to Reduce the Risk of a POTS Flare Post-Vaccination
Dysautonomia specialists who are aware of the convergence of symptoms between COVID-19 and POTS suggest that the solution lies in stabilizing the autonomic system that controls unconscious responses.
Here are some tips on how to manage POTS flare-ups post-COVID vaccination;
Before the shot:
- Increase hydration 24–48 hours prior
- Increase salt (unless restricted by a doctor)
- Eat a balanced meal beforehand.
- Avoid high-intensity activity that day.y
After the shot :
- Maintain high fluid and salt intake
- Get rest for 2–3 days.
- Wear compression garments
- Take electrolytes like sodium, along with potassium and magnesium, either through Oral Rehydration Salts (ORS), Electrolyte Drink Mixes, or salt tablets.
- Stick to recumbent positions when fatigue hits
- Continue medications unless your specialist advises otherwise.
Seek medical advice if you’ve had past adverse immune reactions.
Should People With POTS Get the COVID-19 Vaccine?
The Vaccine is an effective way to minimize severe SARS-CoV-2 complications, and thus hospitalization and death. Dr. Svetlana Blitshteyn, Director of the Dysautonomia Clinic in Buffalo, NY, acknowledges that while POTS may occur in a small percentage of people after COVID-19 vaccination, the benefits of COVID-19 vaccination outweigh the risks. Each patient is unique, and therefore, consulting a POTS specialist can help you make the right decision.
Why Autoimmune POTS May React Differently
Not all POTS is the same. Understanding your subtype can help predict your vaccine response:
Autoimmune POTS
This is mainly caused by antibodies targeting autonomic receptors, which lead to a dysfunction in automatic responses like heart rate after standing or sitting up. Accounting for 15-20% of the POTS population, people with autoimmune POTS are likely to be more reactive to immune triggers like vaccines.
This leads to a heightened risk of temporary flare, but also vulnerability to COVID infection itself.
The best approach is to discuss precise timing with your immunologist; some patients benefit from scheduling vaccines during stable periods.
Neuropathic POTS
This POTS type is attributed to damaged small nerve fibers. This makes the individual less reactive to vaccines, so a stable response can be expected.
Hypovolemic POTS
Regarded as the most common type, it is characterized by low blood volume. This makes it particularly amenable to hydration strategies by increasing blood flow and stabilizing circulation. Those who are in this group are recommended to increase their fluid intake to preferably 2-3 liters prior to the vaccination.
Hyperadrenergic POTS
This POTS type is characterized by high norepinephrine levels, driven by an overactive sympathetic nervous system. This leads to a marked surge in blood pressure, leading to extreme heart rate increase along with palpitations and anxiety. Such patients may experience more anxiety-related symptoms around vaccination. If your doctor has prescribed any Beta-blockers, they should typically be continued.
If you don’t know your POTS subtype, discuss testing options with a dysautonomia specialist before vaccination
Does Vaccine Type Matter for POTS Patients?
A major portion of research focuses on mRNA vaccines like Pfizer or Moderna. Here’s what we know about different types:
mRNA Vaccines (Pfizer-BioNTech, Moderna)
MRINA vaccines are the most studied in POTS populations, with a high level of tolerance seen in POTS patients. They stand out for their stronger immune response, which can increase the chances of developing temporary symptoms.
Viral Vector Vaccines (Johnson & Johnson/Janssen)
In this vaccine type, a Single dose may be appealing for patients who found the first mRNA dose stressful. Although it works on the same activation principles as mRNA vaccines, there is limited data on the POTS-specific reactions it produces.
Protein Subunit Vaccines (Novavax)
This is one of the newer options to arrive in the market with a potentially milder side effect profile. It’s well-suited for patients who have had severe reactions to mRNA vaccines. As compared to mRNA, it has a modest impact on the immune system.
Overall, it can be said that there’s no definitive “best” vaccine for POTS patients.
- Discuss concerns with a POTS specialist to determine POTS severity and subtype.
- Review previous reactions to vaccines
- Consider timing (avoid during significant flares)
- Availability in your area
Conclusion
To conclude, while some people with POTS experience temporary symptom changes after the COVID vaccine, the majority tolerate it without significant issues. The key is to stay informed about your POTS type and the vaccination options to ensure you are well-protected against COVID-19.
The fact that COVID-19 can cause or exacerbate existing POTs symptoms means that a vaccine is a must to avoid a COVID-19 infection at all costs. Finally, you should stay connected with your healthcare provider to pin down the exact cause of your symptoms and get personalized guidance to maximize your long-term health and well-being.
At POTS.net, our specialists in Dallas provide comprehensive care for individuals with dysautonomia and POTS, helping patients navigate decisions with clarity and confidence. Contact us for an appointment to understand your risk profile and the best treatment options.