The purpose of this article is to report on 23 women with evidence of axillary adenopathy at breast imaging after recent COVID-19 vaccination. A total of 13% of patients had symptoms (axillary lump), 43% were undergoing screening, and 43% were undergoing diagnostic imaging for other reasons. BI-RADS category 2 was assigned in one case, BI-RADS 3 in 21 (ultrasound in 4-24 weeks), and BI-RADS 4 in one. Radiologist familiarity and evidence-based guidelines are needed to avoid follow-up imaging and biopsies for reactive adenopathy after COVID-19 vaccination.