1
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Kim HJ, Jeong S, Song J, Park SJ, Park YJ, Oh YH, Jung J, Park SM. Risk of pulmonary embolism and deep vein thrombosis following COVID-19: a nationwide cohort study. MedComm (Beijing) 2024; 5:e655. [PMID: 39006761 PMCID: PMC11246596 DOI: 10.1002/mco2.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 06/08/2024] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Recent studies elucidate that coronavirus disease 2019 (COVID-19) patients may face a higher risk of cardiovascular complications. This study aimed to evaluate association of COVID-19 with the risk of pulmonary embolism (PE) or deep vein thrombosis (DVT). This nationwide population-based retrospective cohort study included Korean adult citizens between January 2021 and March 2022 from the Korea Disease Control and Prevention Agency COVID-19 National Health Insurance Service cohort. The Fine and Gray's regression with all-cause death as a competing event was adopted to evaluate PE and DVT risks after COVID-19. This study included a total of 1,601,835 COVID-19 patients and 14,011,285 matched individuals without COVID-19. The risk of PE (adjusted hazard ratio [aHR], 6.25; 95% confidence interval [CI], 3.67-10.66; p < 0.001) and DVT (aHR, 3.05; 95% CI, 1.75-5.29; p < 0.001) was higher in COVID-19 group in individuals without complete COVID-19 vaccination. In addition, individuals with complete COVID-19 vaccination still had a higher risk of COVID-19-related PE (aHR, 1.48; 95% CI, 1.15-1.88; p < 0.001). However, COVID-19 was not a significant risk factor for DVT among those with complete COVID-19 vaccination. COVID-19 was identified as an independent factor that elevated PE and DVT risks, especially for individuals without complete COVID-19 vaccination.
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Affiliation(s)
- Hye Jun Kim
- Department of Biomedical Sciences Seoul National University College of Medicine Seoul South Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics Korea University College of Medicine Seoul South Korea
| | - Jihun Song
- Department of Biomedical Sciences Seoul National University College of Medicine Seoul South Korea
| | - Sun Jae Park
- Department of Biomedical Sciences Seoul National University College of Medicine Seoul South Korea
| | - Young Jun Park
- Medical Research Center Genomic Medicine Institute Seoul National University Seoul South Korea
| | - Yun Hwan Oh
- Department of Family Medicine Chung-Ang University Gwangmyeong Hospital Chung-Ang University College of Medicine Gwangmyeong South Korea
| | - Jaehun Jung
- Department of Preventive Medicine Gachon University College of Medicine Incheon South Korea
| | - Sang Min Park
- Department of Biomedical Sciences Seoul National University College of Medicine Seoul South Korea
- Department of Family Medicine Seoul National University Hospital Seoul South Korea
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2
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Finsterer J. Sudden Death Is More Likely to Result From SARS-COV-2 Infection Than Multiple Sclerosis. J Korean Med Sci 2023; 38:e393. [PMID: 37967883 PMCID: PMC10643249 DOI: 10.3346/jkms.2023.38.e393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/13/2023] [Indexed: 11/17/2023] Open
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3
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Pandey AK, Rooeintan T. Spontaneous Intracranial Hypotension Complicated by a Cerebral Venous Thrombosis Following an mRNA Covid-19 Vaccination: Coincidence vs Cause? Eur J Case Rep Intern Med 2023; 10:004064. [PMID: 37920224 PMCID: PMC10619528 DOI: 10.12890/2023_004064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/04/2023] [Indexed: 11/04/2023] Open
Abstract
Spontaneous intracranial hypotension (SIH) is a rare cause of persistent headache, particularly among young and middle-aged people. A potentially life-threatening complication of SIH is a cerebral venous thrombosis (CVT). The authors present a case in which a patient presented with SIH complicated by CVT one week after receiving a booster dose of mRNA COVID-19 vaccine. According to our literature review, this is the first such case report. LEARNING POINTS Spontaneous intracranial hypotension is rarely complicated by cerebral venous thrombosis (CVT).The majority of cerebral venous thrombosis cases post-COVID-19 vaccination occurred in patients administered with adenoviral vaccines. CVT following administration of mRNA COVID-19 vaccines is rare.Clinicians should consider COVID-19 vaccine-induced CVT in recently vaccinated patients; MRI plays an important role in accurate diagnosis.
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Affiliation(s)
| | - Taleb Rooeintan
- Department of Neurology, Burjeel Speciality Hospital, Sharjah, United Arab Emirates
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4
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Favas TT, Lall N, Joshi D, Singh VK, Pathak A, Chakravarty K, Mishra VN, Chaurasia RN, Kumar A. Thrombotic and Thromboembolic Complications After Vaccination Against COVID-19: A Systematic Review. Cureus 2023; 15:e37275. [PMID: 37182082 PMCID: PMC10167937 DOI: 10.7759/cureus.37275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Thromboembolic complications after the COVID-19 vaccination have been reported from all over the world. We aimed to identify the thrombotic and thromboembolic complications that can arise after receiving various types of COVID-19 vaccines, their frequency, and distinguishing characteristics. Articles published in Medline/PubMed, Scopus, EMBASE, Google Scholar, EBSCO, Web of Science, the Cochrane Library, the CDC database, the WHO database, ClinicalTrials.gov, and servers like medRxiv.org and bioRxiv.org, as well as the websites of several reporting authorities between December 1, 2019, and July 29, 2021, were searched. Studies were included if they reported any thromboembolic complications post-COVID-19 vaccination and excluded editorials, systematic reviews, meta-analyses, narrative reviews, and commentaries. Two reviewers independently extracted the data and conducted the quality assessment. Thromboembolic events and associated hemorrhagic complications after various types of COVID-19 vaccines, their frequency, and distinguishing characteristics were assessed. The protocol was registered at PROSPERO (ID-CRD42021257862). There were 59 articles, enrolling 202 patients. We also studied data from two nationwide registries and surveillance. The mean age of presentation was 47 ± 15.5 (mean ± SD) years, and 71.1% of the reported cases were females. The majority of events were with the AstraZeneca vaccine and with the first dose. Of these, 74.8% were venous thromboembolic events, 12.7% were arterial thromboembolic events, and the rest were hemorrhagic complications. The most common reported event was cerebral venous sinus thrombosis (65.8%), followed by pulmonary embolism, splanchnic vein thrombosis, deep vein thrombosis, and ischemic and hemorrhagic stroke. The majority had thrombocytopenia, high D-dimer, and anti-PF4 antibodies. The case fatality rate was 26.5%. In our study, 26/59 of the papers were of fair quality. The data from two nationwide registries and surveillance revealed 6347 venous and arterial thromboembolic events post-COVID-19 vaccinations. COVID-19 vaccinations have been linked to thrombotic and thromboembolic complications. However, the benefits far outweigh the risks. Clinicians should be aware of these complications because they may be fatal and because prompt identification and treatment can prevent fatalities.
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Affiliation(s)
- T T Favas
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, IND
| | - Neha Lall
- Department of Radiation Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, IND
| | - Deepika Joshi
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, IND
| | - Varun K Singh
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, IND
| | - Abhishek Pathak
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, IND
| | - Kamalesh Chakravarty
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Vijaya Nath Mishra
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, IND
| | - Rameshwar N Chaurasia
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, varanasi, IND
| | - Anand Kumar
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, IND
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5
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Jeon YH, Choi S, Park JH, Lee JK, Yeo NS, Lee S, Suh YL. Sudden Death Associated With Possible Flare-Ups of Multiple Sclerosis After COVID-19 Vaccination and Infection: A Case Report and Literature Review. J Korean Med Sci 2023; 38:e78. [PMID: 36918031 PMCID: PMC10010908 DOI: 10.3346/jkms.2023.38.e78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/30/2022] [Indexed: 03/06/2023] Open
Abstract
We present an autopsy case of a 19-year-old man with a history of epilepsy whose unwitnessed sudden death occurred unexpectedly in the night. About 4 years before death, he was diagnosed with unilateral optic neuritis (ON). Demyelinating disease was suspected, but he was lost to follow up after the recovery. Six months before death, he received a second dose of mRNA coronavirus disease 2019 (COVID-19) vaccine. Three months before death, he experienced epileptic seizures for the first time. Seventeen days before death, he was infected with COVID-19, which showed self-limited course under home isolation. Several days before death, he complained of seizures again at night. Autopsy revealed multifocal gray-tan discoloration in the cerebrum. Histologically, the lesions consisted of active and inactive demyelinated plaques in the perivenous area of the white matter. Perivascular lymphocytic infiltration and microglial cell proliferation were observed in both white matter and cortex. The other major organs including heart and lung were unremarkable. Based on the antemortem history and postmortem findings, the cause of death was determined to be multiple sclerosis with suspected exacerbation. The direct or indirect involvement of cortex and deep gray matter by exacerbated multiple sclerosis may explain the occurrence of seizures. Considering the absence of other structural abnormalities except the inflammatory demyelination of the cerebrum, fatal arrhythmia or laryngospasm in the terminal epileptic seizure may explain his sudden unexpected death in the benign circumstances. In this case, the onset of seizure was preceded by COVID-19 vaccination, and the exacerbation of seizure was preceded by COVID-19 infection, respectively. Literature reporting first manifestation or relapse of multiple sclerosis temporally associated with COVID-19 vaccination or infection are reviewed.
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Affiliation(s)
- Yo Han Jeon
- Department of Forensic Medicine, Defense Institute of Forensic Science, Criminal Investigation Command, Ministry of National Defense, Seoul, Korea
| | - Sangjoon Choi
- Department of Forensic Medicine, Defense Institute of Forensic Science, Criminal Investigation Command, Ministry of National Defense, Seoul, Korea
| | - Ji Hyun Park
- Department of Forensic Medicine, Defense Institute of Forensic Science, Criminal Investigation Command, Ministry of National Defense, Seoul, Korea
| | - Jong Kyu Lee
- Department of Forensic Medicine, Defense Institute of Forensic Science, Criminal Investigation Command, Ministry of National Defense, Seoul, Korea
| | - Nam Seok Yeo
- Department of Forensic Medicine, Defense Institute of Forensic Science, Criminal Investigation Command, Ministry of National Defense, Seoul, Korea
| | - SangHan Lee
- Department of Forensic Medicine, Defense Institute of Forensic Science, Criminal Investigation Command, Ministry of National Defense, Seoul, Korea.
| | - Yeon-Lim Suh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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6
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Frommeyer TC, Wu T, Gilbert MM, Brittain GV, Fuqua SP. Cerebral Venous Sinus Thrombosis Following an mRNA COVID-19 Vaccination and Recent Oral Contraceptive Use. Life (Basel) 2023; 13:life13020464. [PMID: 36836821 PMCID: PMC9961502 DOI: 10.3390/life13020464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
Rising concerns of cerebral venous sinus thrombosis (CVST) and other forms of venous thromboembolism have been associated with the SARS-CoV-2 vaccinations. Adverse effects with vector-based vaccines are well documented in the literature, while less is known about the mRNA vaccines. This report documents a case of CVST in a 32-year-old female patient who received her second Pfizer mRNA COVID-19 vaccination 16 days prior to hospital admission and had started oral combined contraceptives approximately 4 months beforehand. Clinicians should be cognizant of the possibility that mRNA vaccines, when combined with other risk factors like oral contraceptive pill use, may enhance one's hypercoagulable status.
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Affiliation(s)
- Timothy C. Frommeyer
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
- Correspondence:
| | - Tongfan Wu
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Michael M. Gilbert
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Garrett V. Brittain
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Stephen P. Fuqua
- Department of Neurology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
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7
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Fan BE, Ling RR, Ramanathan K, Leung BPL, Lim XR, Chadachan VM, Thirugnanam U, Stegner D, Tu TM. COVID-19 mRNA vaccine-associated cerebral venous thrombosis: Rare adverse event or coincidence? Am J Hematol 2023; 98:E4-E7. [PMID: 36308514 PMCID: PMC9874395 DOI: 10.1002/ajh.26773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Bingwen Eugene Fan
- Department of HaematologyTan Tock Seng HospitalSingapore,Department of Laboratory MedicineKhoo Teck Puat HospitalSingapore,Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore,Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Department of Cardiothoracic and Vascular SurgeryNational University Heart CentreSingapore
| | - Bernard Pui Lam Leung
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Health and Social SciencesSingapore Institute of TechnologySingapore,Department of Rheumatology, Allergy and ImmunologyTan Tock Seng HospitalSingapore
| | - Xin Rong Lim
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore,Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Department of Rheumatology, Allergy and ImmunologyTan Tock Seng HospitalSingapore
| | - Veerendra M. Chadachan
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore,Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Department of General MedicineTan Tock Seng HospitalSingapore
| | - Umapathi Thirugnanam
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore,Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Department of NeurologyNational Neuroscience InstituteSingapore
| | - David Stegner
- Institute of Experimental Biomedicine I, University Hospital and Rudolf Virchow Center for Integrative and Translational Bioimaging, University of WuerzburgWuerzburgGermany
| | - Tian Ming Tu
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore,Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Department of NeurologyNational Neuroscience InstituteSingapore
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8
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Nakagawa I, Okamoto A, Kotsugi M, Yokoyama S, Yamada S, Nakase H. Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis after mRNA-based SIRS-CoV-2 vaccination. INTERDISCIPLINARY NEUROSURGERY 2022; 30:101644. [PMID: 35966341 PMCID: PMC9364928 DOI: 10.1016/j.inat.2022.101644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/19/2022] [Accepted: 08/07/2022] [Indexed: 12/04/2022] Open
Abstract
Background As vaccinations against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue worldwide, increased rates of venous thrombotic events, mainly as cerebral venous sinus thrombosis (CVST), have been reported following adenovirus vector-based SARS-CoV-2 vaccination. However, few reports have described the occurrence of venous thrombosis after messenger RNA (mRNA)-based vaccination. Here, we describe a case of CVST after a first dose of mRNA-based vaccination that was treated with emergent endovascular mechanical thrombectomy and systemic heparinization. Case Description. A 43-year-old, previously healthy man suffered severe headache and partial seizures affecting the left arm 4 days after receiving the first dose of an mRNA-based SARS-CoV-2 vaccination (FC3661; Pfizer/BioNTech). Computed tomography showed intraparenchymal hemorrhage. Seven days after vaccination, symptoms worsened and he was transferred to our tertiary hospital. Magnetic resonance venography revealed CVST with occlusion of the superior sagittal sinus (SSS) and right transverse sinus (TS). Since no findings suggested thrombosis with thrombocytopenia syndrome, the patient underwent systemic heparinization and emergent mechanical thrombectomy with balloon transluminal angioplasty, a stent retriever and an aspiration catheter. Complete SSS and right TS recanalization were achieved and the patient was discharged without neurological deficits. Conclusion Clinicians should be aware that apparently healthy individuals with no risk factors can develop CVST after receiving an mRNA-based vaccine and appropriate treatment including EMT need to be performed immediately. (228 words)
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Affiliation(s)
- Ichiro Nakagawa
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Ai Okamoto
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Masashi Kotsugi
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shohei Yokoyama
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shuichi Yamada
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroyuki Nakase
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
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9
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Tan LJ, Koh CP, Lai SK, Poh WC, Othman MS, Hussin H. A systemic review and recommendation for an autopsy approach to death followed the COVID 19 vaccination. Forensic Sci Int 2022; 340:111469. [PMID: 36162300 PMCID: PMC9487151 DOI: 10.1016/j.forsciint.2022.111469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/28/2022] [Accepted: 09/18/2022] [Indexed: 11/21/2022]
Abstract
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in December 2019. An immediate prevention approach for the outbreak is the development of a vaccination program. Despite a growing number of publications showing the effectiveness of vaccination in preventing SARS-CoV-2 outbreak and reducing the mortality rate, substantial fatal adverse effects were reported after vaccination. Confirmation of the causal relationship of death is required to reimburse under the national vaccination program and could provide a reference for the selection of vaccination. However, a lack of guidelines in the laboratory study and autopsy approach hampered the investigation of post-vaccination death. In this paper, we performed a systematic electronic search on scientific articles related to severe Covid-19 vaccination adverse effects and approaches in identifying the severe side effects using PubMed and Cochrane libraries. A summary on the onset, biochemistry changes and histopathological analyzes of major lethally side effects post-vaccination were discussed. Ultimately, a checklist is suggested to improve the quality of investigation.
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Affiliation(s)
- Lii Jye Tan
- Department of Forensic Medicine, Hospital Raja Permaisuri Bainun, Ipoh, Perak Darul Ridzuan, Malaysia.
| | - Cai Ping Koh
- Department of Biochemistry, Faculty of Medicine, Quest International University, Malaysia
| | - Shau Kong Lai
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - Woon Cheng Poh
- Department of Biochemistry, Faculty of Medicine, Quest International University, Malaysia
| | - Mohammad Shafie Othman
- Department of Forensic Medicine, Hospital Raja Permaisuri Bainun, Ipoh, Perak Darul Ridzuan, Malaysia
| | - Huzlinda Hussin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
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10
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Alonso Castillo R, Martínez Castrillo JC. Neurological manifestations associated with COVID-19 vaccine. Neurologia 2022:S2173-5808(22)00141-9. [PMID: 36288776 PMCID: PMC9595420 DOI: 10.1016/j.nrleng.2022.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has spread rapidly, giving rise to a pandemic, causing significant morbidity and mortality. In this context, many vaccines have emerged to try to deal with this disease. OBJECTIVE To review the reported cases of neurological manifestations after the application of COVID-19 vaccines, describing clinical, analytical and neuroimaging findings and health outcomes. METHODS We carried out a review through bibliographic searches in PubMed. RESULTS We found 86 articles, including 13 809 patients with a wide spectrum of neurological manifestations temporally associated with COVID-19 vaccination. Most occurred in women (63.89%), with a median age of 50 years. The most frequently reported adverse events were Bell's palsy 4936/13 809 (35.7%), headache (4067/13 809), cerebrovascular events 2412/13 809 (17.47%), Guillain-Barré syndrome 868/13 809 (6.28%), central nervous system demyelination 258/13 809 (1.86%) and functional neurological disorder 398/13 809 (2.88%). Most of the published cases occurred in temporal association with the Pfizer vaccine (BNT162b2), followed by the AstraZeneca vaccine (ChAdOX1-S). CONCLUSIONS It is not possible to establish a causal relationship between these adverse events and COVID-19 vaccines with the currently existing data, nor to calculate the frequency of appearance of these disorders. However, it is necessary for health professionals to be familiar with these events, facilitating their early diagnosis and treatment. Large controlled epidemiological studies are necessary to establish a possible causal relationship between vaccination against COVID-19 and neurological adverse events.
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Affiliation(s)
- R Alonso Castillo
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - J C Martínez Castrillo
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
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11
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Ding Y, Ge Y. Inflammatory myopathy following coronavirus disease 2019 vaccination: A systematic review. Front Public Health 2022; 10:1007637. [PMID: 36339243 PMCID: PMC9634642 DOI: 10.3389/fpubh.2022.1007637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/06/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction Reports of unexpected side effects have accompanied the vaccination of larger proportions of the population against coronavirus disease 2019 (COVID-19), including a few cases of inflammatory myopathy (IM). In a bid to improve understanding of the clinical course of vaccine complications, a systematic review of reported cases of IM following COVID-19 vaccination has been conducted. Methods The PRISMA guideline 2020 was followed. Two independent investigators systematically searched PubMed and Embase to identify relevant studies published up to July 2022, using the following keywords: COVID-19 Vaccine, inflammatory myositis. The Joanna Briggs Institute critical appraisal tools were used for the risk of bias. Results A total of 24 articles presenting clinical features of 37 patients with IM following COVID-19 vaccine were identified. Female patients composed 59.5% of cases and 82.4% had been vaccinated with BNT162b2 or ChAdOx1. Onset of symptoms occurred within 2 weeks of the first or second vaccine dose in 29 (85.3%) patients and included muscular weakness in 54.1% and skin rash in 71.4% of patients. Myositis specific autoantibodies (MSAs) and myositis associated autoantibodies (MAAs) were reported in 28 patients. Specific clinical subtypes of myositis, reported in 27 patients, included 22 (81.5%) cases of dermatomyositis (DM) and 3 (11.1%) cases of immune-mediated necrotizing myopathy (IMNM). Following treatment, 32 (86.5%) patients showed improvement on follow-up. Conclusion COVID-19 vaccine may induce various clinical myositis subtypes and related antibodies. Muscular weakness was the most common presenting symptom. Clinicians should be aware of this unexpected adverse event following COVID-19 vaccination and arrange for appropriate management. Systematic review registration INPLASY https://inplasy.com/inplasy-2022-9-0084/ [INPLASY202290084].
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Affiliation(s)
- Yukang Ding
- Department of Rheumatology, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yongpeng Ge
- Department of Rheumatology, Key Laboratory of Myositis, China-Japan Friendship Hospital, Beijing, China,*Correspondence: Yongpeng Ge
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12
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Castillo RA, Castrillo JCM. [NEUROLOGICAL MANIFESTATIONS ASSOCIATED WITH COVID-19 VACCINE]. Neurologia 2022:S0213-4853(22)00187-6. [PMID: 36245941 PMCID: PMC9554338 DOI: 10.1016/j.nrl.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has spread rapidly, giving rise to a pandemic, causing significant morbidity and mortality. In this context, many vaccines have emerged to try to deal with this disease. OBJECTIVE To review the reported cases of neurological manifestations after the application of COVID-19 vaccines, describing clinical, analytical and neuroimaging findings and health outcomes. METHODS We carried out a review through bibliographic searches in PubMed. RESULTS We found 86 articles, including 13,809 patients with a wide spectrum of neurological manifestations temporally associated with COVID-19 vaccination. Most occurred in women (63.89%), with a median age of 50 years. The most frequently reported adverse events were Bell's palsy 4936/13809 (35.7%), headache (4067/13809), cerebrovascular events 2412/13809 (17.47%), Guillain-Barré syndrome 868/13809 (6.28%), central nervous system demyelination 258/13809 (1.86%) and functional neurological disorder 398/13809 (2.88%). Most of the published cases occurred in temporal association with the Pfizer vaccine (BNT162b2), followed by the AstraZeneca vaccine (ChAdOX1 nCoV-19). CONCLUSIONS It is not possible to establish a causal relationship between these adverse events and COVID-19 vaccines with the currently existing data, nor to calculate the frequency of appearance of these disorders. However, it is necessary for health professionals to be familiar with these events, facilitating their early diagnosis and treatment. Large controlled epidemiological studies are necessary to establish a possible causal relationship between vaccination against COVID-19 and neurological adverse events.
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Affiliation(s)
- Rocío Alonso Castillo
- Servicio de Neurología. Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Spain
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13
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Esmaeilzadeh A, Maleki AJ, Moradi A, Siahmansouri A, Yavari MJ, Karami P, Elahi R. Major severe acute respiratory coronavirus-2 (SARS-CoV-2) vaccine-associated adverse effects; benefits outweigh the risks. Expert Rev Vaccines 2022; 21:1377-1394. [DOI: 10.1080/14760584.2022.2116008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Abdolreza Esmaeilzadeh
- Department of Immunology, Zanjan University of Medical Sciences, Zanjan, Iran
- Cancer Gene Therapy Research Center (CGRC), Zanjan University of Medical Sciences, Zanjan, Iran
| | - Armin Jahani Maleki
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amirhosein Moradi
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amir Siahmansouri
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Parsa Karami
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Reza Elahi
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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14
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miri C, Bouchlarhem A, boulouiz S, El ouafi N, Bazid Z. Pulmonary embolism with junctional tachycardia: A serious complication after COVID-19 vaccination. Ann Med Surg (Lond) 2022; 80:103983. [PMID: 35784614 PMCID: PMC9238028 DOI: 10.1016/j.amsu.2022.103983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 10/25/2022] Open
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15
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Aran S, Kayder OO, Chopra T, Abujudeh H. Superficial thrombophlebitis in ipsilateral breast after COVID-19 vaccination. Radiol Case Rep 2022; 17:2883-2887. [PMID: 35711742 PMCID: PMC9189435 DOI: 10.1016/j.radcr.2022.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 12/04/2022] Open
Abstract
On December 2020, the US Food and Drug Administration issued the first emergency use authorization for a vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report development of superficial thrombophlebitis in the ipsilateral breast of a 43-year-old female 7 days after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine. Given that this is the first case of superficial thrombophlebitis in the breast shortly after mRNA vaccination for COVID-19 reported to our knowledge, we suggest that this may be a rare vaccine-related event.
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Affiliation(s)
- Shima Aran
- Division of Radiology, Detroit Receiving Hospital/University Health Network 3L8, 4201 St Antoine Blvd, Detroit, MI 48201, USA
| | - Orest O. Kayder
- Division of Radiology, Detroit Receiving Hospital/University Health Network 3L8, 4201 St Antoine Blvd, Detroit, MI 48201, USA
- Corresponding author.
| | - Teena Chopra
- Division of Infectious Diseases, Detroit Medical Center, Detroit Receiving Hospital/University Health Network 2E, 4201 St Antoine Blvd, Detroit, MI 48201, USA
| | - Hani Abujudeh
- Division of Radiology, Detroit Receiving Hospital/University Health Network 3L8, 4201 St Antoine Blvd, Detroit, MI 48201, USA
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16
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Chui CSL, Fan M, Wan EYF, Leung MTY, Cheung E, Yan VKC, Gao L, Ghebremichael-Weldeselassie Y, Man KK, Lau KK, Lam ICH, Lai FTT, Li X, Wong CKH, Chan EW, Cheung CL, Sing CW, Lee CK, Hung IFN, Lau CS, Chan JYS, Lee MKY, Mok VCT, Siu CW, Chan LST, Cheung T, Chan FLF, Leung AYH, Cowling BJ, Leung GM, Wong ICK. Thromboembolic events and hemorrhagic stroke after mRNA (BNT162b2) and inactivated (CoronaVac) covid-19 vaccination: A self-controlled case series study. EClinicalMedicine 2022; 50:101504. [PMID: 35770253 PMCID: PMC9233170 DOI: 10.1016/j.eclinm.2022.101504] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study aims to evaluate the association between thromboembolic events and hemorrhagic stroke following BNT162b2 and CoronaVac vaccination. METHODS Patients with incident thromboembolic events or hemorrhagic stroke within 28 days of covid-19 vaccination or SARS-CoV-2 positive test during 23 February to 30 September 2021 were included. The incidence per 100,000 covid-19 vaccine doses administered and SARS-CoV-2 test positive cases were estimated. A modified self-controlled case series (SCCS) analysis using the data from the Hong Kong territory-wide electronic health and vaccination records. Seasonal effect was adjusted by month. FINDINGS A total of 5,526,547 doses of BNT162b2 and 3,146,741 doses of CoronaVac were administered. A total of 334 and 402 thromboembolic events, and 57 and 49 hemorrhagic stroke cases occurred within 28 days after BNT162b2 and CoronaVac vaccination, respectively. The crude incidence of thromboembolic events and hemorrhagic stroke per 100,000 doses administered for both covid-19 vaccines were smaller than that per 100,000 SARS-CoV-2 test positive cases. The modified SCCS detected an increased risk of hemorrhagic stroke in BNT162b2 14-27 days after first dose with adjusted IRR of 2.53 (95% CI 1.48-4.34), and 0-13 days after second dose with adjusted IRR 2.69 (95% CI 1.54-4.69). No statistically significant risk was observed for thromboembolic events for both vaccines. INTERPRETATION We detected a possible safety signal for hemorrhagic stroke following BNT162b2 vaccination. The incidence of thromboembolic event or hemorrhagic stroke following vaccination is lower than that among SARS-CoV-2 test positive cases; therefore, vaccination against covid-19 remains an important public health intervention. FUNDING This study was funded by a research grant from the Food and Health Bureau, The Government of the Hong Kong Special Administrative Region (reference COVID19F01).
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Affiliation(s)
- Celine Sze Ling Chui
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, SAR, China
| | - Min Fan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Eric Yuk Fai Wan
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Miriam Tim Yin Leung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Edmund Cheung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Vincent Ka Chun Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Le Gao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Kenneth K.C. Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, United Kingdom
| | - Kui Kai Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Ivan Chun Hang Lam
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Francisco Tsz Tsun Lai
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xue Li
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Carlos King Ho Wong
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Esther W. Chan
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ching-Lung Cheung
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Chor-Wing Sing
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cheuk Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Hospital Authority, Hong Kong, China
- Expert Committee on Clinical Events Assessment Following COVID-19 Immunization, Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong, SAR, China
| | - Ivan Fan Ngai Hung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
- Expert Committee on Clinical Events Assessment Following COVID-19 Immunization, Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong, SAR, China
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Joseph Yat Sun Chan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, The Chinese University of Hong Kong, Hong Kong
| | - Michael Kang-Yin Lee
- Expert Committee on Clinical Events Assessment Following COVID-19 Immunization, Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong, SAR, China
- Queen Elizabeth Hospital, Hospital Authority, Hong Kong, China
| | - Vincent Chung Tong Mok
- Expert Committee on Clinical Events Assessment Following COVID-19 Immunization, Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Chung-Wah Siu
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Lot Sze Tao Chan
- Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong, SAR, China
| | - Terence Cheung
- Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong, SAR, China
| | - Frank Ling Fung Chan
- Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong, SAR, China
| | - Anskar Yu-Hung Leung
- Division of Hematology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Benjamin John Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, SAR, China
| | - Gabriel Matthew Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, SAR, China
| | - Ian Chi Kei Wong
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, United Kingdom
- Expert Committee on Clinical Events Assessment Following COVID-19 Immunization, Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong, SAR, China
- Corresponding author at: L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong
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17
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Association of Cerebral Venous Thrombosis with mRNA COVID-19 Vaccines: A Disproportionality Analysis of the World Health Organization Pharmacovigilance Database. Vaccines (Basel) 2022; 10:vaccines10050799. [PMID: 35632556 PMCID: PMC9145068 DOI: 10.3390/vaccines10050799] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 12/16/2022] Open
Abstract
Cerebral venous thrombosis (CVT), a rare thrombotic event that can cause serious neurologic deficits, has been reported after some ChAdOx1 nCoV-19 vaccinations against coronavirus disease 2019 (COVID-19). However, there are few reports of associations between COVID-19 mRNA vaccination and CVT. We retrospectively analyzed CVT occurrence, time of onset after vaccination, outcomes (recovered/not recovered), and death after COVID-19 vaccination from adverse drug reactions (ADR) reports in VigiBase. A disproportionality analysis was performed regarding COVID-19 mRNA vaccines (BNT162b2 and mRNA-1273) and the ChAdOx1 nCoV-19 vaccine. We identified 756 (0.07%) CVT cases (620 (0.05%) after BNT162b2 and 136 (0.01%) after mRNA-1273) of 1,154,023 mRNA vaccine-related ADRs. Significant positive safety signals were noted for COVID-19 mRNA vaccines (95% lower end of information component = 1.56; reporting odds ratio with 95% confidence interval (CI) = 3.27). The median days to CVT onset differed significantly between the BNT162b2 and ChAdOx1 nCoV-19 vaccines (12 (interquartile range, 3−22) and 11 (interquartile range, 7−16), respectively; p = 0.02). Fewer CVT patients died after receiving mRNA vaccines than after receiving the ChAdOx1 nCoV-19 vaccine (odds ratio, 0.32; 95% CI, 0.22−0.45; p < 0.001). We noted a potential safety signal for CVT occurrence after COVID-19 mRNA vaccination. Therefore, awareness about the risk of CVT, even after COVID-19 mRNA vaccination, is necessary.
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18
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Serrao A, Agrippino R, Brescini M, Mormile R, Chistolini A. Thromboembolic events following mRNA vaccines for COVID 19: a case series. J Thromb Thrombolysis 2022; 53:971-973. [PMID: 35118582 PMCID: PMC8812355 DOI: 10.1007/s11239-021-02627-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/25/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Alessandra Serrao
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Roberta Agrippino
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Mattia Brescini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Rosaria Mormile
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Antonio Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy.
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19
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Yousaf Z, Ata F, Mohammed Hammamy RA. Thrombosis post-mRNA-based SARS-CoV-2 vaccination (BNT162b2) - Time to think beyond thrombosis with thrombocytopenia syndrome (TTS). THROMBOSIS UPDATE 2022; 7:100104. [PMID: 38620755 PMCID: PMC9013693 DOI: 10.1016/j.tru.2022.100104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/20/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022] Open
Abstract
The COVID-19 pandemic has affected the global socioeconomic and healthcare infrastructure. Vaccines have been the cornerstone in limiting the global spread of the pandemic. However, the mass scale vaccination has resulted in some unanticipated adverse events. Arguably the most serious of these has been the development of widespread thrombosis with viral-vectored vaccines. We present a case of extensive thrombosis associated with the messenger RNA (m-RNA) vaccine.
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Affiliation(s)
- Zohaib Yousaf
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fateen Ata
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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20
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Cerebral Venous Sinus Thrombosis Associated with Vaccine-Induced Thrombotic Thrombocytopenia—A Narrative Review. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6020011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In March 2021, cerebral venous sinus thrombosis and thrombocytopenia after vaccination with adenovirus-based vaccine against SARS-CoV-2 were first reported. The underlining condition has been termed vaccine-induced immune thrombocytopenia (VITT). Anti-platelet factor 4 antibodies have been proposed as a central component of the pathomechanism. Treatment recommendations entailed immunomodulation with intravenous immunoglobulins, avoidance of heparins and avoidance of platelet transfusions. Although mortality from VITT-associated cerebral venous sinus thrombosis has decreased over time, it remains high. The aim of this narrative review is to describe different aspects of this disease according to the current state of knowledge.
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21
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Roncati L, Manenti A, Corsi L. A Three-Case Series of Thrombotic Deaths in Patients over 50 with Comorbidities Temporally after modRNA COVID-19 Vaccination. Pathogens 2022; 11:pathogens11040435. [PMID: 35456110 PMCID: PMC9032304 DOI: 10.3390/pathogens11040435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 01/04/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is the most dramatic pandemic of the new millennium; to counteract it, specific vaccines have been launched in record time under emergency use authorization or conditional marketing authorization by virtue of a favorable risk/benefit balance. Among the various technological platforms, there is that exploiting a nucleoside-modified messenger RNA (modRNA), such as Comirnaty®, and that which is adenoviral vector-based. In the ongoing pharmacovigilance, the product information of the latter has been updated about the risk of thrombotic thrombocytopenia, venous thromboembolism without thrombocytopenia and immune thrombocytopenia without thrombosis. However, from an in-depth literature review, the same adverse events can rarely occur with modRNA vaccines too. In support of this, we here report a three-case series of thrombotic deaths in patients over 50 with comorbidities temporally after Comirnaty®, investigated by means of post-mortem histopathology and immunohistochemistry. In two out of three cases, the cause of death is traced back to pulmonary microthromboses rich in activated platelets, quite similar morphologically to those described in patients who died from severe COVID-19. Even if remote in the face of millions of administered doses, clinicians should be aware of the possible thrombotic risk also after Comirnaty®, in order to avoid a misdiagnosis with potentially lethal consequences. Since COVID-19 vaccines are inoculated in subjects to be protected, maximum attention must be paid to their safety, and prophylactic measures to increase it are always welcome. In light of the evidence, the product information of modRNA COVID-19 vaccines should be updated about the thrombotic risk, as happened for adenoviral vector-based vaccines.
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Affiliation(s)
- Luca Roncati
- Institute of Pathology, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Correspondence: or or
| | - Antonio Manenti
- Unit of Surgery, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Lorenzo Corsi
- Department of Life Sciences, Section of Pharmacology, University of Modena and Reggio Emilia, 41125 Modena, Italy;
- National Institute of Biostructures and Biosystems, Inter-University Consortium, 00136 Rome, Italy
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22
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Lim XR, Leung BP, Sum CLL, Lim GH, Chua CG, Tu TM, Ramanathan K, Huang MY, Howe HS, Fan BE. BNT162b2 mRNA SARS-CoV-2 vaccination does not cause upregulation of endothelial activation markers or hypercoagulability: A prospective, single-arm, longitudinal study. Am J Hematol 2022; 97:E141-E144. [PMID: 35015303 PMCID: PMC9011698 DOI: 10.1002/ajh.26462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Xin Rong Lim
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Bernard PuiLam Leung
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Health and Social Sciences Singapore Institute of Technology Singapore
| | | | - Gek Hsiang Lim
- Clinical Research and Innovation Office Tan Tock Seng Hospital Singapore
| | - Choon Guan Chua
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Tian Ming Tu
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Department of Neurology National Neuroscience Institute Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Department of Cardiac, Thoracic and Vascular Surgery National University Heart Centre Singapore
| | - Mei Yan Huang
- Health and Social Sciences Singapore Institute of Technology Singapore
| | - Hwee Siew Howe
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Bingwen Eugene Fan
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Department of Haematology Tan Tock Seng Hospital Singapore
- Department of Laboratory Medicine Khoo Teck Puat Hospital Singapore
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23
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Coagulopathy and Fibrinolytic Pathophysiology in COVID-19 and SARS-CoV-2 Vaccination. Int J Mol Sci 2022; 23:ijms23063338. [PMID: 35328761 PMCID: PMC8955234 DOI: 10.3390/ijms23063338] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is frequently complicated by thrombosis. In some cases of severe COVID-19, fibrinolysis may be markedly enhanced within a few days, resulting in fatal bleeding. In the treatment of COVID-19, attention should be paid to both coagulation activation and fibrinolytic activation. Various thromboses are known to occur after vaccination with SARS-CoV-2 vaccines. Vaccine-induced immune thrombotic thrombocytopenia (VITT) can occur after adenovirus-vectored vaccination, and is characterized by the detection of anti-platelet factor 4 antibodies by enzyme-linked immunosorbent assay and thrombosis in unusual locations such as cerebral venous sinuses and visceral veins. Treatment comprises high-dose immunoglobulin, argatroban, and fondaparinux. Some VITT cases show marked decreases in fibrinogen and platelets and marked increases in D-dimer, suggesting the presence of enhanced-fibrinolytic-type disseminated intravascular coagulation with a high risk of bleeding. In the treatment of VITT, evaluation of both coagulation activation and fibrinolytic activation is important, adjusting treatments accordingly to improve outcomes.
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24
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Liu R, Pan J, Zhang C, Sun X. Cardiovascular Complications of COVID-19 Vaccines. Front Cardiovasc Med 2022; 9:840929. [PMID: 35369340 PMCID: PMC8971371 DOI: 10.3389/fcvm.2022.840929] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/17/2022] [Indexed: 12/14/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has become a global public health catastrophe. Vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is proven to be the most effective measure to suppress the pandemic. With the widespread application of the four vaccines, namely, ChAdOx1, Ad26.COV2.S, BNT162b2, and mRNA-1273.2, several adverse effects have been reported. The most serious type of complication is cardiovascularly related, including myocarditis, immune thrombocytopenia (ITP), cerebral sinus venous thrombosis, among others. All these adverse events undermine the health of the vaccinees and affect the administration of the vaccines. As the distribution of COVID-19 vaccines is surrounded by suspicion and rumors, it is essential to provide the public with accurate reports from trusted experts and journals. Monitoring the safety of COVID-19 vaccines is an important and ongoing process that is also urgent. Thus, we summarized the cardiovascular complications of the major types of COVID-19 vaccines, including mRNA vaccines, which are now generally considered to be innovative vaccines, and the future for vaccination against COVID-19, in addition to the underlying pathogenesis and potential therapeutics.
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Affiliation(s)
- Runyu Liu
- Department of General Surgery (Vascular Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Junbing Pan
- Department of General Surgery (Vascular Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chunxiang Zhang
- Key Laboratory of Medical Electrophysiology, Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
- Nucleic Acid Medicine of Luzhou Key Laboratory, Southwest Medical University, Luzhou, China
| | - Xiaolei Sun
- Department of General Surgery (Vascular Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Key Laboratory of Medical Electrophysiology, Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
- Nucleic Acid Medicine of Luzhou Key Laboratory, Southwest Medical University, Luzhou, China
- Department of Interventional Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- King's College London British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, Faculty of Life Science and Medicine, King's College London, London, United Kingdom
- *Correspondence: Xiaolei Sun ;
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25
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Kakovan M, Shirkouhi SG, Zarei M, Andalib S. Stroke Associated with COVID-19 Vaccines. J Stroke Cerebrovasc Dis 2022; 31:106440. [PMID: 35339857 PMCID: PMC8894799 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106440] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/28/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives Development of safe and effective vaccines against coronavirus disease 2019 (COVID-19) remains the cornerstone of controlling this pandemic. However, there are increasing reports of various types of stroke including ischemic stroke, and hemorrhagic stroke, as well as cerebral venous sinus thrombosis (CVST) after COVID-19 vaccination. This paper aims to review reports of stroke associated with COVID-19 vaccines and provide a coherent clinical picture of this condition. Materials and methods A literature review was performed with a focus on data from recent studies. Results Most of such patients are women under 60 years of age and who had received ChAdOx1 nCoV-19 vaccine. Most studies reported CVST with or without secondary ischemic or hemorrhagic stroke, and some with Vaccine-induced Thrombotic Thrombocytopenia (VITT). The most common clinical symptom of CVST seen after COVID-19 vaccination was headache. The clinical course of CVST after COVID-19 vaccination may be more severe than CVST not associated with COVID vaccination. Management of CVST following COVID-19 vaccination is challenging and may differ from the standard treatment of CVST. Low molecular weight heparin is commonly used in the treatment of CVST; however, it may worsen outcomes in CVST associated with VITT. Furthermore, administration of intravenous immunoglobulin and high-dose glucocorticoids have been recommended with various success rates. Conclusion These contradictory observations are a source of confusion in clinical decision-making and warrant further study and development of clinical guidelines. Clinicians should be aware of clinical presentation, diagnosis, and management of stroke associated with COVID-19 vaccination.
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Intracellular Reverse Transcription of Pfizer BioNTech COVID-19 mRNA Vaccine BNT162b2 In Vitro in Human Liver Cell Line. Curr Issues Mol Biol 2022; 44:1115-1126. [PMID: 35723296 PMCID: PMC8946961 DOI: 10.3390/cimb44030073] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 12/25/2022] Open
Abstract
Preclinical studies of COVID-19 mRNA vaccine BNT162b2, developed by Pfizer and BioNTech, showed reversible hepatic effects in animals that received the BNT162b2 injection. Furthermore, a recent study showed that SARS-CoV-2 RNA can be reverse-transcribed and integrated into the genome of human cells. In this study, we investigated the effect of BNT162b2 on the human liver cell line Huh7 in vitro. Huh7 cells were exposed to BNT162b2, and quantitative PCR was performed on RNA extracted from the cells. We detected high levels of BNT162b2 in Huh7 cells and changes in gene expression of long interspersed nuclear element-1 (LINE-1), which is an endogenous reverse transcriptase. Immunohistochemistry using antibody binding to LINE-1 open reading frame-1 RNA-binding protein (ORFp1) on Huh7 cells treated with BNT162b2 indicated increased nucleus distribution of LINE-1. PCR on genomic DNA of Huh7 cells exposed to BNT162b2 amplified the DNA sequence unique to BNT162b2. Our results indicate a fast up-take of BNT162b2 into human liver cell line Huh7, leading to changes in LINE-1 expression and distribution. We also show that BNT162b2 mRNA is reverse transcribed intracellularly into DNA in as fast as 6 h upon BNT162b2 exposure.
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27
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Mahgoub AE, Awuah D, Hussain M, Deliwala S, Bachuwa G, Younas M. Development of Venous Thromboembolism After COVID-19 mRNA-1273 Vaccine Inoculation. Cureus 2022; 14:e22179. [PMID: 35308698 PMCID: PMC8923564 DOI: 10.7759/cureus.22179] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 01/05/2023] Open
Abstract
A 79-year-old man suddenly developed right lower extremity (RLE) pain and swelling a few days after receiving his 1st dose of the mRNA-1273 COVID-19 vaccine. Despite this, he proceeded to receive the 2nd dose of his mRNA-1273 COVID-19 vaccine. Investigations confirmed extensive acute deep venous thrombosis and a concurrent acute pulmonary embolism. Therapeutic anticoagulation was initiated and he was eventually discharged home on supplemental oxygen. The overall benefits of the vaccine in curbing severe disease overwhelmingly outweigh the handful of cases of reported adverse events. To our knowledge, this is one of the first few cases of provoked venous thrombosis after receiving the mRNA-1273 COVID-19 vaccine during the pharmacovigilance period.
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Garg RK, Paliwal VK. Spectrum of neurological complications following COVID-19 vaccination. Neurol Sci 2022; 43:3-40. [PMID: 34719776 PMCID: PMC8557950 DOI: 10.1007/s10072-021-05662-9] [Citation(s) in RCA: 131] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/08/2021] [Indexed: 12/12/2022]
Abstract
COVID-19 vaccines have brought us a ray of hope to effectively fight against deadly pandemic of COVID-19 and hope to save lives. Many vaccines have been granted emergency use authorizations by many countries. Post-authorization, a wide spectrum of neurological complications is continuously being reported following COVID-19 vaccination. Neurological adverse events following vaccination are generally mild and transient, like fever and chills, headache, fatigue, myalgia and arthralgia, or local injection site effects like swelling, redness, or pain. The most devastating neurological post-vaccination complication is cerebral venous sinus thrombosis. Cerebral venous sinus is frequently reported in females of childbearing age, generally following adenovector-based vaccination. Another major neurological complication of concern is Bell's palsy that was reported dominantly following mRNA vaccine administration. Acute transverse myelitis, acute disseminated encephalomyelitis, and acute demyelinating polyneuropathy are other unexpected neurological adverse events that occur as result of phenomenon of molecular mimicry. Reactivation of herpes zoster in many persons, following administration of mRNA vaccines, has been also recorded. Considering the enormity of recent COVID-19-vaccinated population, the number of serious neurological events is miniscule. Large collaborative prospective studies are needed to prove or disprove causal association between vaccine and neurological adverse events occurring vaccination.
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Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh India PIN-226003
| | - Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli road, Lucknow, India
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29
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Scendoni R, Petrelli C, Giustozzi M, Logullo FO. Multiple sites of thrombosis without thrombocytopenia after a second dose of Pfizer-BioNTech COVID-19 vaccine. Int J Immunopathol Pharmacol 2022; 36:3946320221128534. [PMID: 36123789 PMCID: PMC9486676 DOI: 10.1177/03946320221128534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In the current international scientific panorama, rare cases of venous thrombotic complications following mRNA vaccine administration have been reported, consisting mainly of cerebral sinus thromboses and acute venous thromboembolism. The present paper describes the case of a 75-year-old woman in good health who developed cerebral venous thrombosis, deep venous thrombosis, and bilateral pulmonary emboli after receiving a second dose of Pfizer-BioNTech COVID-19 vaccine. A series of laboratory tests performed during hospitalization yielded interesting results, allowing us to exclude thrombophilic risk factors and to certify the absence of thrombocytopenia in the patient. Although COVID-19 vaccination is the most important tool in stopping the pandemic, pharmacovigilance is crucial for detecting potential multisystem thrombotic events, even for mRNA vaccines.
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30
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Kjoersvik O, Bate A. Black Swan Events and Intelligent Automation for Routine Safety Surveillance. Drug Saf 2022; 45:419-427. [PMID: 35579807 PMCID: PMC9112242 DOI: 10.1007/s40264-022-01169-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 01/28/2023]
Abstract
Effective identification of previously implausible safety signals is a core component of successful pharmacovigilance. Timely, reliable, and efficient data ingestion and related processing are critical to this. The term 'black swan events' was coined by Taleb to describe events with three attributes: unpredictability, severe and widespread consequences, and retrospective bias. These rare events are not well understood at their emergence but are often rationalized in retrospect as predictable. Pharmacovigilance strives to rapidly respond to potential black swan events associated with medicine or vaccine use. Machine learning (ML) is increasingly being explored in data ingestion tasks. In contrast to rule-based automation approaches, ML can use historical data (i.e., 'training data') to effectively predict emerging data patterns and support effective data intake, processing, and organisation. At first sight, this reliance on previous data might be considered a limitation when building ML models for effective data ingestion in systems that look to focus on the identification of potential black swan events. We argue that, first, some apparent black swan events-although unexpected medically-will exhibit data attributes similar to those of other safety data and not prove algorithmically unpredictable, and, second, standard and emerging ML approaches can still be robust to such data outliers with proper awareness and consideration in ML system design and with the incorporation of specific mitigatory and support strategies. We argue that effective approaches to managing data on potential black swan events are essential for trust and outline several strategies to address data on potential black swan events during data ingestion.
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Affiliation(s)
| | - Andrew Bate
- grid.418236.a0000 0001 2162 0389Global Safety, GSK, 980 Great West Road, Brentford, TW8 9GS Middlesex UK ,grid.8991.90000 0004 0425 469XDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK ,grid.137628.90000 0004 1936 8753Department of Medicine at NYU Grossman School of Medicine, New York, USA
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31
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Al-Ali D, Elshafeey A, Mushannen M, Kawas H, Shafiq A, Mhaimeed N, Mhaimeed O, Mhaimeed N, Zeghlache R, Salameh M, Paul P, Homssi M, Mohammed I, Narangoli A, Yagan L, Khanjar B, Laws S, Elshazly MB, Zakaria D. Cardiovascular and haematological events post COVID-19 vaccination: A systematic review. J Cell Mol Med 2021; 26:636-653. [PMID: 34967105 PMCID: PMC8817142 DOI: 10.1111/jcmm.17137] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022] Open
Abstract
Since COVID‐19 took a strong hold around the globe causing considerable morbidity and mortality, a lot of effort was dedicated to manufacturing effective vaccines against SARS‐CoV‐2. Many questions have since been raised surrounding the safety of the vaccines, and a lot of media attention to certain side effects. This caused a state of vaccine hesitancy that may prove problematic in the global effort to control the virus. This review was undertaken with the aim of putting together all the reported cardiovascular and haematological events post COVID‐19 vaccination in published literature and to suggest possible mechanisms to explain these rare phenomena.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lina Yagan
- Weill Cornell Medicine Qatar, Doha, Qatar
| | | | - Sa'ad Laws
- Weill Cornell Medicine Qatar, Doha, Qatar
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Kuzumi A, Yoshizaki A, Chiba K, Mitsuo S, Matsuda KM, Norimatsu Y, Nagai K, Omatsu J, Miyake T, Sato S. Genital necrosis with cutaneous thrombosis after COVID-19 mRNA vaccination. J Eur Acad Dermatol Venereol 2021; 36:e185-e186. [PMID: 34839563 PMCID: PMC9011818 DOI: 10.1111/jdv.17837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- A Kuzumi
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - A Yoshizaki
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - K Chiba
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - S Mitsuo
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - K M Matsuda
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Y Norimatsu
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - K Nagai
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - J Omatsu
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - T Miyake
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - S Sato
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Yamaguchi Y, Kimihira L, Nagasawa H, Seo K, Wada M. Cerebral Venous Sinus Thrombosis After BNT162b2 mRNA COVID-19 Vaccination. Cureus 2021; 13:e18775. [PMID: 34796065 PMCID: PMC8590453 DOI: 10.7759/cureus.18775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 02/03/2023] Open
Abstract
W present a rare case of cerebral venous sinus thrombosis after the BNT162b2 mRNA COVID-19 vaccine. A 61-year-old Japanese man developed a headache 10 days after the first dose of the vaccine. Magnetic resonance venography and contrast-enhanced brain MRI showed thrombosis in the superior sagittal sinus and the right transverse sinus. Anticoagulation with intravenous unfractionated heparin followed by oral warfarin was started. His headache improved, and brain MRI on day 22 showed resolution of thrombus. He was maintained on anticoagulation with warfarin and discharged without any neurological sequelae. This case is presented in the context of the relevant literature.
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Affiliation(s)
- Yoshitaka Yamaguchi
- Department of Neurology, Yamagata Prefectural Central Hospital, Yamagata, JPN
| | - Luna Kimihira
- Department of Neurology, Yamagata Prefectural Central Hospital, Yamagata, JPN
| | - Hikaru Nagasawa
- Department of Neurology, Yamagata Prefectural Central Hospital, Yamagata, JPN
| | - Kyoichi Seo
- Department of Neurosurgery, Yamagata Prefectural Central Hospital, Yamagata, JPN
| | - Manabu Wada
- Department of Neurology, Yamagata Prefectural Central Hospital, Yamagata, JPN
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Thrombosis post COVID-19 vaccinations: Potential link to ACE pathways. Thromb Res 2021; 206:137-138. [PMID: 34479129 PMCID: PMC8397505 DOI: 10.1016/j.thromres.2021.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/26/2022]
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35
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Tozinameran. REACTIONS WEEKLY 2021. [PMCID: PMC8417662 DOI: 10.1007/s40278-021-01910-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Graça LL, Amaral MJ, Serôdio M, Costa B. Extensive thrombosis after COVID-19 vaccine: cause or coincidence? BMJ Case Rep 2021; 14:14/8/e244878. [PMID: 34400433 PMCID: PMC8370539 DOI: 10.1136/bcr-2021-244878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 62-year-old Caucasian female patient presented with abdominal pain, vomiting and fever 1 day after administration of COVID-19 vaccine. Bloodwork revealed anaemia and thrombocytosis. Abdominal CT angiography showed a mural thrombus at the emergence of the coeliac trunk, hepatic and splenic arteries, and extensive thrombosis of the superior and inferior mesenteric veins, splenic and portal veins, and the inferior vena cava, extending to the left common iliac vein. The spleen displayed extensive areas of infarction. Aetiological investigation included assessment of congenital coagulation disorders and acquired causes with no relevant findings. Administration of COVID-19 vaccine was considered a possible cause of the extensive multifocal thrombosis. After reviewing relevant literature, it was considered that other causes of this event should be further investigated. Thrombosis associated with COVID-19 vaccine is rare and an aetiological relationship should only be considered in the appropriate context and after investigation of other, more frequent, causes.
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Affiliation(s)
- Luís Lourenço Graça
- Cardiothoracic Surgery, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Maria João Amaral
- General Surgery, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Marco Serôdio
- General Surgery, HBP Unit and Liver transplantation Unit, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Beatriz Costa
- General Surgery, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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