Skip to main content
The Egyptian Journal of Internal Medicine
Download PDF

An analysis of fatal adverse conditions in temporal association of COVID-19 vaccination to boost the safety of vaccination for COVID-19

The Egyptian Journal of Internal Medicine volume 35, Article number: 11 (2023) Cite this article

Abstract

SARS-CoV-2, the causative agent of COVID-19, claimed multiple lives in a very short span of time. Seeing the urgency of situation, vaccines were developed in hitherto unseen time frame. Vaccines definitely passed the test of safety and efficacy in clinical trials, but post mass vaccination data revealed cases of fatal adverse conditions in the temporal association of vaccination.

The temporal association does not guarantee that the fatality is due to vaccination, but at the same time, it does create a concern. To overcome this concern and improve the safety of vaccination, we reviewed literature and collected data of 15 studies comprising of total 22 cases of fatal adverse condition/death in the temporal association of COVID-19 vaccination.

Analysis of these data shows that many persons (40.90%) who succumbed were previously healthy individuals. All those who died developed symptoms or were admitted to hospital within a period of 3 weeks after vaccination. 86.36% cases of death took place within a period of 3 weeks after vaccination/presentation/admission/intervention. Complications which lead to death were CVST, thrombocytopenia/thrombosis /VITT, DIC and haemorrhage in 81.18% of cases. 81.81% cases of death were noted in the temporal association with ChAdOx1 nCoV-19 vaccine. 68.18% persons developed symptoms after first dose. Death was more common in females (59.09%), and the most commonly affected age group was 20 to 60 years (86.36%).

Knowledge of fatal adverse conditions in the temporal association of vaccination will help to tackle these situations well and improve the safety of vaccination drive further.

Background

COVID-19, a disease caused by SARS-CoV-2, has drastically changed the life of human being in last 2 years. All around the world, fear of surge of COVID-19 cases, development of new variant, getting infected with virus and loss of own/near and dear one’s life keeps looming. In order to combat this viral disease, old time-tested formula of vaccine was brought forward. But, the time to test the vaccine, i.e. time required from identification of virus to development of vaccine to approval of vaccine, was kept short.

While the time required from isolation/identification of pathogen in laboratory to approval of vaccine for mass vaccination programme for most of the vaccines is in years, this time frame for COVID-19 vaccines is within a year. Fastest time in which a vaccine got approval after sampling of virus is 4 years, and the vaccine which got the approval in this time range is mumps vaccine developed in 1960s [1].

Though COVID-19 vaccines have been found to be safe and effective in clinical trials, a close watch on adverse effects developing after vaccination is essential as large numbers of people are being vaccinated and even a small fraction of serious adverse effect may be a significant number.

Most of the adverse effects developing after vaccination have been found to be mild and self-limiting. However, some cases of serious adverse effects after vaccination have also been reported. Few reports of adverse effects which ultimately resulted into death have also been found. Though cause of death in these reports cannot be directly attributed to vaccination, the temporal association with vaccination does raise the question [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16].

In this study, an attempt has been made to present information about fatal adverse effects developing after vaccination (whether causal or merely an association), so that a better understanding of these lethal untoward effects can be made and appropriate measures to handle these adverse situations can be taken and ultimately safety of vaccination can be improved.

Material and methods

In order to find out cases of death after COVID-19 vaccination, literature search was performed using the key words like death/mortality/adverse effects after COVID-19 vaccination. Since many reports of serious adverse effects like myocarditis and thrombotic thrombocytopenia after COVID-19 vaccination were noted, these papers were also thoroughly evaluated to find cases who succumbed to death. Only case reports and case series were included in the study. A total of 15 studies with 22 deaths in the temporal association of COVID-19 vaccination were noted.

Result

Data was collected from 15 different studies for 22 cases of death in the temporal association of COVID-19 vaccination (see Table 1); when analysed in relation to various factors like adverse effects after vaccination which probably lead to death, past medical history, age and sex of person vaccinated, type of vaccine used, time of onset of symptoms/admission after vaccination, dose after which symptoms developed, and time of death after presentation/vaccination/admission/intervention, it yielded the following results.

Table 1 Showing features of death in the temporal association of COVID-19 vaccination
Full size table

Adverse effects noted after vaccination

CVST was the most common complication resulting into death. Out of 22 deaths, it was found to be associated with 15 (68.18%) cases of death. In majority of cases, CVST was associated with thrombocytopenia (n = 8). It was also found to be associated with DIC, intracerebral haemorrhage, and SAH.

Thrombocytopenia with acute ischemic stroke with B/L adrenal haemorrhage, intracerebral haemorrhage, VITT with DIC, and autoimmune hepatitis; each resulted in one case of death (4x 4.54%). Myocardial infarction was noted in one case (4.54%) and myocarditis in 2 cases (9.09%) of death (see Table 2).

Table 2 Adverse effects noted after COVID-19 vaccination
Full size table

Past medical history

Out of 22 cases, majority of cases (n = 9) (40.90%) had no significant previous medical history. Three (13.63%) patients had H/o HTN out of which one had H/o HTN along with Hashimoto thyroiditis, one had HTN and H/o HRT, and one patient had only HTN. Diabetes mellitus was noted in 2 cases (9.09%), out of which one had DM and past H/o jaundice and one had only DM. H/o pollen allergy was found in 3 cases (13.63%) out of which 2 patients also had H/o contraceptive vaginal rings and one patient had H/o OCP along with pollen allergy. Past H/o Ca prostate (status—post sx and RT) on ADT along with h/o atrial fibrillation was found in one case (4.54%). Individuals with H/o Ménière’s disease (1 case = 4.54%), fibromyalgia (1 case = 4.54%), multiple sclerosis (1 case = 4.54%), and H/o PSC along with migraine (1 case = 4.54%) accounted for the remaining cases (see Table 3).

Table 3 Past medical history of persons who succumbed to death
Full size table

Age and sex wise distribution

Most of the deaths (19 out of 22 = 86.36%) took place between ages 20 to 60 years.

Females outnumbered the males. Out of 22 cases, 13 were females (59.09%), and 9 were males (40.90%) (see Fig. 1).

Fig. 1
figure 1

Characteristics of persons who died in the temporal association of vaccination along with number of deaths

Full size image

Type of vaccine

Eighteen out of 22 cases (= 81.81%) were associated with ChAdOx1 nCoV-19 vaccine {this includes ChAdOx1 nCoV-19 vaccines (11) +AstraZeneca vaccine (3) + Covishield (1) + Vaxzevria (2) + AZD-122(1)}. BNT 162 b2 MRNA was associated with 2 deaths (9.09%). Janssen COVID-19 vaccine was associated with two cases (9.09%) (see Fig. 1).

Time of onset of symptoms/admission

Most of the cases, 12 out of 22 (54.54%), developed symptoms or were admitted to hospital within 7 days of vaccination. Nine cases (40.90%) were noted in 2nd week and one case (4.54%) in 3rd week. Earliest onset of symptom was within 30 min (noted in one case) (see Fig. 1).

Dose after which symptoms developed

Fifteen cases (68.18%) developed symptoms after 1st dose. In 7 cases (31.81%), exact description of dose could not be made out (see Fig. 1).

Time of death after vaccination/presentation/admission/intervention

Majority of death (14 out of 22 = 63.63%) took place within 1 week after vaccination/presentation/admission/intervention. Out of these 14 cases, 11 deaths occurred within 3 days. Two deaths (9.09%) occurred between 1 to 2 weeks and 3 deaths (13.63%) between 2 to 3 weeks. In 3 cases (13.63%), the exact time of death after presentation/vaccination/admission/intervention could not be identified, but these deaths took place during treatment for the complication developed after vaccination (see Fig. 2).

Fig. 2
figure 2

Time of death after vaccination/ presentation/admission/intervention along with number of deaths during that time frame

Full size image

Discussion

SARS-CoV-2, the causative agent of COVID-19 starting from Wuhan China, spread all around the globe in very short period of time. The impact of the disease all around the world is palpable as it shook the whole mankind and claimed large number of lives. The disease appeared as a threat against the human race. In order to save the existence of mankind, there was an urgent need to develop a weapon to fight this enemy of humanity. Multiple treatment options got started to be explored. Also, S.Muslim et al. suggested newer treatment option using rhACE2, angiotensin (1–7), and angiotensin (1–9) [17]. Since prevention is better than cure, vaccines definitely are a more preferred option over drugs used for treatment.

Seeing the urgency of the situation, there was a need to develop the vaccine as early as possible, and so, the vaccine was developed in a very small time frame. COVID-19 was first identified in December 2019 and by next December, i.e. December 2020, vaccines were available for mass vaccination [1, 18].

The UK Medicine and Healthcare product Regulatory Agency (MHRA) gave approval to ChAdOx1 nCoV-19 vaccine for large-scale vaccination of adults over 18 years in December 2020 [19].

Other vaccines which got approval in December 2020 were mRNA 1273 vaccine by Moderna and mRNA BNT 162b2 or mRNA BioNtech/ Pfizer Vaccine. These vaccines were approved by US FDA [20, 21].

Multiple other vaccines also followed. Janssen vaccine by Johnson and Johnson got US FDA approval in February 2021 [22].

ChAdOx1 nCoV-19 was developed by the Oxford University. It includes AZ1222, Covishield, Vaxzevria, and AstraZeneca vaccine. It is a recombinant adenovirus vector-based vaccine which encodes S-Protein of SARS-CoV-2. Four randomised controlled trials were conducted in different countries like South Africa, Brazil, and UK to establish the safety and efficacy of this vaccine. The vaccine was found to be safe and effective, and no increased incidence of thrombosis or thrombocytopenia was noted in these trials [23].

However, when mass vaccination programme was started, reports of increased incidence of thrombosis/thrombocytopenia were noted. The European Medical Agency (EMA) analysed the reports of 62 cases of CVST and 24 case of splanchnic vein thrombosis (SVT). Out of these, 18 cases had fatal outcome. EMA concluded that there is no direct link between thrombocytopenia and vaccination, and the only possible hypothesis is a condition similar to HIT (heparin-induced thrombocytopenia), and benefit of vaccination is more than the risk [24].

Greinacher et al. demonstrated that following vaccination with ChAdOx1 nCoV-19, there may be a development of a rare condition mediated by platelet-activating antibody directed against platelet factor 4 (PF-4) leading to immune thrombotic thrombocytopenia, and this condition clinically appears similar to autoimmune heparin-induced thrombocytopenia [25].

Schultz et al. reported cases of venous thrombosis and thrombocytopenia developing after ChAdOx1 nCoV-19 vaccine and proposed the term vaccine-induced thrombotic thrombocytopenia (VITT) for this condition, which is similar to heparin-induced thrombocytopenia [26].

One study reported the post mortem investigations of 18 persons who had died and had a recent history of COVID-19 vaccination. In this study, one case of myocarditis resulting into death was considered possibly associated with vaccination but could not be confidently proven. Two cases of death were likely because of VITT (vaccine-induced thrombotic thrombocytopenia), and in the remaining cases, no correlation with vaccination was found [27].

Myocarditis following vaccination has previously also been described after small pox vaccine and is supposed to be caused by autoimmune response [28].

There are multiple reports of myocarditis after COVID-19 vaccination.

One study reported an estimated incidence of 2.13 case/100,000 persons for myocarditis after BNT162b2mRNA vaccine. In this study, post vaccination myocarditis was more common in males, and most cases were mild to moderate in severity [29].

In the present study, most cases of death (18 out of 22 = 81.81%) were associated with CVST, thrombocytopenia/thrombosis/VITT, DIC, and haemorrhage. Three out of 22 (13.63%) cases had fatal cardiac adverse effects (myocarditis/myocardial infarction), and one (4.54%) patient died because of autoimmune hepatitis.

Majority of cases (18 out of 22 = 81.81%) had received ChAdOx1 nCoV-19 vaccines, 2 cases (9.09%) had received BNT162b2mRNA vaccine, and another 2 cases (9.09%) had received Janssen vaccine.

Nineteen out of 22 (86.36%) cases were between the age group 20 to 60 years. Thirteen out of 22 (59.09%) were females, and 9 (40.90%) were males.

Nine out of 22 (40.90%) had no significant medical history, while the remaining 13 cases (59.09%) had some previous medical history.

Most of the cases, 12 out of 22 (54.54%) developed symptoms or were admitted to hospital within 7 days of vaccination. Nine cases (40.90%) were noted in 2nd week and one case (4.54%) in 3rd week. Earliest onset of symptom was within 30 min (noted in one case).

Fifteen cases (68.18%) developed symptoms after 1st dose. In 7 cases (31.81%), the exact description of dose could not be made out.

Majority of death (14 out of 22 = 63.63%) took place within 1 week after vaccination/presentation/admission/intervention. Out of these 14 cases, 11 deaths occurred within 3 days. Two deaths (9.09%) occurred between 1 to 2 weeks and 3 deaths (13.63%) between 2 to 3 weeks. In 3 cases (13.63%), the exact time of death after presentation/vaccination/admission/intervention could not be identified, but these deaths took place during treatment for the complication developed after vaccination.

Analysis of these data indicates that persons who died had recent history of COVID-19 vaccination and probably succumbed to complications which developed in the temporal association of vaccination. Interestingly, many of these persons were previously healthy individuals and had no significant past medical history, though merely history of recent vaccination does not mean that these deaths occurred because of vaccination, but at the same time, it must be kept in mind that mankind till date has not found any magic bullet which will have only favourable effects and no adverse effects. So, a close watch must be kept on complications developing after vaccination (whether causal or association), and proper collection and analysis of post vaccination data regarding adverse effects must be done so that safety of vaccination can further be improved.

Conclusion

Deaths noted in the present study cannot be definitely attributed to vaccination. However, a temporal association of death with vaccination does create a concern, which ultimately leads to hesitancy in vaccination. This panic and hesitancy can be overcome with proper understanding of fatal adverse conditions.

Information obtained from the present analysis will help in understanding the features of probable fatal adverse conditions in the temporal association of vaccination and will help the healthcare agencies to be prepared beforehand to tackle any untoward lethal event.

Understanding of fatal adverse conditions and preparedness to tackle these conditions will ultimately boost the safety of vaccination drive further.

Disclaimer

The aim of this study is not to deter the vaccination programme, but it is to make the vaccination programme more safe by being aware of fatal adverse conditions in the temporal association of vaccination so that health care agency may remain prepared to tackle any untoward events.

Availability of data and materials

Not applicable.

Abbreviations

CVST:

Cerebral venous sinus thrombosis

VITT:

Vaccine-induced thrombotic thrombocytopenia

DIC:

Disseminated intravascular coagulation

HTN:

Hypertension

NAD:

Nothing abnormal detected

DM:

Diabetes mellitus

NA:

Not available

SAH:

Subarachnoid haemorrhage

MI:

Myocardial infarction

HT:

Hashimoto thyroiditis

HRT:

Hormone replacement therapy

VCR:

Vaginal contraceptive ring

OCP:

Oral contraceptive pill

Sx:

Surgery

RT:

Radiation therapy

ADT:

Androgen deprivation therapy

AF:

Atrial fibrillation

References

  1. Ball P (2021) The lightning-fast quest for COVID vaccines - and what it means for other diseases. Nature. 589(7840):16–18. https://doi.org/10.1038/d41586-020-03626-1 PMID: 33340018

    Article  CAS  Google Scholar 

  2. Tajstra M, Jaroszewicz J, Gąsior M (2021) Acute coronary tree thrombosis after vaccination for COVID-19. JACC Cardiovasc Interv. 14(9):e103–e104. https://doi.org/10.1016/j.jcin.2021.03.003 PMID: 33958175; PMCID: PMC8092130

    Article  Google Scholar 

  3. Blauenfeldt RA, Kristensen SR, Ernstsen SL, Kristensen CCH, Simonsen CZ, Hvas AM (2021) Thrombocytopenia with acute ischemic stroke and bleeding in a patient newly vaccinated with an adenoviral vector-based COVID-19 vaccine. J Thromb Haemost 19(7):1771–1775. https://doi.org/10.1111/jth.15347 Epub 2021 May 5. PMID: 33877737; PMCID: PMC8250306

    Article  CAS  Google Scholar 

  4. D'Agostino V, Caranci F, Negro A, Piscitelli V, Tuccillo B, Fasano F, Sirabella G, Marano I, Granata V, Grassi R, Pupo D, Grassi R (2021) A rare case of cerebral venous thrombosis and disseminated intravascular coagulation temporally associated to the COVID-19 vaccine administration. J Pers Med. 11(4):285. https://doi.org/10.3390/jpm11040285 PMID: 33917902; PMCID: PMC8068274

    Article  Google Scholar 

  5. Bano F, Badugama B, Chandra D (2021) Thrombosis and thrombocytopaenia after ChAdOx1 nCoV-19 vaccination: a single UK centre experience. BMJ Case Rep. 14(7):e243894. https://doi.org/10.1136/bcr-2021-243894 PMID: 34257129; PMCID: PMC8278891

    Article  Google Scholar 

  6. Rela M, Jothimani D, Vij M, Rajakumar A, Rammohan A (2021) Auto-immune hepatitis following COVID vaccination. J Autoimmun. 123:102688. https://doi.org/10.1016/j.jaut.2021.102688 Epub 2021 Jul 3. PMID: 34225251

    Article  CAS  Google Scholar 

  7. Nassar M, Nso N, Gonzalez C, Lakhdar S, Alshamam M, Elshafey M, Abdalazeem Y, Nyein A, Punzalan B, Durrance RJ, Alfishawy M, Bakshi S, Rizzo V (2021) COVID-19 vaccine-induced myocarditis: case report with literature review. Diabetes Metab Syndr 15(5):102205. https://doi.org/10.1016/j.dsx.2021.102205 Epub 2021 Jul 10. Erratum in: Diabetes Metab Syndr. 2021 Sep-Oct;15(5):102277. PMID: 34293552; PMCID: PMC8270733

    Article  Google Scholar 

  8. Suresh P, Petchey W (2021) ChAdOx1 nCOV-19 vaccine-induced immune thrombotic thrombocytopenia and cerebral venous sinus thrombosis (CVST). BMJ Case Rep. 14(6):e243931. https://doi.org/10.1136/bcr-2021-243931 PMID: 34135077; PMCID: PMC8211078

    Article  Google Scholar 

  9. Castelli GP, Pognani C, Sozzi C et al. (2021) Cerebral venous sinus thrombosis associated with thrombocytopenia post-vaccination for COVID-19. Crit Care 25:137. https://doi.org/10.1186/s13054-021-03572-y

    Article  Google Scholar 

  10. Halvor B-TT, Rudjord A, Anker P (2021) Fatal cerebral haemorrhage after COVID-19 vaccine. Tidsskr Nor Laegeforen 141. https://doi.org/10.4045/tidsskr.21.0312 PMID: 33928772

  11. Franchini M, Testa S, Pezzo M, Glingani C, Caruso B, Terenziani I, Pognani C, Bellometti SA, Castelli G (2021) Cerebral venous thrombosis and thrombocytopenia post-COVID-19 vaccination. Thromb Res. 202:182–183. https://doi.org/10.1016/j.thromres.2021.04.001 Epub 2021 Apr 8. PMID: 33878469; PMCID: PMC8028600

    Article  CAS  Google Scholar 

  12. Mehta PR, Apap Mangion S, Benger M et al. (2021) Cerebral venous sinus thrombosis and thrombocytopenia after COVID-19 vaccination - a report of two UK cases. Brain Behav Immun. 95:514–517. https://doi.org/10.1016/j.bbi.2021.04.006

    Article  CAS  Google Scholar 

  13. Gessler F, Schmitz AK, Dubinski D, Bernstock JD, Lehmann F, Won SY, Wittstock M, Güresir E, Hadjiathanasiou A, Zimmermann J, Miesbach W, Freiman T, Vatter H, Schuss P (2021) Neurosurgical considerations regarding decompressive craniectomy for intracerebral hemorrhage after SARS-CoV-2-vaccination in vaccine induced thrombotic thrombocytopenia-VITT. J Clin Med. 10(13):2777. https://doi.org/10.3390/jcm10132777 PMID: 34202817; PMCID: PMC8269113

    Article  CAS  Google Scholar 

  14. Wiedmann M, Skattør T, Stray-Pedersen A, Romundstad L, Antal EA, Marthinsen PB, Sørvoll IH, Leiknes Ernstsen S, Lund CG, Holme PA, Johansen TO, Brunborg C, Aamodt AH, Schultz NH, Skagen K, Skjelland M (2021) Vaccine induced immune thrombotic thrombocytopenia causing a severe form of cerebral venous thrombosis with high fatality rate: a case series. Front Neurol. 12:721146. https://doi.org/10.3389/fneur.2021.721146 PMID: 34393988; PMCID: PMC8363077

    Article  Google Scholar 

  15. Aladdin Y, Algahtani H, Shirah B (2021) Vaccine-induced immune thrombotic thrombocytopenia with disseminated intravascular coagulation and death following the ChAdOx1 nCoV-19 vaccine. J Stroke Cerebrovasc Dis. 30(9):105938. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105938 Epub 2021 Jun 23. PMID: 34171649; PMCID: PMC8219525

    Article  Google Scholar 

  16. Choi S, Lee S, Seo JW, Kim MJ, Jeon YH, Park JH, Lee JK, Yeo NS (2021) Myocarditis-induced sudden death after BNT162b2 mRNA COVID-19 vaccination in Korea: case report focusing on histopathological findings. J Korean Med Sci. 36(40):e286. https://doi.org/10.3346/jkms.2021.36.e286 PMID: 34664804; PMCID: PMC8524235

    Article  CAS  Google Scholar 

  17. Muslim S, Nasrin N, Alotaibi FO, Prasad G, Singh SK, Alam I, Mustafa G (2020) Treatment options available for COVID-19 and an analysis on possible role of combination of rhACE2, angiotensin (1-7) and angiotensin (1-9) as effective therapeutic measure. SN Compr Clin Med 22:1–6. https://doi.org/10.1007/s42399-020-00407-9 Epub ahead of print. PMID: 32864572; PMCID: PMC7442548

    Article  CAS  Google Scholar 

  18. Lu H, Stratton CW, Tang YW (2020) Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol 92(4):401–402. https://doi.org/10.1002/jmv.25678 Epub 2020 Feb 12. PMID: 31950516; PMCID: PMC7166628

    Article  CAS  Google Scholar 

  19. 1 Gov.UK. Regulatory approval of COVID-19 vaccine AstraZeneca [Internet]. GOV.UK, 2021. Available: https://www.gov.uk/government/publications/regulatory-approval-ofcovid-19-vaccine-astrazeneca

  20. Oliver SE, Gargano JW, Marin M, Wallace M, Curran KG, Chamberland M et al. (2020) The advisory committee on immunization practices' interim recommendation for use of Pfizer-BioNTech COVID-19 vaccine -United States, December 2020. MMWR Morb Mortal Wkly Rep 69(50):1922–1924

    Article  CAS  Google Scholar 

  21. Oliver SE, Gargano JW, Marin M, Wallace M, Curran KG, Chamberland M et al. (2021) The advisory committee on immunization practices' interim recommendation for use of Moderna COVID-19 vaccine – United States, December 2020. MMWR Morb Mortal Wkly Rep 69(5152):1653–1656

    Article  CAS  Google Scholar 

  22. Spring S (2021) Janssen COVID-19 vaccine emergency use authorization. Food and Drug Administration cited 2021; Available from: https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/janssen-covid-19-vaccine

  23. Voysey M, Clemens SAC, Madhi SA et al. (2021) Safety and efficacy of the ChAdOx1nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet 397:99–111

    Article  CAS  Google Scholar 

  24. Mahase E (2021) AstraZeneca vaccine: Blood clots are “extremely rare” and benefits outweigh risks, regulators conclude. BMJ:373. https://doi.org/10.1136/bmj.n931

  25. Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S (2021) Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. New Engl J Med 384(22):2092–2101

    Article  CAS  Google Scholar 

  26. Schultz NH, Sørvoll IH, Michelsen AE, Munthe LA, Lund-Johansen F, Ahlen MT, Wiedmann M, Aamodt AH, Skattør TH, Tjønnfjord GE, Holme PA (2021) Thrombosis and thrombocytopenia after ChAdOx1 nCoV-19 vaccination. New Engl J Med 384(22):2124–2130

    Article  CAS  Google Scholar 

  27. Schneider J, Sottmann L, Greinacher A, Hagen M, Kasper HU, Kuhnen C, Schlepper S, Schmidt S, Schulz R, Thiele T, Thomas C (2021) Postmortem investigation of fatalities following vaccination with COVID-19 vaccines. Int J Legal Med 135(6):2335–2345

    Article  Google Scholar 

  28. Keinath K, Church T, Kurth B et al. (2018) Myocarditis secondary to smallpox vaccination. Case Reports 2018:bcr-2017-223523

    Google Scholar 

  29. Witberg G, Barda N, Hoss S, Richter I, Wiessman M, Aviv Y, Grinberg T, Auster O, Dagan N, Balicer RD, Kornowski R (2021) Myocarditis after COVID-19 vaccination in a large health care organization. N Engl J Med 385(23):2132–2139. https://doi.org/10.1056/NEJMoa2110737 Epub 2021 Oct 6. PMID: 34614329; PMCID: PMC8531986

    Article  CAS  Google Scholar 

Download references

Acknowledgements

No fund/grant received for this study.

Code availability

Not applicable.

Funding

No funding was received.

Author information

Authors and Affiliations

  1. Madhubani Medical College and Hospital, Madhubani, Bihar, India

    Shahnawaz Muslim

  2. College of Pharmacy, Shaqra University, Shaqra, 11961, Saudi Arabia

    Gulam Mustafa

  3. Katihar Medical College & Hospital, Katihar, Bihar, India

    Nasrin Nasrin & Shambhu Kumar Singh

  4. Eiwa Hospital, Katihar, Bihar, India

    Aaisha Firdaus

Authors
  1. Shahnawaz Muslim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gulam Mustafa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nasrin Nasrin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aaisha Firdaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shambhu Kumar Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SM conceptualised and designed the study. GM, NN, AF, and SKS along with SM did the collection and analysis of the data and helped in the preparation of the manuscript. SM gave the final approval to the manuscript. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Shahnawaz Muslim.

Ethics declarations

Ethics approval consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Muslim, S., Mustafa, G., Nasrin, N. et al. An analysis of fatal adverse conditions in temporal association of COVID-19 vaccination to boost the safety of vaccination for COVID-19. Egypt J Intern Med 35, 11 (2023). https://doi.org/10.1186/s43162-023-00191-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s43162-023-00191-7

Keywords