Same-Day Deaths After COVID-19 Vaccinations: Autopsy Findings in 54 Cases : American Journal of Therapeutics

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Editorial

Same-Day Deaths After COVID-19 Vaccinations: Autopsy Findings in 54 Cases

Manu, Peter MD

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doi: 10.1097/MJT.0000000000001576
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The largest immunization effort in world history is underway, and 12.7 billon doses of COVID-19 vaccines have been administered from December 2020 to September 2022.1 The vaccine is remarkably safe and has contributed to a significant reduction in the number of deaths and life-threatening conditions produced by acute COVID-19 infections.2 However, segments of social media are promoting false narratives linking the administration of COVID-19 vaccines with same-day deaths. The most widely publicized “death” is that of a Tennessee nurse who fainted after the injection during a live video recording.3 For more than a year after her rapid and full recovery, dozens of statements from her family and employer, and independent fact-checks, scores of internet users continue to believe that she has died at the time of her fainting spell.3,4

We searched Medline using the key words “death”, “deaths”, “COVID-19”, “vaccine” and “vaccination” to identify same-day fatalities after COVID-19 vaccinations. Six reports5–12 contained demographic and autopsy data on 54 patients (38 males and 16 females, age range 23-94) fulfilling the scope of our search (Table 1).

Table 1. - Demographic and autopsy features of same-day deaths after COVID-19 vaccinations.
Authors, Country Year Age Gender Vaccine manufacturer Dose # Autopsy findings suggesting the cause of death
Schneider Et al, 5 Germany 2021
82 M Moderna 1 Severe coronary sclerosis; extensive previous myocardial infarction scars; cardiac hypertrophy
91 F Moderna 1 Severe coronary sclerosis; extensive previous myocardial infarction scars; cardiac hypertrophy
34 F AstraZeneca 1 Acute myocardial infarction; previous myocardial infarction scars
65 M Pfizer 1 Myocarditis
71 M Pfizer 1 Coronary sclerosis; massive ventricular hypertrophy
Murata Et al, 6 Japan 2022
31 M Pfizer 2 None
Barouti Et al, 7 Italy 2022
58 M Pfizer 2 Acute myocardial infarction; left anterior descending coronary artery thrombosis
50 F Pfizer 2 Acute myocardial infarction; left anterior descending coronary artery thrombosis
Ittiwut Et al, 8 Thailand 2022
23 M AstraZeneca 2 None
33 M AstraZeneca 2 None
43 M Pfizer 3 Dilated cardiomyopathy
35 M Sinovac 1 None
36 M AstraZeneca 2 None
38 M Sinovac 2 Coronary atherosclerosis
72 M AstraZeneca 1 Coronary atherosclerosis
53 F AstraZeneca 1 None
59 F AstraZeneca 1 Coronary atherosclerosis
Yeo Et al, 9 Singapore 2022
74 M Pfizer 1 Coronary artery disease
63 M Pfizer 2 Ischemic heart disease
91 M Pfizer 2 Acute myocardial infarction
76 F Pfizer 2 Subarachnoid hemorrhage due to ruptured berry aneurysm
80 M Pfizer 1 Ischemic heart disease
86 M Pfizer 2 Ischemic heart disease
94 F Pfizer 2 Hypertensive heart disease
69 M Pfizer 2 Ischemic heart disease
72 M Pfizer 1 Pneumonia
63 M Pfizer 2 Ruptured Ascending aortic dissection
53 M Pfizer 1 Acute coronary thrombosis
69 M Pfizer 2 Coronary artery disease; severe interstitial lung disease
23 M Pfizer 2 Severe obesity with associated cardiomyopathy
65 M Moderna 2 Head injury
56 M Moderna 2 Hemorrhagic stroke
52 M Pfizer 1 Coronary artery disease
53 F Pfizer 2 Coronary atherosclerosis
33 M Moderna 2 Right ventricular dysplasia
39 M Pfizer 1 Ischemic heart disease
67 M Pfizer 2 Head injury
Suzuki Et al, 10 Japan
86 F Pfizer 1 Drowning (emphysema aquosum)
87 F Pfizer 1 Drowning (emphysema aquosum)
81 M N/A 1 Severe coronary sclerosis; cardiomegaly; myocardial scar
79 F Pfizer 2 Severe sclerosis of the left anterior descending artery
76 M Pfizer 2 Drowning (emphysema aquosum)
82 F Pfizer 2 Severe sclerosis with coronary stent implantations; myocardial scars
83 F Pfizer 2 Ruptured aortic aneurysm dissection
77 M Pfizer ! Diabetic ketoacidosis; diabetic nephropathy
74 F Pfizer 2 Cardiomegaly; mitral stenosis
65 M Pfizer N/A Ischemic heart disease; cardiomegaly
69 M N/A N/A None
55 M Pfizer 2 Bacterial pneumonia (multilobar)
74 M Pfizer 2 Ischemic heart disease; lung edema
53 M Pfizer 1 Myocardial infarction
67 F Pfizer 2 Ischemic heart disease; lung edema
52 M N/A 1 Transverse sinus thrombosis; cerebral hemorrhage
48 F Moderna 1 Diabetic ketoacidosis
N/A, not available.

Cases were vaccinated in countries reporting very large numbers of COVID-19 vaccine doses administered (Japan 340 million, Germany 185 million, Thailand 143 million, Italy 141 million, and Singapore 14 millions).1 Anaphylaxis was excluded in all cases. Coronary artery disease was the most common cause of death after autopsy (46.3%). A direct relationship with the vaccination was felt possible in two cases, one with myocarditis, the other with transverse sinus thrombosis and cerebral hemorrhage. In seven patients (13%), the autopsy did not identify findings explaining the sudden death.

These data indicate that same-day deaths after COVID-19 vaccination are extraordinary infrequent. They support a nationwide survey showing no positive association between acute myocardial infarction and pulmonary embolism, common causes of sudden death, in persons receiving mRNA-based vaccines during the 3 weeks following the administration of either the first or the second dose.11 Arterial thrombotic events have been reported after adenovirus-based vaccines,11 but the association is not apparent among the published cases of same-day death.

Vaccinations campaigns prior to the COVI-19 pandemic have led to a mortality rate of 1/1,000 within one day of the innoculation.12 This rate reflects a large number of vaccines as well as anaphylactic events. It seems reasonable to assume that the same-day rate of death for a single vaccine might be in a very large range, going from 1/1,000 to 1/1,000,000. The most conservative death rate of 1/1,000,000 would translate, for the COVID-vaccinated population in the Unites States, to at least 224 cases, but none have been reported in the literature as of October 2022.

REFERENCES

1. Available at: https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/. Updated September 15, 2022. Accessed September 15, 2022.
2. McMenamin ME, Nealon J, Lin Y, et al. Vaccine effectiveness of one, two, and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong: a population-based observational study. Lancet Infect Dis. 2022;22(10):1435–1443.
3. Putterman S. There's Still No Evidence a Tennessee Nurse Who Fainted after Getting the Vaccine Is Dead; 2021. Available at: https://www.politifact.com/factchecks/2021/oct/20/instagram-posts/theres-still-no-evidence-tennessee-nurse-who-faint/. Updated October 20, 2021. Accessed September 15, 2022.
4. Available at: https://www.reuters.com/article/uk-factcheck-nurse-covid-vaccine-dead/fact-check-nurse-who-fainted-after-covid-19-vaccine-did-not-die-idUSKBN29629G. Updated January 4, 2021. Accessed September 12, 2022.
5. Schneider J, Sottmann L, Greinacher A, et al. Postmortem investigation of fatalities following vaccination with COVID-19 vaccines. Int J Leg Med. 2021;135(6):2335–2345.
6. Murata K, Nakao N, Ishiuchi N, et al. Four cases of cytokine storm after COVID-19 vaccination: case report. Front Immunol. 2022;13:967226.
7. Baronti A, Gentile F, Manetti AC, et al. Myocardial infarction following COVID-19 vaccine administration: Post Hoc, Ergo Propter Hoc? Viruses. 2022;14(8):1644.
8. Ittiwut C, Mahasirimongkol S, Srisont S, et al. Genetic basis of sudden death after COVID-19 vaccination in Thailand. Heart Rhythm. 2022:S1547-5271(22)02266-4.
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