Delayed Large Local Reactions to mRNA-1273 Vaccine against SARS-CoV-2

Blumenthal, Kimberly G.; Freeman, Esther E.; Saff, Rebecca R.; Robinson, Lacey B.; Wolfson, Anna R.; Foreman, Ruth K.; Hashimoto, Dean M.; Banerji, Aleena; Li, Lily; Anvari, Sara; Shenoy, Erica S.

doi:10.1056/nejmc2102131

Cited by 259 publications

(400 citation statements)

References 2 publications

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“…These eruptions may vary morphologically, but are typically characterized by erythema with mild induration at or near the initial injection site. 25 , 26 , 27 They are primarily distinguished from immediate injection site reactions by their later time of onset (e.g. days vs. hours).…”

Section: Frequently-reported Cutaneous Adverse Eventsmentioning

confidence: 99%

“…27 Blumenthal et al and Johnston et al separately verified the development of delayed local reactions presenting approximately 1 week after the Moderna vaccine. 12 , 26 Reports suggest that delayed large local reactions are temporary, resolving 3–6 days after onset. 6 , 12 , 26 These presentations may also be less frequent after the second dose, 6 , 12 , 26 which is important to communicate to concerned patients.…”

Section: Frequently-reported Cutaneous Adverse Eventsmentioning

confidence: 99%

“…Authors concur that these delayed cutaneous findings likely represent T-cell-mediated hypersensitivity, which is supported by skin pathology readings demonstrating perivascular and perifollicular lymphocytic infiltrates. 6 , 12 , 25 , 26 , 27 While the specific hypersensitivity trigger remains unclear, authors affirm that these manifestations likely do not lessen vaccine safety. Recognition of delayed reactions is nonetheless important to guide patient expectations and avoid unnecessary medical therapies (e.g., antibiotics) as these eruptions are not infectious in nature.…”

Section: Frequently-reported Cutaneous Adverse Eventsmentioning

confidence: 99%

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Attention all anti-vaccinators: The cutaneous adverse events from the mRNA COVID-19 vaccines are not an excuse to avoid them!

Gronbeck

Grant‐Kels

2021

Clinics in Dermatology

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Despite the growing availability of Covid-19 vaccines in the general population, a significant proportion of individuals demonstrate vaccine hesitancy. We sought to consolidate and update current evidence on cutaneous adverse events from Covid-19 vaccines to aid in education and counseling of patients concerned about potential cutaneous side effects. We conducted a literature review of PubMed in May 2021 to identify reports of cutaneous events following the Pfizer-BioNTech and Moderna vaccines (post-authorization clinical reports pertaining to the Johnson and Johnson and AstraZeneca vaccines were limited). Event reports in the Vaccine Adverse Event Reporting System (VAERS) were also reviewed. Localized cutaneous reactions were common following the mRNA vaccines, consistent with clinical trial findings. Reported urticarial and morbilliform eruptions may reflect immediate hypersensitivity but have rarely been associated with anaphylaxis. There are infrequent reports of herpes zoster, dermatologic filler reactions, and immune thrombocytopenia, mainly occurring in high-risk patient groups. Ultimately, the identified cutaneous reactions are largely self-limited and should not discourage vaccination. Existing reports should reassure patients of the overall compelling safety profiles and benignity of skin reactions following the mRNA Covid-19 vaccines.

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Section: Frequently-reported Cutaneous Adverse Eventsmentioning

confidence: 99%

Section: Frequently-reported Cutaneous Adverse Eventsmentioning

confidence: 99%

Section: Frequently-reported Cutaneous Adverse Eventsmentioning

confidence: 99%

See 1 more Smart Citation

Attention all anti-vaccinators: The cutaneous adverse events from the mRNA COVID-19 vaccines are not an excuse to avoid them!

Gronbeck

Grant‐Kels

2021

Clinics in Dermatology

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“…The delayed reactions were described as annular, uniformly edematous, targetoid, and/or urticarial plaques, some of which with considerable induration near the vaccination site. A skin biopsy performed on one patient showed superficial perivascular and perifollicular lymphocytic infiltrate with rare eosinophils and scattered mast cells [10].…”

Section: Discussionmentioning

confidence: 99%

“…A recently published report by Baden et al [10] describes delayed local-adjacent cutaneous reactions following the administration of the mRNA-1273 vaccine against SARS-CoV-2 in 12 patients enrolled in a phase three trial. The lesions appear after the eight days of receiving the first dose near the injection site after full resolution of the initial local and systemic reactions associated with immunization.…”

Section: Discussionmentioning

confidence: 99%

BCG Scar Local Skin Inflammation as a Novel Reaction Following mRNA COVID-19 Vaccines in Two International Healthcare Workers

Lopatynsky-Reyes¹,

Acosta-Lazo²,

Ulloa‐Gutiérrez³

et al. 2021

Cureus

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Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine

et al. 2021

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In response to the coronavirus disease 2019 (COVID-19) pandemic, 2 mRNA vaccines (Pfizer-BioNTech and Moderna) received emergency use authorization from the US Food and Drug Administration in December 2020. Some patients in the US have developed delayed localized cutaneous vaccine reactions that have been dubbed "COVID arm."OBJECTIVE To describe the course of localized cutaneous injection-site reactions to the Moderna COVID-19 vaccine, subsequent reactions to the second vaccine dose, and to characterize the findings of histopathologic examination of the reaction. DESIGN, SETTING, AND PARTICIPANTSThis retrospective case series study was performed at Yale New Haven Hospital, a tertiary medical center in New Haven, Connecticut, with 16 patients referred with localized cutaneous injection-site reactions from January 20 through February 12, 2021. MAIN OUTCOMES AND MEASURESWe collected each patient's demographic information, a brief relevant medical history, clinical course, and treatment (if any); and considered the findings of a histopathologic examination of 1 skin biopsy specimen. RESULTSOf 16 patients (median [range] age, 38 [25-89] years; 13 [81%] women), 14 patients self-identified as White and 2 as Asian. The delayed localized cutaneous reactions developed in a median (range) of 7 (2-12) days after receiving the Moderna COVID-19 vaccine. These reactions occurred at or near the injection site and were described as pruritic, painful, and edematous pink plaques. None of the participants had received the Pfizer-BioNTech vaccine. Results of a skin biopsy specimen demonstrated a mild predominantly perivascular mixed infiltrate with lymphocytes and eosinophils, consistent with a dermal hypersensitivity reaction. Of participants who had a reaction to first vaccine dose (15 of 16 patients), most (11 patients) developed a similar localized injection-site reaction to the second vaccine dose; most (10 patients) also developed the second reaction sooner as compared with the first-dose reaction.CONCLUSIONS AND RELEVANCE Clinical and histopathologic findings of this case series study indicate that the localized injection-site reactions to the Moderna COVID-19 vaccine are a delayed hypersensitivity reaction. These reactions may occur sooner after the second dose, but they are self-limited and not associated with serious vaccine adverse effects. In contrast to immediate hypersensitivity reactions (eg, anaphylaxis, urticaria), these delayed reactions (dubbed "COVID arm") are not a contraindication to subsequent vaccination.

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Delayed Large Local Reactions to mRNA-1273 Vaccine against SARS-CoV-2

Cited by 259 publications

References 2 publications

Attention all anti-vaccinators: The cutaneous adverse events from the mRNA COVID-19 vaccines are not an excuse to avoid them!

Attention all anti-vaccinators: The cutaneous adverse events from the mRNA COVID-19 vaccines are not an excuse to avoid them!

BCG Scar Local Skin Inflammation as a Novel Reaction Following mRNA COVID-19 Vaccines in Two International Healthcare Workers

Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine

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