Several coronavirus vaccine candidates are authorized for emergency use around the world. Most Western countries use a combination of Pfizer / BioNTech, Moderna and AstraZeneca / Oxford vaccines. The Johnson & Johnson drug has just passed regulatory review and is now also available in several countries. In addition, Russia and China are using their own vaccines and have exported their medicines to other markets. Nearly 276 million vaccine doses have been administered worldwide since Thursday morning, with 58 million people receiving the full two-stage regimen.
Several new studies have provided a lot of additional evidence that the vaccines effectively prevent serious COVID-19 and deaths. The drugs are also well tolerated and usually have minimal side effects. The side effects list includes injection site pain and brief flu-like symptoms. An extremely low rate of allergic reactions has also been observed with certain vaccines. And now doctors are starting to notice a weird new side effect of the COVID-19 vaccine that can last more than a week in some people. Fortunately, it is extremely mild and is not a cause for concern at all.
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The new symptoms appear a few days after the second shot. The arm may become red, painful, itchy and swollen, The New York Times reports. The reaction appears harmless and should not be confused with an infection. A letter in The New England Journal of Medicine tackles the symptom, as seen in people who received the Moderna vaccine at Massachusetts General Hospital.
The letter describes 12 cases of delayed skin reactions that appeared about 8 days after the first shot. The symptoms then disappeared about six days after the onset. The patients were advised to continue full treatment and all completed the vaccination course. Three patients had a similar response after the second shot. But the skin lesions appeared more quickly, two days after the second injection, and then lasted up to three days.
Some of these delayed skin reactions include lesions greater than 10 cm in diameter. Other patients developed skin rashes in areas farther from the injection site, such as the palm and elbow. Some patients also experienced fatigue and muscle pain, which are expected side effects associated with COVID-19 vaccines. The following series of photos shows the types of skin lesions that can occur:
Some patients were treated with antihistamines, others required steroids, and one was accidentally prescribed an antibiotic.
The authors of the letter want to raise awareness of this type of side effect so that patients and doctors know that such side effects are possible. The authors also advise against treating with antibiotics to resolve the skin problems:
Doctors may not be willing to delay local reactions to the disease [Moderna] mRNA-1273 vaccine. Given the scaling up of massive vaccination campaigns around the world, these responses are likely to be of concern to patients and require evaluation. These reactions have not been consistently recognized, guidelines regarding the second dose of vaccine are varied, and many patients have received unnecessary antibiotics. We hope that this letter encourages additional reporting and communication regarding the epidemiological features, causes and implications of these delayed skin reactions, as this information can allay patients’ concerns, encourage completion of vaccination and minimize the unnecessary use of antibiotics.
Dr. Kimberly Blumenthal, one of the letter’s authors, told me The times that these symptoms prompted Massachusetts General Hospital to change the patient handout. “We said it was normal to have redness, itching and swelling when you get the vaccine,” she said. “We changed the wording to say it can also start 7-10 days after you get the vaccine.” The allergy expert also said she doesn’t understand why the delayed skin reactions only occurred in patients who received the Moderna vaccine and not the BioNTech drug. Both are mRNA vaccines.
Massachusetts General Hospital has created a registry to track patients with delayed skin reactions. Blumenthal said about 30 cases have been seen so far, and most of them are women.
Moderna reported delayed skin reactions after the phase 3 study and said 0.8% of the volunteers experienced them after the first dose and 0.2% after the second shot. The NEJM letter points out that the Moderna process did not fully characterize these delayed responses. Here are the most common side effects of the Moderna vaccine, as listed by the FDA:
The most commonly reported adverse reactions, which typically lasted for several days, were injection site pain, fatigue, headache, muscle pain, chills, joint pain, swollen lymph nodes in the same arm as the injection, nausea and vomiting, and fever. Note that more people experienced these side effects after the second dose than after the first dose, so it is important for vaccination providers and recipients to expect some side effects to occur after each dose, but even more so after the second dose.
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Chris Smith started writing about gadgets as a hobby and before he knew it, he was sharing his thoughts on tech matters with readers around the world. When not writing about gadgets, he sadly fails to stay away from them, although he desperately tries. But that’s not necessarily a bad thing.