This week I will continue discussion on the topic of gaining protection against COVID-19 through vaccination versus infection. Last week’s article discussed how common reinfection with SARS-CoV-2 is and the level of protection that the vaccines have provided for us. Both vaccination and surviving infection provide a level of protection against future severe COVID-19 disease. An important matter to consider is what the consequences are of choosing to be infected with the virus are versus being vaccinated. In this article I will discuss the potential side effects of vaccination. I will present next week information about the consequences of becoming infected with the virus. We are still learning much about the variant that is rapidly becoming the most common lineage in the United States. I expect that within a couple weeks we should be getting a clearer picture of just how often infection with the Omicron variant results in severe disease. I will include information specific to the Omicron variant next week. For those interested in up-to-date information on the Omicron variant I will include suggested sources in the resources section of this article. Next week I will continue discussion on the topic of gaining protection against COVID-19 through vaccination versus infection. Information presented in these articles is intended to provide a medical perspective - the articles are not intended as a political statement for or against any public policy. Statements in these articles should be considered coming from myself, not from any organization I represent or my employer.
What are the most common side effects that you can expect from a COVID-19 vaccination?
You can expect to have a sore arm for a few days. You may even get some swelling or redness at the injection site or in your armpit - this is not a sign of anything bad and should get better within a few days. Most people will otherwise only experience mild to moderate discomforts or no problems at all from the vaccine. However, some may have symptoms bad enough that their daily lives are interfered with, and some people may even want to take a day off from work. Many people have had body aches, headaches, and have felt tired for a day or two after getting the vaccine. You may feel sick to your stomach, but most people will not feel bad enough that they vomit or cannot eat. Fever can happen but it is not common. All these symptoms are expected, and if caused by the vaccine - will get better. These symptoms should be mostly better within a couple days. If you are still having symptoms more than 3 or 4 days after your injection, then your symptoms may be from something else - not the vaccine - you should make an appointment to be evaluated by your primary care provider.
Can you get COVID-19 from a COVID-19 vaccination?
You will not become infected with the virus by having the vaccine injected into you. The vaccine does not contain SARS-CoV-2. However, people can get infected with SARS-CoV-2 after being vaccinated. The vaccines are not 100% effective, and a person could be infected before they got vaccinated and not know it. People who experience symptoms of COVID-19 other than those listed above should contact their primary care provider or otherwise seek medical attention. People with COVID-19 may lose their sense of taste or smell. They may have chest pain, trouble breathing, cough or sore throat. These symptoms are NOT caused by the vaccine and you should seek medical attention.
What is the most serious side effect from an mRNA COVID-19 vaccination?
Severe allergic reactions including anaphylaxis can occur with vaccines, medications or foods. Anaphylactic and other severe allergic-like reactions have been reported with both the mRNA vaccines (Moderna and Pfizer-BioNTech) as well as the vaccine developed by Janssen Pharmaceuticals which is owned by Johnson & Johnson.
What is the risk of an anaphylactic reaction to an mRNA COVID-19 vaccination?
Various studies have looked at how often anaphylaxis has occurred with the two vaccines most commonly used in the United States (over 90% of those vaccinated in the US have received either the Moderna or Pfizer-BioNTech vaccine). Each of the studies have found a very low number of cases of anaphylaxis. A systematic review and meta-analysis of 26 different studies found the incidence of anaphylaxis from an mRNA COVID-19 vaccine was 7.91 cases per 1 million vaccinations. The article describing this analysis was published in October of 2021 in The Journal of Allergy and Clinical Immunology: In Practice which is an official publication of the American Academy of Allergy, Asthma & Immunology.
To put that in perspective, for penicillin the risk of anaphylaxis is about 100-400 episodes per 1 million administrations of penicillin given by injection or infusion. The occurrence of anaphylaxis with oral amoxicillin has been noted in one study to be about 5 episodes per 1 million administrations of oral amoxicillin.
All COVID-19 vaccination locations are required to have medications immediately on hand to treat anaphylaxis. Most cases of vaccine associated anaphylaxis occur within 15 minutes and almost all cases are successfully treated with no complications.
Can a COVID-19 vaccination cause myocarditis?
Myocarditis and pericarditis have been reported following receipt of the mRNA vaccines. Most cases have been in male adolescents and young adults. If you look at just that group of people, the incidence of myocarditis is still very low. In an analysis published in the MMWR, the estimated rate of myocarditis/pericarditis among males 12 to 29 years of age was 41 cases per million following a second dose of an mRNA.
It is known that myocarditis, pericarditis and a variety of other cardiac problems are associated with COVID-19 infections. Various research groups have looked to quantify just how much more risky infection is than vaccination. There is a range of estimates, but it is clear a person is far more likely to get myocarditis or pericarditis from a COVID-19 infection than from a COVID-19 vaccination.
It should also be noted that almost all cases of myocarditis that have been associated with the vaccines have been described as mild to moderate in severity and resolved within a short period of time.
Can a COVID-19 vaccination cause blood clots?
Blood clot problems are NOT associated with the two vaccines that are most used in the United States (over 90% of those vaccinated in the US have received either the Moderna or Pfizer-BioNTech vaccine).
The vaccine developed by Janssen Pharmaceuticals which is owned by Johnson & Johnson has been associated with a small number of severe and even fatal cases of blood clot problems; primarily in women in their 30’s and 40’s. While very concerning it is an important to keep in mind that that serious blood clot problems are far more likely to be associated with a COVID-19 infection than with the Johnson and Johnson vaccine.
The CDC and others have been collecting and analyzing data on the incidence of serious clotting problems. Because of the accumulating data - the CDC recently released a statement recommending that the Moderna and Pfizer-BioNTech vaccines be given preferentially over the J&J vaccine.
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