Study Tracks Delayed Local Reactions in 12 Recipients of Moderna’s COVID-19 Vaccine

(Reuters Health) – Local reaction to Moderna’s COVID-19 vaccine can appear up to 11 days after vaccination and symptoms can persist for as long as 11 days, a team of Boston doctors warns in an online letter to The New England Journal of Medicine.

Their analysis of 12 patients with delayed reactions after the first dose of the vaccine found that when delayed reactions occurred, the median time to onset was 8 days and symptoms resolved after a median of 6 days.

Reactions didn’t always occur at the injection site. A 40-year-old woman developed papules on her palm and fingers that were believed to be the result of a shot. A 43-year-old man developed urticarial plaques on his elbows.

Such side effects may catch many doctors and patients by surprise, because “these reactions have not been consistently recognized, guidance regarding the second dose of vaccine has varied and many patients have unnecessarily received antibiotic agents” to treat them, said the team led by Dr. Kimberly Blumenthal of Massachusetts General Hospital.

They said the reactions are not a reason to eschew the vaccine.

About 84% of people who get their first dose of the Moderna vaccine have some type of reaction, such a muscle soreness or tenderness, and 0.8% of patients in the initial vaccine trial reported a delayed injection-site reaction on or after 8 days.

A delayed reaction such as erythema, induration and tenderness was less common — seen in 0.2% of patients — after the second dose. Most symptoms resolved after 5 days.

In their examination of the phenomenon, the Blumenthal team details 12 cases where the recipients saw any immediate side effects disappear, only to have a reaction sometime between 4 to 11 days after the first dose.

Their symptoms persisted for 2 to 11 days.

Five of the reactions in the 12 patients produced grade 3 plaques, meaning their diameter was at least 10 cm in diameter. Some had systemic symptoms associated with the vaccination.

The 47-year-old man whose symptoms reappeared 11 days after vaccination had initially suffered pain, fatigue, myalgias and a 7 cm lesion. His symptoms resolved after 6 days and his second dose produced fatigue, fever, chills and a similar-size rash.

The 49-year-old female whose symptoms persisted for 11 days developed two separate lesions 3 to 4 cm in diameter 8 days after her shot, along with pruritus, burning, pain, warmth, erythema, induration, and hyperpigmentation near the injection site. Her second dose produced chills and myalgias, slight erythema around day 2 and idiopathic urticaria recurred on day 12.

All 12 patients were given a second dose despite their delayed reactions.

Seven had a complete resolution of their symptoms before that second shot. Three had hyperpigmentation, with one having a burning sensation, another reporting tingling and dullness at the site. One had pain and itching. The 12th had mild elbow symptoms.

After the second dose, half “did not have a recurrence of large local reactions, three patients had recurrent reactions that were similar to those after the initial dose, and three patients had recurrent reactions that were of a lower grade than those after the initial dose,” the Blumenthal team reported.

In those cases, it took a median of 2 days for the reactions to appear.

SOURCE: The New England Journal of Medicine, online March 3, 2021.

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