ssrn | Introduction: In 2020, prior to COVID-19 vaccine rollout, the Coalition
for Epidemic Preparedness Innovations and Brighton Collaboration created
a priority list, endorsed by the World Health Organization, of
potential adverse events relevant to COVID-19 vaccines. We leveraged the
Brighton Collaboration list to evaluate serious adverse events of
special interest observed in phase III randomized trials of mRNA
COVID-19 vaccines.
Methods: Secondary analysis of serious adverse
events reported in the placebo-controlled, phase III randomized
clinical trials of Pfizer and Moderna mRNA COVID-19 vaccines
(NCT04368728 and NCT04470427), focusing analysis on potential adverse
events of special interest identified by the Brighton Collaboration.
Results:
Pfizer and Moderna mRNA COVID-19 vaccines were associated with an
increased risk of serious adverse events of special interest, with an
absolute risk increase of 10.1 and 15.1 per 10,000 vaccinated over
placebo baselines of 17.6 and 42.2 (95% CI -0.4 to 20.6 and -3.6 to
33.8), respectively. Combined, the mRNA vaccines were associated with an
absolute risk increase of serious adverse events of special interest of
12.5 per 10,000 (95% CI 2.1 to 22.9). The excess risk of serious
adverse events of special interest surpassed the risk reduction for
COVID-19 hospitalization relative to the placebo group in both Pfizer
and Moderna trials (2.3 and 6.4 per 10,000 participants, respectively).
Discussion:
The excess risk of serious adverse events found in our study points to
the need for formal harm-benefit analyses, particularly those that are
stratified according to risk of serious COVID-19 outcomes such as
hospitalization or death.
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