Global & Disaster Medicine

CDC: Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine — United States, December 21, 2020–January 10, 2021.

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine — United States, December 21, 2020–January 10, 2021. MMWR Morb Mortal Wkly Rep. ePub: 22 January 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7004e1external icon

 

TABLE 1. Characteristics of reported cases of anaphylaxis (n = 10) after receipt of the first dose of Moderna COVID-19 vaccine — Vaccine Adverse Events Reporting System (VAERS), United States, December 21, 2020–January 10, 2021Return to your place in the text
Age, yrs Sex Past history Onset after receipt (mins) Signs and symptoms Treatment setting Epi received Brighton level§ Outcome or disposition
Allergies or allergic reactions* Previous anaphylaxis episode
37 F Penicillin, phenytoin, ibuprofen No 1 Respiratory failure, vomiting Inpatient Yes 2 Discharged home
39 F Penicillin, aloe Yes, penicillin 2 Decreased peripheral perfusion, persistent dry cough, nausea Inpatient Yes 3 Discharged home
63 F Acetaminophen, azithromycin No 4 Periorbital edema, nausea ED Yes 2 Not specified
55 F Multiple unspecified environmental and food allergies Yes, unspecified 5 Hypotension, wheezing Inpatient Yes 2 Not specified
31 F No No 5 Diffuse erythematous rash, throat swelling ED Yes 1 Discharged home
49 F Gadolinium, iodine Yes, gadolinium, iodine 10 Diffuse erythematous rash, tongue swelling, wheezing ED Yes 1 Recovered at time of report
37 F Unspecified intravenous contrast dye, penicillin Yes, intravenous contrast dye 11 Generalized urticarial rash, tongue swelling Inpatient Yes 1 Discharged home
50 F Unspecified allergies or allergic reactions Yes, unspecified 12 Diffuse erythematous rash, wheezing Inpatient Yes 1 Discharged home
57 F Multiple drugs including penicillin and sulfa No 13 Periorbital edema, tongue swelling ED Yes 1 Recovered at time of report
44 F Morphine, codeine No 45 Diffuse erythematous rash, marked tongue swelling Inpatient Yes 1 Discharged home

Abbreviations: COVID-19 = coronavirus disease 2019; ED = emergency department; Epi = epinephrine; F = female.
* As documented in the VAERS report or medical records, or through confirmation with the treating health care provider or the patients themselves.
† Inpatient hospitalization.
§ The Brighton Collaboration case definition uses combinations of symptoms to define levels of diagnostic certainty. Brighton level 1 represents the highest level of
diagnostic certainty that a reported case is indeed a case of anaphylaxis; levels 2 and 3 are successively lower levels of diagnostic certainty. Level 4 is a case reported
as anaphylaxis but that does not meet the Brighton Collaboration case definition. Level 5 is a case that was neither reported as anaphylaxis nor meets the case
definition (https://doi.org/10.1016/j.vaccine.2007.02.064).
¶ As documented in the description of the adverse event in the VAERS report in Box 18 or as documented in recovery status in Box 20.

 

 

 

Minutes from vaccine receipt to onset of anaphylaxis (A)* and nonanaphylaxis allergic reactions (B) after receipt of the first dose of Moderna COVID-19 vaccine — Vaccine Adverse Events Reporting System (VAERS), United States, December 21, 2020–January 10, 2021

This report describes cases of anaphylaxis after administration of first doses of the Moderna COVID-19 vaccine during December 21, 2020–January 10, 2021.

Abbreviation: COVID-19 = coronavirus disease 2019.

* The interval from vaccine receipt to symptom onset was >30 minutes for one anaphylaxis case (45 minutes).

The interval from vaccine receipt to symptom onset was ≥60 minutes for three nonanaphylaxis patients who had a documented history of allergies or allergic reactions at 60, 90, and 98 minutes and for four who did not have a documented history of allergies or allergic reactions (60 minutes, 10 hours, 20 hours, and 24 hours). The interval from vaccine receipt to symptom onset was missing in two case reports, both of which documented a history of allergies or allergic reactions. Four cases of nonanaphylaxis allergic reactions with symptom onset occurring later than the day after vaccination (i.e., outside of the 0–1-day risk window) were excluded from the final analysis.

 

TABLE 2. Characteristics of patients with reported anaphylaxis and nonanaphylaxis allergic reactions after receipt of the first dose of Moderna COVID-19 vaccine — Vaccine Adverse Events Reporting System (VAERS), United States, December 21, 2020–January 10, 2021Return to your place in the text
Characteristic Type of reported reaction, no. (%)
Anaphylaxis (n = 10) Nonanaphylaxis allergic reactions (n = 43)*
Median age, yrs (range) 47 (31–63) 43 (22–96)
Female 10 (100) 39 (91)
Minutes to symptom onset, median (range) 7.5 (1–45) 15 (<1–1,440 [24 hrs])
Symptom onset ≤15 mins 9 (90) 21 (51)
Symptom onset ≤30 mins 9 (90) 30 (73)
Documented history of allergies or allergic reactions 9 (90)§ 26 (60)

Abbreviation: COVID-19 = coronavirus disease 2019.
* Four of the initial 47 nonanaphylaxis allergic reaction reports were excluded from the final analysis because symptom onset occurred later than the day after vaccination (i.e., outside the 0–1-day risk window).
Two nonanaphylaxis allergic reaction reports were missing information on time of symptom onset; percentage calculated among 41 case reports with onset documented.
§ Five anaphylaxis reports included a patient history of a previous anaphylaxis episode.

 


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