Published: 20 October 2021

COVID-19

Adverse events following immunisation with COVID-19 vaccines: Safety Report #31 – 2 October 2021

Medsafe advises people NOT to make any decisions about vaccination based on information contained in this report. If you have questions or concerns about receiving a vaccine, please speak to a health care professional.

Introduction

This page provides information on the number of adverse events following immunisation (AEFI) reports received for COVID-19 vaccines.

An AEFI is an untoward medical event which follows immunisation and does not necessarily have a causal relationship with the administration of the vaccine. The adverse event may be an unfavourable or unintended sign, abnormal laboratory finding, symptom or disease.

The national roll-out of COVID-19 vaccines commenced on 20 February 2021. The vaccine currently available in New Zealand is Pfizer-BioNTech (Comirnaty). All medicines can cause side effects, the known side effects for Comirnaty are listed in the data sheet and consumer medicine information.

Suspected AEFI to COVID-19 vaccines are reported to the Centre for Adverse Reactions Monitoring (CARM). The Ministry of Health (through Medsafe) contracts the collection of this information to CARM, based at the University of Otago in Dunedin. Medsafe is closely monitoring the AEFI reported from the use of the COVID-19 vaccine. Find out more about vaccine safety monitoring.

Medsafe and CARM thank everyone who has contributed to the monitoring of COVID-19 vaccines. Please continue to report any adverse events following immunisation.

Adverse events following immunisation (AEFI) reported

The information below includes:

  • AEFI reports received and vaccine doses administered
  • AEFI reports by prioritised ethnicity and vaccine dose
  • AEFI reports by age band and vaccine dose
  • the top 10 most frequently reported AEFIs by vaccine dose.

AEFI reports received and vaccine doses administered, up to and including 2 October 2021

2,020

New AEFI reports since last update

(1,939 new non-serious and 81 new serious)

0

New safety signals (potential safety issues) have been identified

 

5,321,863

Total doses administered

(cumulative)

24,142

Total AEFI reports that were non-serious

929

Total AEFI reports that were serious

25,071

Total AEFI reports that were received

(cumulative)


There were 1,939 non-serious and 81 serious reports this week. Sadly, this week we have 11 more notifications of death. Any possibility of a causal link is investigated as part of our routine investigations and no new safety concerns with the Comirnaty vaccine were raised by these reports.

For information about reported deaths, please refer to the summary of reported deaths section.

AEFI reports received by prioritised ethnicity and vaccine dose, up to and including 2 October 2021

Ethnicitya Dose 1 Dose 2 Total
Māori 1,229 686 1,915
Pacific Peoples 482 365 847
Asian 1,946 1,086 3,032
European/Other 11,945 6,891 18,836
Unknownb 298 140 438
Total 15,900  9,168  25,068c

Notes:

  1. The prioritised ethnicity classification system allocates each person to a single ethnic group, based on the ethnic groups they identify with. Where people identify with more than one group, they are assigned in this order of priority: Māori, Pacific Peoples, Asian, and European/Other. So, if a person identifies as being Māori and New Zealand European, the person is counted as Māori. See Ethnicity Data Protocols for further information.
  2. There were 438 AEFI reports where the person’s ethnicity was not reported. Counts may change due to receipt of additional information. Ethnicity is not required for an AEFI report to be considered valid. See ‘Valid report’ in the Definitions section below.
  3. The total is different from the cumulative total above because it excludes 3 AEFI reports received for infants who did not receive the vaccine.

AEFI reports received by age band and vaccine dose, up to and including 2 October 2021

Age Dose 1 Dose 2 Total
10 - 19 years 1,719 285 2,004
20 - 29 years 2,977 1,311 4,288
30 - 39 years 3,198 1,724 4,922
40 - 49 years 2,697 1,742 4,439
50 - 59 years 2,439 1,817 4,256
60 - 69 years 1,619 1,273 2,892
70 - 79 years 839 696 1,535
80+ years 391 308 699
Unknowna 21 12 33
Total 15,900  9,168  25,068b

Note:

  1. There were 33 AEFI reports where the person’s age was not reported. Counts may change due to receipt of additional information. Age is not required for an AEFI report to be considered valid. See ‘Valid report’ in the Definitions section below.
  2. The total is different from the cumulative total above because it excludes 3 AEFI reports received for infants who did not receive the vaccine.

Top 10 most frequently reported AEFIs, dose 1 and dose 2, up to and including 2 October 2021

Reaction Number dose 1 Number dose 2 Number any dose
Dizziness 5,542 2,332 7,874
Headache 3,704 3,722 7,426
Injection site pain 2,968 2,905 5,873
Lethargy 2,815 2,994 5,809
Nausea 3,093 2,241 5,334
Fever 1,170 2,078 3,248
Chest discomfort 2,016 1,216 3,232
Numbness 1,381 773 2,154
Syncope (fainting) 1,525 542 2,067
Shortness of breath 1,186 721 1,907


Download a list of the top 50 most frequently reported AEFIs (any dose)..

Reported AEFIs by reporter type up to and including 2 October 2021

Reporter type Number of reportsa
Public: Patient 8,531
CIR Vaccinator 7,984
Nurse 4,434
Other 2,573
General Practitioner 1,860
Public: On behalf of a patient 707
Pharmacist 179
Not specified 111
  1. The total number here differs from the total reported cases elsewhere because a single case can contain multiple reports from different sources.

Please note that one adverse event report, which represents one person, may report on more than one symptom. Reports are sent to CARM if the reporter suspects that the vaccine may have caused the event. This does not necessarily mean that the vaccine did cause the event.

The number of reports can be influenced by how many people are being vaccinated, media attention, the nature of the events (eg, how painful the vaccination was), and other factors which vary over time. Not everyone who has an adverse reaction reports it, and some people may report AEFIs after each vaccination. The information here shows the number of reports not the number of people who experienced an AEFI.

The information is limited by the information provided in the report and may change over time due to quality control procedures and/or receipt of additional information. Non-valid reports are not included in the data.

Summary of reported deaths

Up to and including 2 October 2021, a total of 86 deaths were reported to CARM after the administration of the Comirnaty vaccine. Following medical assessments by CARM and Medsafe it has been determined that:

  • 31 of these deaths are unlikely related to the COVID-19 vaccine
  • 26 deaths could not be assessed due to insufficient information
  • 28 cases are still under investigation.
  • 1 death was likely due to vaccine induced myocarditis (awaiting Coroner’s determination)

By chance, some people will experience new illnesses or die from a pre-existing condition shortly after vaccination, especially if they are elderly. Therefore, part of our review process includes comparing natural death rates to observed death rates following vaccination, to determine if there are any specific trends or patterns that might indicate a vaccine safety concern. See below for more information about these observed-versus-expected analyses.

To date, the observed number of deaths reported after vaccination is actually less than the expected number of natural deaths.

Mortalities by age group up to and including 2 October 2021 reported to CARM

Age Mortalities
10 - 29 years 1
30 - 59 years 13
60 - 79 years 42
80+ years 30

Observed-versus-expected analyses

Mortality rates by ethnicity

It is important to note that no conclusions should be made from these observed-versus-expected analyses in isolation. Other investigations looking at pre-existing risk factors are always required.

The analyses below shows that the number of deaths recorded in the mortality register for people vaccinated with the Comirnaty vaccine is lower than expected based on the average number of deaths in previous years over the same number of days (natural death rate).

Observed / Expected Rate = Relative Risk (RR)

The methods used to calculate the relative risk also provide a confidence interval (CI). The confidence interval is a range of values that we are fairly sure our true value lies in. We are using a 95 percent confidence interval (95% CI), which is the range that will include the true value 95 percent of the time. If both the relative risk AND the lower end of the confidence interval are greater than one (>1.0), this is statistically significant and could indicate an increased risk of death in the vaccinated population. This will be highlighted in the table when applicable.

For these mortality by ethnicity analyses, we are monitoring people for 1 year after vaccination. Age- and ethnicity-specific natural (expected) death rates were obtained for 2019 from the mortality collection and Stats NZ’s best available population estimate.

These analyses do not consider causality and instead, report on all deaths that have occurred in the monitoring period (observed deaths). This results in a much higher number than those reported to CARM where the reporter (e.g., family member or health care provider) might have had a suspicion the vaccine could have played a role. The number of observed deaths also includes deaths from other causes, such as deaths due to accidents, medical conditions, other medicines or medical treatments.

Please note that the mortality collections operate many weeks in arrears. This means that these observed-versus-expected analyses will only be updated once a month and will also be in arrears – for example, the tables below are for the period up to 31 July 2021.

Observed-versus-expected deathsa by ethnicity group from any cause, up to 1 year after dose 1, 19 February 2021 to 31 July 2021

Prioritised ethnicity Dose 1 – number administered Expected deathsb in monitoring period Observed deathsc in monitoring period Relative risk
(95% confidence interval)
Māori 108,062 261 173 0.66 [0.57 – 0.77]
Pacific peoples 74,197 128 62 0.48 [0.37 – 0.62]
Asian 185,063 88 56 0.64 [0.48 – 0.82]
European or other 803,823 2,150 2,210 1.03d [0.99 – 1.07]
  1. Expected and observed deaths among people who have received 1 dose of the Pfizer/BioNTech vaccine during the specified period, corrected for age of the individual monitored. Inclusion criteria were: monitoring time of 1 year after receiving dose 1, all genders, all ethnicities, aged 16 years and older. The data was collected from the Mortality database.
  2. Data for expected death rates was obtained from the mortality collection and Stats NZ’s best available population estimate for 2019.
  3. The observed deaths column is a raw data observation, and this is used to calculate the relative risk (5th column).
  4. The relative risk of 1.03 does not indicate there is an increased risk of mortality in this ethnicity group because the lower end of the confidence interval is 0.99 (i.e., ≤1.0). Medsafe will continue to monitor this closely.

For further reading about the methodology used to analyse death rates, see:

Adverse events of special interest

Adverse events of special interest (AESI) are pre-specified medically significant events that have the potential to be causally associated with the vaccine and must be carefully monitored. AESI can be serious or non-serious and can include:

  • Events of interest due to their association with COVID-19 infection.
  • Events of interest for vaccines in general (e.g. to the specific vaccine type or adjuvants).

The list of AESIs below takes into consideration the lists of AESIs from expert groups such as the Brighton Collaboration, manufacturers and other regulatory authorities. The AESI list changes based on the evolving safety profile of vaccines. It is important to note that although these adverse events may occur after being vaccinated with a COVID-19 vaccine in New Zealand, they are rare and may not necessarily be related to the vaccine. Medsafe and CARM review the reports to determine whether the vaccine may have played a role in the occurrence of these events.

Adverse events of special interest (AESI) up to and including 2 October 2021

AESI Category AESI Totala
Immune system disorders Guillain-Barré Syndrome 9
Thrombocytopenia 16
Thrombosis with thrombocytopenia syndrome (TTS) 0
Anaphylaxisb 60
Cardiovascular system Myocardial infarction (heart attack) 29
Myocarditis/pericarditis 118
Blood and lymphatic system Thrombosis 26
Embolism 56
Deep vein thrombosis (DVT) 58
Vasculitis 23
Haemorrhage 79
Hepato-gastrointestinal and renal system Acute kidney injury 9
Acute liver injury 0
Pancreatitis <6
Nervous system Aseptic meningitis 0
Encephalitis <6
Stroke 58
Bell's Palsy/facial paralysis 92
Myelitis/myelitis transverse <6
Infections and musculoskeletal Erythema multiforme <6
Arthritis 26
Herpes zoster 154
Pregnancy, puerperium and perinatal conditions Abortion (spontaneous abortion /miscarriage) 9
  1. Includes all reports, both serious and non-serious. Counts below 6 are reported as <6 for privacy reasons. Counts may change due to receipt of additional information and subsequent reclassification of cases.
  2. Includes reports meeting levels 1-3 of the Brighton Collaboration case definition.

Summary of safety signals

Summary of Medsafe’s investigations into possible safety signals

Safety signal Outcome
Blood clots Continue to monitor. See also the Monitoring communication
Appendicitis Continue to monitor
Myocarditis/pericarditis Information has been added to Comirnaty data sheet. See also the Alert communication
Herpes zoster Continue to monitor
Bell’s palsy/facial paralysis Continue to monitor
Menstrual disorder Continue to monitor
Stroke Continue to monitor
Tinnitus Continue to monitor
AEFIs in the elderly Continue to monitor and updated data sheet
Pancreatitis Continue to monitor
Glomerular diseases Continue to monitor
Guillain-Barré Syndrome Continue to monitor
Thrombocytopenia Continue to monitor
AEFIs in children Continue to monitor

Definitions

Adverse event following immunisation (AEFI)
An AEFI is an untoward medical event which follows immunisation and does not necessarily have a causal relationship with the administration of the vaccine. The adverse event may be an unfavourable or unintended sign, abnormal laboratory finding, symptom or disease.
Serious adverse event following immunisation
An AEFI is considered serious if it:
  • is a medically important event or reaction
  • requires hospitalisation or prolongs an existing hospitalisation
  • causes persistent or significant disability or incapacity
  • is life threatening
  • causes a congenital anomaly/birth defect
  • results in death.
It is possible for different people to have experienced the same event but for the report to be serious for one person and non-serious for another person.
Adverse events of special interest (AESI)
An AESI is a pre-specified medically significant event that has the potential to be causally associated with the vaccine product based on past experience, the technology used to make the vaccine or the infection the vaccine is used to protect against. AESIs need to be carefully monitored and any potential association to vaccination confirmed by further analysis and studies.
Safety signal
Information on a new or known adverse event that may be caused by the vaccine and requires further investigation. Safety signals can be detected from a wide range of sources such as CARM reports, clinical studies and scientific literature.
Valid report
There are only four requirements for a valid AEFI report:
  1. one patient identifier (eg, name, initials, gender, date of birth, age)
  2. suspect medicine(s)
  3. suspected reaction(s)
  4. reporter details.
These four requirements are the minimum requirements. However, including more information in the report helps Medsafe to investigate the reaction more quickly. Reporting is easiest online.

More information

See the data sheets and consumer medicine information for the expected reactions for approved COVID-19 vaccines.

COVID-19 Vaccine Safety Monitoring Process

View Ministry of Health COVID-19 vaccine data

Latest listing of all cases received

The latest listing of AEFIs received is included in the attached spreadsheet. Medsafe advises patients NOT to make any decisions about vaccination based on information contained here.

Download AEFI-line-listing.xlsm

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