"Abstract
Thorough postmortem investigations of fatalities following vaccination with coronavirus disease 2019 (COVID-19) vaccines are of great social significance. From 11.03.2021 to 09.06.2021, postmortem investigations of 18 deceased persons who recently received a vaccination against COVID-19 were performed. Vaxzevria was vaccinated in nine, Comirnaty in five, Spikevax in three, and Janssen in one person. In all cases, full autopsies, histopathological examinations, and virological analyses for the severe acute respiratory syndrome coronavirus 2 were carried out. Depending on the case, additional laboratory tests (anaphylaxis diagnostics, VITT [vaccine-induced immune thrombotic thrombocytopenia] diagnostics, glucose metabolism diagnostics) and neuropathological examinations were conducted...
Introduction
... Due to the inherently limited number of people that were studied in the initial trials, it is necessary to further monitor adverse events after vaccination during population wide roll out of COVID-19 vaccines to detect also very rare adverse events. This allows ongoing benefit-risk assessments of the approved vaccines.
Since end of February 2021, venous thromboses at unusual sites including cerebral venous thrombosis (CVT) and/or splanchnic vein thrombosis in combination with moderate to severe thrombocytopenia occurred in several hundred individuals typically 4 to 30 days after vaccination with Vaxzevria and Janssen... The underlying syndrome has been designated vaccine-induced immune thrombotic thrombocytopenia (VITT)...
Besides VITT, other immune syndromes were reported following COVID-19 vaccination including thrombotic thrombocytopenic purpura/hemolytic uremic syndrome, (auto-)immune thrombocytopenia or Guillain-Barré Syndrome. Furthermore, peri-/myocarditis was reported as a rare event following vaccination with mRNA-based vaccines...
Results
... In one case (case 6), myocarditis was found to be the cause of death (Fig. 1). A causal relationship to vaccination is possible, but cannot be proven beyond doubt....
In four cases, there was evidence of VITT (cases 3, 12, 14, and 18). In case 14, the cause of death was established in hospital, being CVT and cerebral hemorrhage with hypoxic brain damage. The diagnosis was confirmed by postmortem investigations. A second patient who died in a hospital (case 12) suffered a severe anaphylactic shock during narcosis induction, resulting in hypoxic brain damage. This patient was vaccinated 12 days before she developed the shock symptomatic... Case 3 involved a 32-year-old woman who died at home; the autopsy revealed a cerebral mass hemorrhage without CVT. Laboratory tests for VITT were positive, so a causal relationship with vaccination and death is very likely. In case 18, a 69-year-old man who also died at home, the autopsy revealed CVT and the laboratory tests for VITT were positive... Thus, a causal relationship between vaccination and death is possible, but cannot be proven beyond doubt."
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