Advances in Aging Research, 2024, 13, 121-135

https://www.scirp.org/journal/aar
ISSN Online: 2169-0502
ISSN Print: 2169-0499

Adverse Side Effects of COVID-19 Vaccines in

Older Adults: A Comprehensive Review of
Current Research

Jacob Selbe, Andrej Podlutsky

Biochemistry & Medical Genetics, Lake Erie College of Osteopathic Medicine, Erie, PA, USA

How to cite this paper: Selbe, J. and Podlut- Abstract

sky, A. (2024) Adverse Side Effects of
COVID-19 Vaccines in Older Adults: A The purpose of this research review was to examine current scientific literature
Comprehensive Review of Current Re- on COVID-19 vaccine-induced side effects in older adults. We reviewed stud-
search. Advances in Aging Research, 13,
ies focusing on side effects categorized into cardiologic, immunologic, neuro-
121-135.
https://doi.org/10.4236/aar.2024.136009 logic, and ocular groups. Cardiologic side effects included myocarditis, peri-
carditis, and myocardial infarction. Immunologic conditions examined were
Received: October 1, 2024 anaphylaxis and vaccine-induced immune thrombotic thrombocytopenia.
Accepted: November 17, 2024
Published: November 20, 2024
Neurologic side effects included Guillain-Barré syndrome and Bell’s Palsy.
Ocular side effects covered ocular swelling, submacular hemorrhage, and cor-
Copyright © 2024 by author(s) and neal graft rejection after keratoplasty and Descemet membrane endothelial
Scientific Research Publishing Inc.
keratoplasty. Additionally, less common side effects in older adults were re-
This work is licensed under the Creative
Commons Attribution International viewed but found to be statistically rare. Overall, COVID-19 vaccine-induced
License (CC BY 4.0). side effects in elderly populations were rare. We concluded that the vaccine’s
http://creativecommons.org/licenses/by/4.0/ efficacy in preventing excess deaths due to COVID-19 is significant, and the
Open Access
risk of these rare side effects does not justify foregoing vaccination in at-risk
individuals. Patients at higher risk for these side effects should be informed,
and additional considerations should be made by their treating physician. This
review aims to increase awareness of rare vaccine-induced side effects to en-
courage further studies, enhancing understanding of their etiology and prev-
alence in at-risk older adult populations.

Keywords
COVID-19 Vaccine, Adverse Side Effects, Older Adults, Vaccine Safety

1. Introduction
The COVID-19 pandemic is one of the most impactful events of the 21st century.

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J. Selbe, A. Podlutsky

The 2020 outbreak and subsequent lockdowns have caused major changes in ad-
ministration worldwide. A significant body of research has demonstrated major
adverse side effects associated with COVID-19, many of which are debilitating
and chronic [1].
The speed at which COVID-19 vaccinations were developed and brought to
market is unprecedented in medical history. To address the global morbidity and
mortality of COVID-19, the vaccine development process was expedited by con-
ducting clinical trials in parallel rather than sequentially [2]. The first COVID-19
vaccines available in the United States were developed and sold by Pfizer and
Moderna, marking the first mRNA-based vaccines approved for human use [3].
The Pfizer-BioNTech COVID-19 Vaccine BNT162b2, sold as Comirnaty, was the
first to receive regulatory approval from the Food and Drug Administration [4].
This vaccine was collaboratively developed by the U.S. pharmaceutical firm Pfizer
and the German biotechnology company BioNTech. The Pfizer-BioNTech vac-
cine received emergency use authorization from the FDA in December 2020, with
the authorization expanded to include ages 12 and older in May 2021 [4]. Co-
mirnaty received full regulatory approval from the FDA in August 2021. Since
December 2020, more than 4.6 billion doses of BNT162b2 have been distributed
globally [5].
The second COVID-19 vaccine available in the United States was developed by
Moderna, an American pharmaceutical corporation. The Moderna COVID-19
vaccine, mRNA-1273, branded as Spikevax, received emergency regulatory ap-
proval from the U.S. Food and Drug Administration on December 18, 2020 [4].
The original variant of this vaccine is now known as Spikevax 0. Moderna began
producing an updated COVID-19 vaccine, mRNA-1273.222, starting in 2022 to
combat the Omicron variant [6]. The Moderna vaccine is designed to be stored
and transported at a standard refrigerator temperature of 2 to 8 degrees Celsius,
compared to the ultra-cold temperature requirements of −90 to −60 degrees Cel-
sius for the Pfizer-BioNTech BNT162b2 vaccine [7]. Because of this, Moderna
vaccinations were preferentially distributed to rural communities in the United
States and exported to nations lacking deep refrigeration capabilities. The relative
geographic distribution of the different vaccines is important to consider when
studying their side effects at a community level.
Viral-vector COVID-19 vaccines have been marketed and distributed in the
United States and abroad. Adenovirus viral vector vaccines have been developed
and used to combat COVID-19, though their efficacy in preventing its spread has
been debated [8]. The Sputnik V COVID-19 vaccine was the first adenovirus viral
vector vaccine, receiving regulatory approval from the Russian Ministry of Health
in August 2020 [9].1 This made it the first publicly available COVID-19 vaccine
1
Sputnik V was the first widely available COVID-19 vaccine in the world, but does not feature prom-
inently in this publication. This is because the premise of our work focuses primarily on medium to
long-term effects, and data from the Russian Federation and partner nations on the side effects and
efficacy of Sputnik V is largely unavailable. The Chinese Sinopharm vaccine does not feature in this
review for the same reason.

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 J. Selbe, A. Podlutsky

worldwide. However, Sputnik V has never been marketed in the United States and
has not received FDA approval. The Oxford-AstraZeneca COVID-19 vaccine,
ChAdOx1, developed in the United Kingdom, also uses an adenovirus viral vector
approach toward SARS-CoV-2 [10]. It was approved by the UK’s Medicines and
Healthcare Products Regulatory Agency on December 30, 2020, and later by the
European Medicines Agency. Notably, the Oxford-AstraZeneca vaccine did not
gain regulatory approval in the United States and is not sold there [11]. The
Janssen COVID-19 vaccine, Ad26.COV2.S, marketed as JCovden, was developed
by the Belgian pharmaceutical company Janssen and received emergency use au-
thorization from the U.S. FDA in February 2021 [12].
The rapidly developed vaccines helped combat the pandemic. A common trait
among all first-generation COVID-19 vaccines is the speed with which they were
developed and distributed.2 Less than a year passed from the first reported cases
of COVID-19 to the distribution of the first doses of the COVID-19 vaccine in the
United States. The distribution of COVID-19 vaccines saved an estimated 14.4
million lives globally in 2021 alone, increasing to 19.3 million lives saved when
excess deaths due to pandemic knock-on effects are included [13]. Vaccines
against COVID-19 also accelerated the end of global lockdown policies and re-
duced the economic and social burdens associated with excess deaths and pro-
longed shelter-in-place orders. Public vaccination campaigns were considerably
more cost-effective than shelter-in-place orders. In Israel, the cost of preventing
each excess death due to COVID-19 using shelter-in-place methods was $9,700,000
USD, while each death prevented using primary vaccination efforts was just
$57,000 USD [14].3 The effectiveness of vaccination is demonstrated by CDC data
collected from thirteen U.S. districts between April 9 and June 19, 2021: a mortal-
ity rate of 1.6 per 100,000 for unvaccinated individuals compared to 0.1 per
100,000 for fully vaccinated individuals [15].4
Vaccines significantly improve the survival rate of patients who become in-
fected with COVID-19 [15]. However, it is important to objectively study and as-
sess the known side effects of COVID-19 vaccines. The rapid development of these
vaccines has raised questions about their side effects. These side effects are now
better studied due to the abundance of clinical reports and data available over
time. Concerns about vaccine-induced side effects are common among the public
and are often cited as reasons for vaccine hesitancy [16]. Proper documentation
and assessment of these side effects are crucial to increasing public confidence in
the safety of COVID-19 vaccines. This will provide individuals and healthcare
providers with the necessary information to make informed decisions for long-
term health outcomes.
The purpose of this article is to review and document the latest research and

First-generation is defined as vaccines developed to treat the original strain of Sars-Cov-2.

2

Prices are converted from Israeli Shekels to United States Dollars.

3

4
Geographic areas of data collection were Alabama, Arizona, Colorado, Indiana, Los Angeles (Cali-
fornia), Louisiana, Maryland, Minnesota, New Mexico, New York City (New York), North Carolina,
Seattle (Washington), and Utah.

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J. Selbe, A. Podlutsky

case studies demonstrating adverse side effects of COVID-19 vaccines in elderly

populations. Our research is divided into sections that assess the side effects of
bodily systems. Our goal is to highlight commonly cited vaccine-induced side ef-
fects of COVID-19 vaccines currently marketed in the Western world. We aim to
increase awareness of the potential risks these vaccines may pose to elderly indi-
viduals and to facilitate a comprehensive risk-reward analysis by individuals and
clinicians considering their use.

2. COVID-19 Vaccine-Associated Cardiological Symptoms in

Elders
Multiple studies have found significant variation in the presentation of cardiolog-
ical dysfunction following the administration of COVID-19 vaccines. Pericarditis
is a commonly reported side effect associated with mRNA-based COVID-19 vac-
cines in elderly populations.

Box-1. Pericarditis is inflammation of the pericardial sac and is the most common
pathological process involving the pericardium. The pericardium is a double-layered,
fibroelastic sac surrounding the heart. Pericardial inflammation often leads to increased
fluid accumulation within the pericardial sac, forming a pericardial effusion, which may
be serous, hemorrhagic, or purulent [17].
Myocarditis is an inflammation of the myocardium. It typically occurs in young pa-
tients but can happen at any age. It most commonly results from a viral illness but can
also be due to non-infectious causes. The clinical presentation varies and may include
febrile illness, mild chest pain, arrhythmias, heart failure, cardiogenic shock, or death
[18].
Atrial fibrillation is the most common type of cardiac arrhythmia. It results from ab-
normal electrical activity within the atria of the heart, causing them to fibrillate. It is
characterized as a tachyarrhythmia, meaning the heart rate is often fast. Due to its irreg-
ular rhythm, blood flow through the heart becomes turbulent, increasing the risk of
forming a thrombus (blood clot), which can dislodge and cause a stroke [19].

Diaz et al. conducted a study between February and May 2021 using data from
2,000,287 patients across 40 U.S. hospitals. Their research found that 15 patients
developed pericarditis after one dose of the COVID-19 vaccine, and 22 developed
it after two doses [20]. The mean onset of symptoms was 20 days post-vaccination.
Seventy-three percent of reported cases were male, with the average age of onset
being 59 years. The mean monthly number of pericarditis cases in the same local-
ity during the pre-vaccine era (January 2019 to January 2020) was 49.1 (95% CI,
46.4 - 51.9), compared to 78.8 (95% CI, 70.3 - 87.9) in the post-vaccine era (Feb-
ruary to May 2021). This data demonstrates a statistically significant increase in
cases following the availability of the COVID-19 vaccine, suggesting an increased
prevalence of pericarditis post-vaccination. Further studies are necessary to deter-
mine if a direct causal relationship exists. The high average age of onset is signifi-
cant, as there may be a correlation between the age at vaccination and the onset
of post-vaccination pericarditis.

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 J. Selbe, A. Podlutsky

Myocarditis is a commonly reported side effect associated with COVID-19

vaccines. This condition has also been reported as a side effect of smallpox and
influenza vaccines [21]. Myocarditis following COVID-19 vaccination with
mRNA-type vaccines has a significantly higher incidence rate among adolescent
and young adult males [1]. The incidence of myocarditis reported in young adult
males under 40 ranges from 8.1 to 39 cases per 100,000 doses given [22]. Cases
of COVID-19 vaccine-induced myocarditis have also been observed in elderly
populations. Duke University Medical Center conducted a study on patients
vaccinated against COVID-19 who later developed myocarditis [23]. Of the 7
patients hospitalized with myocarditis during the study, 3 did not receive a
COVID-19 vaccine. Of the seven patients hospitalized with myocarditis during
the study, three had not received a COVID-19 vaccine. Among the vaccinated
patients, three were young males, with two vaccinated with BNT162b2 and one
with mRNA-1273. The only elderly patient was a 70-year-old female hospital-
ized with myocarditis after her second vaccine dose. Her Troponin I level
peaked at 2.34 ng/dL, and she had a left ventricular ejection fraction of 40%. The
episode resolved after 12 hours, and she was discharged four days later. The
researchers determined that her myocarditis was likely associated with her vac-
cination status. The study concluded that myocarditis is a rare side effect of
mRNA COVID-19 vaccines but noted limitations in their study. While myocar-
ditis has been observed in elderly patients following COVID-19 vaccination, the
side effect does not show a clear preference for older individuals [22]. Further
studies are needed to determine the prevalence of COVID-19 vaccine-induced
myocarditis in elderly populations.
Myocardial infarction (MI) is a potential complication of COVID-19 vaccines.
Most cases associated with MI were STEMIs linked to the Oxford-AstraZeneca
ChAdOx1 viral-vector vaccine [11]. However, a direct population-level link be-
tween MI and COVID-19 vaccination status has not been found. A French study
evaluating the short-term side effects of the Pfizer-BioNTech BNT162b2 mRNA-
based vaccine found no increased risk of MI for patients over the age of 75 [24].
Of the 3.9 million French nationals over 75 who had received at least one dose of
BNT162b2, 11,113 had been hospitalized for MI, representing a relative incidence
of 0.97 (95% CI, 0.88 - 1.06) for those who had received one dose and 1.04 (95%
CI, 0.93 - 1.16) for those who had received two doses. Although this correlation
was considered by some in the medical community, the data does not indicate a
significant link between COVID-19 vaccines and the onset of MI in the elderly.
However, while population-level data does not suggest a correlation, further stud-
ies considering ethnic and genetic backgrounds, individual medical history, and
risk factors are necessary to rule out the absolute age-related risk of developing
COVID-19 vaccine-induced MI.
Atrial fibrillation is a COVID-19 vaccine-induced side effect studied in elderly
populations. Kumar et al. conducted a comprehensive review of the VAERS (Vac-
cine Adverse Event Reporting System) co-managed by the CDC and FDA [25].

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J. Selbe, A. Podlutsky

The study found 2,611 events of atrial fibrillation, split between 1,328 men and
1,245 women, the majority of whom were over 40 years old. The data showed that
the rate of atrial fibrillation onset among the vaccinated public was 5 in 1,000,000.
Importantly, this side effect shows a propensity for older populations, with most
cases occurring in middle-aged and elderly individuals.

3. COVID-19 Vaccine-Associated Immunological Symptoms in

Elders
Anaphylaxis is a COVID-19 vaccine-induced side effect that affects elderly popu-
lations. The reported incidence rate of post-vaccine anaphylaxis is currently 1 in
100,000 individuals [26].

Box-2. Anaphylaxis is a common medical emergency and a life-threatening acute hy-

persensitivity reaction. It is defined as a rapidly evolving, generalized, multi-system al-
lergic reaction. Without treatment, anaphylaxis is often fatal due to its rapid progression
to respiratory collapse [27].

It is important to note that COVID-19 vaccine-induced anaphylaxis shows no

preference for elderly patients and is reported at statistically equal rates among
both young and elderly individuals [26]. However, the risk of anaphylaxis is often
greater in elderly individuals due to more severe presentations stemming from
age-related immune hypersensitivity [28]. Vaccine guidance literature recom-
mends monitoring patients for at least 15 minutes to ensure they can receive rapid
assistance if symptoms of anaphylaxis occur. Hives, pruritus, flushing, and angi-
oedema are common initial symptoms of vaccine-induced allergic reactions that
must be monitored following the administration of COVID-19 vaccines [29].
These symptoms may be treated with antihistamines and glucocorticoids, with
continued monitoring for 4 hours. Severe symptoms such as syncope, swollen
tongue, or shortness of breath should be immediately treated with an epinephrine
auto-injection [26].
Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) is an im-
munologic condition reported as a side effect of the COVID-19 vaccine. Immune
thrombocytopenia (ITP) is an autoimmune disorder characterized by low platelet
counts (<100,000 platelets/μL blood) that cannot be explained by any other etiol-
ogy [30]. COVID-19 vaccines interact with platelets or platelet factor 4 (PF4) in
the blood serum, potentially resulting in VITT [31]. The Oxford-AstraZeneca
COVID-19 vaccine, ChAdOx1, came under international scrutiny for its associa-
tion with VITT [32]. COVID-19 vaccine-induced VITT is reported in just 1 in
500,000 patients [32].
Saluja et al. conducted a systematic review of reported cases of VITT in Med-
line, Embase, and Ebsco up to June 2022 [33]. A total of 66 cases of COVID-19
vaccine-induced VITT were reported. The mean time from vaccination to presen-
tation was 8.4 days, and the mean patient age was 63 years, with 60.6% of cases

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 J. Selbe, A. Podlutsky

being female. Patients were treated with steroids, intravenous immunoglobulins

(IVIG), or both. There were no reported deaths, suggesting promising treatment
outcomes. The data suggests a higher incidence of VITT in elderly populations,
which is notable since ITP typically presents in younger female populations [34].
This implies an unknown mechanism in COVID-19 vaccine-induced immune
thrombotic thrombocytopenia leading to a higher prevalence among the elderly.
Further investigation is needed to understand the age disparity in the presentation
of COVID-19 VITT compared to standard ITP.

4. COVID-19 Vaccine-Associated Neurologic Symptoms in

Elders
Guillain-Barré syndrome (GBS) is a reported side effect of COVID-19 vaccination
currently under investigation.

Box-3. Guillain-Barré syndrome is a rare immune-mediated disease characterized by

damage to the peripheral and autonomic nervous systems. It is one of the leading causes
of flaccid paralysis worldwide. Although relatively rare, it can be life-threatening and
debilitating [35].
Bell’s palsy is the most common peripheral paralysis of the seventh cranial nerve, char-
acterized by a rapid and unilateral onset. This idiopathic condition causes partial or
complete weakness of one side of the face, along with changes in taste, sensitivity to
sound, and alterations in lacrimation and salivation [36].

Ogunjimi et al. conducted a meta-analysis of data on PubMed to investigate the

prevalence of GBS following COVID-19 vaccination [37]. Their study found a
prevalence of 8.1 (95% CI 30 - 220) cases per 1,000,000. The mean age of onset for
GBS in vaccinated patients was 56.8 years, with the greatest occurrence in males
aged 40 - 60. Viral vector COVID-19 vaccines were associated with an increased
risk of developing GBS, while mRNA COVID-19 vaccines were not. Demyelinating
type GBS was the most common neurophysiological type secondary to COVID-19
vaccination. More than 80% of the patients developed GBS within 21 days follow-
ing their first dose of a viral vector vaccine [37]. Facial nerve paralysis can occur
in isolation or as part of autoimmune diseases such as Guillain-Barré syndrome,
polyneuritis, or other forms of autoimmune neuropathy [38]. Keh et al. reported
a spike in GBS cases above the 2016-2020 average in March-April 2021, with 198
cases occurring within 6 weeks of the first dose of the COVID-19 vaccine in the
United Kingdom [39]. GBS is now considered a well-established side effect of
COVID-19 vaccines, with development favoring older populations, as indicated
by the mean onset age of 56.8 years.
Bell’s palsy (BP) is a neurological condition identified as a potential side effect
of the COVID-19 vaccine. Albakri et al. conducted a systematic review of Pub-
Med, SCOPUS, and EBSCO from the start of COVID-19 vaccination efforts
through October 2022 to determine the prevalence of COVID-19 vaccine-associ-
ated Bell’s palsy [40]. Their study found a prevalence of 25 cases per 1,000,000,

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J. Selbe, A. Podlutsky

with 62.8% of cases presenting with unilateral facial paralysis [40]. The majority
of cases occurred after the first dose of the COVID-19 vaccine, with hypertension
being the most common comorbidity among the patients studied. The average
onset time was 1 - 1.6 days post-vaccination. The mechanism by which COVID-
19 vaccines may cause Bell’s Palsy remains unclear. However, 69.2% of patients in
the study made a full recovery. Cases of vaccine-induced Bell’s Palsy are rare, and
further studies are needed to determine its true clinical association. The onset ap-
pears to favor elderly populations based on the available data.

5. COVID-19 Vaccine-Associated Ocular Symptoms in Elders

Several COVID-19 vaccine-induced ocular symptoms disproportionately affect
elderly populations. Acute eyelid swelling is a commonly reported side effect with
a higher occurrence rate in elderly patients. Al-Khames et al. conducted a study
on reported side effects in 1,736 patients and found that acute eyelid swelling im-
mediately following the COVID-19 vaccine had a prevalence of 1,150 per
1,000,000 doses [41]. Lee and Huang found the average age of COVID-19 vaccine-
induced eyelid swelling to be 57.7 years (range 44 - 67), indicating an increased
prevalence in older individuals. The mechanism by which this side effect occurs
remains unclear but is believed to be associated with an immunological response
to the vaccine [42].

Box-4. Submacular hemorrhage (SMH) is a potentially blinding complication of mac-

ular neovascular (MNV) diseases. The retinal pigment epithelium and the neurosensory
retina, particularly the photoreceptor layer, can be severely compromised by the depos-
ited blood [43].
Acute transplant rejection is a condition that occurs within days to months after trans-
plantation when the recipient's immune system identifies the grafted organ as foreign
and mounts a defense. The etiology, pathophysiology, presentation, and management
of this common transplantation complication are complex. Diagnosis is based on clini-
cal features involving the grafted organ and is confirmed by diagnostic laboratory stud-
ies, including tissue biopsy [44].

Submacular hemorrhage is another COVID-19 vaccine-induced side effect doc-

umented in ocular studies. Park et al. conducted a clinical study on patients expe-
riencing ocular side effects from the COVID-19 vaccine and found 21 individuals
who met the study criteria, with an average age of 77 years [45]. Fifty-two percent
of reported cases involved submacular hemorrhage, with the average time to onset
being 2 days. All patients were negative for anti-PF4 antibodies, suggesting the
findings were not secondary to VITT [31]. The average age of patients with sub-
macular hemorrhage in Park’s study was 81, indicating a greater prevalence in
elderly individuals. Interestingly, COVID-19 vaccine-induced submacular hem-
orrhage showed a propensity for mRNA-type vaccines, with 73% of cases receiv-
ing mRNA vaccines [45]. The cause of this side effect is not yet known, and the
author recommends further studies with larger subject pools.

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Corneal surface manifestations have been documented as side effects induced

by the COVID-19 vaccine. Lee and Huang conducted a review of these ocular side
effects in a clinical study. They found the average onset of ocular surface manifes-
tations to be at 68.5 years (range 56 - 83), indicating a significant prevalence in
elderly patients [42]. Corneal graft rejection after keratoplasty (PKP) following
the COVID-19 vaccine was documented in half of the patients. The average pa-
tient age was 64.5 years (range 56 - 73). Graft failure onset ranged from 13 to 21
days post-vaccination, with findings evenly distributed between mRNA and viral
vector vaccines. Ravichandran and Natarajan proposed that COVID-19 vaccines
may cause an immune response inducing Class II MHC complex antigens in the
grafted cornea [46]. This effect has been documented with influenza vaccines, but
it is unclear if the same mechanism affects tissue rejection with COVID-19 vac-
cines [47]. The presentation in elderly individuals could be due to age-related im-
mune hypersensitivity often seen in this age group [28].
Corneal graft rejection after Descemet membrane endothelial keratoplasty
(DMEK) occurred in half of all patients with corneal surface manifestations in Lee
and Huang’s study [42]. The average patient age was 74.5 years (range 66 - 83),
with symptoms appearing 7 to 21 days post-vaccination. Similar to cases of PKP,
symptoms showed no preference for a specific vaccine type. The mechanism of
onset for vaccine-induced DMEK cases is speculated to be similar to those of
COVID-19 vaccine-induced PKP [48]. The exact mechanism of COVID-19 vac-
cine-induced graft rejection is still debated, and further studies are needed to de-
termine causality conclusively.

6. Conclusions
Our review identified various COVID-19 vaccine-induced side effects in older
adults, with cardiological, immunological, neurological, and ocular symptoms be-
ing the most prevalent. Common side effects included myocarditis, pericarditis,
anaphylaxis, Guillain-Barré syndrome, Bell’s Palsy, and ocular conditions like
submacular hemorrhage and corneal graft rejection. While these side effects are
rare, they highlight the need for careful monitoring, especially in older, high-risk
populations.
Despite these concerns, the efficacy of COVID-19 vaccines in preventing severe
illness and death in elderly populations remains clear. The benefits of vaccination
outweigh the risks of rare side effects. Future research should focus on the under-
lying mechanisms of these side effects and strategies for mitigating risks, ensuring
continued vaccine safety and effectiveness across all age groups.

7. Case Studies
7.1. Atrial Fibrillation Post-Vaccination
A 55-year-old woman with a history of paroxysmal atrial fibrillation, mild mitral
prolapse, and hypertension presented to the emergency room with palpitations,
chest pain, and dyspnea three days after receiving her first dose of mRNA-1273

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J. Selbe, A. Podlutsky

[49]. Her echocardiogram indicated normal left ventricular ejection fraction, se-
vere tricuspid regurgitation, and severe mitral regurgitation. Permanent atrial fi-
brillation was diagnosed after failing to restore normal cardiac rhythm. She un-
derwent tricuspid valve annuloplasty, mitral valve repair surgery, and bilateral
maze ablation 14 days after admission. Chen reviewed five additional cases of
atrial fibrillation post-mRNA-1273 vaccination, noting that three patients were
over 55, all female, and experienced onset within eight days of their first vaccina-
tion with an mRNA-type COVID-19 vaccine. The study concluded that fibrillary
cardiac disorders may be a rare vaccine-associated side effect requiring further
investigation to establish causality.

7.2. Myocarditis Presentation

A 66-year-old male with a history of hyperlipidemia, hypertension, and type II
diabetes mellitus was admitted to the emergency room three months after his sec-
ond dose of BNT162b2. Testing showed elevated Troponin-I, peaking at 4.96
ng/dL eight hours after admission, and a 44% left ventricular ejection fraction
[21]. The patient had spontaneous resolution within 24 hours, attributed to a late
presentation of myocarditis due to BNT162b2 exposure.

7.3. Hyperthyroidism Post-Vaccination

A 67-year-old male was admitted to the hospital 18 days after his second dose of
the COVID-19 vaccine, presenting with hypertension, frequent atrial extra beats,
fever, weight loss, and neck pain. Examination revealed an enlarged thyroid with
poorly defined echogenic regions and pseudo-nodules. Serum TSH was low (0.005
uIU/mL) and T4 was elevated (2.87 ng/dL). Symptoms gradually improved, and
thyroid hormones stabilized within two months. Physicians suspected vaccine-
induced hyperthyroidism [50]. Further studies are needed to confirm the causa-
tive relationship of COVID-19 vaccines with acute onset hyperthyroidism and its
remission.

7.4. Acute CHF Exacerbation

A 67-year-old male presented to the emergency room six hours after his second
COVID-19 vaccine dose, experiencing shortness of breath, fever, and chills. He
later developed nausea, orthopnea, and fatigue. His medical history included hy-
pertension, type 2 diabetes mellitus, hyperlipidemia, coronary artery disease, and
congestive heart failure (CHF) with preserved ejection fraction. He was diagnosed
with acute CHF exacerbation post-vaccination [51]. Treatment with diuretics and
supplemental oxygen led to significant symptom improvement over the next two
days. Further research is needed to determine the causative relationship between
COVID-19 vaccines and CHF exacerbation.

7.5. Retinal Vascular Occlusion

An 82-year-old woman visited her ophthalmologist two weeks after her second

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 J. Selbe, A. Podlutsky

dose of the BNT162b2 COVID-19 vaccine, complaining of sudden reduced visual

acuity. With no history of hypertension or vascular occlusion, her visual acuity
was 20/63. An ophthalmic examination revealed inferotemporal branching retinal
vein occlusions, edema, and retinal hemorrhage, leading to a diagnosis of probable
COVID-19 vaccine-induced retinal vascular occlusion [52]. The patient was treated
with steroids, and follow-up showed symptom resolution and improved visual
acuity to 20/40. Further investigation is needed to determine the etiology of retinal
vascular occlusion in relation to COVID-19 vaccination.

Conflicts of Interest
The authors have no financial stake in any organization or corporation that may
benefit from the results of this study. They declare no conflicts of interest regard-
ing the publication of this paper.

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Abbreviations
BP: Bell’s Palsy
CDC: Centers for Disease Control and Prevention
COVID-19: Coronavirus Disease 2019
DMEK: Descemet’s Membrane Endothelial Keratoplasty
FDA: Food and Drug Administration
GBS: Guillain-Barré syndrome
ITP: Immune thrombocytopenic purpura
IVIG: Intravenous Immunoglobulin
MI: Myocardial Infarction
MNV: Macular Neovascular (Diseases)
PF4: Platelet Factor 4
PKP: Penetrating keratoplasty
SMH: Submacular Hemorrhage
VAERS: Vaccine Adverse Event Reporting System
VITT: Vaccine-Induced Immune Thrombotic Thrombocytopenia

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