Good recovery of immunization stress-related responses presenting as cluster of stroke-like events following CoronaVac and ChAdOx1 vaccinations

  1. Metha Apiwattanakul
  2. Narupat Suanprasert
  3. Arada Rojana-Udomsart
  4. Thanes Termglinchan
  5. Chaichana Sinthuwong
  6. Tasanee Tantirittisak
  7. Suchat Hanchaiphiboolkul
  8. Pantep Angchaisuksiri
  9. Suphot Srimahachota
  10. Jurai Wongsawat
  11. Somjit Stiudomkajorn
  12. Sasisopin Kiertiburanakul
  13. Chonnamet Techasaensiri
  14. Wannada Laisuan
  15. Weerawat Manosuthi
  16. Pawinee Doungngern
  17. Wereyarmarst Jaroenkunathum
  18. Teeranart Jivapaisarnpong
  19. Apinya Panjangampatthan
  20. Jirapa Chimmanee
  21. Kulkanya Chokephaibulkit
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Abstract

Background

Immunization stress-related responses presenting as stroke-like symptoms may develop following COVID-19 vaccination. This study aimed to describe the clinical characteristics of immunization stress-related responses causing stroke-like events following COVID-19 vaccination.

Methods

We conducted a retrospective study of the secondary data of reported adverse events following COVID-19 immunization that presented with neurologic manifestations. Between March 1 and July 31, 2021, we collected and analyzed the medical records of 221 patients diagnosed with stroke-like symptoms following immunization. Demographic and medical data included sex, age, vaccine type, sequence dose, time to event, laboratory data, and recovery status as defined by the modified Rankin score (i.e., defining the degree of severity/dependence, with higher scores indicating greater disability). The affected side was evaluated for associations with the injection site.

Results

In total, 221 patients were diagnosed with immunization stress-related responses (stroke-like symptoms) following CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca) vaccinations. Most patients (83.7%) were women. The median (interquartile range) age of onset was 34 (28–42) years in patients receiving CoronaVac and 46 (33.5–60) years in those receiving ChAdOx1. The median interval between vaccination and symptom onset for each vaccine type was 60 (16–960) min and 30 (8.8–750) min, respectively. Sensory symptoms were the most common symptomology. Most patients (53.8%) developed symptoms on the left side of the body; 99.5% of the patients receiving CoronaVac and 90% of those receiving ChAdOx1 recovered well (modified Rankin scores ≤2, indicating slight or no disability).

Conclusions

Immunization stress-related responses presenting as stroke-like symptoms can develop following COVID-19 vaccination. Symptoms that are more likely to occur on the injection side are transient (i.e., without permanent pathological deficits). Public education and preparedness are important for administering successful COVID-19 vaccination programs.

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