The largest immunization effort in world history is underway, and 12.7 billon doses of COVID-19 vaccines have been administered from December 2020 to September 2022.1 The vaccine is remarkably safe and has contributed to a significant reduction in the number of deaths and life-threatening conditions produced by acute COVID-19 infections.2 However, segments of social media are promoting false narratives linking the administration of COVID-19 vaccines with same-day deaths. The most widely publicized “death” is that of a Tennessee nurse who fainted after the injection during a live video recording.3 For more than a year after her rapid and full recovery, dozens of statements from her family and employer, and independent fact-checks, scores of internet users continue to believe that she has died at the time of her fainting spell.3,4

We searched Medline using the key words “death”, “deaths”, “COVID-19”, “vaccine” and “vaccination” to identify same-day fatalities after COVID-19 vaccinations. Six reports5–12 contained demographic and autopsy data on 54 patients (38 males and 16 females, age range 23-94) fulfilling the scope of our search (Table 1).

Table 1. - Demographic and autopsy features of same-day deaths after COVID-19 vaccinations. Authors, Country Year Age Gender Vaccine manufacturer Dose # Autopsy findings suggesting the cause of death Schneider Et al,5 Germany 2021 82 M Moderna 1 Severe coronary sclerosis; extensive previous myocardial infarction scars; cardiac hypertrophy 91 F Moderna 1 Severe coronary sclerosis; extensive previous myocardial infarction scars; cardiac hypertrophy 34 F AstraZeneca 1 Acute myocardial infarction; previous myocardial infarction scars 65 M Pfizer 1 Myocarditis 71 M Pfizer 1 Coronary sclerosis; massive ventricular hypertrophy Murata Et al,6 Japan 2022 31 M Pfizer 2 None Barouti Et al,7 Italy 2022 58 M Pfizer 2 Acute myocardial infarction; left anterior descending coronary artery thrombosis 50 F Pfizer 2 Acute myocardial infarction; left anterior descending coronary artery thrombosis Ittiwut Et al,8 Thailand 2022 23 M AstraZeneca 2 None 33 M AstraZeneca 2 None 43 M Pfizer 3 Dilated cardiomyopathy 35 M Sinovac 1 None 36 M AstraZeneca 2 None 38 M Sinovac 2 Coronary atherosclerosis 72 M AstraZeneca 1 Coronary atherosclerosis 53 F AstraZeneca 1 None 59 F AstraZeneca 1 Coronary atherosclerosis Yeo Et al,9 Singapore 2022 74 M Pfizer 1 Coronary artery disease 63 M Pfizer 2 Ischemic heart disease 91 M Pfizer 2 Acute myocardial infarction 76 F Pfizer 2 Subarachnoid hemorrhage due to ruptured berry aneurysm 80 M Pfizer 1 Ischemic heart disease 86 M Pfizer 2 Ischemic heart disease 94 F Pfizer 2 Hypertensive heart disease 69 M Pfizer 2 Ischemic heart disease 72 M Pfizer 1 Pneumonia 63 M Pfizer 2 Ruptured Ascending aortic dissection 53 M Pfizer 1 Acute coronary thrombosis 69 M Pfizer 2 Coronary artery disease; severe interstitial lung disease 23 M Pfizer 2 Severe obesity with associated cardiomyopathy 65 M Moderna 2 Head injury 56 M Moderna 2 Hemorrhagic stroke 52 M Pfizer 1 Coronary artery disease 53 F Pfizer 2 Coronary atherosclerosis 33 M Moderna 2 Right ventricular dysplasia 39 M Pfizer 1 Ischemic heart disease 67 M Pfizer 2 Head injury Suzuki Et al,10 Japan 86 F Pfizer 1 Drowning (emphysema aquosum) 87 F Pfizer 1 Drowning (emphysema aquosum) 81 M N/A 1 Severe coronary sclerosis; cardiomegaly; myocardial scar 79 F Pfizer 2 Severe sclerosis of the left anterior descending artery 76 M Pfizer 2 Drowning (emphysema aquosum) 82 F Pfizer 2 Severe sclerosis with coronary stent implantations; myocardial scars 83 F Pfizer 2 Ruptured aortic aneurysm dissection 77 M Pfizer ! Diabetic ketoacidosis; diabetic nephropathy 74 F Pfizer 2 Cardiomegaly; mitral stenosis 65 M Pfizer N/A Ischemic heart disease; cardiomegaly 69 M N/A N/A None 55 M Pfizer 2 Bacterial pneumonia (multilobar) 74 M Pfizer 2 Ischemic heart disease; lung edema 53 M Pfizer 1 Myocardial infarction 67 F Pfizer 2 Ischemic heart disease; lung edema 52 M N/A 1 Transverse sinus thrombosis; cerebral hemorrhage 48 F Moderna 1 Diabetic ketoacidosis

Cases were vaccinated in countries reporting very large numbers of COVID-19 vaccine doses administered (Japan 340 million, Germany 185 million, Thailand 143 million, Italy 141 million, and Singapore 14 millions).1 Anaphylaxis was excluded in all cases. Coronary artery disease was the most common cause of death after autopsy (46.3%). A direct relationship with the vaccination was felt possible in two cases, one with myocarditis, the other with transverse sinus thrombosis and cerebral hemorrhage. In seven patients (13%), the autopsy did not identify findings explaining the sudden death.

These data indicate that same-day deaths after COVID-19 vaccination are extraordinary infrequent. They support a nationwide survey showing no positive association between acute myocardial infarction and pulmonary embolism, common causes of sudden death, in persons receiving mRNA-based vaccines during the 3 weeks following the administration of either the first or the second dose.11 Arterial thrombotic events have been reported after adenovirus-based vaccines,11 but the association is not apparent among the published cases of same-day death.

Vaccinations campaigns prior to the COVI-19 pandemic have led to a mortality rate of 1/1,000 within one day of the innoculation.12 This rate reflects a large number of vaccines as well as anaphylactic events. It seems reasonable to assume that the same-day rate of death for a single vaccine might be in a very large range, going from 1/1,000 to 1/1,000,000. The most conservative death rate of 1/1,000,000 would translate, for the COVID-vaccinated population in the Unites States, to at least 224 cases, but none have been reported in the literature as of October 2022.

2. McMenamin ME, Nealon J, Lin Y, et al. Vaccine effectiveness of one, two, and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong: a population-based observational study. Lancet Infect Dis. 2022;22(10):1435–1443. 3. Putterman S. There's Still No Evidence a Tennessee Nurse Who Fainted after Getting the Vaccine Is Dead; 2021. Available at: https://www.politifact.com/factchecks/2021/oct/20/instagram-posts/theres-still-no-evidence-tennessee-nurse-who-faint/. Updated October 20, 2021. Accessed September 15, 2022. 5. Schneider J, Sottmann L, Greinacher A, et al. Postmortem investigation of fatalities following vaccination with COVID-19 vaccines. Int J Leg Med. 2021;135(6):2335–2345. 6. Murata K, Nakao N, Ishiuchi N, et al. Four cases of cytokine storm after COVID-19 vaccination: case report. Front Immunol. 2022;13:967226. 7. Baronti A, Gentile F, Manetti AC, et al. Myocardial infarction following COVID-19 vaccine administration: Post Hoc, Ergo Propter Hoc? Viruses. 2022;14(8):1644. 8. Ittiwut C, Mahasirimongkol S, Srisont S, et al. Genetic basis of sudden death after COVID-19 vaccination in Thailand. Heart Rhythm. 2022:S1547-5271(22)02266-4. 9. Yeo A, Kuek B, Lau M, et al. Post COVID-19 vaccine deaths - Singapore's early experience. Forensic Sci Int. 2022;332:111199. 10. Suzuki H, Ro A, Takada A, et al. Autopsy findings of post-COVID-19 vaccination deaths in Tokyo Metropolis, Japan, 2021. Leg Med (Tokyo). 2022;59:102134. 11. Botton J, Jabagi MJ, Bertrand M, et al. Risk for myocardial infarction, stroke, and pulmonary embolism following COVID-19 vaccines in adults younger than 75 Years in France. Ann Intern Med. 2022:M22–M0988. 12. McCarthy NL, Weintraub E, Vellozzi C, et al. Mortality rates and cause-of-death patterns in a vaccinated population. Am J Prev Med. 2013;45(1):91–97.