
==== Front
Pharmacol Res Perspect
Pharmacol Res Perspect
10.1002/(ISSN)2052-1707
PRP2
Pharmacology Research & Perspectives
2052-1707
John Wiley and Sons Inc. Hoboken

10.1002/prp2.70008
PRP270008
PRP2-2024-06-0225.R1
Commentary
Commentary
An improvement of the safety profile of SARS‐CoV‐2 vaccines is desirable
Finsterer
Finsterer Josef https://orcid.org/0000-0003-2839-7305
1 fifigs1@yahoo.de

1 Neurology Department Neurology & Neurophysiology Center Vienna Austria
* Correspondence
Josef Finsterer, Neurology Department, Neurology & Neurophysiology Center, Postfach 20, 1180 Vienna, Austria.
Email: fifigs1@yahoo.de

12 9 2024
10 2024
12 5 10.1002/prp2.v12.5 e7000806 8 2024
29 6 2024
03 9 2024
© 2024 The Author(s). Pharmacology Research & Perspectives published by British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics and John Wiley & Sons Ltd.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

adverse reactions
Guillain‐Barre syndrome
SARS‐CoV‐2 vaccination
side effects
VITT
source-schema-version-number2.0
cover-dateOctober 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:12.09.2024
Finsterer J . An improvement of the safety profile of SARS‐CoV‐2 vaccines is desirable. Pharmacol Res Perspect. 2024;12 :e70008. doi:10.1002/prp2.70008
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pmcWe read with interest the article by Padilla‐Flores et al. on a non‐systematic review of adverse events of SARS‐CoV‐2 vaccines. 1 It was noted that despite testing the tolerability of each vaccine in clinical trials prior to general use, serious adverse events, usually with low incidence, have occurred and that it has proven difficult to establish a direct link between SARS‐CoV‐2 vaccination (SC2V) and the occurrence of adverse effects. 1 The review focused on the main adverse effects observed after vaccination, including anaphylaxis, myocarditis, vaccine‐induced thrombotic thrombocytopenia (VITT), Guillain‐Barré syndrome (GBS) and transverse myelitis. 1 It was concluded that healthcare professionals need to be made more aware of the serious adverse events and that, regardless of the ongoing debate about the safety of SC2V, these adverse effects need to be promptly recognized and effectively treated to reduce the risk of further complications. 1 The review is impressive, but some points still need to be discussed.

The first point is that the spectrum of side effects of SARS‐CoV‐2 vaccines is not limited to anaphylaxis, myocarditis, VITT, GBS and transverse myelitis, but includes a plethora of other diseases that need to be known in order to make a prompt and appropriate diagnosis and treat in time to prevent further complications. We also do not believe that transverse myelitis is a common complication of SC2V.

The second issue is that adverse reactions to SARS‐CoV‐2 vaccines occur clinically either as acute Covid vaccine syndrome (ACVS), which occurs within hours or a few days after SC2V vaccination, or as post‐acute COVID vaccine syndrome (PACVS) several days or months after vaccination. 2 The distinction between these two forms is crucial, as the treatment of both forms may be different. ACVS usually resolves after a few days without the need for significant treatment, while post‐acute COVID vaccination syndrome persists for months or years and is not only difficult to recognize but also difficult to treat, as there are no general guidelines for the therapeutic treatment of PACVS.

The third point is that there are not only primary complications directly related to the vaccine, but also secondary complications that should be considered when reviewing the side effects of SC2Vs. One of these is Takotsubo syndrome (TTS). Awareness of this stress response is crucial as it can itself be complicated by heart failure, malignant ventricular arrhythmias, cardio‐embolism and sudden death. Another secondary complication can be secondary infections due to the impairment of the immune system by the SC2V. Secondary infections must be included in the therapeutic considerations as they can strongly influence the outcome of PACVS.

The fourth point is that myositis, a common complication of SC2V, was not addressed in the review. The degree of muscle involvement can vary greatly from patient to patient, ranging from myalgia to necrotizing myositis and rhabdomyolysis. As many patients complain of fatigue or muscle pain shortly after taking SC2V, this common complication should have been included in an overview of the side effects of SC2V. Hyposmia and hypogeusia should also have been included.

The fifth point is that GBS is not unique to the Moderna vaccine and the AstraZeneca vaccine, as claimed in Table 3. 1 Several cases of GBS have been reported following vaccination with the BNT162b2 vaccine and other brands. 3 , 4 Although the type and severity of adverse reactions may vary slightly between brands, in general the same adverse reactions may occur with all brands.

In conclusion, it can be said that this interesting study has limitations that relativize the results and their interpretation. Addressing these limitations could strengthen the conclusions and reinforce the message of the study. To understand the pathophysiology of SC2V side effects and to develop the most effective treatment, it is essential to discuss not only a small part but the whole spectrum.

AUTHOR CONTRIBUTIONS

JF was responsible for the design and conception, discussed available data with coauthors, wrote the first draft, and gave final approval. SM: contributed to literature search, discussion, correction, and final approval.

FUNDING INFORMATION

None received.

CONFLICT OF INTEREST STATEMENT

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

ETHICS STATEMENT

Not applicable.

ACKNOWLEDGMENTS

None.

DATA AVAILABILITY STATEMENT

All data are available from the corresponding author.
==== Refs
REFERENCES

1 Padilla‐Flores T , Sampieri A , Vaca L . Incidence and management of the main serious adverse events reported after COVID‐19 vaccination. Pharmacol Res Perspect. 2024;12 (3 ):e1224. doi:10.1002/prp2.1224 38864106
2 Scholkmann F , May CA . COVID‐19, post‐acute COVID‐19 syndrome (PACS, "long COVID") and post‐COVID‐19 vaccination syndrome (PCVS, "post‐COVIDvac‐syndrome"): similarities and differences. Pathol Res Pract. 2023;246 :154497. doi:10.1016/j.prp.2023.154497 37192595
3 Abara WE , Gee J , Marquez P , et al. Reports of Guillain‐Barré syndrome after COVID‐19 vaccination in the United States. JAMA Netw Open. 2023;6 (2 ):e2253845. doi:10.1001/jamanetworkopen.2022.53845 36723942
4 Algahtani HA , Shirah BH , Albeladi YK , Albeladi RK . Guillain‐Barré syndrome following the BNT162b2 mRNA COVID‐19 vaccine. Acta Neurol Taiwanica. 2023;32 (2 ):82‐85.
