Comparing the possible risks of the COVID-19 vaccines

VACCINE ROLLOUT

One in a million?

Comparing the side effects and potential risks of the COVID-19 vaccines

UPDATED APRIL 13

U.S. federal health agencies have recommended pausing the use of Johnson & Johnson’s COVID-19 vaccine after six recipients developed a rare disorder involving blood clots, in a fresh setback to global efforts to tackle the pandemic.

The move comes a week after European regulators said they had found a possible link between AstraZeneca’s COVID-19 vaccine and a rare blood clotting problem that had led to a small number of deaths.

The U.S. Food and Drug Administration (FDA) said one person had died from the rare blood clotting condition after taking the single-dose J&J vaccine and another was in a critical condition. Immunology experts stressed the risk posed by the vaccine appeared extremely low, but they acknowledged the need for health officials to proceed with caution to understand the best ways to mitigate any risk.

In general, common side effects from vaccines include those that affect the injection area, such as pain, redness or swelling, and those that affect the rest of the body, like fatigue, headache, muscle pain, chills, fever or nausea. These are usually normal signs that the vaccine is working as the body is building protection.

MORE COMMON EFFECTS

Less than 1 in 10 people

More than 1 in 10 people

Swelling and redness at the injection site, nausea

Pain at injection site,

fatigue, headache, muscle pain, chills, joint pain, fever

Pfizer-BioNTech

Rash, redness or hives at the injection site

Pain or swelling at the injection site, tenderness and swelling of the underarm glands, headache, nausea, vomiting, muscle and joint aches, stiffness, fatigue, chills, fever

Moderna

Swelling, redness or a lump at the injection site, fever, vomiting, diarrhoea, flu-like symptoms

Tenderness, pain,

warmth, itching or bruising where the injection is given,

fatigue, chills or feeling feverish, headache, nausea,

joint pain or muscle ache

Astrazeneca

Pain at the injection site,

fatigue, headache,

muscle ache,

nausea

Johnson

& Johnson

Fever, redness and

swelling at the injection

site

Source: U.S. Food and Drug Administration; U.K. Medicines & Healthcare products

Regulatory Agency; REUTERS

MORE COMMON EFFECTS

Less than 1 in 10 people

More than 1 in 10 people

Swelling and redness at the injection site, nausea

Pain at injection site,

fatigue, headache, muscle pain, chills, joint pain, fever

Pfizer-BioNTech

Rash, redness or hives at the injection site

Pain or swelling at the injection site, tenderness and swelling of the underarm glands, headache, nausea, vomiting, muscle and joint aches, stiffness, fatigue, chills, fever

Moderna

Tenderness, pain,

warmth, itching or bruising where the injection is given,

fatigue, chills or feeling feverish, headache, nausea,

joint pain or muscle ache

Swelling, redness or a lump at the injection site, fever, vomiting, diarrhoea, flu-like symptoms

Astrazeneca

Johnson & Johnson

Pain at the injection site,

fatigue, headache,

muscle ache,

nausea

Fever, redness and

swelling at the injection

site

Source: U.S. Food and Drug Administration; U.K. Medicines & Healthcare products Regulatory Agency; REUTERS

MORE COMMON EFFECTS

Less than 1 in 10 people

More than 1 in 10 people

Swelling and redness at the injection site, nausea

Pain at injection site,

fatigue, headache, muscle pain, chills, joint pain, fever

Pfizer-BioNTech

Rash, redness or hives at the injection site

Pain or swelling at the injection site, tenderness and swelling of the underarm glands, headache, nausea, vomiting, muscle and joint aches, stiffness, fatigue, chills, fever

Moderna

Tenderness, pain,

warmth, itching or bruising where the injection is given,

fatigue, chills or feeling feverish, headache, nausea,

joint pain or muscle ache

Swelling, redness or a lump at the injection site, fever, vomiting, diarrhoea, flu-like symptoms

Astrazeneca

Johnson & Johnson

Pain at the injection site,

fatigue, headache,

muscle ache,

nausea

Fever, redness and

swelling at the injection

site

Source: U.S. Food and Drug Administration; U.K. Medicines & Healthcare products Regulatory Agency; REUTERS

MORE COMMON EFFECTS

Less than

1 in 10 people

More than

1 in 10 people

Pfizer-BioNTech

Pain at injection site,

fatigue, headache, muscle pain, chills, joint pain, fever

Swelling and redness at the injection site, nausea

Moderna

Rash, redness or hives at the injection site

Pain or swelling at the injection site, tenderness and swelling of the underarm glands, headache, nausea, vomiting, muscle and joint aches, stiffness, fatigue, chills, fever

Astrazeneca

Swelling, redness or a lump at the injection site, fever, vomiting, diarrhoea, flu-like symptoms

Tenderness, pain,

warmth, itching or bruising where the injection is given,

fatigue, chills or feeling feverish, headache, nausea, joint pain or muscle ache

Johnson & Johnson

Pain at the injection site,

fatigue, headache,

muscle ache,

nausea

Fever, redness and

swelling at the injection

site

Source: U.S. Food and Drug Administration; U.K. Medicines

& Healthcare products Regulatory Agency; REUTERS

In the six J&J cases, a type of blood clot called cerebral venous sinus thrombosis (CVST) was seen in combination with low levels of blood platelets (thrombocytopenia). The recipients were women between the ages of 18 and 48, and the symptoms occurred six to 13 days after vaccination. J&J said it was delaying the rollout of the vaccine to Europe and it was working closely with regulators. The company noted that no clear causal relationship had been established between the events and the vaccine made by its Janssen unit.

As of April 12, more than 6.8 million doses of the J&J vaccine had been administered in the United States, compared with more than 180 million shots combined of the Moderna and Pfizer/BioNTech vaccines. Europe’s drugs regulator continues to recommend the use of AstraZeneca’s COVID-19 vaccine, saying the benefits outweigh the risks. Several EU countries, however, have limited its use to certain age groups.

Number of serious disorders registered in Europe

ASTRAZENECA

JOHNSON&JOHNSON

MODERNA

PFIZER -

BIONTECH

289

2,764

3,110

Blood and lymphatic disorders

938

4,261

4,721

Cardiac disorders

1,627

11,083

33,965

Gastrointestinal disorders

3,210

20,627

63,671

Nervous system disorders

1,537

7,647

10,658

Respiratory system disorders

Note: Data as of April 12. These symptoms were observed following the use of the vaccine,

but no causal link has been established.

 

Source: European database of suspected adverse drug reaction reports

Number of serious disorders registered in Europe

ASTRAZENECA

JOHNSON&JOHNSON

MODERNA

PFIZER -

BIONTECH

289

2,764

3,110

7

Blood and lymphatic disorders

938

4,261

4,721

21

Cardiac disorders

1,627

11,083

33,965

39

Gastrointestinal disorders

3,210

20,627

63,671

98

Nervous system disorders

1,537

7,647

10,658

30

Respiratory system disorders

Note: Data as of April 12. These symptoms were observed following the use of the vaccine,

but no causal link has been established.

 

Source: European database of suspected adverse drug reaction reports

Number of serious disorders registered in Europe

ASTRAZENECA

JOHNSON&JOHNSON

PFIZER -

BIONTECH

MODERNA

289

2,764

Blood and lymphatic disorders

3,110

7

938

4,261

Cardiac disorders

4,721

21

1,627

11,083

Gastrointestinal disorders

33,965

39

3,210

20,627

Nervous system disorders

63,671

98

1,537

Respiratory system disorders

7,647

10,658

30

Note: Data as of April 12. These symptoms were observed following the use of the vaccine,

but no causal link has been established.

 

Source: European database of suspected adverse drug reaction reports

Number of serious disorders

registered in Europe

PFIZER -

BIONTECH

MODERNA

J&J

ASTRAZENECA

Blood and

lymphatic

289

2,764

3,110

7

938

Cardiac

4,261

4,721

21

1,627

Gastrointestinal

11,083

33,965

39

3,210

Nervous

20,627

63,671

98

1,537

Respiratory

7,647

10,658

30

Note: Data as of April 12. These symptoms were

observed following the use of the vaccine, but no

causal link has been established.

 

Source: European database of suspected adverse drug

reaction reports

Although Johnson & Johnson’s and AstraZeneca’s vaccines are the focus of recent attention, other illnesses have also been occasionally observed following the use of vaccines by other drug makers. More research is needed to determine whether there is a link between those conditions and the vaccines – experts say the number of cases seen so far could be in line with background rates in the general population with or without vaccination.

“Even if all of the cases were caused by the vaccine, the risk of less than one in a million would have to be set against the benefits of protection from COVID-19 disease; a disease which, in itself, causes clotting in many cases,” said Peter English, a retired consultant in communicable disease control and a vaccine expert.

SOME SYMPTOMS REPORTED AFTER VACCINATIONS

AstraZeneca

Johnson & Johnson

Pfizer-BioNTech

Moderna

1.9 cases per million

1.1 cases per million

6 cases of venous thromboembolism (VTE) among 6.8 million people vaccinated in the U.S.

32 cases of venous thromboembolism (VTE) among 17 million people vaccinated in Europe and the UK.

(cannot be estimated

from the available data)

(cannot be estimated

from the available data)

Blood clots

(Venous

thromboembolism)

(Bell’s Palsy)

197 cases per million

(cannot be estimated

from the available data)

183 cases per million

(cannot be estimated

from the available data)

Facial paralysis

In Moderna’s trials, three cases were recorded among the group that received the vaccine (15,208).

Four cases of Bell’s Palsy were recorded among people who got the vaccine (21,823) during the clinical trials.

2.5 cases per million

5-11 cases per million

In the United States, 10 cases of anaphylaxis were reported between Dec. 10, 2020 and Jan. 10 with a rate of 2.5 cases per million.

21 cases of anaphylaxis were detected in December at a rate of 11.1 cases per million. Updated data through Jan. 18 lowers that figure to 5 per million.

Severe allergy

(cannot be estimated

from the available data)

(cannot be estimated

from the available data)

(Anaphylaxis)

Source: Rates for Moderna and Pfizer-BioNTech based on FDA safety reports and CDC. Rate for AstraZeneca based on figures published by the company.

SOME SYMPTOMS REPORTED AFTER VACCINATIONS

AstraZeneca

Johnson & Johnson

Moderna

Pfizer-BioNTech

1.9 cases per million

1.1 cases per million

32 cases of venous thromboembolism (VTE) among 17 million people vaccinated in Europe and the UK.

6 cases of venous thromboembolism (VTE) among 6.8 million people vaccinated in the U.S.

(cannot be estimated

from the available data)

(cannot be estimated

from the available data)

Blood clots

(Venous thromboembolism)

(Bell’s Palsy)

197 cases per million

(cannot be estimated

from the available data)

(cannot be estimated

from the available data)

183 cases per million

Facial paralysis

In Moderna’s trials, three cases were recorded among the group that received the vaccine (15,208).

Four cases of Bell’s Palsy were recorded among people who got the vaccine (21,823) during the clinical trials.

2.5 cases per million

5-11 cases per million

In the United States, 10 cases of anaphylaxis were reported between Dec. 10, 2020 and Jan. 10 with a rate of 2.5 cases per million.

21 cases of anaphylaxis were detected in December at a rate of 11.1 cases per million. Updated data through Jan. 18 lowers that figure to 5 per million.

Severe allergy

(cannot be estimated

from the available data)

(cannot be estimated

from the available data)

(Anaphylaxis)

Source: Rates for Moderna and Pfizer-BioNTech based on FDA safety reports and CDC. Rate for AstraZeneca based on figures published by the company.

SOME SYMPTOMS REPORTED AFTER VACCINATIONS

Blood clots

(Venous thromboembolism)

ASTRAZENECA

JOHNSON & JOHNSON

1.9 cases per million

1.1 cases per million

6 cases of venous thromboembolism (VTE) among 6.8 million people vaccinated in the U.S.

32 cases of venous thromboembolism (VTE) among 17 million people vaccinated in Europe and the UK.

Severe allergy

(Anaphylaxis)

MODERNA

PFIZER-BIONTECH

5-11 cases per million

2.5 cases per million

21 cases of anaphylaxis were detected in December at a rate of 11.1 cases per million. Updated data through Jan. 18 lowers that figure to 5 per million.

In the United States, 10 cases of anaphylaxis were reported between Dec. 10, 2020 and Jan. 10 with a rate of 2.5 cases per million.

Facial paralysis

(Bell’s Palsy)

MODERNA

PFIZER-BIONTECH

197 cases per million

183 cases per million

In Moderna’s trials, three cases were recorded among the group that received the vaccine (15,208).

Four cases of Bell’s Palsy were recorded among people who got the vaccine (21,823) during the clinical trials.

SOME SYMPTOMS REPORTED AFTER VACCINATIONS

Blood clots

(Venous thromboembolism)

ASTRAZENECA

JOHNSON & JOHNSON

1.9 cases per million

1.1 cases per million

6 cases of venous thromboembolism (VTE) among 6.8 million people vaccinated in the U.S.

32 cases of venous thromboembolism (VTE) among 17 million people vaccinated in Europe and the UK.

Severe allergy

(Anaphylaxis)

MODERNA

PFIZER-BIONTECH

2.5 cases per million

5-11 cases per million

21 cases of anaphylaxis were detected in December at a rate of 11.1 cases per million. Updated data through Jan. 18 lowers that figure to 5 per million.

In the United States, 10 cases of anaphylaxis were reported between Dec. 10, 2020 and Jan. 10 with a rate of 2.5 cases per million.

Facial paralysis

(Bell’s Palsy)

MODERNA

PFIZER-BIONTECH

197 cases per million

183 cases per million

In Moderna’s trials, three cases were recorded among the group that received the vaccine (15,208).

Four cases of Bell’s Palsy were recorded among people who got the vaccine (21,823) during the clinical trials.

SOME SYMPTOMS REPORTED AFTER VACCINATIONS

AstraZeneca

Johnson & Johnson

Pfizer-BioNTech

Moderna

1.9 cases per million

1.1 cases per million

32 cases of venous thromboembolism (VTE) among 17 million people vaccinated in Europe and the UK.

6 cases of venous thromboembolism (VTE) among 6.8 million people vaccinated in the U.S.

Blood clots

(cannot be estimated

from the available data)

(cannot be estimated

from the available data)

(Venous thromboembolism)

(Bell’s Palsy)

Facial paralysis

197 cases per million

183 cases per million

(cannot be estimated

from the available data)

(cannot be estimated

from the available data)

In Moderna’s trials, three cases were recorded among the group that received the vaccine (15,208).

Four cases of Bell’s Palsy were recorded among people who got the vaccine (21,823) during the clinical trials.

2.5 cases per million

5-11 cases per million

Severe allergy

In the United States, 10 cases of anaphylaxis were reported between Dec. 10, 2020 and Jan. 10 with a rate of 2.5 cases per million.

21 cases of anaphylaxis were detected in December at a rate of 11.1 cases per million. Updated data through Jan. 18 lowers that figure to 5 per million.

(Anaphylaxis)

(cannot be estimated

from the available data)

(cannot be estimated

from the available data)

Source: Rates for Moderna and Pfizer-BioNTech based on FDA safety reports and CDC. Rate for AstraZeneca based on figures published by the company.

1 million

Venous

thromboembolism

among people

who received

Johnson & Johnson

in the U.S.

1.1 cases

per million

Pulmonary embolism

among people who received

AstraZeneca vaccine

in the EU and UK

1.3 cases per million

Anaphylaxis with Moderna

2.5 cases per million

Anaphylaxis with PfizerBioNTech

5 to 11 cases per million

1 million

Venous

thromboembolism

among people

who received

Johnson & Johnson

in the U.S.

1.1 cases

per million

Pulmonary embolism

among people who received

AstraZeneca vaccine

in the EU and UK

1.3 cases per million

Anaphylaxis with Moderna

2.5 cases per million

Anaphylaxis with PfizerBioNTech

5 to 11 cases per million

1 million

Venous

thromboembolism

among people

who received

J&J in the U.S.

1.1 cases

per million

Pulmonary

embolism

with AstraZeneca

1.3 million

Anaphylaxis

with Moderna

2.5 per million

Anaphylaxis with

PfizerBioNTech

5 to 11 per million

1 million

Venous

thromboembolism

among people

who received

Johnson & Johnson

in the U.S.

1.1 cases

per million

Pulmonary

embolism

with AstraZeneca

1.3 cases

per million

Anaphylaxis

with Moderna

2.5 per million

Anaphylaxis with

PfizerBioNTech

5 to 11 per million

1 million

Venous

thromboembolism

among people

who received

Johnson & Johnson

in the U.S.

1.1 cases

per million

Pulmonary embolism

among people who received

AstraZeneca vaccine

in the EU and UK

1.3 cases per million

Anaphylaxis with Moderna

2.5 cases per million

Anaphylaxis with PfizerBioNTech

5 to 11 cases per million

COMPARING

THE RISKS

Anaphylaxis

among those who get

the Hepatitis B vaccine

1 case per million

Severe pulmonary embolism is a type of deep vein thrombosis (DVT). It is extremely rare after flights that are shorter than 8 hours. Following flights over 12 hours, the rate is 5 cases per million.

Pulmonary embolism

among passengers who take

a flight over 12 hours long

5 per million

CVST is a rare form of stroke that affects about 5 people in 1 million each year. The risk can be higher for newborns during the first month.

Cerebral venous sinus

thrombosis (CVST) in

common population

5 per million

Low platelet count, causing bruising or bleeding, occurs after the first dose of MMR vaccine (measles, mumps, rubella), at a rate of about 1 case in 20,000 to 30,000

Platelet disorders

after taking Rubella vaccine

50 per 1m-1.5m

The risk of developing a blood clot among women using other hormonal contraceptives is about 6 women in 10,000.

 

The risk of developing a blood clot among women using drospirenone-containing oral contraceptives would be about 10 in 10,000

Venous thromboembolism

among women taking other

hormonal contraceptives

600 per million

Venous thromboembolism

among women taking

drospirenone-containing

oral contraceptives

1k per million

Clotting disorders may affect up to 1 in 1,000 people. In the same proportion other blood disorders such as reduction in platelets, white blood cells and neutrophils in the blood, and the abnormal breakdown of red blood cells

Clotting disorders after

taking paracetamol

1k per million

Coronavirus-related deaths

in the U.S. as of April 13

1.7k per million

The overall prevalence of thromboembolic events during pregnancy is approximately 2 per 1,000 deliveries

Clots in pregnant women

2k per million

About 1 in 10 cases could experience an increase in the number of nose bleeds and/or longer bleeding time

Bleeding disorders

after taking aspirin

100k per million

COMPARING

THE RISKS

Anaphylaxis

among those who get

the Hepatitis B vaccine

1 case per million

Severe pulmonary embolism is a type of deep vein thrombosis (DVT). It is extremely rare after flights that are shorter than 8 hours. Following flights over 12 hours, the rate is 5 cases per million.

Pulmonary embolism

among passengers who take

a flight over 12 hours long

5 per million

CVST is a rare form of stroke that affects about 5 people in 1 million each year. The risk can be higher for newborns during the first month.

Cerebral venous sinus

thrombosis (CVST) in

common population

5 per million

Low platelet count, causing bruising or bleeding, occurs after the first dose of MMR vaccine (measles, mumps, rubella), at a rate of about 1 case in 20,000 to 30,000

Platelet disorders

after taking Rubella vaccine

50 per 1m-1.5m

The risk of developing a blood clot among women using other hormonal contraceptives is about 6 women in 10,000.

 

The risk of developing a blood clot among women using drospirenone-containing oral contraceptives would be about 10 in 10,000

Venous thromboembolism

among women taking

drospirenone-containing

oral contraceptives

1k per million

Venous thromboembolism

among women taking other

hormonal contraceptives

600 per million

Clotting disorders may affect up to 1 in 1,000 people. In the same proportion other blood disorders such as reduction in platelets, white blood cells and neutrophils in the blood, and the abnormal breakdown of red blood cells

Clotting disorders after

taking paracetamol

1k per million

Coronavirus-related deaths

in the U.S. as of April 13

1.7k per million

The overall prevalence of thromboembolic events during pregnancy is approximately 2 per 1,000 deliveries

Clots in pregnant women

2k per million

About 1 in 10 cases could experience an increase in the number of nose bleeds and/or longer bleeding time

Bleeding disorders

after taking aspirin

100k per million

COMPARING THE RISKS

Anaphylaxis

among those who get

the Hepatitis B vaccine

1 case per million

Pulmonary embolism

among passengers who take

a flight over 12 hours long

Severe pulmonary embolism is a type of deep vein thrombosis (DVT). It is extremely rare after flights that are shorter than 8 hours. Following flights over 12 hours, the rate is 5 cases per million.

5 per million

Cerebral venous sinus thrombosis

(CVST) in common population

CVST is a rare form of stroke that affects about 5 people in 1 million each year. The risk can be higher for newborns during the first month.

5 per million

Platelet disorders

after taking Rubella vaccine

Low platelet count, causing bruising or bleeding, occurs after the first dose of MMR vaccine (measles, mumps, rubella), at a rate of about 1 case in 20,000 to 30,000

50 per 1m-1.5m

Venous thromboembolism

among women taking

drospirenone-containing

oral contraceptives

The risk of developing a blood clot among women using drospirenone-containing oral contraceptives would be about 10 in 10,000

 

The risk of developing a blood clot among women using other hormonal contraceptives is about 6 women in 10,000.

 

1k per million

Venous thromboembolism

among women taking other

hormonal contraceptives

600 per million

Clotting disorders after

taking paracetamol

Clotting disorders may affect up to 1 in 1,000 people. In the same proportion other blood disorders such as reduction in platelets, white blood cells and neutrophils in the blood, and the abnormal breakdown of red blood cells

1k per million

Coronavirus-related deaths

in the U.S. as of April 13

1.7k per million

Clots in pregnant women

The overall prevalence of thromboembolic events during pregnancy is approximately 2 per 1,000 deliveries

2k per million

Bleeding disorders

after taking aspirin

About 1 in 10 cases could experience an increase in the number of nose bleeds and/or longer bleeding time

100k per million

COMPARING

THE RISKS

Anaphylaxis

among those who get

the Hepatitis B vaccine

1 case per million

Severe pulmonary embolism is a type of deep vein thrombosis (DVT). It is extremely rare after flights that are shorter than 8 hours. Following flights over 12 hours, the rate is 5 cases per million.

Pulmonary embolism

among passengers who take

a flight over 12 hours long

5 per million

CVST is a rare form of stroke that affects about 5 people in 1 million each year. The risk can be higher for newborns during the first month.

Cerebral venous sinus

thrombosis (CVST) in

common population

5 per million

Low platelet count, causing bruising or bleeding, occurs after the first dose of MMR vaccine (measles, mumps, rubella), at a rate of about 1 case in 20,000 to 30,000

Platelet disorders

after taking Rubella vaccine

50 per 1m-1.5m

The risk of developing a blood clot among women using other hormonal contraceptives is about 6 women in 10,000.

 

The risk of developing a blood clot among women using drospirenone-containing oral contraceptives would be about 10 in 10,000

Venous thromboembolism

among women taking other

hormonal contraceptives

600 per million

Venous thromboembolism

among women taking

drospirenone-containing

oral contraceptives

1k per million

Clotting disorders after

taking paracetamol

1k per million

Clotting disorders may affect up to 1 in 1,000 people. In the same proportion other blood disorders such as reduction in platelets, white blood cells and neutrophils in the blood, and the abnormal breakdown of red blood cells

Coronavirus-related deaths

in the U.S. as of April 13

1.7k per million

The overall prevalence of thromboembolic events during pregnancy is approximately 2 per 1,000 deliveries

Clots in pregnant women

2k per million

About 1 in 10 cases could experience an increase in the number of nose bleeds and/or longer bleeding time

Bleeding disorders

after taking aspirin

100k per million

Sources

U.S. Food and Drug Administration; Centers for Disease Control and Prevention; European Medicines Agency; U.K. Medicines & Healthcare products Regulatory Agency; Department of Health of the Government of Australia; American Heart Association; U.K. Electronic Medicines Compendium; Johns Hopkins Medicine; Watson HG, Baglin TP. Guidelines on travel-related venous thrombosis. Br J Haematol; REUTERS

Graphics by

Samuel Granados

Edited by

Tiffany Wu and Jon McClure