Evaluation of late disorders as possible long-COVID and/or vaccination consequences

Evaluation of late disorders as possible long-COVID and/or vaccination consequences | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Article Evaluation of late disorders as possible long-COVID and/or vaccination consequences Mona Sadat Larijani, Anahita Bavand, Mohammad Banifazl, Fatemeh Ashrafian, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3447623/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Following SARS-CoV-2 outbreak, another crisis has been established by progress or persistence of COVID-19 symptoms, as post or long COVID, which is critical to be recognized according to increasing number of late symptoms reports. In this study, we investigated long-term disorders in vaccinated individuals who developed late adverse events/side effects post-vaccination and/or COVID-19 episode owing to the challenging differentiation between them. Methods: The vaccinated individuals of four vaccine regimens including inactivated virus-based/prime-boost group, inactivated virus-based prime/subunit protein-based boost, adenovirus-based prime/boost and adenovirus-based prime/subunit protein-based boost were followed from the first dose of vaccination up to 6-month post the booster shot. All the vaccine adverse events were documented through in-depth interview using a researcher-made questionnaire as well as the COVID-19 history and demographics. The medical history of all the cases were also collected and the late disorders post-vaccination were investigated by Adverse Events Committee of Pasteur Institute of Iran. Results: Totally 329 individuals who got 3 doses of vaccination were followed 6 months after the booster shots among whom 41 (12.4%) of investigated cases (including 31 females) with the mean age of 40.9±10.48 years had a type of disorder following vaccination. The late adverse events/side effects were captured in various forms among which gynecological and osteoarticular involvements were the most common ones. After evaluation of the medical background, age, vaccination and the date of disorder initiation, 39% of the documented complains have been found to be linked with long-COVID-19 as a trigger. Interestingly, the average time of symptoms persistence was 155±10.4 days and mostly continued up to the end of the study. Conclusion: In this era in which the vast majority of the global population have developed COVID-19 and/or got vaccinated against it, identification of the late disorders as the vaccine side effect or long-COVID manifestation is difficult. Therefore, some complications though late ones, might be a possible consequence of any SARS-CoV-2 infection or vaccination. This study takes the advantage of long-term follow-up which presents various forms of late events in each episode of COVID-19 infection and vaccination. The rate of late-disorders in the present study also highlights the importance of long-term follow-up studies among population worldwide. Health sciences/Diseases Health sciences/Medical research Health sciences/Risk factors Late AEs Long-COVID Long-VAX long-term disorders Figures Figure 1 Introduction As the world has overcome the recent COVID-19 pandemic, owing to the great effort on vaccine development, the struggle against the long-term effects of the infection has emerged as a pandemic post the other one called “long COVID” [ 1 , 2 ]. According to the definition by the World Health Organization, long COVID is a condition occurring in individuals with a background of probable or confirmed SARS-CoV-2 infection in which the symptoms usually appears three months after the COVID-19 symptoms onset and continues at least for two months [ 3 ]. This condition can affect a wide range of organs in the body through various symptoms [ 4 ]. Although vaccination against COVID-19 has been a crucial step to manage the pandemic, uncertainties about the side effects of long COVID have brought concerns in the general population causing vaccine hesitancy which is potentially important for next probable new COVID-19 peaks and need of booster doses [ 5 , 6 ]. There is no doubt that vaccinations have significantly decreased the severity of the illness and also the risk of hospitalization, however, the effect of vaccines on long-COVID has remained less discussed [ 7 – 9 ]. What is more, vaccinated individuals might be infected and be asymptomatic or even suffer from mild to moderate forms of COVID-19 [ 10 – 12 ]. Long-COVID can manifest after all types of severity. Hence, COVID-19 vaccines could possibly impact on long-COVID symptoms. There have been studies showing that vaccines might reduce the risk of long-COVID [ 13 , 14 ]. A crucial factor to determine this issue is the time of infection and vaccination. It seems that vaccination before infection might limit long-COVID [ 15 ]. What is unknown is the re-infection impact which could give a rise to long-OVID persistence. From another point of view, long term manifestations of vaccination has also came to attention by evidences and case reports worldwide [ 16 , 17 ]. The late adverse events thought to be rare, however, they may cause seriously durable problems and influence the life quality as well. Furthermore, the majority of the global population have already been immunized and may still develop the infection in this era. To determine that a long-term symptom is the long COVID manifestation or the vaccination side effects seems a challenging puzzle to resolve [ 18 ]. Therefore, in addition to the current vaccine safety reports and long COVID studies, it is of high value to investigate the symptomology of SARS-CoV-2 infection before and after vaccination and also to estimate associations between long-COVID symptoms and vaccination consequences [ 19 ]. The long-term assessment of late disorders post COVID-19 vaccination has been previously investigated in our last report [ 16 ]. Some identified problems were not associated to the vaccinations according to the opinion of the Adverse Events Committee of Pasteur Institute of Iran. Hereby, we aimed to describe some late disorders in vaccinated individuals who mostly suffered from COVID-19 infection and tried to classify them as the incidences causing by the COVID-19 infection and/or vaccination against it. Methods In this long-term follow-up study, we investigated vaccinated individuals from the first dose of COVID-19 vaccination up to at least 6-month post the booster shot. The participants were classified by the vaccine regimes including standard and combinational ones as: The individuals who primed with Sinopharm and got a booster dose of PastoCovac or PastoCovac Plus (protein subunit vaccines)[ 20 ], The individuals who primed with AstraZeneca and got a booster dose of PastoCovac Plus, The individuals who got three doses of Sinopharm, The individuals who got three doses of AstreaZeneca. The full medical history of the participants were collected through face-to-face interview or on call including any underlying diseases, COVID-19 history, time of incidence, symptoms, vaccine doses, any kind of adverse events (AEs), medical care, hospitalization and symptoms persistence. The collected AEs during an 18-month period (6 months after the booster dose) were then evaluated by AEs assessment committee of Pasteur Institute of Iran, to associate any causal inference of AEs with the vaccine/COVID-19. Descriptive statistics are presented as means (SD) for quantitative variables and as frequency (percentage) for categorical variables. All statistical analyses were performed with an alpha level of 0.05 in Stata software (version 17). All the participants were provided with informed consent prior to enrolment and the study was performed according to the Declaration of Helsinki (Fortaleza, 13 October 2013). The ethical approval was achieved from Pasteur Institute of Iran National Committee for Ethics (ethics code numbers: IR.PII.REC.1400.077 and IR.PII.REC.1400.076). Results Participants Totally, 329 individuals participated in the follow-up study (171 females, 158 males) with the mean age of 40.9 (SD: 13.2) and the mean BMI of 26.56 (SD: 4.58). The medical history showed that the most common underlying disease were thyroid disorders (7.2%), hypertension (5.4%) and diabetes mellitus (4.5%), respectively. Of the total population, 75 ones got Sinopharm/Sinopharm, 110 individuals got Sinopharm/PastoCovac Plus, 54 participants got Sinopharm/PastoCovac, 70 persons got AstraZeneca/ PastoCovac Plus, and 20 individuals were AstraZeneca/ AstraZeneca recipients. Long-term symptoms classification During the retrospective follow-up all the reported disorders were collected into a researcher made form by trained experts according to the time of the incidence and duration. Only, the late AEs which started post-21-day after each dose of vaccination were considered in this study. The collective data showed that in total, 41 individuals (12.46%) had at least one disorder following vaccination (31 females, 12 males) with a mean age of 40.9 ± 10.48, among whom menstrual problems (discussed in other under review data), hair loss, osteoarticular disorders, neuritis at the injection site, headache and skin manifestations were the most common, respectively (Table 1.). 18 individuals (nearly 44%) had an underlying diseases among whom hypothyroidism was the most frequent. Nevertheless, the compatible comorbidity with the AEs/side effect were only hyperlipidemia and joints inflammation in two cases who reported worsen pre-existing condition after the vaccination. In general, the identified symptoms were mostly persistent up to the end of the study with a mean duration of 155 days. In order to find the probable cause of each complication, the medical background of each case was firstly noticed. What is more, the gap time between the symptoms initiation with COVID-19 infection and also vaccination was considered. Furthermore, the coincidence of the infection and vaccination was considered as a dual effect cause on the late symptoms. By considering the role of COVID-19 in various types of late involvements and also the vaccine which could possibly trigger the previous impact of the infection, we found that in 17 (41.4%) of the cases, long-COVID could possibly manifest in which vaccination also gave a rise as a trigger, whereas 10 cases without any documented history of the infection which were then possibly affected by the vaccination. Moreover, by considering the duration between the late symptom/disorder presentation and vaccination and COVID-19, 24 whom were affected by the vaccine according to AEs committee members’ opinion (Fig. 1 ). Table 1. The clinical characteristics of cases with persistent disorders after COVID-19 vaccine doses. Case No. Gender Age BMI Disorder type COVID-19 vaccine regimen Time of disorder initiation Persistency of the disorder Underlying medical conditions Covid-19 history time Vaccine outcome Long –COVID-19 manifest Possibility 1 Female 44 22.5 Menstrual Sinopharm/ PastoCovac plus After each dose 30 - 9 months after the booster dose ⎫ - 2 Female 31 25.1 Menstrual and hair loss Sinopharm/ PastoCovac plus Post the booster dose 180 - 2 weeks after the booster ⎫ ⎫ 3 Female 41 24 Joints involvement Sinopharm/ PastoCovac plus Post the booster dose 180 hypertension 3 months before vaccination ⎫ ⎫ 4 Male 51 25.7 Morphea Sinopharm/ PastoCovac plus Post the booster dose 180 - 6 months before vaccination ⎫ - 5 Female 46 35.3 Skin rashes Sinopharm/ PastoCovac plus Post the booster dose 180 Endometriosis,polycystic ovary 1 month after the booster ⎫ ⎫ 6 Male 42 22.7 Skin rashes Sinopharm/ PastoCovac plus Post the booster dose 180 IBS - ⎫ - 7 Female 52 23.3 Hair loss Sinopharm/ PastoCovac plus Post the booster dose 90 - - ⎫ - 8 Female 42 30.9 Joints involvement Sinopharm/ PastoCovac plus Post the 1st dose 180 Asthma 2 months before vaccination and shortly after the 1st dose ⎫ ⎫ 9 Female 54 34.9 Joints inflammation worsening Sinopharm/ PastoCovac plus Post the booster dose 180 Joints inflammation 2 months before vaccination ⎫ ⎫ 10 Female 37 31.9 Hair loss AstraZeneca/ PastoCovac plus Post the booster dose 180 Hypothyroidism 6 months after the booster shot ⎫ - 11 Female 50 26.5 Pain at the injection site Sinopharm/ PastoCovac plus Post the booster dose 180 - - ⎫ - 12 Female 37 25.2 Pain at the injection site Sinopharm/ PastoCovac Post the booster dose 30 - - ⎫ - 13 Male 38 32.7 Blurred vision Sinopharm/ PastoCovac Post the booster dose 180 - 1 year before vaccination ⎫ − 14 Female 44 28.7 Menstrual and Hyper lipedema (worsening) AstraZeneca/ PastoCovac plus Post the booster dose 180 Hyper lipedema 8 months After 3rd dose ⎫ - 15 Male 42 27.2 Joints inflammation AstraZeneca/ PastoCovac plus Post the booster dose 90 Hyper lipedema 2 months after the booster ⎫ − 16 Female 66 25.9 Hair loss AstraZeneca/ PastoCovac plus Post the 1st dose 180 - One year before vaccination ⎫ − 17 Female 33 22.5 Menstrual AstraZeneca/ PastoCovac plus Post the 1st dose 180 - 1 month post the booster ⎫ ⎫ 18 Male 37 25 headache AstraZeneca/ PastoCovac plus Post the 2nd dose 180 - 7 months before vaccination and post each dose ⎫ ⎫ 19 Female 27 20.8 Hair loss AstraZeneca/ PastoCovac plus Post the booster dose 180 - - ⎫ - 20 Female 32 26 Menstrual AstraZeneca/ PastoCovac plus Post each dose 90 Hypothyroidism 2 months after the 1st dose and 2 months after the booster dose ⎫ ⎫ 21 Female 42 29.1 Menstrual AstraZeneca/ PastoCovac plus Post the 2nd dose 180 - 7 months before vaccination ⎫ - 22 Female 45 23.6 Menstrual AstraZeneca/ PastoCovac plus Post the 1st dose 60 Hypothyroidism & hyperlipidemia 6 months post the booster dose ⎫ - 23 Female 37 36.2 Joints inflammation/problem Sinopharm/PastoCovac Post the booster dose 180 - 10 months before vaccination ⎫ - 24 Male 52 30.7 Joints involvement Sinopharm/PastoCovac Post the booster dose 180 Hypertension 3 months before vaccination ⎫ ⎫ 25 Female 22 29.8 Flu-like symptoms Sinopharm/PastoCovac Post the booster dose 180 - 1 month after the booster shot ⎫ ⎫ 26 Female 38 21.6 Hair loss Sinopharm/PastoCovac Post the booster dose 180 - 5 months post booster ⎫ - 27 Female 23 23.9 Hair loss Sinopharm/PastoCovac Post the booster dose 180 - Shortly after the 2nd dose ⎫ ⎫ 28 Female 44 24.1 Hypothyroidism worsening Sinopharm/PastoCovac Post the booster dose 180 Hypothyroidism 6 months before vaccination - ⎫ 29 Female 42 19.4 Headache Sinopharm/PastoCovac Post the booster dose 180 Anemia 2 months before vaccination and 2 months after the 2nd dose ⎫ ⎫ 30 Female 24 23.2 Hair loss Sinopharm/PastoCovac Post the booster dose 180 - 2 months after the 2nd dose ⎫ ⎫ 31 Male 55 34.7 Hyperglycemia Sinopharm/ Sinopharm Post the booster dose 180 Hypertension - ⎫ - 32 Male 42 34.5 Gastritis Sinopharm/ Sinopharm Post the booster dose 180 - 4 months before vaccination ⎫ ⎫ 33 Female 56 23 Muscles involvement Sinopharm/ Sinopharm Post the booster dose 180 Hypothyroidism - ⎫ - 34 Male 22 22.5 Hypertension Sinopharm/ Sinopharm Post the booster dose 180 - - ⎫ - 35 Female 21 23.7 Muscles involvement Sinopharm/ Sinopharm Post the booster dose 180 - 5 months before vaccination and 2months post the 2nd dose ⎫ ⎫ 36 Female 59 25.6 Pain at the injection site Sinopharm/ Sinopharm Post the booster dose 180 - - ⎫ - 37 Female 44 29.4 Menstrual and headache Sinopharm/ Sinopharm Post the booster dose 180 - 1 month after the 1st dose ⎫ - 38 Female 42 23.7 Pain at the injection site Sinopharm/ Sinopharm Post the booster dose 180 Hypothyroidism - ⎫ - 39 Female 37 25.7 headache Sinopharm/ Sinopharm Post the booster dose 14 Hypothyroidism 8 months before vaccination ⎫ - 40 Female 49 21.6 Hives and bruises AstraZenca/AsraZeneca Post the 1st dose 14 - Shortly after the booster ⎫ - 41 Female 37 32.1 Menstrual AstraZenca/AsraZeneca Post 1st dose 180 Hypothyroidism 8 months before vaccination and 6 months post the booster ⎫ ⎫ Discussion Persistent symptoms of COVID-19, as the long-term effect of COVID-19 has evolved recently. It is stated that nearly two-thirds of COVID-19 experienced individuals report at least one residual symptom even after 3 months. [ 21 ]. More recently, some other reports on long-term AEs came to attention by COVID-19 vaccine implementation. This fact makes long-COVID incidence or vaccination consequences really undistinguishable. In addition to long-COVID, there is another condition which appears in a number of vaccinated individuals against COVID-19 called “Long Vax” due to the fact that symptoms have resembled long COVID. Therefore, it could be stated that the late and persistent symptoms which initiated after the vaccination might be considered as the long vaccine syndrome [ 22 ]. Although we attempted to associate the incidences to the COVID-19 infection and/or vaccination, it should not be neglected that the discussed disorders might be only spontaneous events as age, life style or other conditions. In the present study, we tried to investigate individuals after full vaccine schedule with a kind of disorder. First of all, the impact of the applied vaccine was considered as the potential cause. Nevertheless, some cases had a coincidence of COVID-19 infection and a vaccine dose (shortly after the vaccine). It has been claimed that vaccination could possibly reduce the rate of long COVID incidence in those who develop the infection after vaccination [ 23 ]. In the present study, we observed that 15 (36.5%) individuals had a COVID-19 history before vaccination (< 1 year) in whom vaccine could act as a trigger to set up the disorder and present the late symptoms. On the other side, are the cases 16 (39%) who developed a kind of irregularities without previous COVID-19 infection but post-vaccination. It is hypothesized that in this population, the vaccine was the main cause and the infection, Long VAX, could act as the trigger for late side effects of the vaccine. Furthermore, 15 individuals with a persistent symptom got infected after vaccination in whom the time of the disorder was mostly after the booster shots. Therefore, vaccination itself may lead to some sorts of persistent side effects. The advantage of this study is the long-term follow-up of vaccinated individuals through different vaccine regimens. Long-COVID could be a situation caused by the infection itself which could be similar to Long VAX condition as they both result in similar symptoms. The difficulty of defining this issue stems from largely vaccinated people who had a previous infection, a post-exposure or reinfection. The present data evaluated some late disorders in vaccinated individuals as possible long-COVID, the vaccine side effects or the both. Conclusion We live in an era in which the vast majority of people have infected by SARS-CoV-2 and/or got vaccinated against it, differentiation of the late disorders as the vaccine side effect or long-COVID manifestation is difficult. Hence, some complications though late ones, might be a possible consequence of COVID-19 or its vaccination. The present data takes the advantage of long-term follow-up which presents various forms of late events in each episode of COVID-19 infection beside the vaccination. The rate of late symptoms in the present study also highlights the importance of long-term follow-up studies among population worldwide. Declarations Funding None. Declaration of interest The authors have no conflict of interest to declare. Data availability All data generated or analyzed during this study are included in this published article. References Greenhalgh, T., et al., Management of post-acute covid-19 in primary care . BMJ, 2020. 370: p. m3026. Soriano, J.B., et al., A clinical case definition of post-COVID-19 condition by a Delphi consensus . The Lancet Infectious Diseases, 2022. 22(4): p. e102-e107. Coronavirus disease (COVID-19): Post COVID-19 condition , 2023, World Health Organization Sadat Larijani, M., et al., Characterization of long COVID-19 manifestations and its associated factors: A prospective cohort study from Iran . Microbial Pathogenesis, 2022. 169: p. 105618. Raveendran, A.V., R. Jayadevan, and S. Sashidharan, Long COVID: An overview . Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2021. 15(3): p. 869–875. Arnold, C.G., et al., Vaccination Hesitancy and Postacute Sequelae of SARS-CoV-2: Is It Time to Reconsider? Viral Immunology, 2021. 34(10): p. 666–668. Mumtaz, A., et al., COVID-19 Vaccine and Long COVID: A Scoping Review . Life (Basel), 2022. 12(7). Zheng, C., et al., Real-world effectiveness of COVID-19 vaccines: a literature review and meta-analysis . International Journal of Infectious Diseases, 2022. 114: p. 252–260. Ashrafian, F., et al. A Comparative Study of Immunogenicity, Antibody Persistence, and Safety of Three Different COVID-19 Boosters between Individuals with Comorbidities and the Normal Population . Vaccines, 2023. 11, DOI: 10.3390/vaccines11081376 . Venkatesan, P., Do vaccines protect from long COVID? The Lancet Respiratory Medicine, 2022. 10(3): p. e30. van Kessel, S.A.M., et al., Post-acute and long-COVID-19 symptoms in patients with mild diseases: a systematic review . Family Practice, 2022. 39(1): p. 159–167. Farahmand, B., et al., Evaluation of PastoCovac plus vaccine as a booster dose on vaccinated individuals with inactivated COVID-19 vaccine . Heliyon, 2023. 9(10): p. e20555. Mahase, E., Covid-19: Vaccinated people are less likely to get long covid, review finds . BMJ, 2022. 376: p. o407. Paul, K., et al., Association between vaccination status and reported incidence of post-acute COVID-19 symptoms in Israel: a cross-sectional study of patients tested between March 2020 and November 2021. medRxiv, 2022: p. 2022.01.05.22268800. Notarte, K.I., et al., Impact of COVID-19 vaccination on the risk of developing long-COVID and on existing long-COVID symptoms: A systematic review . eClinicalMedicine, 2022. 53. Sadat Larijani, M., et al., Assessment of long-term adverse events regarding different COVID-19 vaccine regimens within an 18-month follow-up study . Pathogens and Disease, 2023: p. ftad010. Sadat Larijani, M.D., D.; Banifazl, M.; Karami, A.; Bavand, A.; Ashrafian, F.; Ramezani, A, A Landscape on Disorders Following Different COVID-19 Vaccination: A Systematic Review of Iranian Case Reports. Preprints.org, 2023. Fernández-de-las-Peñas, C., et al. Differences in Long-COVID Symptoms between Vaccinated and Non-Vaccinated (BNT162b2 Vaccine) Hospitalized COVID-19 Survivors Infected with the Delta Variant . Vaccines, 2022. 10, DOI: 10.3390/vaccines10091481 . Ayoubkhani, D., et al., Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study . BMJ, 2022. 377: p. e069676. Ramezani, A., et al., PastoCovac and PastoCovac Plus as protein subunit COVID-19 vaccines led to great humoral immune responses in BBIP-CorV immunized individuals . Scientific Reports, 2023. 13(1): p. 8065. Davis, H.E., et al., Long COVID: major findings, mechanisms and recommendations . Nat Rev Microbiol, 2023. 21(3): p. 133–146. Safavi, F., et al., Neuropathic symptoms with SARS-CoV-2 vaccination . medRxiv, 2022: p. 2022.05.16.22274439. Vaccination after SARS-CoV-2 infection linked to a decrease in long covid symptoms , 2023, The BMJ. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3447623","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":240365710,"identity":"f96ebd90-b0e4-4cb6-b5ac-b4be173b2473","order_by":0,"name":"Mona Sadat Larijani","email":"","orcid":"","institution":"Pasteur Institute of Iran","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mona","middleName":"Sadat","lastName":"Larijani","suffix":""},{"id":240365711,"identity":"efa259f7-7e80-4917-b246-73b56fca45dd","order_by":1,"name":"Anahita Bavand","email":"","orcid":"","institution":"Pasteur Institute of Iran","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Anahita","middleName":"","lastName":"Bavand","suffix":""},{"id":240365712,"identity":"53a726f2-fb5d-4911-9403-047961621388","order_by":2,"name":"Mohammad Banifazl","email":"","orcid":"","institution":"Iranian Society for Support of Patients with Infectious Disease","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Banifazl","suffix":""},{"id":240365713,"identity":"693ca611-c88b-4ab7-994a-10ab247dc37e","order_by":3,"name":"Fatemeh Ashrafian","email":"","orcid":"","institution":"Pasteur Institute of Iran","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Ashrafian","suffix":""},{"id":240365714,"identity":"aa459d23-9f2f-4e89-bd18-8d645a011a5b","order_by":4,"name":"Ladan Moradi","email":"","orcid":"","institution":"Pasteur Institute of Iran","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ladan","middleName":"","lastName":"Moradi","suffix":""},{"id":240365715,"identity":"8549f5db-d51e-49dc-92e4-0ba62b3332c8","order_by":5,"name":"Amitis Ramezani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYFACxgaGBDjHwAbCTijAq6WxAUlLWgIDG0iLASFrEOAwRAsDHi380w63P3jw5568bnv7w88FBefz+OW7Ez88MGCQ5xc7gFWLxO3ExobEtmLDbWcOJEvPMLhdLNnGu1kC6DDDmbMTsGphAGtpSGDcdiPhgDSPwe3EDcd4N4C0JBjcxq5FHqQl4U+C/bb7D5t/8xicA2nZ/AOfFgOwFraExG03mNmAthwAadmG1xZDoJYZiW0JydvOpLFZ8xgkJ85sy91mkWAggdMvcrfTH3z88SfBdtvx449v8/yxS+xnPrv55o8KG3l+aRzexwUkSFM+CkbBKBgFowAFAADDsGax6o3tcQAAAABJRU5ErkJggg==","orcid":"","institution":"Pasteur Institute of Iran","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Amitis","middleName":"","lastName":"Ramezani","suffix":""}],"badges":[],"createdAt":"2023-10-15 07:14:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3447623/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3447623/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":44932695,"identity":"aa40e12e-75c0-40c4-8153-4a11806c6fee","added_by":"auto","created_at":"2023-10-19 16:28:59","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":209926,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCharacterization of persistent symptoms post COVID-19 vaccination/infection.\u003c/strong\u003eTotally 41 individuals developed a kind of late disorders post COVID-19 and/or vaccination. The time of symptoms onset is shown according to the COVID-19 history and vaccination. In three cases, long-COVID could considered as the main cause where as in 16 cases it gave rise to vaccination regarding the persistent condition.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3447623/v1/f0dc3b110d97250de75d902e.jpeg"},{"id":45835412,"identity":"b7347d7f-5850-46e4-a351-97aa76ffcad8","added_by":"auto","created_at":"2023-11-03 20:22:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":379160,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3447623/v1/e1bf1637-3add-43e0-9032-f2755fa88514.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of late disorders as possible long-COVID and/or vaccination consequences","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAs the world has overcome the recent COVID-19 pandemic, owing to the great effort on vaccine development, the struggle against the long-term effects of the infection has emerged as a pandemic post the other one called \u0026ldquo;long COVID\u0026rdquo; [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to the definition by the World Health Organization, long COVID is a condition occurring in individuals with a background of probable or confirmed SARS-CoV-2 infection in which the symptoms usually appears three months after the COVID-19 symptoms onset and continues at least for two months [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This condition can affect a wide range of organs in the body through various symptoms [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough vaccination against COVID-19 has been a crucial step to manage the pandemic, uncertainties about the side effects of long COVID have brought concerns in the general population causing vaccine hesitancy which is potentially important for next probable new COVID-19 peaks and need of booster doses [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. There is no doubt that vaccinations have significantly decreased the severity of the illness and also the risk of hospitalization, however, the effect of vaccines on long-COVID has remained less discussed [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. What is more, vaccinated individuals might be infected and be asymptomatic or even suffer from mild to moderate forms of COVID-19 [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Long-COVID can manifest after all types of severity. Hence, COVID-19 vaccines could possibly impact on long-COVID symptoms. There have been studies showing that vaccines might reduce the risk of long-COVID [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A crucial factor to determine this issue is the time of infection and vaccination. It seems that vaccination before infection might limit long-COVID [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. What is unknown is the re-infection impact which could give a rise to long-OVID persistence.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eFrom another point of view, long term manifestations of vaccination has also came to attention by evidences and case reports worldwide [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The late adverse events thought to be rare, however, they may cause seriously durable problems and influence the life quality as well. Furthermore, the majority of the global population have already been immunized and may still develop the infection in this era. To determine that a long-term symptom is the long COVID manifestation or the vaccination side effects seems a challenging puzzle to resolve [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Therefore, in addition to the current vaccine safety reports and long COVID studies, it is of high value to investigate the symptomology of SARS-CoV-2 infection before and after vaccination and also to estimate associations between long-COVID symptoms and vaccination consequences [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe long-term assessment of late disorders post COVID-19 vaccination has been previously investigated in our last report [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Some identified problems were not associated to the vaccinations according to the opinion of the Adverse Events Committee of Pasteur Institute of Iran. Hereby, we aimed to describe some late disorders in vaccinated individuals who mostly suffered from COVID-19 infection and tried to classify them as the incidences causing by the COVID-19 infection and/or vaccination against it.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn this long-term follow-up study, we investigated vaccinated individuals from the first dose of COVID-19 vaccination up to at least 6-month post the booster shot. The participants were classified by the vaccine regimes including standard and combinational ones as:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe individuals who primed with Sinopharm and got a booster dose of PastoCovac or PastoCovac Plus (protein subunit vaccines)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e],\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe individuals who primed with AstraZeneca and got a booster dose of PastoCovac Plus,\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe individuals who got three doses of Sinopharm,\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe individuals who got three doses of AstreaZeneca.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe full medical history of the participants were collected through face-to-face interview or on call including any underlying diseases, COVID-19 history, time of incidence, symptoms, vaccine doses, any kind of adverse events (AEs), medical care, hospitalization and symptoms persistence. The collected AEs during an 18-month period (6 months after the booster dose) were then evaluated by AEs assessment committee of Pasteur Institute of Iran, to associate any causal inference of AEs with the vaccine/COVID-19. Descriptive statistics are presented as means (SD) for quantitative variables and as frequency (percentage) for categorical variables. All statistical analyses were performed with an alpha level of 0.05 in Stata software (version 17).\u003c/p\u003e \u003cp\u003e All the participants were provided with informed consent prior to enrolment and the study was performed according to the Declaration of Helsinki (Fortaleza, 13 October 2013). The ethical approval was achieved from Pasteur Institute of Iran National Committee for Ethics (ethics code numbers: IR.PII.REC.1400.077 and IR.PII.REC.1400.076).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eTotally, 329 individuals participated in the follow-up study (171 females, 158 males) with the mean age of 40.9 (SD: 13.2) and the mean BMI of 26.56 (SD: 4.58).\u003c/p\u003e \u003cp\u003eThe medical history showed that the most common underlying disease were thyroid disorders (7.2%), hypertension (5.4%) and diabetes mellitus (4.5%), respectively. Of the total population, 75 ones got Sinopharm/Sinopharm, 110 individuals got Sinopharm/PastoCovac Plus, 54 participants got Sinopharm/PastoCovac, 70 persons got AstraZeneca/ PastoCovac Plus, and 20 individuals were AstraZeneca/ AstraZeneca recipients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eLong-term symptoms classification\u003c/h2\u003e \u003cp\u003eDuring the retrospective follow-up all the reported disorders were collected into a researcher made form by trained experts according to the time of the incidence and duration. Only, the late AEs which started post-21-day after each dose of vaccination were considered in this study.\u003c/p\u003e \u003cp\u003eThe collective data showed that in total, 41 individuals (12.46%) had at least one disorder following vaccination (31 females, 12 males) with a mean age of 40.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.48, among whom menstrual problems (discussed in other under review data), hair loss, osteoarticular disorders, neuritis at the injection site, headache and skin manifestations were the most common, respectively (Table\u0026nbsp;1.).\u003c/p\u003e \u003cp\u003e18 individuals (nearly 44%) had an underlying diseases among whom hypothyroidism was the most frequent. Nevertheless, the compatible comorbidity with the AEs/side effect were only hyperlipidemia and joints inflammation in two cases who reported worsen pre-existing condition after the vaccination. In general, the identified symptoms were mostly persistent up to the end of the study with a mean duration of 155 days.\u003c/p\u003e \u003cp\u003eIn order to find the probable cause of each complication, the medical background of each case was firstly noticed. What is more, the gap time between the symptoms initiation with COVID-19 infection and also vaccination was considered. Furthermore, the coincidence of the infection and vaccination was considered as a dual effect cause on the late symptoms.\u003c/p\u003e \u003cp\u003eBy considering the role of COVID-19 in various types of late involvements and also the vaccine which could possibly trigger the previous impact of the infection, we found that in 17 (41.4%) of the cases, long-COVID could possibly manifest in which vaccination also gave a rise as a trigger, whereas 10 cases without any documented history of the infection which were then possibly affected by the vaccination. Moreover, by considering the duration between the late symptom/disorder presentation and vaccination and COVID-19, 24 whom were affected by the vaccine according to AEs committee members\u0026rsquo; opinion (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"10\" nameend=\"c12\" namest=\"c3\"\u003e \u003cp\u003eTable\u0026nbsp;1. The clinical characteristics of cases with persistent disorders after COVID-19 vaccine doses.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCase No.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c3\" namest=\"c2\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDisorder type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCOVID-19 vaccine regimen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eTime of disorder initiation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePersistency of the disorder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eUnderlying medical conditions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCovid-19 history time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003eVaccine outcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003eLong \u0026ndash;COVID-19 manifest\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e\u003cb\u003ePossibility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMenstrual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAfter each dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9 months after the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMenstrual and hair loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 weeks after the booster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eJoints involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ehypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3 months before vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMorphea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6 months before vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSkin rashes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eEndometriosis,polycystic ovary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 month after the booster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSkin rashes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIBS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHair loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eJoints involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the 1st dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAsthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 months before vaccination and shortly after the 1st dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eJoints inflammation worsening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eJoints inflammation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 months before vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHair loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAstraZeneca/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6 months after the booster shot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePain at the injection site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePain at the injection site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ PastoCovac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBlurred vision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ PastoCovac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 year before vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003csup\u003e\u0026minus;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMenstrual and Hyper lipedema (worsening)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAstraZeneca/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHyper lipedema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8 months After 3rd dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eJoints inflammation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAstraZeneca/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHyper lipedema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 months after the booster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003csup\u003e\u0026minus;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHair loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAstraZeneca/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the 1st dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eOne year before vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003csup\u003e\u0026minus;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMenstrual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAstraZeneca/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the 1st dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 month post the booster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eheadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAstraZeneca/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the 2nd dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7 months before vaccination and post each dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHair loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAstraZeneca/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMenstrual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAstraZeneca/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost each dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 months after the 1st dose and 2 months after the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMenstrual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAstraZeneca/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the 2nd dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7 months before vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMenstrual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAstraZeneca/ PastoCovac plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the 1st dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypothyroidism \u0026amp; hyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6 months post the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eJoints inflammation/problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/PastoCovac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10 months before vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eJoints involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/PastoCovac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3 months before vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003csup\u003e⎫\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFlu-like symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/PastoCovac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 month after the booster shot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHair loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/PastoCovac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5 months post booster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHair loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/PastoCovac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eShortly after the 2nd dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHypothyroidism worsening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/PastoCovac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6 months before vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHeadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/PastoCovac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 months before vaccination and 2 months after the 2nd dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHair loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/PastoCovac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 months after the 2nd dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHyperglycemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ Sinopharm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGastritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ Sinopharm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4 months before vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMuscles involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ Sinopharm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ Sinopharm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMuscles involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ Sinopharm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5 months before vaccination and 2months post the 2nd dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePain at the injection site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ Sinopharm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMenstrual and headache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ Sinopharm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 month after the 1st dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePain at the injection site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ Sinopharm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eheadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSinopharm/ Sinopharm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the booster dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8 months before vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHives and bruises\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAstraZenca/AsraZeneca\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost the 1st dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eShortly after the booster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMenstrual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAstraZenca/AsraZeneca\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost 1st\u003c/p\u003e \u003cp\u003edose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8 months before vaccination and 6 months post the booster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e⎫\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePersistent symptoms of COVID-19, as the long-term effect of COVID-19 has evolved recently. It is stated that nearly two-thirds of COVID-19 experienced individuals report at least one residual symptom even after 3 months. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. More recently, some other reports on long-term AEs came to attention by COVID-19 vaccine implementation. This fact makes long-COVID incidence or vaccination consequences really undistinguishable. In addition to long-COVID, there is another condition which appears in a number of vaccinated individuals against COVID-19 called \u0026ldquo;Long Vax\u0026rdquo; due to the fact that symptoms have resembled long COVID. Therefore, it could be stated that the late and persistent symptoms which initiated after the vaccination might be considered as the long vaccine syndrome [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough we attempted to associate the incidences to the COVID-19 infection and/or vaccination, it should not be neglected that the discussed disorders might be only spontaneous events as age, life style or other conditions.\u003c/p\u003e \u003cp\u003eIn the present study, we tried to investigate individuals after full vaccine schedule with a kind of disorder. First of all, the impact of the applied vaccine was considered as the potential cause. Nevertheless, some cases had a coincidence of COVID-19 infection and a vaccine dose (shortly after the vaccine).\u003c/p\u003e \u003cp\u003eIt has been claimed that vaccination could possibly reduce the rate of long COVID incidence in those who develop the infection after vaccination [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In the present study, we observed that 15 (36.5%) individuals had a COVID-19 history before vaccination (\u0026lt;\u0026thinsp;1 year) in whom vaccine could act as a trigger to set up the disorder and present the late symptoms. On the other side, are the cases 16 (39%) who developed a kind of irregularities without previous COVID-19 infection but post-vaccination. It is hypothesized that in this population, the vaccine was the main cause and the infection, Long VAX, could act as the trigger for late side effects of the vaccine. Furthermore, 15 individuals with a persistent symptom got infected after vaccination in whom the time of the disorder was mostly after the booster shots. Therefore, vaccination itself may lead to some sorts of persistent side effects.\u003c/p\u003e \u003cp\u003eThe advantage of this study is the long-term follow-up of vaccinated individuals through different vaccine regimens. Long-COVID could be a situation caused by the infection itself which could be similar to Long VAX condition as they both result in similar symptoms. The difficulty of defining this issue stems from largely vaccinated people who had a previous infection, a post-exposure or reinfection. The present data evaluated some late disorders in vaccinated individuals as possible long-COVID, the vaccine side effects or the both.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe live in an era in which the vast majority of people have infected by SARS-CoV-2 and/or got vaccinated against it, differentiation of the late disorders as the vaccine side effect or long-COVID manifestation is difficult. Hence, some complications though late ones, might be a possible consequence of COVID-19 or its vaccination. The present data takes the advantage of long-term follow-up which presents various forms of late events in each episode of COVID-19 infection beside the vaccination. The rate of late symptoms in the present study also highlights the importance of long-term follow-up studies among population worldwide.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflict of interest to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGreenhalgh, T., et al., \u003cem\u003eManagement of post-acute covid-19 in primary care\u003c/em\u003e. BMJ, 2020. 370: p.\u0026nbsp;m3026.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoriano, J.B., et al., \u003cem\u003eA clinical case definition of post-COVID-19 condition by a Delphi consensus\u003c/em\u003e. The Lancet Infectious Diseases, 2022. 22(4): p.\u0026nbsp;e102-e107.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eCoronavirus disease (COVID-19): Post COVID-19 condition\u003c/em\u003e, 2023, World Health Organization\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSadat Larijani, M., et al., \u003cem\u003eCharacterization of long COVID-19 manifestations and its associated factors: A prospective cohort study from Iran\u003c/em\u003e. Microbial Pathogenesis, 2022. 169: p.\u0026nbsp;105618.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaveendran, A.V., R. Jayadevan, and S. Sashidharan, \u003cem\u003eLong COVID: An overview\u003c/em\u003e. Diabetes \u0026amp; Metabolic Syndrome: Clinical Research \u0026amp; Reviews, 2021. 15(3): p.\u0026nbsp;869\u0026ndash;875.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArnold, C.G., et al., \u003cem\u003eVaccination Hesitancy and Postacute Sequelae of SARS-CoV-2: Is It Time to Reconsider?\u003c/em\u003e Viral Immunology, 2021. 34(10): p.\u0026nbsp;666\u0026ndash;668.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMumtaz, A., et al., \u003cem\u003eCOVID-19 Vaccine and Long COVID: A Scoping Review\u003c/em\u003e. Life (Basel), 2022. 12(7).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng, C., et al., \u003cem\u003eReal-world effectiveness of COVID-19 vaccines: a literature review and meta-analysis\u003c/em\u003e. International Journal of Infectious Diseases, 2022. 114: p.\u0026nbsp;252\u0026ndash;260.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAshrafian, F., et al. \u003cem\u003eA Comparative Study of Immunogenicity, Antibody Persistence, and Safety of Three Different COVID-19 Boosters between Individuals with Comorbidities and the Normal Population\u003c/em\u003e. Vaccines, 2023. 11, DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/vaccines11081376\u003c/span\u003e\u003cspan address=\"10.3390/vaccines11081376\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenkatesan, P., \u003cem\u003eDo vaccines protect from long COVID?\u003c/em\u003e The Lancet Respiratory Medicine, 2022. 10(3): p.\u0026nbsp;e30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Kessel, S.A.M., et al., \u003cem\u003ePost-acute and long-COVID-19 symptoms in patients with mild diseases: a systematic review\u003c/em\u003e. Family Practice, 2022. 39(1): p.\u0026nbsp;159\u0026ndash;167.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarahmand, B., et al., \u003cem\u003eEvaluation of PastoCovac plus vaccine as a booster dose on vaccinated individuals with inactivated COVID-19 vaccine\u003c/em\u003e. Heliyon, 2023. 9(10): p.\u0026nbsp;e20555.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahase, E., \u003cem\u003eCovid-19: Vaccinated people are less likely to get long covid, review finds\u003c/em\u003e. BMJ, 2022. 376: p.\u0026nbsp;o407.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaul, K., et al., \u003cem\u003eAssociation between vaccination status and reported incidence of post-acute COVID-19 symptoms in Israel: a cross-sectional study of patients tested between March 2020 and November\u003c/em\u003e 2021. medRxiv, 2022: p.\u0026nbsp;2022.01.05.22268800.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNotarte, K.I., et al., \u003cem\u003eImpact of COVID-19 vaccination on the risk of developing long-COVID and on existing long-COVID symptoms: A systematic review\u003c/em\u003e. eClinicalMedicine, 2022. 53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSadat Larijani, M., et al., \u003cem\u003eAssessment of long-term adverse events regarding different COVID-19 vaccine regimens within an 18-month follow-up study\u003c/em\u003e. Pathogens and Disease, 2023: p.\u0026nbsp;ftad010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSadat Larijani, M.D., D.; Banifazl, M.; Karami, A.; Bavand, A.; Ashrafian, F.; Ramezani, A, \u003cem\u003eA Landscape on Disorders Following Different COVID-19 Vaccination: A Systematic Review of Iranian Case Reports.\u003c/em\u003e Preprints.org, 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFern\u0026aacute;ndez-de-las-Pe\u0026ntilde;as, C., et al. \u003cem\u003eDifferences in Long-COVID Symptoms between Vaccinated and Non-Vaccinated (BNT162b2 Vaccine) Hospitalized COVID-19 Survivors Infected with the Delta Variant\u003c/em\u003e. Vaccines, 2022. 10, DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/vaccines10091481\u003c/span\u003e\u003cspan address=\"10.3390/vaccines10091481\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyoubkhani, D., et al., \u003cem\u003eTrajectory of long covid symptoms after covid-19 vaccination: community based cohort study\u003c/em\u003e. BMJ, 2022. 377: p.\u0026nbsp;e069676.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamezani, A., et al., \u003cem\u003ePastoCovac and PastoCovac Plus as protein subunit COVID-19 vaccines led to great humoral immune responses in BBIP-CorV immunized individuals\u003c/em\u003e. Scientific Reports, 2023. 13(1): p.\u0026nbsp;8065.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis, H.E., et al., \u003cem\u003eLong COVID: major findings, mechanisms and recommendations\u003c/em\u003e. Nat Rev Microbiol, 2023. 21(3): p.\u0026nbsp;133\u0026ndash;146.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSafavi, F., et al., \u003cem\u003eNeuropathic symptoms with SARS-CoV-2 vaccination\u003c/em\u003e. medRxiv, 2022: p. 2022.05.16.22274439.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eVaccination after SARS-CoV-2 infection linked to a decrease in long covid symptoms\u003c/em\u003e, 2023, The BMJ.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Late AEs, Long-COVID, Long-VAX, long-term disorders","lastPublishedDoi":"10.21203/rs.3.rs-3447623/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3447623/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003eFollowing SARS-CoV-2 outbreak, another crisis has been established by progress or persistence of COVID-19 symptoms, as post or long COVID, which is critical to be recognized according to increasing number of late symptoms reports. In this study, we investigated long-term disorders in vaccinated individuals who developed late adverse events/side effects post-vaccination and/or COVID-19 episode owing to the challenging differentiation between them.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The vaccinated individuals of four vaccine regimens including inactivated virus-based/prime-boost group, inactivated virus-based prime/subunit protein-based boost, adenovirus-based prime/boost and adenovirus-based prime/subunit protein-based boost were followed from the first dose of vaccination up to 6-month post the booster shot. All the vaccine adverse events were documented through in-depth interview using a researcher-made questionnaire as well as the COVID-19 history and demographics. The medical history of all the cases were also collected and the late disorders post-vaccination were investigated by Adverse Events Committee of Pasteur Institute of Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eTotally 329 individuals who got 3 doses of vaccination were followed 6 months after the booster shots among whom 41 (12.4%) of investigated cases (including 31 females) with the mean age of 40.9±10.48 years had a type of disorder following vaccination. The late adverse events/side effects were captured in various forms among which gynecological and osteoarticular involvements were the most common ones. After evaluation of the medical background, age, vaccination and the date of disorder initiation, 39% of the documented complains have been found to be linked with long-COVID-19 as a trigger. Interestingly, the average time of symptoms persistence was 155±10.4 days and mostly continued up to the end of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIn this era in which the vast majority of the global population have developed COVID-19 and/or got vaccinated against it, identification of the late disorders as the vaccine side effect or long-COVID manifestation is difficult. Therefore, some complications though late ones, might be a possible consequence of any SARS-CoV-2 infection or vaccination. This study takes the advantage of long-term follow-up which presents various forms of late events in each episode of COVID-19 infection and vaccination. The rate of late-disorders in the present study also highlights the importance of long-term follow-up studies among population worldwide.\u003c/p\u003e","manuscriptTitle":"Evaluation of late disorders as possible long-COVID and/or vaccination consequences","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-19 16:28:54","doi":"10.21203/rs.3.rs-3447623/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e5646797-f63a-42bb-838c-3f74f60bdb8c","owner":[],"postedDate":"October 19th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":25401103,"name":"Health sciences/Diseases"},{"id":25401104,"name":"Health sciences/Medical research"},{"id":25401105,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2023-11-03T20:14:15+00:00","versionOfRecord":[],"versionCreatedAt":"2023-10-19 16:28:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3447623","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3447623","identity":"rs-3447623","version":["v1"]},"buildId":"afDZ1USd8LLqUjqjB8QhT","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}