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International Journal of Legal Medicine
Published in: International Journal of Legal Medicine 6/2021

Open Access 01-11-2021 | Autopsy | Original Article

Postmortem investigation of fatalities following vaccination with COVID-19 vaccines

Authors: Julia Schneider, Lukas Sottmann, Andreas Greinacher, Maximilian Hagen, Hans-Udo Kasper, Cornelius Kuhnen, Stefanie Schlepper, Sven Schmidt, Ronald Schulz, Thomas Thiele, Christian Thomas, Andreas Schmeling

Published in: International Journal of Legal Medicine | Issue 6/2021

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Abstract

Thorough postmortem investigations of fatalities following vaccination with coronavirus disease 2019 (COVID-19) vaccines are of great social significance. From 11.03.2021 to 09.06.2021, postmortem investigations of 18 deceased persons who recently received a vaccination against COVID-19 were performed. Vaxzevria was vaccinated in nine, Comirnaty in five, Spikevax in three, and Janssen in one person. In all cases, full autopsies, histopathological examinations, and virological analyses for the severe acute respiratory syndrome coronavirus 2 were carried out. Depending on the case, additional laboratory tests (anaphylaxis diagnostics, VITT [vaccine-induced immune thrombotic thrombocytopenia] diagnostics, glucose metabolism diagnostics) and neuropathological examinations were conducted. In 13 deceased, the cause of death was attributed to preexisting diseases while postmortem investigations did not indicate a causal relationship to the vaccination. In one case after vaccination with Comirnaty, myocarditis was found to be the cause of death. A causal relationship to vaccination was considered possible, but could not be proven beyond doubt. VITT was found in three deceased persons following vaccination with Vaxzevria and one deceased following vaccination with Janssen. Of those four cases with VITT, only one was diagnosed before death. The synopsis of the anamnestic data, the autopsy results, laboratory diagnostic examinations, and histopathological and neuropathological examinations revealed that VITT was the very likely cause of death in only two of the four cases. In the other two cases, no neuropathological correlate of VITT explaining death was found, while possible causes of death emerged that were not necessarily attributable to VITT. The results of our study demonstrate the necessity of postmortem investigations on all fatalities following vaccination with COVID-19 vaccines. In order to identify a possible causal relationship between vaccination and death, in most cases an autopsy and histopathological examinations have to be combined with additional investigations, such as laboratory tests and neuropathological examinations.
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Metadata
Title
Postmortem investigation of fatalities following vaccination with COVID-19 vaccines
Authors
Julia Schneider
Lukas Sottmann
Andreas Greinacher
Maximilian Hagen
Hans-Udo Kasper
Cornelius Kuhnen
Stefanie Schlepper
Sven Schmidt
Ronald Schulz
Thomas Thiele
Christian Thomas
Andreas Schmeling
Publication date
01-11-2021
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Legal Medicine / Issue 6/2021
Print ISSN: 0937-9827
Electronic ISSN: 1437-1596
DOI
https://doi.org/10.1007/s00414-021-02706-9

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