The condition causes temporary muscle weakness or paralysis in one side of the face, and occurs when the nerve that controls facial muscles becomes inflamed or compressed. Neural transmissions were observed to be normal in EMG (electromyography) examination. 2020;586:594599. Muscular weakness, nerve injury, and pain syndromes are common in people who require intensive care during infections. In Pfizers and Modernas clinicals trials which combined include over 37,000 people vaccine recipients reported mild or moderate reactions, such as pain at >> Police: Area Smashburger employee in custody after argument leads to exchange of gunfire. Fasciculations may pass from a part of body to another one. Ethical Approval and Consent to participate: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A further 14 have been seen after 1.1 million Moderna doses and 487 after 47 million AstraZeneca doses. The first was for the death of 28-year-old Bangladesh national, Mr Rajib. 2021 Mar;69(3):488-509. doi: 10.4103/ijo.IJO_297_21. Indian J Ophthalmol. In 2004, a flu jab in Switzerland was found to significantly increase the risk of Bells palsy and was discontinued. After 1 year, very few serious adverse events were reported, and instances of myocarditis (inflammation of heart muscle) were lower than initially reported. 679215 Registered office: 1 London Bridge Street, London, SE1 9GF. Among all vaccine recipients, 66.6% reported at least one systemic reaction in the 7 days after vaccination. 2023 BDG Media, Inc. All rights reserved. Would you like email updates of new search results? Ocular manifestations after receiving COVID-19 vaccines may appear on the eyelid, cornea and ocular surface, retina, uvea, nerve, and vessel. The .gov means its official. The Ohio Department of Health repealed authorization for the monovalent COVID-19 vaccines from Moderna and Pfizerthe same type of vaccines many Americans received during the start of the pandemic. 5-times and 7-times higher than would be expected in the general population., However, the team concluded: We feel the available coronavirus mRNA vaccines offer a substantial net benefit to public health., The UKs medicine regulator, the MHRA, says: The number of reports of facial paralysis received so far is similar to the expected natural rate and does not currently suggest an increased risk following the vaccines.. This review was undertaken to help clinicians recognize the possible manifestations and systemic pathogenesis, especially those related to the eye, after receiving COVID-19 vaccination. After Mdm Ontal died, her family applied to the Ministry of Health (MOH) under the Vaccine Injury Financial Assistance Programme, which provides one-time financial assistance to those who experienced serious side effects that are assessed to be related to COVID-19 vaccines administered in Singapore. Posner-Schlossman syndrome relapse following inactivated COVID-19 vaccination in China. No muscle weakness or atrophy was found in neurological examination. A 43-year-old male patient applied to our clinic with complaints of widespread fasciculation in the tongue and entire body developing 1 day after the vaccination. The Pfizer-BioNTech COVID-19 vaccine is 91% effective in preventing severe illness with COVID-19 in people age 16 and older. Both the Pfizer and the Moderna COVID-19 vaccinations involve two injections separated by several weeks. The application was successful, although the coroner did not specify how much Mdm Ontal's family received. doi: 10.1038/s41586-020-2607-z. 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No severe adverse effect was observed and the adverse effects that have been observed include pain at the point of injection, fever, asthenia, diarrhea, and muscle pain [2] [4] [5] [6] . Intense and long-duration exercises may cause or worsen the fasciculations [8] . It is related with anxiety level; it is known as fasciculation anxiety syndrome. The spasms are due to compression of the facial nerve by the artery at the root exit of the brainstem. PMC The ocular manifestations occurred up to forty-two days after vaccination, and vaccine-induced immunologic responses may be responsible. Sometimes, a mild peripheral weakness can develop. This paper presents a benign fasciculation syndrome case developing after CoronaVac vaccination. Despite receiving appropriate medical care, her condition deteriorated rapidly and she died on Dec 13, 2021. The forensic pathologist who conducted the autopsy found inflammation of Mdm Ontal's heart muscle, which was consistent with myocarditis. Fasciculation finding was not reported as an adverse effect after COVID vaccine. Other common symptoms include generalized fatigue or asthenia, parasthesis, and muscle cramps or symptoms [7] . -, Jackson L.A., Anderson E.J., Rouphael N.G., Roberts P.C., Makhene M., Coler R.N., McCullough M.P., Chappell J.D., Denison M.R., Stevens L.J., et al. 2022 Jun 9;11(12):3318. doi: 10.3390/jcm11123318. Yes, to the twitching. Let your body rest, and take an Epsom salt bath to relax your muscles if youre got a bathtub and enjoy a good soak. If your muscles are bugging you after your COVID vaccine, you dont have to just wait it out. ECG. The coroner said Mdm Ontal was a healthy woman with no chronic illnesses, and although a benign tumour was found at autopsy, it did not cause her death. doi: 10.1056/NEJMoa2022483. The prevalence of adverse effects in vaccinated group was found to be 33%, whereas the same parameter was found to be 22% in placebo group and no statistically significant difference was found with placebo, except for the pain at the point of injection. She called her husband and told him she found it difficult to breathe. >> Police: Area Smashburger employee in custody after argument leads to exchange of gunfire. SINGAPORE: A 43-year-old woman who received a COVID-19 vaccine booster died about four days later, a coroner's court heard on Friday (Apr 14). They included five with myoclonus, where muscles twitch or jerk involuntarily. I had my last booster in November 2021 and currently have leg twitching all during the day. WebThe 2nd dose of Pfizer took place at the end of July and since then I have always had muscles twitching and calf cramps, and pain (soft) that randomly occur on the thighs, The pandemic caused by the SARS-CoV-2, a new coronavirus, is the most important health problem of the 21st century. Ocular inflammatory manifestations following COVID-19 vaccinations in Taiwan: A case series. This site needs JavaScript to work properly. Copyright 2006-2023 Scientific Research Publishing Inc. All Rights Reserved. Ocular adverse effects of COVID-19 vaccines: A systematic review. Today in Pediatrics researchers published the safety data of the Pfizer-BioNTech (BNT-162b2) COVID-19 vaccine in adolescents ages 12 to 17 years. Keywords: sharing sensitive information, make sure youre on a federal and transmitted securely. Sky Sports' Martin Tyler slammed for 'racist' comment about Spurs star Son, Olly Murs breaks down on stage over Caroline Flack 'regret', Fulham's Pereira stretchered off with suspected broken leg in worrying scenes, One dead and seven injured as knifeman goes on bloody rampage near club, News Group Newspapers Limited in England No. Copyright 2023 by authors and Scientific Research Publishing Inc. Online ahead of print. He had no known comorbidity or medication usage. The Pfizer-BioNTech COVID-19 vaccine is 91% effective in preventing severe illness with COVID-19 in people age 16 and older. If it is, a quick check-in with your doctor might be helpful to give you peace of mind. He did not take any medication or psychotherapy. Benign fasciculation syndrome was found to have no association with any vaccine. Choi M, Seo MH, Choi KE, Lee S, Choi B, Yun C, Kim SW, Kim YY. WebAnswer (1 of 7): Probably not, but since you are concerned I would suggest you contact your provider for your own piece of mind. This service is not intended for persons residing in the E.U. BFS may also be caused by long-term use of steroid or anticholinergic, as well as nicotine, caffeine, alcohol, and exposure to insecticides and pesticides [8] . But reporting of a side effect does not prove cause, only that the event occurred in the period after the jab. Follow the COVID-19 vaccination Indian J Ophthalmol. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. The authors have no relevant financial or non-financial interests to disclose. I recommend avoiding caffeine and taking Fasciculation may develop in any voluntary muscle group but the most remarkable ones are eyelids, arms, hands, fingers, legs, and feet. After the vaccine I had a huge constellation of symptoms from head to toe, the 46-year-old said, describing it as similar to mutant long Covid. 2 min read. This is the second reported coroner's case where a person's death was linked to a COVID-19 vaccine. During the 42 minutes of observation at the clinic, she did not exhibit any adverse effects. Epub 2022 Oct 14. government site. adverse events; coronavirus disease 2019 (COVID-19); ophthalmology; vaccines. The author declares no conflicts of interest regarding the publication of this paper. Rare side effects include short-term seizures and low platelet count. Spinal cord imaging was normal. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. The vaccination in Turkey has started with medical personnel in October 2020. He said myocarditis is a known adverse effect following an mRNA vaccine. For these two-shot vaccinations: If you had COVID-19 before As for Pfizer, Fang said, third-party funding is just one of the many strategies the drugmaker deployed to drive COVID-19 policymaking. WebThe worst was muscle contraction of my calves at night , because that hurt a lot. Bethesda, MD 20894, Web Policies 2023 Mar 12;42:103513. doi: 10.1016/j.pdpdt.2023.103513. WebCOVID-19 vaccines can cause mild side effects after the first or second dose, including: Pain, redness or swelling where the shot was given; Fever; Fatigue; Headache; Muscle pain; SINGAPORE: A 43-year-old woman who received a COVID-19 vaccine booster died about four days later, a coroner's court heard on Friday (Apr 14). She walked to a clinic for a check-up for mild chest discomfort, but was discharged from the clinic after she was assessed to be normal and she said she did not have any further discomfort. It is extremely rare but not unknown for a person who has received the vaccine to develop myocarditis, added the coroner. This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License. The cause ofMadam Ontal Charlene Vargas' deathwas determined to be myocarditis, or inflammation of the heart. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-dise 110-2628-B-006-018/Ministry of Science and Technology Taiwan, Lundstrom K., Barh D., Uhal B.D., Takayama K., Aljabali A.A.A., Abd El-Aziz T.M., Lal A., Redwan E.M., Adadi P., Chauhan G., et al. The cause of Madam and Muscle cramps can occur later as well, so you dont have to be overly concerned if you wake up sore the next day. Single-shot Ad26 vaccine protects against SARS-CoV-2 in rhesus macaques. Front Public Health. Its largely about not getting enough H2O, says Dr. Michael Green, M.D., a family medicine physician and the associate medical director of Northwell Health-GoHealth Urgent Care. Mediacorp Pte Ltd. All rights reserved. WebThe recipients health condition or recommendations for vaccination may change from one visit to the next. COVID arm, which should be more accurately referred to as "COVID vaccine arm" per Dr. Little, is a delayed hypersensitivity reaction to a component of the COVID vaccine. The main types of COVID-19 vaccines currently available in the U.S. or being studied include: Messenger RNA (mRNA) vaccine. Benign fasciculation Syndrome (BFS) is related with anxiety level; it is known as fasciculation anxiety syndrome. The vaccine is 100% effective in preventing COVID-19 in children ages 12 through 15. Vaccine makers Pfizer Inc, Moderna Inc and Johnson & The patient was taken to follow-up and the fasciculations were completely recovered in 3 weeks by gradually decreasing. Your soreness may start relatively quickly, or it might creep up on you. 2023 Feb 5;11(2):365. doi: 10.3390/vaccines11020365. Ylmaz, B. It was aimed to present the case that was first in the literature. Photodiagnosis Photodyn Ther. Also, it is difficult to say that it is related or unrelated to the vaccine, which seems unlikely. This paper presents a benign fasciculation syndrome case developing after CoronaVac vaccination. Nature. 2022 Aug 1;12(4):465-471. doi: 10.4103/2211-5056.353129. Web(BioNTech/Pfizer), COVID-19 Vaccine Moderna (Moderna) and COVID-19 Vaccine AstraZeneca (AstraZeneca). Sheng Q, Sun Y, Zhai R, Fan X, Ying Y, Kong X. Dr. Michael Green, M.D., family medicine physician, associate medical director of Northwell Health-GoHealth Urgent Care, Dr. Natasha Bhuyan, M.D., regional medical director of One Medical, Feel Like Your ADHD Meds Arent Working? eCollection 2022. Ive had headaches, chest pains, abdominal pains, unbelievable muscle twitching, issues focusing my vision. Horozoglu F, Sener H, Evereklioglu C, Polat OA. Two case-control studies/retrospective cohort studies, one cross-sectional study, three case series, sixteen case reports, two images, and seven letters were included. See this image and copyright information in PMC. 2022 Feb 21;10(2):342. doi: 10.3390/vaccines10020342. Her condition worsened on Dec 12, 2021 and she suddenly became unresponsive. [(accessed on 21 September 2021)]; Available online: Sahin U., Muik A., Derhovanessian E., Vogler I., Kranz L.M., Vormehr M., Baum A., Pascal K., Quandt J., Maurus D., et al. Serum Vitamin B12. Such twitchings called fasciculations can happen in many medical conditions. It wasnt mega intense, but it was everywhere for a day or two. They took Tylenol and lounged on the couch playing video games for that first day and a half, which they say helped ease the aches and kept their spirits up. The COVID-19 vaccine makers are indemnified by the government and are not party to CICP proceedings. Sung SY, Jenny LA, Chang YC, Wang NK, Liu PK. 2020;383:19201931. 8600 Rockville Pike It is so bad that sometimes it feels like something is If body aches or muscle cramping doesnt resolve within 48 hours, please reach out to your primary care provider, Dr. Bhuyan advises. Remember that your body is having an intense immune response to the vaccine and will use a lot of water for this. Not to mention, you might be drinking fewer fluids if youre also nauseous, but its important to try and down extra water before and after the appointment if you can. A BIZARRE new side effect has been reported by people who have received their Covid-19 vaccine. J. Med. (Put those all together, and you may feel like youve got the flu, which is normal.). Thyroid disease may cause similar symptoms. SINGAPORE: A 43-year-old woman who received a COVID-19 vaccine booster died about four days later, a coroner's court heard on Friday (Apr 14). Post-vaccine body aches usually arent super severe you might feel like you just got out of an intense fitness boot camp but Dr. Bhuyan says your level of full-body muscle pain shouldnt really be interfering with your typical activities. Tell us what you think your expectations and concerns. He did not use alcohol, nicotine or caffeine. (2022) Benign Fasciculation Syndrome Developing after COVID Vaccine (Sinovac/CoronaVac). -, Mercado N.B., Zahn R., Wegmann F., Loos C., Chandrashekar A., Yu J., Liu J., Peter L., McMahan K., Tostanoski L.H., et al. I was ready for my arm to fall off, but not to feel like I got kicked all over my body. As for Pfizer, Fang said, third-party funding is just one of the many strategies the drugmaker deployed to drive COVID-19 policymaking. Please enable it to take advantage of the complete set of features! There have been 313 cases of Bells palsy in Pfizer 31.3 million doses reported to the MHRA. COVID-19 vaccine BNT162b1 elicits human antibody and TH1 T cell responses. HHS Vulnerability Disclosure, Help Pfizer flexed its lobbying The good news is, treating muscle cramps after getting your COVID vaccine is pretty simple, as long as youve got some hydration and painkillers on standby. According to the coroner's findings, Mdm Ontal stated at the hospital thatshe had no family history of heart disease or congenital heart problems. This type of vaccine gives your cells instructions for how to make the S protein found on the surface of the COVID-19 virus. A systemic search was performed on 22 August 2021 through Embase, Medline, and Cochrane Library for publications on ocular manifestations after COVID-19 vaccination. PRISMA flow diagram of the articles analyzed. Radiological Biomarkers for Brain Metastases Prognosis: Quantitative Magnetic Resonance Imaging ( Foreign Body Reaction After Hip Augmentation Surgery: A Case Report, An Overview of Emphysematous Epididymo-Orchitis: A Systematic Review of Case Reports, Alabama College of Osteopathic Medicine Research, Baylor Scott & White Medical Center Department of Neurosurgery, California Institute of Behavioral Neurosciences & Psychology, Contemporary Reviews in Neurology and Neurosurgery, DMIMS School of Epidemiology and Public Health, Simulation, Biodesign, & Innovation In Medical Education, The Florida Medical Student Research Publications, University of Florida-Jacksonville Neurosurgery, VCOM Clinical, Biomedical, and Educational Research, American Red Cross Scientific Advisory Council, Canadian Association of Radiation Oncology, International Liaison Committee on Resuscitation, International Pediatric Simulation Society, Medical Society of Delaware Academic Channel, Society for Healthcare & Research Development, Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case Review, Clinical and Economic Benefits of Autologous Epidermal Grafting, Defining Health in the Era of Value-Based Care, Optimization Strategies for Organ Donation and Utilization, MR-Guided Radiation Therapy: Clinical Applications & Experiences, Multiple Brain Metastases: Exceptional Outcomes from Stereotactic Radiosurgery, Proton Therapy: Advanced Applications for the Most Challenging Cases, Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices, Clinical Applications and Benefits Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management, Negative Pressure Wound Therapy with Instillation, NPWT with Instillation and Dwell: Clinical Results in Cleansing and Removal of Infectious Material with Novel Dressings. Additionally, patients with long COVID or those who have been treated or vaccinated can present with MSK symptoms. As far as your arm is concerned, possible symptoms following a coronavirus vaccine are pain, redness, itchiness or swelling near the site of the injection. The ocular manifestations occurred up to forty-two days after vaccination, and vaccine-induced immunologic responses may be responsible. Optic neuritis is an inflammation affecting the optic nerve that sends signals from the back of the eye to the brain. Before Haseeb AA, Solyman O, Abushanab MM, Abo Obaia AS, Elhusseiny AM. COVID effects every part of your body , there are cells effected in every part, those cells the virus By joining Cureus, you agree to our doi: 10.1038/s41586-020-2814-7. Serum Vitamin D3. Benign Fasciculation Syndrome Developing after COVID Vaccine (Sinovac/CoronaVac). 2022 Sep;11(9):5041-5054. doi: 10.4103/jfmpc.jfmpc_747_22. For other inquiries, Contact Us. WebPrepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. Many people who get the COVID vaccine experience injection-site pain AKA, the arm you got your shot in might experience a bout of soreness to end all soreness. However, she grew unwell the next morning, feeling tired and breathless. Central Retinal Vein Occlusion in a Young Woman with Diabetes and Hypertension after mRNA-Based COVID-19 Vaccination-A Case Report and Brief Review of the Literature. Using needle EMG, fasciculation was observed in resting position in all the muscles examined. Later that day, she felt unwell again and told her employer about it before taking a taxi to Singapore General Hospital. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The main types of COVID-19 vaccines currently available in the U.S. or being studied include: Messenger RNA (mRNA) vaccine. When youre dehydrated, your body has a harder time flushing toxins and regulating temperature, which can contribute to soreness. There was no evidence that Mdm Ontal had a bacterial, viral or fungal infection or autoimmune disease, or that she had taken drugs and medication that led to myocarditis. eCollection 2022 Oct-Dec. Graefes Arch Clin Exp Ophthalmol. U.S. Food & Drug AdministrationCOVID-19 Vaccines. It may also be caused by long-term use of steroid or anticholinergic, as well as nicotine, caffeine, alcohol, and exposure to insecticides and pesticides. J Family Med Prim Care. Add your e-mail address to receive free newsletters from SCIRP. It should have been Mdm Ontal. Terms of Use. For people age 12 and older, the Pfizer-BioNTech COVID-19 vaccine involves two shots. Youre Not Alone, How To Stretch Your Hands, According To Physical Therapists, Trainers Say Walking 8,000 Steps A Day Is Just Fine, TYVM, The StairMaster Workout Going Viral On TikTok Is No Joke, Get Even More From Bustle Sign Up For The Newsletter. Today in Pediatrics researchers published the safety data of the Pfizer-BioNTech (BNT-162b2) COVID-19 vaccine in adolescents ages 12 to 17 years. Ocular manifestations after receiving COVID-19 vaccines may appear on the eyelid, cornea and ocular surface, retina, uvea, nerve, and vessel. As for Pfizer, Fang said, third-party funding is just one of the many strategies the drugmaker deployed to drive COVID-19 policymaking. Unable to load your collection due to an error, Unable to load your delegates due to an error. Benign fasciculation syndrome (BFS) is characterized with the fasciculation of voluntary muscles in the body [ 7] . Investigations to be done: MRI cervical spine with screening whole spine. The other significant diseases that should be distinguished include amyotrophic lateral sclerosis (ALS) and other motor neuronal diseases, neuropathy, and spinal cord diseases. The muscle cramps threw me for a loop, says Arti, 29, who recently got the Moderna vaccine. The Pfizer-BioNTech COVID-19 vaccine is 91% effective in preventing severe illness with COVID-19 in people age 16 and older. WebWe would like to show you a description here but the site wont allow us. WebSystemic Reactions. 2 min read. An official website of the United States government. : Stomach pain, nausea, vomiting, diarrhoea 197 twitch 13 Social circumstances E.g. It continues to review cases to analyse case reports against the number expected to occur by chance in the absence of vaccination. The COVID-19 vaccine makers are indemnified by the government and are not party to CICP proceedings. Ocular Complications Following Vaccination for COVID-19: A One-Year Retrospective. Whether your medicine cabinet is stocked with ibuprofen or acetaminophen, neither med will negatively impact the vaccines effectiveness after youve gotten the poke. It is reported in medical literature that myocarditis is a known adverse side effect of receiving the COVID-19 vaccine, said the coroner. 2023 Jan 13;10:1051378. doi: 10.3389/fpubh.2022.1051378. For the rare few who experience a severe or By subscribing to this BDG newsletter, you agree to our. It could be just benign fasciculations syndrome. How concerned are you about adverse events related to the vaccines? 2022 Dec 31:1-10. doi: 10.1007/s00417-022-05954-6. The coroner emphasised that the risk of developing myocarditis is extremely low, and is far outweighed by the benefits of getting the COVID-19 vaccination. Anxiety and somatic symptom disorders and symptoms are widely reported [7] . I do not think that anything serious is going on based on your description. She went home and completed her domestic chores and did not complain of any issue to her employers, son or friends. Federal government websites often end in .gov or .mil. Your post-vaccine aches shouldnt last longer than a couple of days. 2020;586:583588. Disclaimer. Editor's note: The original version of this article referred to the deceased as Mdm Vargas. For me, I went to sleep that night and the aching was gone when I woke up, Dr. Bhuyan says of her own vaccination aches. For people age 12 and older, the Pfizer-BioNTech COVID-19 vaccine involves two shots. MeSH The exact reason for BFS is not known. Nature. She also said that she did not have any reaction to the first and second doses of the Pfizer-BioNTech vaccine. She developed symptoms soon after receiving the vaccine, the court heard. FOIA Clipboard, Search History, and several other advanced features are temporarily unavailable. This service is provided on News Group Newspapers' Limited's Standard Terms and Conditions in accordance with our Privacy & Cookie Policy. Contact us, Despite receiving appropriate medical care, her condition d. eteriorated rapidly and she died on Dec 13, 2021. The COVID-19 vaccine makers are indemnified by the government and are not party to CICP proceedings. The Sun website is regulated by the Independent Press Standards Organisation (IPSO), Our journalists strive for accuracy but on occasion we make mistakes. There are also very rare reports of conditions that develop after SARS-CoV-2 infection, as they sometimes do with other types of infections. Within the MSK system, COVID-19 may affect bones, muscles, the coagulation pathway, peripheral nerves, and joints. The vaccine further advances Pfizers pediatric pneumococcal vaccine portfolio and builds on more than 20 years of Pfizer leadership, legacy and innovation in Neurologists have concerns about potential neurological The Ohio Department of Health repealed authorization for the monovalent COVID-19 vaccines from Moderna and Although rare, COVID-19 can cause seizures or major strokes. : Bedridden 8 Ear symptoms E.g. Upgraded but still having issues? 2 min read. N. Engl. Although the incidence rate of ocular symptoms is considerably lower in the vaccinated subjects than in COVID-19 patients, physicians should be aware of the possible associations between COVID-19 vaccines and ocular symptoms for the early diagnosis and treatment of vision problems or life-threatening complications. Dehydration is a common cause of muscle cramps, he tells Bustle. As with treating other post-vaccine side effects (think: fever and injection-site soreness), Dr. Bhuyan tells Bustle that its OK to take painkillers after getting your shot. joint pain, muscle stiffness, pain in the extremities 208 Gastrointestinal symptoms E.g. SINGAPORE: A 43-year-old woman who received a COVID-19 vaccine booster died about four days later, a coroner's court heard on Friday (Apr 14). Today in Pediatrics researchers published the safety data of the Pfizer-BioNTech (BNT-162b2) COVID-19 vaccine in adolescents ages 12 to 17 years.
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