Background

  • Anyone who experiences a significant reaction following immunisation should first seek medical attention from a health professional
  • While no vaccine is entirely free of potential side effects, the benefits of immunisation far outweigh the risks
  • Severe side effects from vaccines are rare and common side effects are usually mild and short lasting

Should all AEFIs (adverse events following immunisation) following COVID-19 vaccines be reported?

You do not need to routinely report:

  • Common/expected reactions
  • These may include pain, redness, swelling and tenderness at the injection site, tiredness, headache, muscle pain, nausea, fever and chills, feeling unwell, joint pain

You should report:

  • Any event felt to be significant following COVID-19 immunisation, regardless of whether you think the side effect was related to the vaccine or not
  • Any expected reactions that have not gone away after a few days
  • Any reaction to a vaccine which requires assessment by a doctor or nurse
  • Suspected shoulder injury related to vaccine administration (SIRVA)
  • Any vaccination administration errors

Vaxzevria (AstraZeneca) side effects

Common side effects following vaccination with Vaxzevria (AstraZeneca) include swelling, redness, pain or itch at the injection site, joint pain and malaise (feeling unwell). Less common side effects include abdominal pain, dizziness, decreased appetite, pain in limb or enlarged lymph nodes. These side effects are experienced in up to two-thirds of people who receive this vaccine, and mostly resolve within 1-2 days. Symptomatic relief is recommended, eg. a cool compress at the injection site and simple analgesia such as paracetamol or ibuprofen.

Rare side effects include anaphylaxis and a rare clotting condition, thrombosis with thrombocytopenia (TTS). Symptoms of TTS may include a severe, persistent headache that does not settle with analgesia, abdominal pain, significant respiratory problems/distress, visual changes, vomiting, seizures, focal neurological deficits/changes, confusion/encephalopathy and usually occur 4-30 days after vaccination.

Comirnaty (Pfizer) and Spikevax (Moderna) side effects

Common side effects following vaccination with mRNA vaccines Comirnaty and Spikevax include swelling or pain at the injection site, fatigue, headache, myalgia (body aches), fever, chills or joint pain.

Less common side effects include redness at the injection site, nausea, enlarged lymph nodes or malaise (feeling unwell). Itchiness at the injection site, pain in limb or insomnia can also occur following Comirnaty™. These side-effects are usually mild, last 1-2 days and may require time off work. Systemic reactions are more common following the second dose of these vaccines. Symptomatic relief is recommended, eg. a cool compress at the injection site and simple analgesia such as paracetamol or ibuprofen.

Rare side effects following mRNA vaccines include anaphylaxis, myocarditis and perdicarditis. Anaphylaxis following Spikevax has been shown to occur at a rate of 2.5 cases per million doses and, whilst extremely rare, at a slightly higher rate of 4.7 per million doses following Comirnaty.

Cases of myocarditis and pericarditis have been reported following mRNA vaccines, particularly in young males following dose two. Myocarditis is an inflammation of the heart muscle, whilst perdicarditis is an inflammation of the lining of the heart muscle. Symptoms of include pain with breathing, chest pain, pressure or discomfort, shortness or breath, palpitations or syncope (faint) and most commonly occur 4-5 days after vaccination. If these symptoms are experienced following vaccination with an mRNA vaccine a medical review by a GP or presentation to an emergency department is indicated.

Can a patient be referred to a specialist immunisation clinic after experiencing AEFI?

The VicSIS network will provide specialist vaccination services for people who have experienced an AEFI with a COVID-19 vaccine, or those who are identified as at risk of an AEFI (for example, people with a history of anaphylaxis). Most people are able to proceed with future vaccines following an AEFI. Clinical consults will be offered in which individual recommendations will be developed. VicSIS clinics will have the ability to vaccinate under extended observation.

For more information on how to refer to VicSIS, please refer to MVEC: Victorian Specialist Immunisation Services (VicSIS)

Resources

Authors: Francesca Machingaifa (MVEC Education Nurse Coordinator) and Georgina Lewis (SAEFVIC Clinical Manager, Murdoch Children’s Research Institute)

Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator)

Date: September 2021

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.