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The Lancet is engaging in scientific censorship of Autopsy Findings

The Lancet published the following preprint on its server, which is a review of autopsy findings in deaths after COVID-19 gene therapy dosing, that finds “74% of the deaths were caused with the gene therapies”. It then pulled the paper in less than 24 hours with no meaningful explanation. The Daily Sceptic explains here.

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A SYSTEMATIC REVIEW OF AUTOPSY FINDINGS IN DEATHS AFTER COVID-19 VACCINATION

Nicolas Hulscher, BS 1*, Paul E. Alexander, PhD2 , Richard Amerling, MD3 , Heather Gessling, MD3 , Roger Hodkinson, MD3 , William Makis, MD4 , Harvey A. Risch, MD, PhD5 , Mark Trozzi, MD3 , Peter A. McCullough, MD, MPH3 6 1

University of Michigan School of Public Health, Ann Arbor, MI, USA

2Former Senior Pandemic Advisor to A Secretary, Health and Human Services (HHS, Washington, DC, former Assistant Professor in evidence-based medicine and epidemiology, former WHO-PAHO COVID consultant (evidence synthesis; present, advisor to The Wellness Company USA and Canada, Boca Raton, FL

3 Wellness Company, Boca Raton, FL

4Cross Cancer Institute, Alberta Health Services, 11560 University Avenue, Edmonton, AB T6G 1Z2, Canada.

5Professor Emeritus, Yale University School of Public Health, New Haven, CT

6Truth for Health Foundation, Tucson, AZ, ORCID ID: 0000-0002-0997-6355 *Correspondence: nichulscher@gmail.com (Nicolas Hulscher)

Word Count: 2281

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137

Preprint not peer reviewed

Abstract

Background: The rapid development and widespread deployment of COVID-19 vaccines, combined with a high number of adverse event reports, have led to concerns over possible mechanisms of injury including systemic lipid nanoparticle (LNP) and mRNA distribution, spike protein-associated tissue damage, thrombogenicity, immune system dysfunction, and carcinogenicity. The aim of this systematic review is to investigate possible causal links between COVID-19 vaccine administration and death using autopsies and post-mortem analysis.

Methods: We searched for all published autopsy and necropsy reports relating to COVID-19 vaccination up until May 18th, 2023. We initially identified 678 studies and, after screening for our inclusion criteria, included 44 papers that contained 325 autopsy cases and one necropsy case. Three physicians independently reviewed all deaths and determined whether COVID-19 vaccination was the direct cause or contributed significantly to death.

Findings: The most implicated organ system in COVID-19 vaccine-associated death was the cardiovascular system (53%), followed by the hematological system (17%), the respiratory system (8%), and multiple organ systems (7%). Three or more organ systems were affected in 21 cases. The mean time from vaccination to This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed death was 14.3 days. Most deaths occurred within a week from last vaccine administration. A total of 240 deaths (73.9%) were independently adjudicated as directly due to or significantly contributed to by COVID-19 vaccination.

Interpretation: The consistency seen among cases in this review with known COVID-19 vaccine adverse events, their mechanisms, and related excess death, coupled with autopsy confirmation and physician-led death adjudication, suggests there is a high likelihood of a causal link between COVID-19 vaccines and death in most cases. Further urgent investigation is required for the purpose of clarifying our findings.

Research in context

Evidence before this study

COVID-19 vaccines, with known mechanisms of injury to the human body and a substantial number of adverse event reports, represent an exposure that we hypothesized to be possibly linked to death in some cases. Thus, we searched PubMed and ScienceDirect for all published autopsy and necropsy reports relating to COVID-19 vaccination through May 18th, 2023 using keywords relating to COVID-19 vaccines, death, autopsy, and necropsy. We found that no comprehensive review of autopsy findings in a large series of deaths after COVID19 vaccination that accounts for the current state of knowledge has been conducted. The mechanisms of death from COVID-19 vaccination remain largely unexplored.

Added value of this study

Because the state of knowledge has advanced since the time of the original publications, new assessments regarding COVID-19 vaccine adverse events can be made. Based on the previously published literature of COVID-19 vaccine adverse events, their mechanisms, and related excess death, coupled with autopsy confirmation and physician-led death adjudication, we found a high likelihood of a causal link between COVID-19 vaccines and death among most of the 326 included cases. This is the first study that indicates a high probability of causality between COVID-19 vaccine administration and death in many cases. To date, this is the largest review of autopsy findings in deaths after COVID-19 vaccination, helping the medical community to better understand fatal COVID-19 vaccine syndromes.

Implications of all the available evidence

Further urgent investigation is required aimed at confirming our results and further elucidating the mechanisms underlying the described fatal outcomes with the goal of risk mitigation for the large numbers of individuals who have taken one or more COVID-19 vaccines. If a large number of deaths are indeed causally linked to COVID-19 vaccination, the implications could be immense, including: the complete withdrawal of all COVID-19 vaccines from the global market, suspension of all remaining COVID-19 vaccine mandates and passports, loss of public trust in government and medical institutions, investigations and inquiries into the censorship, silencing and persecution of doctors and scientists who raised these concerns, and compensation for those who were harmed as a result of the administration of COVID-19 vaccines.

Introduction

As of May 31st, 2023, SARS-CoV-2 has infected an estimated 767,364,883 people globally, resulting in 6,938,353 deaths1. As a direct response to this worldwide catastrophe, governments adopted a coordinated approach to limit caseloads and mortality utilizing a combination of non-pharmaceutical interventions (NPIs) and novel gene-based vaccine platforms. The first doses of vaccine were administered less than 11 months after the identification of the SARS-CoV-2 genetic sequence (in the United States, under the Operation Warp Speed initiative), which represented the fastest vaccine development in history with limited assurances of short and long-term safety2 . At the time of writing, about 69% of the world population have been inoculated with at least one dose of a COVID-19 vaccine1 .

The most frequently utilized COVID-19 vaccine platforms include inactivated virus (Sinovac – CoronaVac), protein subunit (Novavax – NVXCoV2373), viral vector (AstraZeneca – ChAdOx1 nCoV-19, Johnson & Johnson – Ad26.COV2.S), and messenger RNA (Pfizer-BioNTech – BNT162b2, Moderna – mRNA-1273)3 . All utilize mechanisms that can cause serious adverse events; most involve the uncontrolled synthesis of the spike glycoprotein (SP) as the basis of the immunological response. Circulating SP is the likely deleterious mechanism through which COVID-19 vaccines produce adverse effects4,5,7,8,10,11. SP and/or subunits/peptide fragments can trigger ACE2 receptor degradation and internalization, which may also cause destabilization of the renin–angiotensin system (RAS), resulting in possible enhanced inflammation, vasoconstriction, and thrombosis4 . SP activates platelets, causes endothelial damage, and directly promotes arterial and venous thrombosis5 . Moreover, immune system cells that have taken up the lipid nanoparticles (LNPs) then release them back into the circulation with elevated numbers of exosomes containing SP and microRNAs that play a role in inducing a signaling response in recipient cells at distant sites, resulting in severe inflammatory consequences5 . Further, long term cancer control may be jeopardized in those injected with mRNA COVID-19 vaccines because of IRF7 and IRF9 suppression5 . There is a distinct potential of a causal link between SARS-CoV-2 mRNA vaccination and neurodegenerative disease, myocarditis, immune thrombocytopenia, Bell's palsy, liver disease, impaired adaptive immunity, impaired DNA damage response and tumorigenesis5 . These findings are supported by the recent discovery that repeated COVID-19 vaccination with mRNA-based vaccines causes production of abnormally high levels of IgG4 antibodies which can lead to immune tolerance to SP, immune suppression, and promote the development of autoimmune diseases, myocarditis, and cancer growth6 .

Neurotoxic effects of SP may cause or contribute to the post-COVID syndrome, including headache, tinnitus, autonomic dysfunction, and small fiber neuropathy7 . Specific to the administration of viral vector COVID-19 vaccines (AstraZeneca; Johnson and Johnson) a new clinical syndrome called vaccineinduced immune thrombotic thrombocytopenia (VITT) was identified in 2021 and characterized by the development of thromboses at atypical body sites combined with severe thrombocytopenia after vaccination9 . The pathogenesis of this lifethreatening side effect is currently unknown, though it has been proposed that VITT is caused by post-vaccination antibodies against platelet factor 4 (PF4) triggering extensive platelet activation9 . mRNA-based vaccines rarely cause VITT, but they are associated with myocarditis, or inflammation of myocardium10. The mechanisms for the development of myocarditis after COVID-19 vaccination are not clear, but it has been hypothesized that it may be caused by molecular mimicry of SP and self-antigens, immune response to mRNA, and dysregulated cytokine expression10. In adolescents and young adults diagnosed with post-mRNA vaccine myocarditis, free SP was detected in the blood while vaccinated controls had no circulating SP11. It has been demonstrated that SARS-CoV-2 spike mRNA vaccine sequences can circulate in the blood for at least 28 days after vaccination12. These data indicate that adverse events may occur for an unknown period after vaccination, with SP playing an important potential etiological role.

A Freedom of Information Act (FOIA) document obtained from the Australian Government, titled Nonclinical Evaluation of BNT162b2 [mRNA] COVID-19 vaccine (COMIRNATY), shows systemic distribution of the LNPs containing mRNA after vaccine administration in rats, concluding that LNPs reached their highest concentration at the injection site, followed by the liver, spleen, adrenal glands, ovaries, and bone marrow (femur) over 48 hours13. This biodistribution data suggests that SP may be expressed in cells from many vital organ systems, raising significant concerns regarding the safety profile of COVID19 vaccines. Given the identified vaccination syndromes and their possible mechanisms, the frequency of adverse event reports is expected to be high, especially given the vast number of vaccine doses administered globally.

Through May 5th, 2023, the Vaccine Adverse Events Reporting System (VAERS) contained 1,556,050 adverse event reports associated with COVID-19 vaccines, including 35,324 deaths, 26,928 myocarditis and pericarditis, 19,546 heart attacks, and 8,701 thrombocytopenia reports14. If the alarmingly high number of reported deaths are indeed causally linked to COVID-19 vaccination, the implications could be immense, including: the complete withdrawal of all COVID19 vaccines from the global market, suspension of all remaining COVID-19 vaccine mandates and passports, loss of public trust in government and medical institutions, investigations and inquiries into the censorship, silencing and persecution of doctors and scientists who raised these concerns, and compensation for those who were harmed as a result of the administration of COVID-19 vaccines. Using VAERS data alone to establish a causal link between COVID-19 vaccination and death, however, is not possible due to many limitations and confounding factors.

Autopsies are one of the most powerful diagnostic tools in medicine to establish cause of death and clarify the pathophysiology of disease15. COVID-19 vaccines, with plausible mechanisms of injury to the human body and a substantial number of adverse event reports, represent an exposure that may be causally linked to death in some cases. The purpose of this systematic review is to investigate possible causal links between COVID-19 vaccine administration and death using autopsies and post-mortem analysis.

Methods

We performed a systematic review of all published autopsy and necropsy reports relating to COVID-19 vaccination through May 18th, 2023. All autopsy studies that include COVID-19 vaccines as a possible cause of death were included. All necropsy (analysis of dead tissue) studies that include COVID-19 vaccines as a possible cause of organ death were included. No other restrictions were imposed. The following databases were used: PubMed and ScienceDirect. The following keywords were used: ‘COVID-19 Vaccine’, ‘SARS-CoV-2 Vaccine’, ‘COVID Vaccination’, and ‘Post-mortem’, ‘Autopsy’, or ‘Necropsy’. All selected studies were screened for relevant literature contained in their references. Because the state of knowledge has advanced since the time of the original publications, we performed a contemporary review: three physicians (RH, WM, PAM) with experience in death adjudication and anatomical/clinical pathology independently reviewed the available information of each case and determined whether or not COVID-19 vaccination was the direct cause or contributed significantly to the mechanism of death described. Agreement was reached when two or more physicians adjudicated the case concordantly. For the study by Chaves20, only cardiovascular and hematological system related cases were adjudicated as being linked to the vaccine due to a high probability of COVID-19 vaccination contributing to death and missing individual case information for the other individuals. Given the presence of some missing data, we used all available information to calculate the descriptive statistics. Estimated age (exact age not given) and inferred time from last vaccine administration to death (no definitive time given) were excluded from calculations.

Results

A database search yielded 678 studies that had potential to meet our inclusion criterion. 562 duplicates were screened out. Out of the remaining 116 papers, 36 met our specified inclusion criterion. Through further analysis of references, we located 18 additional papers, with 8 of them meeting our inclusion criterion. In total, we found 44 studies that contained autopsy or necropsy reports of COVID-19 vaccinees (Figure 1).

Table 1 summarizes the 44 studies16-59. There were a total of 325 autopsy cases and 1 necropsy case (heart). The mean age of death was 70.4 years and there were 139 females (42.6%). Most received a Pfizer/BioNTech vaccine (41%), followed by Sinovac (37%), AstraZeneca (13%), Moderna (7%), Johnson & Johnson (1%), and Sinopharm (1%).

The cardiovascular system was most frequently implicated (53%), followed by hematological (17%), respiratory (8%), multiple organ systems (7%), neurological (4%), immunological (3%), and gastrointestinal (1%). In 7% of cases, the cause of death was either unknown, non-natural (drowning, head injury, etc.) or infection (Figure 2). One organ system was affected in 302 cases, two in 3 cases, three in 8 cases, and four or more in 13 cases (Figure 3).

The number of days from vaccination until death was 14.3 (mean), 3 (median) irrespective of dose, 7.8 (mean), 3 (median) after one dose, 23.2 (mean), 2 (median) after two doses, and 5.7 (mean), 2 (median) after three doses. The distribution of days from last vaccine administration to death is highly right skewed, showing that most of the deaths occurred within a week from last vaccination (Figure 4). 240 deaths (73.9%) were independently adjudicated by three physicians to be significantly linked to COVID-19 vaccination (Table S1). Among adjudicators, there was complete independent agreement (all three physicians) of vaccination causing or contributing to death in 203 cases (62.5%). The one necropsy case was judged to be linked to vaccination with complete agreement.

Discussion

We found 73.9% of deaths after COVID-19 vaccination were attributable to fatal vaccine injury syndromes. The cardiovascular system was by far the most implicated organ system in death, followed by hematological, respiratory, multiple organ systems, neurological, immunological, and gastrointestinal (Figure 2), with three or more organ systems affected in 21 cases (Figure 3). The majority of deaths occurred within a week from last vaccine administration (Figure 4) and were independently adjudicated by three physicians to be significantly associated with vaccination (Table S1). These results corroborate known COVID-19 vaccineinduced syndromes and show significant, temporal associations between COVID19 vaccination and death involving multiple organ systems, with a predominant implication of the cardiovascular and hematological systems. Criteria of causality from an epidemiological perspective have been met including biological plausibility, temporal association, internal and external validity, coherence, analogy, and reproducibility with each successive report of death after COVID-19 vaccination.

Our findings amplify concerns regarding COVID-19 vaccine adverse events and their mechanisms. SP’s deleterious effects5,6,7,8,10,11, especially on the heart10,11 , likely explains the high proportion of cardiovascular deaths seen in our study. They also highlight the involvement of multiple organ systems in some of the deaths associated with COVID-19 vaccination. This might be attributed to the Multisystem Inflammatory Syndrome (MIS) that has been detected following COVID-19 vaccination in both children60 and adults61. A possible mechanism by which MIS occurs after vaccination could be the systemic distribution of the LNPs containing mRNA after vaccine administration13 and the consequent systemic SP expression and circulation resulting in system-wide inflammation. A significant proportion of cases were due to hematological system adverse events, which is not surprising given that VITT62 and pulmonary embolism (PE)63 have been reported in the literature as serious adverse events following COVID-19 vaccination. Deaths caused by adverse effects to the respiratory system were also relatively common in our review, a finding that is in line with the possibility of developing acute respiratory distress syndrome (ARDS) or drug-induced interstitial lung disease (DIILD) after COVID-19 vaccination64,65. Although uncommon among cases in this study, immunological66, neurological67, and gastrointestinal68 adverse events can still occur after COVID-19 vaccination and, as with the cardiovascular system, may be directly or indirectly caused by the systemic expression or circulation of SP. Given the average time (14.3 days) in which cases died after vaccination, a temporal association between COVID-19 vaccination and death among most cases is further supported by the finding that SARS-CoV-2 spike mRNA vaccine sequences can circulate in the blood for at least 28 days after vaccination12. Most of the deployed vaccine platforms are associated with death, suggesting that they share a common feature that causes adverse effects, which is most likely SP.

The large number of COVID-19 vaccine induced deaths evaluated in this review is consistent with multiple papers that report excess mortality after vaccination. Pantazatos and Seligmann found that all-cause mortality increased 0- 5 weeks post-injection in most age groups resulting in 146,000 to 187,000 vaccineassociated deaths in the United States between February and August of 202169 . With similar findings, Skidmore estimated that 278,000 people may have died from the COVID-19 vaccine in the United States by December 202170. These concerning results were further elucidated by Aarstad and Kvitastein, who found that among 31 countries in Europe, a higher population COVID-19 vaccine uptake in 2021 was positively correlated with increased all-cause mortality in the first nine months of 2022 after controlling for alternative explanations71. Furthermore, excess mortality from non-COVID-19 causes has been detected in many countries since the mass vaccination programs began72,73,74,75,76,77, suggesting a common deleterious exposure among populations. Pantazatos estimated that VAERS deaths are underreported by a factor of 2069. If we apply this underreporting factor to the May 5th, 2023, VAERS death report count of 35,32414, the number of deaths in the United States alone becomes 706,480. If this extrapolated number of deaths were to be confirmed, the COVID-19 vaccines would represent the largest medical failure in human history.

In summary, we identified a large series of deaths after COVID-19 vaccination, confirmed with autopsy and necropsy, to help the medical community better understand fatal COVID-19 vaccine syndromes. The consistency seen among cases in this review with known COVID-19 vaccine adverse events, their mechanisms, and related excess death, coupled with autopsy confirmation and expert physician death adjudication, suggests there is a high likelihood of a causal link between COVID-19 vaccines and death in most cases. Even with substantial evidence, our paper cannot definitively determine causality as our paper has all the limitations of systematic reviews of previously published papers including selection bias, publication bias, and confounding variables. Further urgent investigation is required aimed at confirming our results and further elucidating the mechanisms underlying the described fatal outcomes with the goal of risk mitigation for the large numbers of individuals who have taken one or more COVID-19 vaccines.

Acknowledgements

None.

Conflict of Interest

Drs Alexander, Amerling, Hodkinson, Makis, McCullough, Risch, Trozzi are affiliated with and receive salary support and or hold equity positions in The Wellness Company, Boca Raton, FL which had no role in funding, analysis, or publication. References

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Leg Med (Tokyo). 2023 Mar 20;63:102244. doi: 10.1016/j.legalmed.2023.102244. Epub ahead of print. PMID: 36990036; PMCID: PMC10027302. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed 18.Jeon YH, Choi S, Park JH, Lee JK, Yeo NS, Lee S, Suh YL. Sudden Death Associated With Possible Flare-Ups of Multiple Sclerosis After COVID-19 Vaccination and Infection: A Case Report and Literature Review. J Korean Med Sci. 2023 Mar 13;38(10):e78. doi: 10.3346/jkms.2023.38.e78. PMID: 36918031; PMCID: PMC10010908. 19.Esposito M, Cocimano G, Vanaria F, Sessa F, Salerno M. Death from COVID-19 in a Fully Vaccinated Subject: A Complete Autopsy Report. Vaccines (Basel). 2023 Jan 9;11(1):142. doi: 10.3390/vaccines11010142. PMID: 36679987; PMCID: PMC9865400. 20.Chaves JJ, Bonilla JC, Chaves-Cabezas V, Castro A, Polo JF, Mendoza O, Correa-Rodríguez J, Piedrahita AC, Romero-Fandiño IA, Caro MV, González AC, Sánchez LK, Murcia F, Márquez G, Benavides A, Quiroga MDP, López J, Parra-Medina R. A postmortem study of patients vaccinated for SARS-CoV-2 in Colombia. Rev Esp Patol. 2023 Jan-Mar;56(1):4-9. doi: 10.1016/j.patol.2022.09.003. Epub 2022 Oct 31. PMID: 36599599; PMCID: PMC9618417. 21.Mörz M. A Case Report: Multifocal Necrotizing Encephalitis and Myocarditis after BNT162b2 mRNA Vaccination against COVID-19. Vaccines (Basel). 2022 Oct 1;10(10):1651. doi: 10.3390/vaccines10101651. PMID: 36298516; PMCID: PMC9611676. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed 22.Alunni V, Bernardi C, Chevalier N, Cabusat C, Quatrehomme G, Torrents J, Biglia E, Gaillard Y, Drici MD. Postmortem PF4 antibodies confirm a rare case of thrombosis thrombocytopenia syndrome associated with ChAdOx1 nCoV-19 anti-COVID vaccination. Int J Legal Med. 2023 Mar;137(2):487- 492. doi: 10.1007/s00414-022-02910-1. Epub 2022 Oct 27. PMID: 36289074; PMCID: PMC9607767. 23.Takahashi M, Kondo T, Yamasaki G, Sugimoto M, Asano M, Ueno Y, Nagasaki Y. An autopsy case report of aortic dissection complicated with histiolymphocytic pericarditis and aortic inflammation after mRNA COVID19 vaccination. Leg Med (Tokyo). 2022 Nov;59:102154. doi: 10.1016/j.legalmed.2022.102154. Epub 2022 Sep 29. PMID: 36191411; PMCID: PMC9519380. 24.Murata K, Nakao N, Ishiuchi N, Fukui T, Katsuya N, Fukumoto W, Oka H, Yoshikawa N, Nagao T, Namera A, Kakimoto N, Oue N, Awai K, Yoshimoto K, Nagao M. Four cases of cytokine storm after COVID-19 vaccination: Case report. Front Immunol. 2022 Aug 15;13:967226. doi: 10.3389/fimmu.2022.967226. PMID: 36045681; PMCID: PMC9420842. 25.Satomi H, Katano H, Kanno H, Kobayashi M, Ohkuma Y, Hashidume N, Usui T, Tsukada S, Ito I. An autopsy case of fulminant myocarditis after severe acute respiratory syndrome coronavirus 2 vaccine inoculation. Pathol This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed Int. 2022 Oct;72(10):519-524. doi: 10.1111/pin.13267. Epub 2022 Aug 30. PMID: 36040128; PMCID: PMC9537995. 26.Suzuki H, Ro A, Takada A, Saito K, Hayashi K. Autopsy findings of postCOVID-19 vaccination deaths in Tokyo Metropolis, Japan, 2021. Leg Med (Tokyo). 2022 Nov;59:102134. doi: 10.1016/j.legalmed.2022.102134. Epub 2022 Aug 20. PMID: 36037554; PMCID: PMC9392553. 27.Mele F, Tafuri S, Stefanizzi P, D Amati A, Calvano M, Leonardelli M, Macorano E, Duma S, De Gabriele G, Introna F, De Donno A. Cerebral venous sinus thrombosis after COVID-19 vaccination and congenital deficiency of coagulation factors: Is there a correlation? Hum Vaccin Immunother. 2022 Nov 30;18(6):2095166. doi: 10.1080/21645515.2022.2095166. Epub 2022 Jul 27. PMID: 35895937; PMCID: PMC9746424. 28.Yoshimura Y, Sasaki H, Miyata N, Miyazaki K, Okudela K, Tateishi Y, Hayashi H, Kawana-Tachikawa A, Iwashita H, Maeda K, Ihama Y, Hatayama Y, Ryo A, Tachikawa N. An autopsy case of COVID-19-like acute respiratory distress syndrome after mRNA-1273 SARS-CoV-2 vaccination. Int J Infect Dis. 2022 Aug;121:98-101. doi: 10.1016/j.ijid.2022.04.057. Epub 2022 Apr 30. PMID: 35500794; PMCID: PMC9054706. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed 29.Roncati L, Manenti A, Corsi L. A Three-Case Series of Thrombotic Deaths in Patients over 50 with Comorbidities Temporally after modRNA COVID19 Vaccination. Pathogens. 2022 Apr 3;11(4):435. doi: 10.3390/pathogens11040435. PMID: 35456110; PMCID: PMC9032304. 30.Kang DH, Na JY, Yang JH, Moon SH, Kim SH, Jung JJ, Cha HJ, Ahn JH, Park YW, Cho SY, Yu HK, Lee SH, Park MY, Kim JW, Byun JH. Fulminant Giant Cell Myocarditis following Heterologous Vaccination of ChAdOx1 nCoV-19 and Pfizer-BioNTech COVID-19. Medicina (Kaunas). 2022 Mar 20;58(3):449. doi: 10.3390/medicina58030449. PMID: 35334625; PMCID: PMC8950462. 31.Kamura Y, Terao T, Akao S, Kono Y, Honma K, Matsue K. Fatal thrombotic microangiopathy with rhabdomyolysis as an initial symptom after the first dose of mRNA-1273 vaccine: A case report. Int J Infect Dis. 2022 Apr;117:322-325. doi: 10.1016/j.ijid.2022.02.031. Epub 2022 Feb 18. PMID: 35189339; PMCID: PMC8853962. 32.Ishioka Y, Makiguchi T, Itoga M, Tanaka H, Taima K, Goto S, Tasaka S. Acute Exacerbation of Interstitial Lung Disease After SARS-CoV-2 Vaccination: A Case Series. Chest. 2022 Dec;162(6):e311-e316. doi: 10.1016/j.chest.2022.08.2213. PMID: 36494131; PMCID: PMC9723271. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed 33.Gill JR, Tashjian R, Duncanson E. Autopsy Histopathologic Cardiac Findings in 2 Adolescents Following the Second COVID-19 Vaccine Dose. Arch Pathol Lab Med. 2022 Aug 1;146(8):925-929. doi: 10.5858/arpa.2021- 0435-SA. PMID: 35157759. 34.Pomara C, Salerno M, Esposito M, Sessa F, Certo F, Tripodo C, Rappa F, Barbagallo GM. Histological and immunohistochemical findings in a fatal case of thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. Pathol Res Pract. 2022 Mar;231:153796. doi: 10.1016/j.prp.2022.153796. Epub 2022 Feb 4. PMID: 35144085. 35.Yeo A, Kuek B, Lau M, Tan SR, Chan S. Post COVID-19 vaccine deaths - Singapore's early experience. Forensic Sci Int. 2022 Jan 19;332:111199. doi: 10.1016/j.forsciint.2022.111199. Epub ahead of print. PMID: 35078041; PMCID: PMC8767909. 36.Ameratunga R, Woon ST, Sheppard MN, Garland J, Ondruschka B, Wong CX, Stewart RAH, Tatley M, Stables SR, Tse RD. First Identified Case of Fatal Fulminant Necrotizing Eosinophilic Myocarditis Following the Initial Dose of the Pfizer-BioNTech mRNA COVID-19 Vaccine (BNT162b2, Comirnaty): an Extremely Rare Idiosyncratic Hypersensitivity Reaction. J Clin Immunol. 2022 Apr;42(3):441-447. doi: 10.1007/s10875-021-01187-0. Epub 2022 Jan 3. PMID: 34978002; PMCID: PMC8720536. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed 37.Günther A, Brämer D, Pletz MW, Kamradt T, Baumgart S, Mayer TE, Baier M, Autsch A, Mawrin C, Schönborn L, Greinacher A, Thiele T. Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia-A Case Report. Vaccines (Basel). 2021 Nov 17;9(11):1344. doi: 10.3390/vaccines9111344. PMID: 34835275; PMCID: PMC8622649. 38.Permezel F, Borojevic B, Lau S, de Boer HH. Acute disseminated encephalomyelitis (ADEM) following recent Oxford/AstraZeneca COVID19 vaccination. Forensic Sci Med Pathol. 2022 Mar;18(1):74-79. doi: 10.1007/s12024-021-00440-7. Epub 2021 Nov 4. PMID: 34735684; PMCID: PMC8567127. 39.Choi S, Lee S, Seo JW, Kim MJ, Jeon YH, Park JH, Lee JK, Yeo NS. Myocarditis-induced Sudden Death after BNT162b2 mRNA COVID-19 Vaccination in Korea: Case Report Focusing on Histopathological Findings. J Korean Med Sci. 2021 Oct 18;36(40):e286. doi: 10.3346/jkms.2021.36.e286. PMID: 34664804; PMCID: PMC8524235. 40.Schneider J, Sottmann L, Greinacher A, Hagen M, Kasper HU, Kuhnen C, Schlepper S, Schmidt S, Schulz R, Thiele T, Thomas C, Schmeling A. Postmortem investigation of fatalities following vaccination with COVID-19 vaccines. Int J Legal Med. 2021 Nov;135(6):2335-2345. doi: This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed 10.1007/s00414-021-02706-9. Epub 2021 Sep 30. PMID: 34591186; PMCID: PMC8482743. 41.Verma AK, Lavine KJ, Lin CY. Myocarditis after Covid-19 mRNA Vaccination. N Engl J Med. 2021 Sep 30;385(14):1332-1334. doi: 10.1056/NEJMc2109975. Epub 2021 Aug 18. PMID: 34407340; PMCID: PMC8385564. 42.Wiedmann M, Skattør T, Stray-Pedersen A, Romundstad L, Antal EA, Marthinsen PB, Sørvoll IH, Leiknes Ernstsen S, Lund CG, Holme PA, Johansen TO, Brunborg C, Aamodt AH, Schultz NH, Skagen K, Skjelland M. Vaccine Induced Immune Thrombotic Thrombocytopenia Causing a Severe Form of Cerebral Venous Thrombosis With High Fatality Rate: A Case Series. Front Neurol. 2021 Jul 30;12:721146. doi: 10.3389/fneur.2021.721146. PMID: 34393988; PMCID: PMC8363077. 43.Pomara C, Sessa F, Ciaccio M, Dieli F, Esposito M, Giammanco GM, Garozzo SF, Giarratano A, Prati D, Rappa F, Salerno M, Tripodo C, Mannucci PM, Zamboni P. COVID-19 Vaccine and Death: Causality Algorithm According to the WHO Eligibility Diagnosis. Diagnostics (Basel). 2021 May 26;11(6):955. doi: 10.3390/diagnostics11060955. PMID: 34073536; PMCID: PMC8229116. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed 44.Althaus K, Möller P, Uzun G, Singh A, Beck A, Bettag M, Bösmüller H, Guthoff M, Dorn F, Petzold GC, Henkes H, Heyne N, Jumaa H, Kreiser K, Limpach C, Luz B, Maschke M, Müller JA, Münch J, Nagel S, Pötzsch B, Müller J, Schlegel C, Viardot A, Bäzner H, Wolf M, Pelzl L, Warm V, Willinek WA, Steiner J, Schneiderhan-Marra N, Vollherbst D, Sachs UJ, Fend F, Bakchoul T. Antibody-mediated procoagulant platelets in SARSCoV-2-vaccination associated immune thrombotic thrombocytopenia. Haematologica. 2021 Aug 1;106(8):2170-2179. doi: 10.3324/haematol.2021.279000. PMID: 34011137; PMCID: PMC8327736. 45.Edler C, Klein A, Schröder AS, Sperhake JP, Ondruschka B. Deaths associated with newly launched SARS-CoV-2 vaccination (Comirnaty®). Leg Med (Tokyo). 2021 Jul;51:101895. doi: 10.1016/j.legalmed.2021.101895. Epub 2021 Apr 17. PMID: 33895650; PMCID: PMC8052499. 46.Hansen T, Titze U, Kulamadayil-Heidenreich NSA, Glombitza S, Tebbe JJ, Röcken C, Schulz B, Weise M, Wilkens L. First case of postmortem study in a patient vaccinated against SARS-CoV-2. Int J Infect Dis. 2021 Jun;107:172-175. doi: 10.1016/j.ijid.2021.04.053. Epub 2021 Apr 16. PMID: 33872783; PMCID: PMC8051011. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed 47.Baronti A, Gentile F, Manetti AC, Scatena A, Pellegrini S, Pucci A, Franzini M, Castiglione V, Maiese A, Giannoni A, Pistello M, Emdin M, Aquaro GD, Di Paolo M. Myocardial Infarction Following COVID-19 Vaccine Administration: Post Hoc, Ergo Propter Hoc? Viruses. 2022 Jul 27;14(8):1644. doi: 10.3390/v14081644. PMID: 36016266; PMCID: PMC9413746. 48.Ittiwut C, Mahasirimongkol S, Srisont S, Ittiwut R, Chockjamsai M, Durongkadech P, Sawaengdee W, Khunphon A, Larpadisorn K, Wattanapokayakit S, Wetchaphanphesat S, Arunotong S, Srimahachota S, Pittayawonganon C, Thammawijaya P, Sutdan D, Doungngern P, Khongphatthanayothin A, Kerr SJ, Shotelersuk V. Genetic basis of sudden death after COVID-19 vaccination in Thailand. Heart Rhythm. 2022 Aug 5;19(11):1874–9. doi: 10.1016/j.hrthm.2022.07.019. Epub ahead of print. PMID: 35934244; PMCID: PMC9352648. 49.Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination. N Engl J Med. 2021 Jun 3;384(22):2092-2101. doi: 10.1056/NEJMoa2104840. Epub 2021 Apr 9. PMID: 33835769; PMCID: PMC8095372. 50.Mauriello A, Scimeca M, Amelio I, Massoud R, Novelli A, Di Lorenzo F, Finocchiaro S, Cimino C, Telesca R, Chiocchi M, Sun Q, Wang Y, Shi Y, This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed Novelli G, Melino G. Thromboembolism after COVID-19 vaccine in patients with preexisting thrombocytopenia. Cell Death Dis. 2021 Aug 3;12(8):762. doi: 10.1038/s41419-021-04058-z. PMID: 34344867; PMCID: PMC8328816. 51.Bjørnstad-Tuveng TH, Rudjord A, Anker P. Fatal cerebral haemorrhage after COVID-19 vaccine. Tidsskr Nor Laegeforen. 2021 Apr 29;141. English, Norwegian. doi: 10.4045/tidsskr.21.0312. PMID: 33928772. 52.Scully M, Singh D, Lown R, Poles A, Solomon T, Levi M, Goldblatt D, Kotoucek P, Thomas W, Lester W. Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021 Jun 10;384(23):2202-2211. doi: 10.1056/NEJMoa2105385. Epub 2021 Apr 16. PMID: 33861525; PMCID: PMC8112532. 53.Choi GJ, Baek SH, Kim J, Kim JH, Kwon GY, Kim DK, Jung YH, Kim S. Fatal Systemic Capillary Leak Syndrome after SARS-CoV-2Vaccination in Patient with Multiple Myeloma. Emerg Infect Dis. 2021 Nov;27(11):2973- 2975. doi: 10.3201/eid2711.211723. Epub 2021 Aug 30. PMID: 34459725; PMCID: PMC8544977. 54.Schwab C, Domke LM, Hartmann L, Stenzinger A, Longerich T, Schirmacher P. Autopsy-based histopathological characterization of myocarditis after anti-SARS-CoV-2-vaccination. Clin Res Cardiol. 2023 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed Mar;112(3):431-440. doi: 10.1007/s00392-022-02129-5. Epub 2022 Nov 27. PMID: 36436002; PMCID: PMC9702955. 55.Hirschbühl K, Schaller T, Märkl B, Claus R, Sipos E, Rentschler L, Maccagno A, Grosser B, Kling E, Neidig M, Kröncke T, Spring O, Braun G, Bösmüller H, Seidl M, Esposito I, Pablik J, Hilsenbeck J, Boor P, Beer M, Dintner S, Wylezich C. High viral loads: what drives fatal cases of COVID19 in vaccinees? - an autopsy study. Mod Pathol. 2022 Aug;35(8):1013- 1021. doi: 10.1038/s41379-022-01069-9. Epub 2022 Apr 1. PMID: 35365771; PMCID: PMC8974809. 56.Hoshino N, Yanase M, Ichiyasu T, Kuwahara K, Kawai H, Muramatsu T, Ishii H, Tsukamoto T, Morimoto SI, Izawa H. An autopsy case report of fulminant myocarditis: Following mRNA COVID-19 vaccination. J Cardiol Cases. 2022 Dec;26(6):391-394. doi: 10.1016/j.jccase.2022.06.006. Epub 2022 Jul 4. PMID: 35812802; PMCID: PMC9250935. 57.Colombo D, Del Nonno F, Marchioni L, Lalle E, Gallì P, Vaia F, Falasca L. Autopsies Revealed Pathological Features of COVID-19 in Unvaccinated vs. Vaccinated Patients. Biomedicines. 2023 Feb 14;11(2):551. doi: 10.3390/biomedicines11020551. PMID: 36831087; PMCID: PMC9953314. 58.Mosna K, Vadkerti P, Papp L, Palkovic M, Janega P, Babal P. GuillainBarré syndrome with lethal outcome following covid-19 vaccination - case This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed report supported by autopsy examination. The Open Neurology Journal. 2022 Mar 10;16(1). doi:10.2174/1874205x-v16-e2207270 59.Kaimori R, Nishida H, Uchida T, Tamura M, Kuroki K, Murata K, Hatakeyama K, Ikeda Y, Amemiya K, Nishizono A, Daa T, Mori S. Histopathologically TMA-like distribution of multiple organ thromboses following the initial dose of the BNT162b2 mRNA vaccine (Comirnaty, Pfizer/BioNTech): an autopsy case report. Thromb J. 2022 Oct 6;20(1):61. doi: 10.1186/s12959-022-00418-7. PMID: 36203145; PMCID: PMC9540301. 60.Wangu Z, Swartz H, Doherty M. Multisystem inflammatory syndrome in children (MIS-C) possibly secondary to COVID-19 mRNA vaccination. BMJ Case Rep. 2022 Mar 30;15(3):e247176. doi: 10.1136/bcr-2021- 247176. PMID: 35354564; PMCID: PMC8968554. 61.Ehikhametalor K, Deans-Minott J, Duncan JP. Multisystem Inflammatory Syndrome in Adults (MIS-A) After COVID-19 Infection and Recent Vaccination with Recombinant Adenoviral Vector Encoding the Spike Protein Antigen of SARS-CoV-2 (ChAdOx1 nCoV-19, Vaxzevria). J Intensive Care Med. 2023 Feb;38(2):232-237. doi: 10.1177/08850666221121589. Epub 2022 Aug 17. PMID: 35979616; PMCID: PMC9389272. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed 62.Zidan A, Noureldin A, Kumar SA, Elsebaie A, Othman M. COVID-19 Vaccine-Associated Immune Thrombosis and Thrombocytopenia (VITT): Diagnostic Discrepancies and Global Implications. Semin Thromb Hemost. 2023 Feb;49(1):9-14. doi: 10.1055/s-0042-1759684. Epub 2023 Jan 5. PMID: 36603593. 63.Ifeanyi N, Chinenye N, Oladiran O, David E, Mmonu C, Ogbonna-Nwosu C. Isolated pulmonary embolism following COVID vaccination: 2 case reports and a review of post-acute pulmonary embolism complications and follow-up. J Community Hosp Intern Med Perspect. 2021 Nov 15;11(6):877-879. doi: 10.1080/20009666.2021.1990825. PMID: 34804412; PMCID: PMC8604520. 64.Abraham B, Mohammed Saeed H, Azeez Pasha SA. Acute respiratory distress syndrome secondary to COVID-19 mRNA vaccine administration in a pregnant woman: A case report. Qatar Med J. 2022 Aug 9;2022(3):40. doi: 10.5339/qmj.2022.40. PMID: 35974885; PMCID: PMC9372495. 65.Yoshifuji A, Ishioka K, Masuzawa Y, Suda S, Murata S, Uwamino Y, Fujino M, Miyahara H, Hasegawa N, Ryuzaki M, Hoshino H, Sekine K. COVID-19 vaccine induced interstitial lung disease. J Infect Chemother. 2022 Jan;28(1):95-98. doi: 10.1016/j.jiac.2021.09.010. Epub 2021 Sep 20. PMID: 34580010; PMCID: PMC8450284. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed 66.Chen Y, Xu Z, Wang P, Li XM, Shuai ZW, Ye DQ, Pan HF. New-onset autoimmune phenomena post-COVID-19 vaccination. Immunology. 2022 Apr;165(4):386-401. doi: 10.1111/imm.13443. Epub 2022 Jan 7. PMID: 34957554. 67.Hosseini R, Askari N. A review of neurological side effects of COVID-19 vaccination. Eur J Med Res. 2023 Feb 25;28(1):102. doi: 10.1186/s40001- 023-00992-0. PMID: 36841774; PMCID: PMC9959958. 68.Ajmera K, Bansal R, Wilkinson H, Goyal L. Gastrointestinal Complications of COVID-19 Vaccines. Cureus. 2022 Apr 12;14(4):e24070. doi: 10.7759/cureus.24070. PMID: 35573556; PMCID: PMC9097558. 69.Pantazatos S, Seligmann H. COVID vaccination and age-stratified all-cause mortality risk. Research Gate 2021 Oct 26. Epub Oct 26. DOI: 10.13140/RG.2.2.28257.43366 70.Skidmore M. The role of social circle COVID-19 illness and vaccination experiences in COVID-19 vaccination decisions: an online survey of the United States population. BMC Infect Dis. 2023 Jan 24;23(1):51. doi: 10.1186/s12879-023-07998-3. Retraction in: BMC Infect Dis. 2023 Apr 11;23(1):223. PMID: 36694131; PMCID: PMC9872073. 71.Aarstad, J.; Kvitastein, O.A. Is there a Link between the 2021 COVID-19 Vaccination Uptake in Europe and 2022 Excess All-Cause Mortality?. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed Preprints.org 2023, 2023020350. https://doi.org/10.20944/preprints202302.0350.v1 72.Beesoon S, Bakal JA, Youngson E, Williams KP, Berzins SA, Brindle ME, Joffe AM. Excess deaths during the COVID-19 pandemic in Alberta, Canada. IJID Reg. 2022 Dec;5:62-67. doi: 10.1016/j.ijregi.2022.08.011. Epub 2022 Aug 30. PMID: 36060856; PMCID: PMC9424127. 73.Todd M, Scheeres A. Excess Mortality From Non-COVID-19 Causes During the COVID-19 Pandemic in Philadelphia, Pennsylvania, 2020-2021. Am J Public Health. 2022 Dec;112(12):1800-1803. doi: 10.2105/AJPH.2022.307096. PMID: 36383938; PMCID: PMC9670212. 74.Karlinsky A, Kobak D. The World Mortality Dataset: Tracking excess mortality across countries during the COVID-19 pandemic. medRxiv [Preprint]. 2021 Jun 4:2021.01.27.21250604. doi: 10.1101/2021.01.27.21250604. Update in: Elife. 2021 Jun 30;10: PMID: 33532789; PMCID: PMC7852240. 75.COVID-19 Excess Mortality Collaborators. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21. Lancet. 2022 Apr 16;399(10334):1513-1536. doi: 10.1016/S0140-6736(21)02796-3. Epub 2022 Mar 10. Erratum in: Lancet. 2022 Apr 16;399(10334):1468. PMID: 35279232; PMCID: PMC8912932. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed 76.Msemburi W, Karlinsky A, Knutson V, Aleshin-Guendel S, Chatterji S, Wakefield J. The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature. 2023 Jan;613(7942):130-137. doi: 10.1038/s41586-022-05522-2. Epub 2022 Dec 14. PMID: 36517599; PMCID: PMC9812776. 77.Shang W, Wang Y, Yuan J, Guo Z, Liu J, Liu M. Global Excess Mortality during COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Vaccines (Basel). 2022 Oct 12;10(10):1702. doi: 10.3390/vaccines10101702. PMID: 36298567; PMCID: PMC9607451. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed Figure Legends Figure 1: Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) flow diagram detailing the study selection process. Figure 2: Proportion of Cases by Affected Organ System Figure 3: Number of Affected Organ Systems by Cases Figure 4: Distribution of Time from Last Vaccine Administration to Death This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed Table Legends Table 1: Characteristics of included studies on COVID-19 vaccination possibly causing death. Supplemental Table 1: Detailed Case Information and Death Adjudications This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed Figure 1. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed Figure 2. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed Figure 3. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed Figure 4. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed AUTHOR YEA R COUNTR Y CASE S* AGE SEX VACCIN E DOS E** DISEASE ORGAN SYSTEM PERIOD *** PROCEDU RE HOJBERG [16] 2023 USA 1 Moderna Eosinophili a Immunologic al ‘recent’ Autopsy NUSHIDA [17] 2023 Japan 1 14 F Pfizer 3 MIS MIS 2 days Autopsy JEON [18] 2023 Korea 1 19 M Pfizer 2 Multiple sclerosis Neurological 182 days Autopsy ESPOSITO [19] 2023 Italy 1 83 M Pfizer 2 COVID-19 MIS Autopsy CHAVES [20] 2022 Columbia 121 84 (mean ) 52% F Sinovac, AZ, Pfizer 1-2 SCD, MI, PE Cardiovascul ar, Hematologica l Autopsy MORZ [21] 2022 Germany 1 76 M Pfizer 2 Encephaliti s, myocarditi s MIS 21 days Autopsy ALUNNI [22] 2022 France 1 70 M AZ 1 VITT Hematologica l 25 days Autopsy TAKAHAS HI [23] 2022 Japan 1 ‘90s’ M Pfizer 3 Pericarditis Cardiovascul ar 14 days Autopsy MURATA [24] 2022 Japan 4 34 (mean ) M Moderna , Pfizer 2 Cytokine Storm Immunologic al 1-10 days Autopsy SATOMI [25] 2022 Japan 1 61 F Pfizer 1 Myocarditi s Cardiovascul ar 10 days Autopsy SUZUKI [26] 2021 Japan 54 68.1 (mean 37% F Pfizer, Moderna 1-2 Various Various <7 days Autopsy This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed ) MELE [27] 2022 Italy 1 54 M J&J 1 VITT Hematologica l ~21 days Autopsy YOSHIMUR A [28] 2022 Japan 1 88 F Moderna 2 VI-ARDS Respiratory 18 days Autopsy RONCATI [29] 2022 Italy 3 72.3 (mean ) 2 F Pfizer 1-2 VITT Hematologica l 18-122 days Autopsy KANG [30] 2022 Korea 1 48 F AZ, Pfizer 2 Myocarditi s (required transplant, no death) Cardiovascul ar 15 days Necropsy (heart) KAMURA [31] 2022 Japan 1 57 M Moderna 1 Thrombosi s/rhabdom yolysis MIS 53 days Autopsy ISHIOKA [32] 2022 Japan 1 67 M Pfizer 1 Exacerbati on of UIP Respiratory 3 days Autopsy GILL [33] 2022 USA 2 ‘teena ge’ M Pfizer 2 Myocarditi s Cardiovascul ar 3-4 days Autopsy POMARA [34] 2022 Italy 1 37 F AZ 1 VITT Hematologica l 24 days Autopsy YEO [35] 2022 Singapore 28 65.1 (mean ) 17.9 % F Pfizer, Moderna 1-2 Various Various <3 days Autopsy AMERATU NGA [36] 2022 New Zealand 1 57 F Pfizer 1 Myocarditi s Cardiovascul ar 3 days Autopsy GUNTHER [37] 2021 Germany 1 54 M AZ 1 VITT Hematologica l ~121 days Autopsy PERMEZEL 2022 Australia 1 63 M AZ 1 ADEM Neurological 32 days Autopsy This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed [38] CHOI [39] 2021 Korea 1 22 M Pfizer 1 Myocarditi s Cardiovascul ar 5 days Autopsy SCHNEIDE R [40] 2021 Germany 18 62.6 (mean ) 50% F AZ, Pfizer, Moderna , J&J 1-2 Various Various 1-14 days Autopsy VERMA [41] 2021 USA 1 42 M Moderna 2 Myocarditi s Cardiovascul ar ~14 days Autopsy WIEDMAN N [42] 2021 Norway 4 41.8 (mean ) F AZ 1 VITT Hematologica l 7-25 days Autopsy POMARA [43] 2021 Italy 2 43.5 (mean ) 1 F AZ VITT Hematologica l 16-24 days Autopsy ALTHAUS [44] 2021 Germany 2 36 (mean ) 1 F AZ 1 VITT Hematologica l 16-17 days Autopsy EDLER [45] 2021 Germany 3 ‘elder ly’ 1 F Pfizer 1 COVID-19, MI, PE Cardiovascul ar, Hematologica l, Respiratory 2-12 days Autopsy HANSEN [46] 2021 Germany 1 86 M Pfizer 1 Renal/respi ratory failure MIS 26 days Autopsy BARONTI [47] 2022 Italy 5 64 (mean ) 1 F Pfizer, Moderna 1-2 MI Cardiovascul ar <1 day – 21 days Autopsy ITTIWUT 2022 Thailand 13 42.8 23% AZ, 1-3 Various Various 1-7 days Autopsy This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed [48] (mean ) F Sinophar m, Sinovac, Pfizer, Moderna GREINACH ER [49] 2021 Germany 1 49 F AZ 1 VITT Hematologica l 10 days Autopsy MAURIELL O [50] 2021 Italy 1 48 F AZ 1 VITT Hematologica l 39 days Autopsy BJØRNSTA D-TUVENG [51] 2021 Norway 1 ‘youn g’ F AZ 1 VITT Hematologica l ~10 days Autopsy SCULLY [52] 2021 U.K. 1 52 F AZ 1 VITT Hematologica l ~>10 days Autopsy CHOI [53] 2021 Korea 1 38 M J&J 1 SCLS Hematologica l 2 days Autopsy SCHWAB [54] 2023 Germany 5 57.6 (mean ) 3 F Pfizer, Moderna 1-2 Myocarditi s Cardiovascul ar <7 days Autopsy HIRSCHBU HL [55] 2022 Germany 29 32-97 45% F Pfizer, AZ, Sinovac 1-2 COVID-19 Various ~1-307 days Autopsy HOSHINO [56] 2022 Japan 1 27 M Moderna 1 Myocarditi s Cardiovascul ar 36 days Autopsy COLOMBO [57] 2023 Italy 5 72 (mean ) 2 F Pfizer 2 Various Respiratory, MIS 188-298 days Autopsy MOSNA [58] 2022 Slovakia 1 71 M Pfizer 2 GBS Neurological 10 days Autopsy This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed *Cases = Number of deaths examined post-mortem **Dose = Cumulative number of vaccine doses received ***Period = Time (in days) from most recent vaccine administration to death ~ = Inferred Period (Estimated period using all available information, definitive period not given) Table 1. KAIMORI [59] 2022 Japan 1 72 F Pfizer 1 TMA Hematologica l 2 days Autopsy

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137 Preprint not peer reviewed

Keywords: Autopsy; necropsy; COVID-19; COVID-19 vaccines; mRNA; SARSCoV-2 vaccination; death; excess mortality; spike protein; organ system