Review

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A SYSTEMATIC REVIEW OF AUTOPSY FINDINGS IN DEATHS AFTER

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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.

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Risch, MD, PhD5, Mark Trozzi, MD3, Peter A. McCullough, MD, MPH3 6

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1University of Michigan School of Public Health, Ann Arbor, MI, USA
2Former
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Senior Pandemic Advisor to A Secretary, Health and Human Services
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(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
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3 Wellness Company, Boca Raton, FL

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4Cross Cancer Institute, Alberta Health Services, 11560 University Avenue,

Edmonton, AB T6G 1Z2, Canada.

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

6Truth for Health Foundation, Tucson, AZ, ORCID ID: 0000-0002-0997-6355
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*Correspondence: [email protected] (Nicolas Hulscher)

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Word Count: 2281

This preprint research paper has not been peer reviewed.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

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Background: The rapid development and widespread deployment of COVID-19

vaccines, combined with a high number of adverse event reports, have led to

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concerns over possible mechanisms of injury including systemic lipid nanoparticle

(LNP) and mRNA distribution, spike protein-associated tissue damage,

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thrombogenicity, immune system dysfunction, and carcinogenicity. The aim of this

systematic review is to investigate possible causal links between COVID-19

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vaccine administration and death using autopsies and post-mortem analysis.

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Methods: We searched for all published autopsy and necropsy reports relating to
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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
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325 autopsy cases and one necropsy case. Three physicians independently

reviewed all deaths and determined whether COVID-19 vaccination was the direct
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cause or contributed significantly to death.

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Findings: The most implicated organ system in COVID-19 vaccine-associated

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death was the cardiovascular system (53%), followed by the hematological system

(17%), the respiratory system (8%), and multiple organ systems (7%). Three or
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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
 death was 14.3 days. Most deaths occurred within a week from last vaccine

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administration. A total of 240 deaths (73.9%) were independently adjudicated as

directly due to or significantly contributed to by COVID-19 vaccination.

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Interpretation: The consistency seen among cases in this review with known

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COVID-19 vaccine adverse events, their mechanisms, and related excess death,

coupled with autopsy confirmation and physician-led death adjudication, suggests

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there is a high likelihood of a causal link between COVID-19 vaccines and death

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in most cases. Further urgent investigation is required for the purpose of clarifying

our findings.
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Keywords: Autopsy; necropsy; COVID-19; COVID-19 vaccines; mRNA; SARS-
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CoV-2 vaccination; death; excess mortality; spike protein; organ system

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

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Evidence before this study

COVID-19 vaccines, with known mechanisms of injury to the human body and a

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substantial number of adverse event reports, represent an exposure that we

hypothesized to be possibly linked to death in some cases. Thus, we searched

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PubMed and ScienceDirect for all published autopsy and necropsy reports relating

to COVID-19 vaccination through May 18th, 2023 using keywords relating to

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COVID-19 vaccines, death, autopsy, and necropsy. We found that no

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comprehensive review of autopsy findings in a large series of deaths after COVID-

19 vaccination that accounts for the current state of knowledge has been
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conducted. The mechanisms of death from COVID-19 vaccination remain largely

unexplored.
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Added value of this study

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Because the state of knowledge has advanced since the time of the original
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publications, new assessments regarding COVID-19 vaccine adverse events can be

made. Based on the previously published literature of COVID-19 vaccine adverse

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events, their mechanisms, and related excess death, coupled with autopsy

confirmation and physician-led death adjudication, we found a high likelihood of a

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causal link between COVID-19 vaccines and death among most of the 326

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 included cases. This is the first study that indicates a high probability of causality

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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,

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helping the medical community to better understand fatal COVID-19 vaccine

syndromes.

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Implications of all the available evidence

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Further urgent investigation is required aimed at confirming our results and further

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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
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COVID-19 vaccines. If a large number of deaths are indeed causally linked to

COVID-19 vaccination, the implications could be immense, including: the

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complete withdrawal of all COVID-19 vaccines from the global market,

suspension of all remaining COVID-19 vaccine mandates and passports, loss of

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public trust in government and medical institutions, investigations and inquiries

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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
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administration of COVID-19 vaccines.

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

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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

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to this worldwide catastrophe, governments adopted a coordinated approach to

limit caseloads and mortality utilizing a combination of non-pharmaceutical

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interventions (NPIs) and novel gene-based vaccine platforms. The first doses of

vaccine were administered less than 11 months after the identification of the

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SARS-CoV-2 genetic sequence (in the United States, under the

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Operation Warp Speed initiative), which represented the fastest vaccine

development in history with limited assurances of short and long-term safety2. At

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the time of writing, about 69% of the world population have been inoculated with

at least one dose of a COVID-19 vaccine1.

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The most frequently utilized COVID-19 vaccine platforms include

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inactivated virus (Sinovac – CoronaVac), protein subunit (Novavax – NVX-

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CoV2373), viral vector (AstraZeneca – ChAdOx1 nCoV-19, Johnson & Johnson –

Ad26.COV2.S), and messenger RNA (Pfizer-BioNTech – BNT162b2, Moderna –

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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
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immunological response. Circulating SP is the likely deleterious mechanism

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 through which COVID-19 vaccines produce adverse effects4,5,7,8,10,11. SP and/or

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subunits/peptide fragments can trigger ACE2 receptor degradation and

internalization, which may also cause destabilization of the renin–angiotensin

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system (RAS), resulting in possible enhanced inflammation, vasoconstriction, and

thrombosis4. SP activates platelets, causes endothelial damage, and directly

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promotes arterial and venous thrombosis5. Moreover, immune system cells that

have taken up the lipid nanoparticles (LNPs) then release them back into the

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circulation with elevated numbers of exosomes containing SP and microRNAs that

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play a role in inducing a signaling response in recipient cells at distant sites,

resulting in severe inflammatory consequences5. Further, long term cancer control

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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
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SARS-CoV-2 mRNA vaccination and neurodegenerative disease, myocarditis,

immune thrombocytopenia, Bell's palsy, liver disease, impaired adaptive

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immunity, impaired DNA damage response and tumorigenesis5.

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These findings are supported by the recent discovery that repeated COVID-19

vaccination with mRNA-based vaccines causes production of abnormally high

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levels of IgG4 antibodies which can lead to immune tolerance to SP, immune

suppression, and promote the development of autoimmune diseases, myocarditis,

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and cancer growth6.

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 ed
Neurotoxic effects of SP may cause or contribute to the post-COVID

syndrome, including headache, tinnitus, autonomic dysfunction, and small fiber

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neuropathy7. Specific to the administration of viral vector COVID-19 vaccines

(AstraZeneca; Johnson and Johnson) a new clinical syndrome called vaccine-

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induced immune thrombotic thrombocytopenia (VITT) was identified in 2021 and

characterized by the development of thromboses at atypical body sites combined

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with severe thrombocytopenia after vaccination9. The pathogenesis of this life-

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threatening side effect is currently unknown, though it has been proposed that

VITT is caused by post-vaccination antibodies against platelet factor 4 (PF4)

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triggering extensive platelet activation9. mRNA-based vaccines rarely cause VITT,

but they are associated with myocarditis, or inflammation of myocardium10. The

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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
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of SP and self-antigens, immune response to mRNA, and dysregulated cytokine

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expression10. In adolescents and young adults diagnosed with post-mRNA vaccine

myocarditis, free SP was detected in the blood while vaccinated controls had no
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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
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This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 data indicate that adverse events may occur for an unknown period after

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vaccination, with SP playing an important potential etiological role.

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A Freedom of Information Act (FOIA) document obtained from the

Australian Government, titled Nonclinical Evaluation of BNT162b2 [mRNA]

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COVID-19 vaccine (COMIRNATY), shows systemic distribution of the LNPs

containing mRNA after vaccine administration in rats, concluding that LNPs

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reached their highest concentration at the injection site, followed by the liver,

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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
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organ systems, raising significant concerns regarding the safety profile of COVID-

19 vaccines. Given the identified vaccination syndromes and their possible

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mechanisms, the frequency of adverse event reports is expected to be high,

especially given the vast number of vaccine doses administered globally.

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Through May 5th, 2023, the Vaccine Adverse Events Reporting System

(VAERS) contained 1,556,050 adverse event reports associated with COVID-19

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vaccines, including 35,324 deaths, 26,928 myocarditis and pericarditis, 19,546

heart attacks, and 8,701 thrombocytopenia reports14. If the alarmingly high number
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of reported deaths are indeed causally linked to COVID-19 vaccination, the

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 implications could be immense, including: the complete withdrawal of all COVID-

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19 vaccines from the global market, suspension of all remaining COVID-19

vaccine mandates and passports, loss of public trust in government and medical

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institutions, investigations and inquiries into the censorship, silencing and

persecution of doctors and scientists who raised these concerns, and compensation

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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

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vaccination and death, however, is not possible due to many limitations and

confounding factors. er
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Autopsies are one of the most powerful diagnostic tools in medicine to

establish cause of death and clarify the pathophysiology of disease15. COVID-19

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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
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to death in some cases. The purpose of this systematic review is to investigate

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possible causal links between COVID-19 vaccine administration and death using

autopsies and post-mortem analysis.

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Methods
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This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 We performed a systematic review of all published autopsy and necropsy

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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

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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

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were imposed. The following databases were used: PubMed and ScienceDirect.

The following keywords were used: ‘COVID-19 Vaccine’, ‘SARS-CoV-2

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Vaccine’, ‘COVID Vaccination’, and ‘Post-mortem’, ‘Autopsy’, or ‘Necropsy’.

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All selected studies were screened for relevant literature contained in their

references. Because the state of knowledge has advanced since the time of the
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original publications, we performed a contemporary review: three physicians (RH,

WM, PAM) with experience in death adjudication and anatomical/clinical

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pathology independently reviewed the available information of each case and

determined whether or not COVID-19 vaccination was the direct cause or

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contributed significantly to the mechanism of death described. Agreement was

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reached when two or more physicians adjudicated the case concordantly. For the

study by Chaves20, only cardiovascular and hematological system related cases

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were adjudicated as being linked to the vaccine due to a high probability of

COVID-19 vaccination contributing to death and missing individual case

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information for the other individuals. Given the presence of some missing data, we

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 used all available information to calculate the descriptive statistics. Estimated age

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(exact age not given) and inferred time from last vaccine administration to death

(no definitive time given) were excluded from calculations.

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Results

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A database search yielded 678 studies that had potential to meet our

inclusion criterion. 562 duplicates were screened out. Out of the remaining 116

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papers, 36 met our specified inclusion criterion. Through further analysis of

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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

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of COVID-19 vaccinees (Figure 1).
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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
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were 139 females (42.6%). Most received a Pfizer/BioNTech vaccine (41%),

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followed by Sinovac (37%), AstraZeneca (13%), Moderna (7%), Johnson &

Johnson (1%), and Sinopharm (1%).

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The cardiovascular system was most frequently implicated (53%), followed

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by hematological (17%), respiratory (8%), multiple organ systems (7%),

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 neurological (4%), immunological (3%), and gastrointestinal (1%). In 7% of cases,

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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,

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three in 8 cases, and four or more in 13 cases (Figure 3).

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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),

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2 (median) after two doses, and 5.7 (mean), 2 (median) after three doses. The

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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
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vaccination (Figure 4). 240 deaths (73.9%) were independently adjudicated by

three physicians to be significantly linked to COVID-19 vaccination (Table S1).

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Among adjudicators, there was complete independent agreement (all three

physicians) of vaccination causing or contributing to death in 203 cases (62.5%).

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The one necropsy case was judged to be linked to vaccination with complete
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agreement.
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Discussion

We found 73.9% of deaths after COVID-19 vaccination were attributable to

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fatal vaccine injury syndromes. The cardiovascular system was by far the most

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 implicated organ system in death, followed by hematological, respiratory, multiple

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organ systems, neurological, immunological, and gastrointestinal (Figure 2), with

three or more organ systems affected in 21 cases (Figure 3). The majority of deaths

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occurred within a week from last vaccine administration (Figure 4) and were

independently adjudicated by three physicians to be significantly associated with

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vaccination (Table S1). These results corroborate known COVID-19 vaccine-

induced syndromes and show significant, temporal associations between COVID-

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19 vaccination and death involving multiple organ systems, with a predominant

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implication of the cardiovascular and hematological systems. Criteria of causality

from an epidemiological perspective have been met including biological

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plausibility, temporal association, internal and external validity, coherence,

analogy, and reproducibility with each successive report of death after COVID-19
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vaccination.
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Our findings amplify concerns regarding COVID-19 vaccine adverse events

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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
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also highlight the involvement of multiple organ systems in some of the deaths

associated with COVID-19 vaccination. This might be attributed to the

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Multisystem Inflammatory Syndrome (MIS) that has been detected following

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 COVID-19 vaccination in both children60 and adults61. A possible mechanism by

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which MIS occurs after vaccination could be the systemic distribution of the LNPs

containing mRNA after vaccine administration13 and the consequent systemic SP

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expression and circulation resulting in system-wide inflammation. A significant

proportion of cases were due to hematological system adverse events, which is not

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surprising given that VITT62 and pulmonary embolism (PE)63 have been reported

in the literature as serious adverse events following COVID-19 vaccination. Deaths

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caused by adverse effects to the respiratory system were also relatively common in

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our review, a finding that is in line with the possibility of developing acute

respiratory distress syndrome (ARDS) or drug-induced interstitial lung disease

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(DIILD) after COVID-19 vaccination64,65. Although uncommon among cases in

this study, immunological66, neurological67, and gastrointestinal68 adverse events

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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

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SP. Given the average time (14.3 days) in which cases died after vaccination, a
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temporal association between COVID-19 vaccination and death among most cases

is further supported by the finding that SARS-CoV-2 spike mRNA vaccine

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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
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share a common feature that causes adverse effects, which is most likely SP.

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 ed
The large number of COVID-19 vaccine induced deaths evaluated in this

review is consistent with multiple papers that report excess mortality after

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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 vaccine-

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associated deaths in the United States between February and August of 202169.

With similar findings, Skidmore estimated that 278,000 people may have died

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from the COVID-19 vaccine in the United States by December 202170. These

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concerning results were further elucidated by Aarstad and Kvitastein, who found

that among 31 countries in Europe, a higher population COVID-19 vaccine uptake

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in 2021 was positively correlated with increased all-cause mortality in the first nine

months of 2022 after controlling for alternative explanations71. Furthermore,

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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

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deleterious exposure among populations. Pantazatos estimated that VAERS deaths

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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
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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

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failure in human history.

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 ed
In summary, we identified a large series of deaths after COVID-19

vaccination, confirmed with autopsy and necropsy, to help the medical community

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better understand fatal COVID-19 vaccine syndromes. The consistency seen

among cases in this review with known COVID-19 vaccine adverse events, their

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mechanisms, and related excess death, coupled with autopsy confirmation and

expert physician death adjudication, suggests there is a high likelihood of a causal

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link between COVID-19 vaccines and death in most cases. Even with substantial

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evidence, our paper cannot definitively determine causality as our paper has all the

limitations of systematic reviews of previously published papers including

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selection bias, publication bias, and confounding variables. Further urgent

investigation is required aimed at confirming our results and further elucidating the
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mechanisms underlying the described fatal outcomes with the goal of risk

mitigation for the large numbers of individuals who have taken one or more
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COVID-19 vaccines.
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Acknowledgements

None.
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Conflict of Interest

Drs Alexander, Amerling, Hodkinson, Makis, McCullough, Risch, Trozzi are

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affiliated with and receive salary support and or hold equity positions in The

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
 Wellness Company, Boca Raton, FL which had no role in funding, analysis, or

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publication.

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69.Pantazatos S, Seligmann H. COVID vaccination and age-stratified all-cause

mortality risk. Research Gate 2021 Oct 26. Epub Oct 26. DOI:
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71.Aarstad, J.; Kvitastein, O.A. Is there a Link between the 2021 COVID-19
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Vaccination Uptake in Europe and 2022 Excess All-Cause Mortality?.

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72.Beesoon S, Bakal JA, Youngson E, Williams KP, Berzins SA, Brindle ME,

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Am J Public Health. 2022 Dec;112(12):1800-1803. doi:

10.2105/AJPH.2022.307096. PMID: 36383938; PMCID: PMC9670212.

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74.Karlinsky A, Kobak D. The World Mortality Dataset: Tracking excess

mortality across countries during the COVID-19 pandemic. medRxiv

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[Preprint]. 2021 Jun 4:2021.01.27.21250604. doi:

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to the COVID-19 pandemic: a systematic analysis of COVID-19-related

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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.

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2022 Apr 16;399(10334):1468. PMID: 35279232; PMCID: PMC8912932.

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 76.Msemburi W, Karlinsky A, Knutson V, Aleshin-Guendel S, Chatterji S,

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

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Figure 1: Preferred Reporting Items for Systemic Reviews and Meta-Analyses

(PRISMA) flow diagram detailing the study selection process.

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Figure 2: Proportion of Cases by Affected Organ System

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Figure 3: Number of Affected Organ Systems by Cases

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Figure 4: Distribution of Time from Last Vaccine Administration to Death
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 Table Legends

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Table 1: Characteristics of included studies on COVID-19 vaccination possibly

causing death.

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Supplemental Table 1: Detailed Case Information and Death Adjudications

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 ed
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Figure 1.
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 ed
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Figure 2.
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 ed
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Figure 3.
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Figure 4.
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This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
AUTHOR

HOJBERG
YEA
R
2023
COUNTR CASE AGE
Y
USA
S*
1
SEX VACCIN DOS
E
Moderna
E**
DISEASE ORGAN
SYSTEM
Eosinophili Immunologic
*** RE d
PERIOD PROCEDU

e
‘recent’ Autopsy
[16]
NUSHIDA
[17]
2023 Japan 1 14 F Pfizer 3
a
MIS
al
MIS

ie w 2 days Autopsy

JEON [18] 2023 Korea 1 19 M Pfizer 2 Multiple

sclerosis

e vNeurological 182 days Autopsy

r
ESPOSITO 2023 Italy 1 83 M Pfizer 2 COVID-19 MIS Autopsy
[19]
CHAVES
[20]
2022 Columbia 121 84 52% Sinovac,
(mean F
)
AZ,
Pfizer
er 1-2 SCD, MI,
PE
Cardiovascul
ar,
Hematologica
Autopsy

MORZ [21] 2022 Germany 1 76 M Pfizer

p e 2
l
Encephaliti MIS
s,
21 days Autopsy

ALUNNI 2022 France 1 70 M

o t AZ 1
myocarditi
s
VITT Hematologica 25 days Autopsy
[22]
TAKAHAS
HI [23]
2022 Japan 1

t n
‘90s’ M Pfizer 3
l
Pericarditis Cardiovascul 14 days
ar
Autopsy

ir n
MURATA 2022 Japan 4 34 M Moderna 2 Cytokine Immunologic 1-10 days Autopsy
[24] (mean , Pfizer Storm al
)
SATOMI
[25]
2022

e p
Japan 1 61 F Pfizer 1 Myocarditi
s
Cardiovascul
ar
10 days Autopsy

SUZUKI
[26]

Pr
2021 Japan 54 68.1 37% Pfizer,
(mean F 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
MELE [27] 2022 Italy 1
)
54 M J&J 1 VITT Hematologica ~21 days
e d
Autopsy

YOSHIMUR 2022
A [28]
Japan 1 88 F Moderna 2 VI-ARDS
l
Respiratory

ie w
18 days Autopsy

v
RONCATI 2022 Italy 3 72.3 2F Pfizer 1-2 VITT Hematologica 18-122 Autopsy
[29] (mean l days

KANG [30] 2022 Korea 1

)
48 F AZ,
r2 Myocarditi
e Cardiovascul 15 days Necropsy

r
Pfizer s (required ar (heart)
transplant,

KAMURA
[31]
2022 Japan 1 57 M Moderna 1

ee no death)
Thrombosi
s/rhabdom
MIS 53 days Autopsy

ISHIOKA
[32]
2022 Japan 1 67 M

t Pfizer
p 1
yolysis
Exacerbati
on of UIP
Respiratory 3 days Autopsy

GILL [33]

POMARA
2022

2022
USA

Italy
2

1
‘teena M

37
n
ge’
F o Pfizer

AZ
2

1
Myocarditi
s
VITT
Cardiovascul 3-4 days
ar
Hematologica 24 days
Autopsy

Autopsy
[34]
YEO [35] 2022 Singapore 28

ir n t
65.1 17.9
(mean % F
)
Pfizer,
Moderna
1-2 Various
l
Various <3 days Autopsy

AMERATU 2022
NGA [36]
GUNTHER 2021
e p
New
Zealand
Germany
1

1
57

54
F

M
Pfizer

AZ
1

1
Myocarditi
s
VITT
Cardiovascul
ar
Hematologica
3 days

~121
Autopsy

Autopsy
[37]

P
PERMEZEL 2022r Australia 1 63 M AZ 1 ADEM
l
Neurological
days
32 days Autopsy

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137
[38]
CHOI [39] 2021 Korea 1 22 M Pfizer 1 Myocarditi Cardiovascul 5 days
e d
Autopsy

SCHNEIDE
R [40]
2021 Germany 18 62.6 50% AZ,
(mean F Pfizer,
1-2
s
Various
ar
Various

ie w 1-14 days Autopsy

v
) Moderna
, J&J
VERMA
[41]
2021 USA 1 42 M Moderna 2

r
Myocarditi
s
e Cardiovascul ~14 days Autopsy
ar

r
WIEDMAN 2021 Norway 4 41.8 F AZ 1 VITT Hematologica 7-25 days Autopsy
N [42] (mean l

POMARA
[43]
2021 Italy 2
)
43.5
(mean
1F AZ

ee VITT Hematologica 16-24

l days
Autopsy

ALTHAUS
[44]
2021 Germany 2
)
36
(mean
1F

t AZ
p 1 VITT Hematologica 16-17
l days
Autopsy

EDLER [45] 2021 Germany 3

)

n
‘elder
ly’
1F
o Pfizer 1 COVID-19, Cardiovascul
MI, PE ar,
2-12 days Autopsy

HANSEN
[46]
2021 Germany
ir n
1 t
86 M Pfizer 1
Hematologica
l, Respiratory
Renal/respi MIS
ratory
26 days Autopsy

BARONTI
[47]
2022

e p
Italy 5 64
(mean
1F Pfizer,
Moderna
1-2
failure
MI Cardiovascul
ar
<1 day –
21 days
Autopsy

ITTIWUT

Pr
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
[48] (mean F
)
Sinophar
m,
e d
Sinovac,
Pfizer,
Moderna

ie w
v
GREINACH 2021 Germany 1 49 F AZ 1 VITT Hematologica 10 days Autopsy
ER [49] l
MAURIELL
O [50]
2021 Italy 1 48 F AZ

r
1 VITT

e Hematologica 39 days
l
Autopsy

r
BJØRNSTA 2021 Norway 1 ‘youn F AZ 1 VITT Hematologica ~10 days Autopsy
D-TUVENG g’ l
[51]
SCULLY
[52]
2021 U.K. 1 52 F AZ

ee 1 VITT Hematologica
l
~>10
days
Autopsy

CHOI [53]

SCHWAB
2021

2023
Korea

Germany
1

5
38

57.6 3F
M

t
J&J

Pfizer, p
1-2
1 SCLS

Myocarditi
Hematologica
l
Cardiovascul
2 days

<7 days
Autopsy

Autopsy
[54]

HIRSCHBU 2022 Germany 29

(mean
)

n
32-97 45% o Moderna

Pfizer, 1-2
s

COVID-19
ar

Various ~1-307 Autopsy

HL [55]

HOSHINO
[56]
2022 Japan
ir n
1 t
27
F

M
AZ,
Sinovac
Moderna 1 Myocarditi
s
Cardiovascul
ar
days

36 days Autopsy

COLOMBO
[57]
2023

e p
Italy 5 72
(mean
)
2F Pfizer 2 Various Respiratory,
MIS
188-298
days
Autopsy

MOSNA
[58]

Pr
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
KAIMORI
[59]
2022 Japan 1 72 F Pfizer 1 TMA Hematologica 2 days
l
e d
Autopsy

ie w
v
*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

r
~ = Inferred Period (Estimated period using all available information, definitive period not given)
e
r
Table 1.

e
p e
o t
t n
ir n
e p
Pr
This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4496137