Editing Delayed onset of vaccine injury

Some evidence suggests that COVID vaccines can lead to delayed and serious reactions weeks after initial vaccination.  There are a few case reports of symptom onset 10 weeks after vaccination.

== MIS-V ==

Multisystem Inflammatory Syndrome (MIS) is labelled as MIS-C when it develops in children following a COVID-19 infection.  In rare cases, it can develop in adults (MIS-A).  Various published case reports have noted that it can also develop after vaccination (MIS-V) without a prior COVID-19 infection.  Onset of MIS-V can be many weeks after initial exposure.

Symptoms of MIS-C/A/V are similar to Kawasaki disease.

=== Published case reports on MIS-V ===

* [https://casereports.bmj.com/content/14/7/e243888 Nune et al.] - 2 days to onset, 44 year old female.  "we highlight the first reported MIS-V case after the SARS-CoV-2 vaccine"
* [https://doi.org/10.3201/eid2802.211938 Choi et al.] - 10 days to onset, 22 year old female.  "Ten days after receiving the first dose of coronavirus disease vaccine, a 22-year-old woman in South Korea experienced myocarditis, myopathy, pericarditis, and gastroenteritis; rash subsequently developed."
* '''[https://doi.org/10.3201/eid2711.211612 Grome et al.] - 22 days to onset''', male healthcare worker in his 30s.  "a fatal case of multisystem inflammatory syndrome in an adult with onset 22 days after a second dose of mRNA coronavirus disease vaccine. Serologic and clinical findings indicated severe acute respiratory syndrome coronavirus 2 infection occurred before vaccination."
* [https://doi.org/10.3201%2Feid2707.210594 Salzman et al.] - Onset not clear, 20 year old female, vaccinated 15 days before hospital admission.
* '''[https://doi.org/10.3390/vaccines9111353 Buchhorn et al.] - Onset 10 weeks after vaccination''', 18 year old male.
* '''[https://doi.org/10.1097/inf.0000000000003432 Yalçinkaya et al.] - Diagnosis 27 days after vaccination''', 12 year old male.
* '''[https://doi.org/10.1097/inf.0000000000003442 Abdelgalil et al.] - Onset ~5 weeks after Moderna vaccination''', 12 year old male.
* [https://doi.org/10.1097/cce.0000000000000578 Kahn et al.] - Symptom onset began 2 hours after vaccine administration, 20 year old male.
* [https://doi.org/10.1016/j.ijid.2021.12.339 Lieu et al.] - Onset 10 days after vaccination, 21 year old female.
* [https://doi.org/10.1002/ccr3.5138 Bishawi et al.] - Onset 10 days after second vaccine, 37 year old female.
* [https://doi.org/10.1097/inf.0000000000003444 DeJong et al.] - 14 year old female.
* [https://doi.org/10.1111/apa.16141 Chai et al.] - Onset 5 days after vaccination, 17 year old male.
* [https://doi.org/10.3346/jkms.2021.36.e312 Park et al.]- Onset 6 days after ChAdOx1 vaccination, 67 year old male.
* [https://doi.org/10.1080/17843286.2021.1977899 Stappers et al.] - Presented symptoms 18 days after Oxford/AstraZeneca vaccine, young woman.

===Selected VAERS case reports===

* [https://openvaers.com/vaersapp/report.php?vaers_id=2006451 2006451] - 12 days to onset, 6 year old female diagnosed with Kawasaki disease.
* [https://openvaers.com/vaersapp/report.php?vaers_id=1998916 1998916] - 27 days to onset, 9 year old female diagnosed with Kawasaki disease.  "5 days after covid-19 pfizer vaccine was given she developed a fever with a mild rash on her extremities.  [...]  Rash progressed to what appeared to be erythema multiforme, she had conjunctivitis as well as persistent fevers. Ended up being sent to ED on 12/31/21 for leukocytosis and thrombocytopenia [...]"
* [https://openvaers.com/vaersapp/report.php?vaers_id=2006451 2006451] - 12 days to onset, 6 year old female who was diagnosed with Kawasaki disease.  Vaccinated on 12-11-2021, developed rash 12/23.
* [https://openvaers.com/vaersapp/report.php?vaers_id=2175151 2175151] - 2 days to onset, 15 year old male diagnosed with Kawasaki's disease.
* '''[https://openvaers.com/vaersapp/report.php?vaers_id=2194347 2194347] - 69 days to onset''', 5 year old female diagnosed with MIS-C.  History of Kawasaki disease X2, 2018/2020.
* [https://openvaers.com/vaersapp/report.php?vaers_id=2226084 2226084] - Kawasaki disease following COVID, vaccination was 266 days ago.
* '''[https://openvaers.com/vaersapp/report.php?vaers_id=2271220 2271220] - 54 days to onset''', 10 year old male with "MIS-C vs Kawasaki".
* '''[https://openvaers.com/vaersapp/report.php?vaers_id=2271233 2271233] - 39 days to onset''', 10 year old male.  "Constellation of symptoms is concerning for Kawasaki versus MIS-C."
* '''[https://openvaers.com/vaersapp/report.php?vaers_id=2137230 2137230] - 43 days to onset''', 7 year old male being treated for MIS-C.
* [https://openvaers.com/vaersapp/report.php?vaers_id=2001194 2001194] - 6 days to onset, 10 year old male with MIS-C symptoms.
* '''[https://openvaers.com/vaersapp/report.php?vaers_id=2001220 2001220] - 16 days''' to onset from most recent COVID vaccination, 5 year old female with MIS-C.
* '''[https://openvaers.com/vaersapp/report.php?vaers_id=2021590 2021590] - 20 days to onset''', 65 year old female with MIS-A.

== Repeated exposure to spike protein ==

Many observational studies show that prior vaccination and COVID-19 infections increase the risk of adverse events following subsequent spike protein exposure.  This suggests that spike protein exposure can cause a long-term vulnerability to spike protein exposure without causing immediately obvious symptoms.  A future vaccine injury or case of Long COVID could be considered to be a delayed side effect of spike protein exposure.

See the [[COVID_prevention_and_treatment#Studies_showing_a_relationship_between_cumulative_spike_protein_exposure_and_risk_of_vaccine_side_effects|studies section]] on the COVID prevention and treatment page.

== Patient survey data ==

* React19's survey #1 (Persistent Symptoms Survey) found a '''minimal number''' of surveyees reporting that their symptoms began post 2 weeks following vaccination.  The survey population may have been skewed by low awareness of vaccine injury, causing those with delayed onset to not view themselves as vaccine injured.
* A German vaccine injury group's [https://nebenwirkungen-covid-impfung.org/pvs_umfrage_ergebnisse/ survey] found that '''more than a tenth''' of surveyees reported symptoms developing more than 2 weeks after vaccination.  An English translation of the survey will be published in the future.
* [https://caers.info/adverse-event-report-findings/ CAERS], a volunteer-run passive surveillance system for Canadians, reported that '''22.9% had delayed AEs 15+ days after injection'''.

== Retrospective convenience sample study ==

* https://doi.org/10.56098/ijvtpr.v3i1.67 - Banoun and Provost found that '''76.1%''' of adverse events occurred more than 6 weeks after vaccination.

== Potential mechanisms ==

A 2013 paper by [https://doi.org/10.1111%2Fimr.12091 Getts et al.] explains that autoimmunity development can take months or even years after the triggering pathogenic infection has resolved:

<blockquote>An important consideration is the fact that in most cases viruses and other microbes can infect a host without triggering any clear clinical symptoms.
[…]
Recently, a potential link between WNV infection and subsequent development of myasthenia gravis was described (158). In this report, disease development occurred several months after disease resolution, highlighting an important point that '''autoimmunity development may require significant time to evolve, becoming clinically evident months if not years after the triggering pathogenic infection has been resolved'''.</blockquote>