Systemic adverse reactions after the 5th dose of COVID-19 vaccine

As fewer and fewer people opt for additional boosters of COVID-19 vaccine, are those who never had vaccine adverse events experiencing new side effects?

VAERS reports many uneventful vaccinations even with extra doses given too soon after previous ones. Yet there are cases such as abdominal pain, or Addisonian crisis after the 5th dose. One case of systemic adverse reactions (14%, out of 7 respondents) was self-reported after the 5th booster in a survey-based study. The study also showed higher incidence of cutaneous reactions after 3rd vs 2nd dose of the same vaccine. 

89 out of 234 vaccinated individuals (38%) who filled out a web-based survey in Turkey reported at least one cutaneous adverse event related to the vaccination. The responders cumulatively received 771 doses. The mean number of vaccine dosages was 3.29 ± 0.76 (minimum:1, maximum:5). Sixty‐six (28.2%) cases had at least one accompanying systemic disease. Additionally, 74 (31.6%) had been diagnosed with one or more allergic disorder such as hay fever, food allergies, and allergic asthma, whereas 107 (45.7%) reported to have predisposition to develop acute or chronic eczema or xerosis. Fifty (21.4%) had at least one skin disorder, most common ones being eczema (n = 15, 30%), seborrheic dermatitis (n = 15, 30%), and chronic urticaria (n = 7, 14%). Fifty‐one (21.8%) respondents had been diagnosed with COVID‐19, prior to the vaccination. Out of 234 participants, only one person (0.4%) had a single dose of COVID‐19 vaccine; 32 (13.7%) had two doses, 105 (44.9%) had three doses, 89 (38%) had four doses, whereas 7 (3%) had five doses. Majority of participants had Sinovac/Coronavac as their initial vaccine series and Pfizer vaccine as their additional booster doses. The distribution of COVID‐19 vaccine types (Pfizer‐BioNTech mRNA COVID‐19 vaccine vs Sinovac‐CoronaVac inactivated COVID‐19 vaccine) is shown in the figure.

1 out of 7 recipients (14%) of the fifth dose of the Pfizer-BioNTech COVID-19 vaccine reported systemic adverse reactions compared to 54 out of 95 after the 4th dose (57%), 113 out of 189 who got BNT162b2 as the 3rd dose, 51 out of 73 who received it as the 2nd dose and 41 out of 69 who received it as their first dose. 

No statistically significant relationship was found between developing at least one systemic adverse event vs having any chronic disease (p = 0.993) and developing one or more cutaneous adverse event vs having a chronic disease (p = 0.143). Interestingly, female participants were found to exhibit systemic side effects compared with the male ones at a statistically significantly higher rate (p = 0.040). No statistically relationships were observed between the mean age (p = 0.202), the mean dose of vaccination (p = 0.276) and exhibiting at least one systemic side effect. No statistically significant relationship was seen between having chronic eczema (p = 0.534), having at least one allergic disease (p = 0.966), gender (p = 0.072), the mean age (p = 0.702), the mean number of vaccine doses (p = 0.400), and developing at least one cutaneous side effect. No statistical difference was found between having any skin disorder and developing a cutaneous side effect after COVID‐19 vaccination (p = 0.738). No statistically significant difference was observed between being diagnosed with COVID‐19 before the vaccination and developing a skin side effect (p = 0.844) or a systemic side effect (p = 0.431). 


Bostan E, Yel B, Karaduman A. Cutaneous adverse events following 771 doses of the inactivated and mRNA COVID-19 vaccines: A survey study among health care providers. J Cosmet Dermatol. 2022 Sep;21(9):3682-3688. doi: 10.1111/jocd.15203. Epub 2022 Jul 19. PMID: 35775860; PMCID: PMC9350229.

As of October 12, 2022, 627.9 million vaccine doses have been administered in the United States. Overall, about 265.1 million people, or 79.9% of the total U.S. population, have received at least one dose of vaccine. About 226.2 million people, or 68.1% of the total U.S. population, have completed a primary series. Of those who have completed a primary series, about 110.8 million people have received a booster dose, and more than 14.78 million people have received an updated (bivalent) booster dose. But 49.6% of the total booster-eligible population (59% of those between 50 and 65) has not yet received a booster dose. Only 4% received a bivalent booster.  As of November 22, 2022: 11% of US population aged >5 received a bivalent booster.

According to Cambodian Ministry of Health, 94.7% of Cambodia's 16 million population have received their 1st dose of the vaccine, 90.5% have taken 2 basic shots, 62% have got a 3rd dose, 24% have obtained a 4th dose, and 3.6% have received a 5th dose.


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