Institute of Legal Medicine, University Hospital Münster, Münster, Germany.
Institute of Immunology and Transfusion Medicine, University Medicine of Greifswald, Greifswald, Germany.
Int J Legal Med. 2021 Nov;135(6):2335-2345. doi: 10.1007/s00414-021-02706-9. Epub 2021 Sep 30.
Thorough postmortem investigations of fatalities following vaccination with coronavirus disease 2019 (COVID-19) vaccines are of great social significance. From 11.03.2021 to 09.06.2021, postmortem investigations of 18 deceased persons who recently received a vaccination against COVID-19 were performed. Vaxzevria was vaccinated in nine, Comirnaty in five, Spikevax in three, and Janssen in one person. In all cases, full autopsies, histopathological examinations, and virological analyses for the severe acute respiratory syndrome coronavirus 2 were carried out. Depending on the case, additional laboratory tests (anaphylaxis diagnostics, VITT [vaccine-induced immune thrombotic thrombocytopenia] diagnostics, glucose metabolism diagnostics) and neuropathological examinations were conducted. In 13 deceased, the cause of death was attributed to preexisting diseases while postmortem investigations did not indicate a causal relationship to the vaccination. In one case after vaccination with Comirnaty, myocarditis was found to be the cause of death. A causal relationship to vaccination was considered possible, but could not be proven beyond doubt. VITT was found in three deceased persons following vaccination with Vaxzevria and one deceased following vaccination with Janssen. Of those four cases with VITT, only one was diagnosed before death. The synopsis of the anamnestic data, the autopsy results, laboratory diagnostic examinations, and histopathological and neuropathological examinations revealed that VITT was the very likely cause of death in only two of the four cases. In the other two cases, no neuropathological correlate of VITT explaining death was found, while possible causes of death emerged that were not necessarily attributable to VITT. The results of our study demonstrate the necessity of postmortem investigations on all fatalities following vaccination with COVID-19 vaccines. In order to identify a possible causal relationship between vaccination and death, in most cases an autopsy and histopathological examinations have to be combined with additional investigations, such as laboratory tests and neuropathological examinations.
对接种 2019 年冠状病毒病（COVID-19）疫苗后死亡病例进行彻底的尸检调查具有重要的社会意义。从 2021 年 3 月 11 日至 6 月 9 日，对最近接种 COVID-19 疫苗的 18 名死者进行了尸检调查。接种 Vaxzevria 的有 9 人，接种 Comirnaty 的有 5 人，接种 Spikevax 的有 3 人，接种 Janssen 的有 1 人。在所有情况下，均进行了全面的尸检、组织病理学检查和严重急性呼吸综合征冠状病毒 2 的病毒学分析。根据具体情况，还进行了其他实验室检查（过敏反应诊断、VITT[疫苗诱导的免疫血栓性血小板减少症]诊断、葡萄糖代谢诊断）和神经病理学检查。在 13 名死者中，死因归因于先前存在的疾病，尸检并未表明与接种疫苗有因果关系。在一例接种 Comirnaty 后，发现心肌炎是死亡的原因。虽然考虑与接种疫苗有关，但不能毫无疑问地证明。在接种 Vaxzevria 的 4 名死者和接种 Janssen 的 1 名死者中发现了 VITT。在这 4 例 VITT 中，只有 1 例在死亡前得到诊断。病史资料摘要、尸检结果、实验室诊断检查、组织病理学和神经病理学检查结果表明，只有在 4 例中的 2 例中，VITT 极有可能是死亡的原因。在另外 2 例中，没有发现可解释死亡的与 VITT 相关的神经病理学相关性，而出现了其他可能的死因，不一定归因于 VITT。我们的研究结果表明，对所有接种 COVID-19 疫苗后死亡的病例进行尸检调查是必要的。为了确定接种疫苗与死亡之间的可能因果关系，在大多数情况下，尸检和组织病理学检查必须结合其他检查，如实验室检查和神经病理学检查。
