Abstract: Background: Vaccines are considered one of the milestones of modern medicine that promoted health and curbed morbidity and mortality. However, with the rapid development and approval of different vaccines, various thrombotic events have been reported. Yet, a comprehensive analysis of vaccine-associated stroke and other thrombotic events is not well-characterized. Methods: We utilized the vaccine adverse event reporting system (VAERS) database from 1990-2021 to examine the association between vaccines and thrombotic events. We analyzed the data by sex and age, and vaccine type, and COVID-19 vaccine manufacturer. Disproportionality signal analysis was conducted by measuring reporting odds ratio (ROR) with a 95% confidence interval (CI). Results: Out of over 1.3 million adverse events reported in VAERS, more than 6000 were strokes between 1990-2021. Most strokes (70%) COVID-19 vaccines accounted for over 80% of all vaccine-related strokes with ROR (CI 95%) of 13.3 (CI 12.4-14.3, p<0.0001). Among COVID-19 vaccines, Pfizer/Biotech was associated with 46%, Moderna with 40%, and Janssen with 12% of strokes. Finally, our data revealed that prothrombic diseases of various vascular territories were reported the most among patients who have received COVID-19 vaccines with ROR (CI 95%) of 19.32 (CI 18.17-20.54; p <0.0001). Among these thrombotic events myocardial infarction, pulmonary embolism, and deep vein thrombosis were the most predominant. Conclusion: Our data suggest a link between COVID-19 vaccines and thrombotic events, especially strokes. This retrospective study highlights the urgent need for further longitudinal studies to examine the safety of vaccines in patients with high risk for thrombosis.

Background: Emerging novel therapeutics have been developed to hamper the progression of multiple sclerosis. However, the adverse events related to these new agents remain largely unknown. Therefore, we sought to investigate the cardiovascular complications of these drugs. Methods: Utilizing data from the U.S. Food and Drug Administration Adverse Events Reporting System, we comprehensively evaluated the cardiovascular complications of the newly FDA approved anti-multiple sclerosis agents. Disproportionality signal analysis was conducted by measuring reporting odds ratio (ROR) with 95% confidence interval of all the cardiovascular adverse events adverse events since approval till 2021. Results: After vetting the newly approved agents for multiple sclerosis, CD20 and CD25 inhibitors and sphingosine-1-phosphate receptors agonists were the latest approved medications for multiple sclerosis since 2015. Two CD20 (ocrelizumab, ofatumumab) and one CD25 inhibitors (daclizumab) were significantly associated with multiple cardiovascular adverse events. Among all the cardiotoxic events; coronary artery disease, cardiac failure and atrial fibrillation were the most predominant among CD20 or CD25 blockers. Interestingly, Sphingosine-1-phosphate receptors agonists showed much fewer reported cardiac adverse events. However, fingolimod and siponimod were associated with significant bradycardia. Conclusions: Our data revealed the new agents prescribed for multiple sclerosis have cardiotoxic effects, including not only the known adverse effects observed effects for S1P receptor modulators but also undefined cardiovascular complications associated with CD20 and CD25 inhibitors. These findings potentially instigate further studies to personalize prescribing these agents for multiple sclerosis based on patient’s cardiovascular profile.