COVID-19 vaccine safety report - 23-02-2023

The most frequently reported side effects suspected to be associated with the vaccines include headache, muscle and joint pain, fever, chills and nausea. Skin reactions at the site of the injection are also common and can include pain, swelling, redness and an itchy rash. These are recognised side effects of vaccination and are usually transient and mild.

Vaccine safety in children and adolescents

The most up-to-date vaccine recommendations for children are available from ATAGI.

The TGA is closely monitoring adverse event reports in people aged under 18 years. Reporting rates of adverse events following COVID-19 vaccination, including those for children and adolescents, are very stable. More detail on vaccine safety in children and adolescents following vaccination is available in the safety report published on 15 December 2022.

Booster doses

The most up-to-date vaccine recommendations for booster doses are available from ATAGI.

The TGA continues to monitor the safety of booster vaccine doses in adults. A booster dose is an additional vaccine dose given after the primary vaccine course. In people who have recently had COVID-19, a 3-month interval is recommended before having their next scheduled dose.

Reporting rates of adverse events following COVID-19 vaccination, including those from booster doses, are very stable.

A small number of myocarditis and pericarditis cases have been reported for booster doses. This is a recognised risk with the Comirnaty (Pfizer) and Spikevax (Moderna) vaccines and we are closely monitoring these events. So far, reports of myocarditis after a booster dose are very rare, occurring in less than 1 in every 100,000 vaccinated people.

Information on vaccine safety following booster doses is available in the safety report published on 15 December 2022.

Reports of death in people who have been vaccinated

Vaccines can lead to death in extremely rare instances. However, most deaths that occur after vaccination are not caused by the vaccine. In large populations in which a new vaccine is given, there are people with underlying diseases who may die from these diseases. When a vaccine is given in that same population, the link between the vaccine and death is usually coincidental - not caused by the vaccine. These deaths are carefully reviewed to assess whether vaccines could be the cause and for the vast majority that is not the case.

The TGA closely reviews all deaths reported in the days and weeks after COVID-19 vaccination. Read more about this process in a previous report. Since the beginning of the vaccine rollout to 19 February 2023, almost 65 million doses of COVID-19 vaccines have been given in Australia. The TGA has identified 14 reports where the cause of death was linked to vaccination from 976 reports received and reviewed. There have been no new vaccine-related deaths identified since 2022.

The 14 deaths likely to be related to vaccination occurred in people aged 21 - 81 years old. More detail on these deaths is available in the safety report published on 15 December 2022. There have been no deaths in children or adolescents determined to be linked to COVID-19 vaccination.

If we identify a new death likely to be related to vaccination, we will publish this information promptly in a vaccine safety report, as we have for all other cases since the start of the vaccine roll-out.

Beware of vaccine misinformation

It is important when looking for information about COVID-19 vaccines to consider whether the source of the information is credible and trustworthy. Websites such as COVID vaccines - is it true? and COVID-19 vaccines: Frequently asked questions help to debunk false claims and misleading rumours.

Comirnaty (Pfizer) mRNA vaccines

The Comirnaty (Pfizer) vaccine is provisionally approved for adults and children aged 5 years and over. A bivalent vaccine from Pfizer is also available as a booster dose in adults.

To 19 February 2023, over 44 million doses have been administered in Australia, as well as about 102,000 doses of the bivalent booster vaccine.

The TGA is actively investigating reports of myocarditis (inflammation of the heart) and/or pericarditis (inflammation of the membrane around the heart) associated with mRNA vaccines. We continue to work with international regulators on this safety signal. See below for reporting rates of myocarditis and pericarditis associated with the Comirnaty (Pfizer) vaccines.

Go to the Comirnaty (Pfizer) information page to find out more about these vaccines.

Update to the Product Information

Heavy menstrual bleeding (also known as heavy periods) has been included in the Product Information (Section 4.8) as an adverse reaction that can potentially occur with the mRNA COVID-19 vaccines. Although this was not identified as a concern in the clinical trials, it has been reported by women in Australia and overseas since the vaccines were rolled out. Most cases appear to be non-serious and temporary. There is no evidence to suggest that COVID-19 vaccination affects fertility.

The TGA has been closely monitoring heavy menstrual bleeding following vaccination and thanks the public for reporting this adverse event to us. Menstrual problems are extremely common and can be affected by many factors including stress, weight gain or loss and underlying conditions like uterine fibroids.

Although a definitive link has not been established, the TGA considers there is a possibility that heavy periods could be causally associated with vaccination. This is based on reporting patterns over time and the detail provided in these reports, along with evidence from overseas regulators. As such, we have updated safety information for health professionals.

Women experiencing changes to their periods after vaccination that are unusual for them or persist over time should contact their doctor. Any new vaginal bleeding after menopause should also be discussed with a doctor.

Information about this adverse reaction has also been added to the Product Information for the Spikevax (Moderna) vaccine. See the Spikevax section below for further details.

Up-to-date information for Comirnaty (Pfizer), including details of potential side effects , can be found in the Consumer Medicine Information (for consumers) and Product Information (for health professionals).

Spikevax (Moderna) mRNA vaccines

The original Spikevax vaccine is provisionally approved for adults and children aged 6 years and over. A paediatric formulation of the original vaccine is available for children aged from 6 months to 5 years (or less than 6 years) as well as a Spikevax bivalent vaccine for use as a booster dose in adults. To 19 February 2023, over 5 million doses have been administered in Australia, as well as about 372,000 doses of the bivalent booster vaccine.

The TGA is actively investigating reports of myocarditis (inflammation of the heart) and/or pericarditis (inflammation of the membrane around the heart) associated with mRNA vaccines. We continue to work with international regulators on this safety signal. See below for reporting rates of myocarditis and pericarditis associated with the Spikevax (Moderna) vaccine.

Go to the Spikevax (Moderna) information page to find out more about these vaccines.

Update to the Product Information

Heavy menstrual bleeding (also known as heavy periods) has been included in the Product Information (Section 4.8) as an adverse reaction that can potentially occur with the mRNA COVID-19 vaccines. Although this was not identified as a concern in the clinical trials, it has been reported by women in Australia and overseas since the vaccines were rolled out. Most cases appear to be non-serious and temporary. There is no evidence to suggest that COVID-19 vaccination affects fertility.

Further information about the TGA’s monitoring of menstrual bleeding following vaccination can be found in the Comirnaty (Pfizer) vaccine section above.

Up-to-date information for Spikevax (Moderna), including details of potential side effects, can be found in the Consumer Medicine Information (for consumers) and Product Information (for health professionals).

Nuvaxovid (Novavax) vaccine

The Nuvaxovid (Novavax) vaccine is provisionally approved for adults. To 19 February 2023, over 242,000 doses of Nuvaxovid (Novavax) have been administered in Australia.

The TGA is actively investigating reports of myocarditis (inflammation of the heart) and pericarditis (inflammation of the membrane around the heart) following vaccination.

Myocarditis is reported in around 3-4 in every 100,000 people who receive a Nuvaxovid dose. Overall, pericarditis is reported in 13 in every 100,000 people but is more common in men aged 18-49 years (estimated at 28 per 100,000* people).

To date, there have only been about 1,700 Nuvaxovid doses administered in people aged 12-17 years and no adverse events following immunisation have been reported.

Go to the Nuvaxovid (Novavax) information page to find out more about this vaccine.

* This reporting rate for pericarditis is less certain than for Comirnaty and Spikevax vaccines due to the low number of Nuvaxovid vaccine doses given.

More information for Nuvaxovid (Novavax), including details about its ingredients and potential side effects, can be found in the Consumer Medicine Information (for consumers) and Product Information (for health professionals).

Vaxzevria (AstraZeneca) vaccine

The Vaxzevria (AstraZeneca) vaccine is provisionally approved for adults. To 19 February 2023, just under 14 million doses of Vaxzevria (AstraZeneca) have been administered in Australia. Very few doses of this vaccine have been used since 2021.

Go to the Vaxzevria (AstraZeneca) information page to find out more about this vaccine.

More general information for Vaxzevria (AstraZeneca), including details of potential side effects can be found in the Consumer Medicine Information (for consumers) and Product Information (for health professionals).

Myocarditis and pericarditis after COVID-19 vaccination

Myocarditis and pericarditis have been reported for the mRNA vaccines and Nuvaxovid (Novavax) vaccine. For more details about what these adverse effects are, their severity and what symptoms to look out for, please refer to the vaccine safety report published on 15 December 2022.

ATAGI continues to emphasise that the protective benefits of the vaccines far outweigh the rare risk of these side effects.

ATAGI has advised that people who have had suspected vaccine-related myocarditis or pericarditis should defer further COVID-19 vaccine doses until at least 6 weeks after their symptoms have resolved. They should also discuss future vaccine doses with their treating doctor. Refer to expert Guidance on myocarditis and pericarditis after COVID-19 vaccines for more information.

What does the TGA know about myocarditis and pericarditis in Australia?

Reports of suspected myocarditis and pericarditis received by the TGA have been reviewed against internationally accepted criteria to classify if they are likely to be related to vaccination.

Tables 1-3 summarise the most up-to-date reporting rates of likely myocarditis and pericarditis for the mRNA vaccines to the 19 February 2023. Rates for the Nuvaxovid (Novavax) vaccine are given above.

Reporting rates of myocarditis

Table 1. Rates of likely myocarditis cases following Comirnaty (Pfizer)‡

Age (years)	All doses		Second doses
	Rate* per 100,000 doses		Rate* per 100,000 doses
		Male	Female	Male	Female
5-11	0.3	0.1	0.2	0
12-17	8.1	1.7	13.2	2.8
18-29	5.1	1.6	9.3	2.9
30-39	2.3	0.9	3.1	1.0
40-49	1.0	1.0	1.5	1.8
50-59	0.7	0.4	0.7	0.4
60-69	0.4	0.3	0.4	0.4
70+	0.1	0.3	0	0.4
All ages*	2.4	0.9	4.7	1.6

Table 2. Rates of likely myocarditis cases following Spikevax (Moderna) †  

Age (years)	All doses		Second doses
	Rate* per 100,000 doses		Rate* per 100,000 doses
		Male	Female	Male	Female
12-17	12.1	2.9	23.6	5.0
18-29	9.8	1.7	20.2	4.7
30-39	3.3	0.7	5.0	0
40-49	1.7	1.1	3.2	2.0
50-59	0.9	1.5	2.0	2.5
60-69	0	0.2	0	0
70+	0	0.1	0	0
All ages*	3.2	1.0	11.2	2.7

Notes for Table 1 and Table 2

* The rate includes cases of myocarditis that occurred after vaccination but may not be vaccine related.

‡ To 19 February 2023, from about 2.4 million vaccine doses given, 4 likely cases of myocarditis have been reported in children aged 5-11 years following vaccination with Comirnaty (Pfizer).

† The rates for Spikevax (Moderna) are less certain due to low numbers of cases overall and small changes in case number can lead to fluctuations in the rates for different groups.

Reporting rates of likely pericarditis

Table 3. Rates of likely pericarditis cases following the mRNA vaccines

Age (years)
	Rate* per 100,000 doses
		Comirnaty (Pfizer)	Spikevax (Moderna)
5-11‡	0.3	-
12-17	2.4	1.1
18-29	4.2	5.2
30-39	4.4	4.8
40-49	2.8	2.7
50-59	1.7	1.5
60-69	0.8	0.4
70+	0.2	0.2
All ages*	2.6	2.4

Notes for Table 3

* The rate includes cases of pericarditis that occurred after vaccination but may not be vaccine related.

‡ To 19 February 2023, from about 2.4 million Comirnaty (Pfizer) vaccine doses given, one probable and 6 possible cases of pericarditis have been reported in children aged 5-11 years. No cases of pericarditis have been reported following Spikevax (Moderna) in this age group.

For more information, see guidance on myocarditis and pericarditis developed by ATAGI and the Cardiac Society of Australia and New Zealand (CSANZ).

Useful links

Watch this video to find out how the TGA monitors and reports the safety of COVID-19 vaccines

COVID-19 vaccines: Frequently asked questions - 17 February 2023

COVID vaccines - is it true? - 8 February 2023

Clinical recommendations for COVID-19 vaccines in Australia - 21 February 2023

Latest advice on COVID-19 vaccination for pregnant and breastfeeding women

TGA COVID-19 vaccines hub

Australian Government Department of Health COVID-19 vaccines hub

COVID vaccine information in your language

Database of Adverse Event Notifications (DAEN)

AusVaxSafety - a national survey on COVID-19 vaccine safety