Year: 2026
Type: article
Study design: Observational Study
Abstract: Autopsies are the foundation of evidence-based medicine and gold standard for determining causes of death. A potential causal relationship between COVID-19 vaccination and death remains a subject of debate, however multidisciplinary, multicentric national autopsy studies are missing. N = 486 eligible SARS-CoV-2 vaccinated autopsy cases from 14 German pathology, neuropathology and legal medicine university centres between 2021 and 2024 were available via the German National Autopsy Registry. For comparison COVID-19 autopsies were included (n = 385 cases, all performed before the vaccination campaign in Germany started). A previously established causality algorithm was applied in a consensus assessment of potential causality between vaccine administration and an adverse event following immunization (AEFI). N = 176 cases with a post vaccination interval ≤ 28d were included into analyses. In a single case of allergic reaction, in 5/8 cases of either myocarditis (n = 4 cases) or perimyocarditis (n = 1 case), and 9/26 cases of thromboembolism, the consensus process resulted in a potential AEFI in these cases, but no definite causality. In n = 3 cases in which the cause of death remained unclear after autopsy, no potential AEFI could be established. In SARS-CoV-2 positive autopsy cases without vaccination, thromboembolism was documented as cause of death in 18/385 cases and myocarditis in 2/385 cases. In conclusion, autopsies are a valuable tool to assess adverse effects. Currently, post vaccination autopsy numbers are too low to draw conclusions on the general population or to identify rare AEFI signals. As part of pandemic preparedness, international guidelines for post vaccination autopsy procedures, diagnostics and interpretation are necessary. Autopsy registries can support this collective effort.
Authors: Saskia von Stillfried, Roman David Bülow, Reinhard Dettmeyer, Benjamin Ondruschka, Carolin Edler, Ann Sophie Schröder, Bruno Märkl, Verena Gassenmeier, Wilfried Roth, Gustavo Baretton, Helena Radbruch, Irene Esposito, Eva Grill, Danny Jonigk, Rainer Röhrig, Peter Boor, for the German National Autopsy Registry (NAREG), NAREG Collaborators#, Ruth Knüchel, Svenja Windeck, Anna K. Kuderna, Martin T. Strauch, Joachim Weis, Juliane Bremer, Jana Böcker, Pauline Tholen, Julia Bley, Dustin Thewes, Raphael Majeed, Lukas Triefenbach, Jan Wienströer, Tina Schaller, Eva Sipos, Klaus Hirschbühl, Rainer Claus, Christine Dhillon, Oliver Spring, Georg Braun, Christoph Römmele, Michael Wittmann, Elisabeth Kling, Thomas Kröncke, Frank L. Heppner, Jenny Meinhardt, Simon Streit, Sefer Elezkurtaj, Torsten Hansen, Ulf Titze, Jessica Pablik, Matthias Meinhardt, Linna Sommer, Julia Hilsenbeck, Meike Meinel, Olaf Holotiuk, Graziano Crudele, Maximilian Seidl, Muhannad Al Kallaa, Nina Mahlke, Arndt Hartmann, Florian Haller, Philip Eichhorn, Fabienne Lange, Kerstin U. Amann, Roland Coras, Elise Gradhand, Kevin Smith, Christoph G. Birngruber, Martin Werner, Christine Fathke, Anja Harder, Markus Glatzel, Jakob Matschke, Susanne Krasemann, Jan-Peter Sperhake, Axel Heinemann, Anke Klein, Daniela Fröb, Klaus Püschel, Antonia Fitzek, Julia Schädler, Dustin Möbius, Larissa Lohner, Eric Dietz, Fabian Heinrich, Inga Kniep, Johann Zwirner, Tobias Huter, Martin Aepfelbacher, Marc Lütgehetmann, Nicole Fischer, Susanne Pfefferle, Christopher Werlein, Rainer M. Bohle, Fidelis Flockerzi, Johannes Hohneck, Dorothea Langer, Stephanie Strobl, Claire Delbridge, Gregor Weirich, Atsuko Kasajima, Peer-Hendrik Kuhn, Konrad Friedrich Stock, Katja Steiger, Katja Evert, Johannes Manhart, Stefan Nigbur, Iris Bittmann, Falko Fend, Hans Bösmüller, Massimo Granai, Karin Klingel, Andreas Rosenwald, Niklas Vogt, Florian Kurz
Institutions: Universitätsklinikum Aachen, RWTH Aachen University, Justus-Liebig-Universität Gießen, Universitätsklinikum Gießen und Marburg, Universität Hamburg, University Medical Center Hamburg-Eppendorf, University of Augsburg, Universitätsklinikum Tübingen, University Medical Center of the Johannes Gutenberg University Mainz, University Hospital Carl Gustav Carus, Technische Universität Dresden, Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Düsseldorf University Hospital, Heinrich Heine University Düsseldorf, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, German Center for Lung Research, University Hospital Augsburg, German Center for Neurodegenerative Diseases, Bielefeld University, Universitätsklinikum Erlangen, University Hospital Frankfurt, University Medical Center Freiburg, University Hospital in Halle, Medizinische Hochschule Hannover, Universitätsklinikum des Saarlandes, Klinikum Magdeburg, University Hospital Magdeburg, Technical University of Munich, TUM Klinikum, University of Würzburg, University Hospital Regensburg, Universitätsmedizin Rostock, Agaplesion Diakonieklinikum Rotenburg
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,790
Award: G3859721310
OpenAlex ID: W7225390205