Factors Associated with Symptom Attribution Following COVID-19 Vaccination – CoVAccS Wave 3 Secondary Analysis
Year: 2026
Type: study-registration
Abstract: Vaccination is the most effective strategy for reducing morbidity and mortality associated with infectious disease (Global Influenza Programme, n.d.). Despite this, vaccination rates are often lower than targeted. One consistently reported reason for non-uptake of vaccinations is concern about side effects or perceived vaccine harm(Cedraschi et al., 2013; Nowak et al., 2018). Evidence suggests that personal experiences of symptoms following vaccination, whether attributable to the vaccine or coincidental, can create long-standing negative beliefs and anxieties about vaccines (Fukai et al., 2023; Smith et al., 2020). More recently, there has been an increase in awareness of, and concern about, vaccine side effects, alongside a growing tendency to question the guidance and recommendations produced by healthcare systems; concerns regarding vaccine safety are a primary motivator behind vaccine refusal (Chapman et al., 2026; Coronavirus Vaccine Hesitancy in Younger Adults - Office for National Statistics, n.d.; Dunn et al., 2015; Gopalan et al., 2025; Welch et al., 2023). Symptom ‘misattribution’ is the process by which people incorrectly label existing symptoms as the effects of exposure (Hoffman et al., 2022; Webster et al., 2016). Evidence suggests that symptoms following vaccination are often misattributed, and these misinterpretations can meaningfully affect decisions about future vaccination, contributing to the vicious cycle of vaccine hesitancy (Dionne et al., 2025). The misattribution of unrelated symptoms to vaccination is common, and can be influenced by factors such as anxiety, prior attitudes, and heightened bodily vigilance (Desai et al., 2023; Smith et al., 2023). In COVID-19 vaccine clinical trials, misattribution contributed substantially to symptom reporting in vaccination contexts, with sham-arm participants reporting high rates of “vaccine side effects” (Haas et al., 2022). Prospective studies also show that individuals with greater pre-existing worry or perceived sensitivity report more post-vaccination symptoms and interpret them as side effects (Faasse et al., 2015; Silvester et al., 2025). Building on Smith et al. (2023), which identified psychological predictors of post-vaccination symptom reporting in the CoVAccS Wave 3 cohort, this project will examine predictors of post-vaccination symptom attribution. Noticing a symptom and linking it to a recent vaccination are separate cognitive steps beyond reporting, and understanding who makes that attribution and why has direct implications for vaccine communication and hesitancy. This project will investigate which psychological factors predict whether symptoms are attributed to the COVID-19 vaccination among CoVAccS participants who experienced non-injection-site symptoms following vaccination. References: Cedraschi, C., Saya, L., Klein, P., Bordet, M. F., & Carrat, F. (2013). Representations of influenza and influenza-like illness in the community - a qualitative study. BMC Family Practice, 14, 15. https://doi.org/10.1186/1471-2296-14-15 Chapman, S., Christodoulaki, M. E., Davey, S. A., & Gaffiero, D. (2026). Understanding vaccine hesitancy: The role of fear and message framing in COVID-19 vaccination intention in adults in the UK. Vaccine, 69, 127999. https://doi.org/10.1016/J.VACCINE.2025.127999 Coronavirus vaccine hesitancy in younger adults - Office for National Statistics. (n.d.). Retrieved 21 July 2026, from https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/articles/coronavirusvaccinehesitancyinyoungeradults/june2021 Desai, S., Kainth, T., Yadav, G., Kochhar, H., Srinivas, S., Kamil, S., & Du, W. (2023). Role of Psychosomatic Symptoms in COVID-19 Vaccine Hesitancy. Vaccines, 11(5), 922. https://doi.org/10.3390/VACCINES11050922 Dionne, M., Sauvageau, C., Ward, J. K., Sylvain-Morneau, J., Gauna, F., Doggui, R., & Dubé, È. (2025). COVID-19 vaccine hesitancy and perceived post-vaccination adverse event: Findings from a cross-sectional survey. Vaccine, 62, 127529. https://doi.org/10.1016/J.VACCINE.2025.127529 Dunn, A. G., Leask, J., Zhou, X., Mandl, K. D., & Coiera, E. (2015). Associations between exposure to and expression of negative opinions about human papillomavirus vaccines on social media: An observational study. Journal of Medical Internet Research, 17(6), e144. https://doi.org/10.2196/jmir.4343 Faasse, K., Grey, A., Horne, R., & Petrie, K. J. (2015). High perceived sensitivity to medicines is associated with higher medical care utilisation, increased symptom reporting and greater information-seeking about medication. Pharmacoepidemiology and Drug Safety, 24(6), 592–599. https://doi.org/10.1002/PDS.3751 Fukai, T., Kawata, K., & Nakabayashi, M. (2023). Updated beliefs and shaken confidence: evidence from vaccine hesitancy caused by experiencing “COVID arm”. BMC Infectious Diseases 2023 23:1, 23(1), 612-. https://doi.org/10.1186/S12879-023-08558-5 Global Influenza Programme. (n.d.). Retrieved 9 December 2025, from https://www.who.int/teams/global-influenza-programme/vaccines Gopalan, R. B., Babu, B. V., Krishna Sarma, S., & John, R. P. (2025). Adverse Effects Following Immunisation and Vaccine Hesitancy: A Qualitative Study in a South Indian District. Drug, Healthcare and Patient Safety, 17, 145. https://doi.org/10.2147/DHPS.S515064 Haas, J. W., Bender, F. L., Ballou, S., Kelley, J. M., Wilhelm, M., Miller, F. G., Rief, W., & Kaptchuk, T. J. (2022). Frequency of Adverse Events in the Placebo Arms of COVID-19 Vaccine Trials: A Systematic Review and Meta-analysis. JAMA Network Open, 5(1), e2143955–e2143955. https://doi.org/10.1001/JAMANETWORKOPEN.2021.43955 Hoffman, Y. S. G., Levin, Y., Palgi, Y., Goodwin, R., Ben-Ezra, M., & Greenblatt-Kimron, L. (2022). Vaccine hesitancy prospectively predicts nocebo side-effects following COVID-19 vaccination. Scientific Reports 2022 12:1, 12(1), 20018-. https://doi.org/10.1038/s41598-022-21434-7 Nowak, G. J., Cacciatore, M. A., & Len-Ríos, M. E. (2018). Understanding and Increasing Influenza Vaccination Acceptance: Insights from a 2016 National Survey of U.S. Adults. International Journal of Environmental Research and Public Health, 15(4). https://doi.org/10.3390/IJERPH15040711 Silvester, C., Gasteiger, C., Gamble, G. D., Wilson, M. S., Faasse, K., Petrie, K. J., & MacKrill, K. (2025). Predicting the side effects of influenza vaccination. Annals of Behavioral Medicine : A Publication of the Society of Behavioral Medicine, 59(1). https://doi.org/10.1093/ABM/KAAF024 Smith, L. E., Amlôt, R., Weinman, J., Yiend, J., & Rubin, G. J. (2020). Why do parents not re-vaccinate their child for influenza? A prospective cohort study. Vaccine, 38(27), 4230–4235. https://doi.org/10.1016/J.VACCINE.2020.04.029 Smith, L. E., Sim, J., Sherman, S. M., Amlôt, R., Cutts, M., Dasch, H., Sevdalis, N., & Rubin, G. J. (2023). Psychological factors associated with reporting side effects following COVID-19 vaccination: A prospective cohort study (CoVAccS - Wave 3). Journal of Psychosomatic Research, 164. https://doi.org/10.1016/J.JPSYCHORES.2022.111104 Webster, R. K., Weinman, J., & James Rubin, G. (2016). A systematic review of factors that contribute to nocebo effects. Health Psychology, 35(12), 1334–1355. https://doi.org/10.1037/HEA0000416 Welch, V. L., Metcalf, T., Macey, R., Markus, K., Sears, A. J., Enstone, A., Langer, J., Srivastava, A., Cane, A., & Wiemken, T. L. (2023). Understanding the Barriers and Attitudes toward Influenza Vaccine Uptake in the Adult General Population: A Rapid Review. Vaccines, 11(1). https://doi.org/10.3390/VACCINES11010180
Source: Open Science Framework
Institution: University of London
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7212558902