Cutaneous Reactions Reported after Moderna and Pfizer COVID-19 Vaccination: A Registry-Based Study of 414 Cases

McMahon, Devon E.; Amerson, Erin; Rosenbach, Misha; Lipoff, Jules B.; Moustafa, Danna; Tyagi, Anisha; Desai, Seemal R.; French, Lars E.; Lim, Henry W.; Thiers, Bruce H.; Hruza, George J.; Blumenthal, Kimberly; Fox, Lindy P.; Freeman, Esther E.

Background Cutaneous reactions after mRNA-based COVID-19 vaccines have been reported but are not well characterized. Objective To evaluate morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines. Methods A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination. Results From December 2020-February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first dose reactions experienced second dose recurrence. Limitations Registry analysis does not measure incidence. Morphologic misclassification is possible. Conclusion We report a spectrum of cutaneous reactions after COVID-19 mRNA vaccines. Most patients with first dose reactions did not develop a second dose reaction, and no patients in the registry developed serious adverse events after the first or second dose. These data provide reassurance to patients and providers.