Expert advice

Guidance on AstraZeneca COVID-19 vaccine side effects

Which side effects might require further nurse investigation?

Guidance on side effects from the AstraZeneca vaccine explains when further nurse investigation might be needed

How many people have had the AstraZeneca COVID-19 vaccine?

According to the Medicines and Healthcare products Regulatory Agency (MHRA), 20.2 million doses of the COVID-19 AstraZeneca vaccine were administered in the UK as of 31 March 2021.

Are many patients seeking treatment for side effects?

The Royal College of Emergency Medicine (RCEM) confirms there is a trend of people who are anxious after having the AstraZeneca vaccine and presenting at emergency departments (EDs), some on the advice of a GP.

All EDs in England are seeing an increase in the

Guidance on side effects from the AstraZeneca vaccine explains when further nurse investigation might be needed

Guidance on side effects from the AstraZeneca vaccine explains when further nurse investigation might be needed
Picture: Alamy

How many people have had the AstraZeneca COVID-19 vaccine?

According to the Medicines and Healthcare products Regulatory Agency (MHRA), 20.2 million doses of the COVID-19 AstraZeneca vaccine were administered in the UK as of 31 March 2021.

Are many patients seeking treatment for side effects?

The Royal College of Emergency Medicine (RCEM) confirms there is a trend of people who are anxious after having the AstraZeneca vaccine and presenting at emergency departments (EDs), some on the advice of a GP.

All EDs in England are seeing an increase in the number of people reporting concerns after having the AstraZeneca vaccine – mainly those with mild and persistent headaches but who are otherwise all right, it says. The ED at Medway NHS Foundation Trust in Kent is seeing around five people a day with post-vaccination symptoms.

Cliff Evans, emergency nurse consultant
Cliff Evans

‘The majority are experiencing headaches,’ says emergency nurse consultant Cliff Evans. ‘But most patients are being managed by primary care services, as there is no immediate emergency input required.’

What are the most common side-effects of the AstraZeneca COVID-19 vaccine?

According to the information given to AstraZeneca vaccine recipients, very common side effects – affecting more than one in ten people – include tenderness, pain, warmth, itching or bruising where the injection was given, generally feeling unwell, fatigue, chills or feeling feverish, headache, nausea, and joint pain or muscle ache.

Common side effects affecting up to one in ten people include swelling, redness or a lump at the injection site, fever, vomiting or diarrhoea, and flu-like symptoms such as high temperature, sore throat, runny nose, cough and chills.

What are the rarer side effects?

Uncommon side effects affecting up to one in 100 people include feeling dizzy, decreased appetite, abdominal pain, enlarged lymph nodes, excessive sweating and itchy skin or rash.

There have also been reports of a very rare and unlikely to occur specific type of blood clot in the brain, known as cerebral venous sinus thrombosis (CVST), occurring together with low levels of platelets – thrombocytopenia.

This has now been termed vaccine induced thrombosis and thrombocytopenia (VITT).

What are the risks of VITT?

Up to 31 March, the MHRA had received 79 UK reports of blood clotting cases, alongside low levels of platelets, following the use of the AstraZeneca vaccine.

The overall risk of blood clots is approximately four people in 1 million who receive the vaccine, says the MHRA. All the cases followed the first dose. This type of blood clot, together with lowered platelets, can also rarely occur naturally in unvaccinated people, as well as in those who have contracted COVID-19, the agency says.

‘There are currently no known risk factors for this extremely rare condition, which appears to be an idiosyncratic reaction on first exposure to the AstraZeneca COVID-19 vaccine,’ says the Joint Committee on Vaccination and Immunisation (JCVI).

Are some groups of people more at risk of VITT than others?

The data suggests there is a slightly higher incidence reported in younger adult age groups, says the MHRA. The agency advises that this evolving evidence should be taken into account when considering the use of the vaccine, but is currently not recommending age restrictions for its use.

Of the 79 reported cases, 19 people have died, 11 of them aged under 50 and three aged less than 30. Of the total, 51 were women, although the MHRA points out that more women than men have received the AstraZeneca vaccine.

What symptoms should nurses be advising patients to look out for?
Picture: iStock

What symptoms should I be advising patients to look out for?

Information produced for vaccine recipients says that if anyone experiences any of the following after around four days following their vaccination they should seek medical advice urgently:

• A severe headache not relieved with simple painkillers that is getting worse or feels worse when the person lies down or bends over.
• An unusual headache that may be accompanied by blurred vision, confusion, difficulty with speech, weakness, drowsiness or seizures.
• A rash that looks like small bruises or bleeding under the skin beyond the injection site.
• Shortness of breath, chest pain, leg swelling or persistent abdominal pain.

Is there any specific guidance I can follow?

The Royal College of Emergency Medicine (RCEM), the Society for Acute Medicine (SAM) and the Royal College of Physicians (RCP) have produced guidance on managing patients presenting to EDs with potential symptoms of VITT.

This offers specific advice on initial assessment, whether the patient can safely go home, and when further investigation is needed, including recommendations on when neuro-imaging is clinically appropriate.

‘Clinical examination includes ruling out red flags and discharging, with the same advice that we give all headache-associated presentations,’ says Mr Evans. This includes simple pain relief, alongside highlighting awareness of any more worrying symptoms.

How can I help alleviate patients’ anxieties?

Everyone offered a vaccine should be fully informed about the risks and benefits of vaccination, says the JCVI. This includes clear information about extremely rare adverse events, how to monitor for symptoms that might relate to VITT, and what action should be taken by the individual if they experience symptoms.

In terms of benefits, analysis of infection data shows vaccination is highly effective, substantially reducing the risks of infection and severe disease.

Public Health England estimates that the vaccination programme prevented at least 6,000 deaths in the first three months of 2021.


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