Table 4.

SLE flares postvaccination^*

Flare severity	Flare type	Flare details	Timing of flare	Vaccine type	Treatment
Mild/moderate	Pleuritis	Recurrent mild pleuritis	After 1st dose	BNT162b2	No treatment
Mild/moderate	Arthritis	Recurrent mild joint pain and swelling	After 2nd dose	BNT162b2	No treatment
Mild/moderate	Renal	Recurrent proteinuria; urine protein:creatinine ratio increased from 0.8 to 1.4	After 2nd dose	BNT162b2	Rituximab/tacrolimus changed to voclosporin
Mild/moderate	Oral ulcers	Recurrent oral ulcers; patient had been off of belimumab for 3 months	After 2nd dose	mRNA‐1273	No treatment
Mild/moderate	Pericarditis	New presumed pericarditis, EKG negative; resolved with naproxen	After 2nd dose (2 weeks)	BNT162b2	Naproxen
Severe	Arthritis	Recurrent arthritis	After 2nd dose	mRNA‐1273	Methotrexate
Mild/moderate	Thrombocytopenia	Recurrent thrombocytopenia within patient's range	After 2nd dose	BNT162b2	No treatment
Mild/moderate	Arthritis	New mild joint pain and swelling	After 2nd dose	BNT162b2	No treatment
Mild/moderate†	Thrombocytopenia	Recurrent thrombocytopenia	After 2nd dose	BNT162b2	No treatment
Non–SLE‐related event	COPD/asthma flare		After 2nd dose	BNT162b2	Treated in emergency room with steroids, then released

^*EKG = electrocardiogram; COPD = chronic obstructive pulmonary disease.

^†A patient with systemic lupus erythematosus (SLE), antiphospholipid syndrome, and end‐stage renal disease was admitted 13 days after the second vaccine dose. The patient had anticoagulation therapy temporarily withheld for a procedure, presented with shortness of breath, and was found to have superior vena cava syndrome. The patient had a prolonged hospital course, complicated by bleeding and sepsis, and was transitioned to hospice care and died 50 days after the second dose.