Table 1.

Cutaneous reactions to AstraZeneca and Sinovac vaccines distant to the injection site: characteristics, associated signs and symptoms, and management

Distant site reactions
Patient	Age/Sex	COVID‐19 Vaccine	Allergy History	Onset postvaccination	Duration of reaction	Cutaneous reactions and associated signs and symptoms	Management
1	57/F	SV	Peanuts, shrimp paste, NSAIDs, aspirin, cotrimoxazole, prednisolone + chlorphenamine maleate	15 min	<1 d	Angioedema on the left eye and left earlobe Metallic taste, lip numbness 9 h postvaccination: wheals developed on the left side of the neck, associated with a coughing spasm	Betamethasone + Loratadine Cetirizine
2	54/M	SV	Etoricoxib Allopurinol	1–2 h	1 d	Petechiae on the chest and abdomen (20% TBSA) Laryngeal spasm, hoarseness, dizziness	IM epinephrine IM diphenhydramine Methylprednisolone Bilastine
3	29/F	AZ	None	3 h	3 d	Angioedema on the upper lip Fever, myalgia, arthralgia 1‐day postvaccination: angioedema on the upper lip, hoarseness, shortness of breath	IM epinephrine IM diphenhydramine Bilastine
4	54/F	AZ	None	15 min	14 d	Wheals on both arms and legs	Cetirizine Hydrocortisone cream
5	36/M	SV	None	<30 min	3 d	Macules and patches, generalized (80% TBSA)	Cetirizine
6	54/F	SV	Shellfish	5 h	<1 h	Angioedema on both 2nd digits, generalized pruritus Elevated BP, tachypnoea, right upper arm weakness, slurring of speech	IV hydrocortisone, IM diphenhydramine Betamethasone + loratadine
7	25/F	SV	None	Day 1	1 d	Wheals on arms and legs with burning sensation, angioedema on the wrist, dermatographism Injection site pain and numbness	IM diphenhydramine Prednisone Bilastine Ebastine +betamethasone
8	28/F	AZ	Ceftriaxone	Day 1	14 d	Purpuric patches on the right inframammary area spreading to the left with a needle‐prick sensation Injection site tenderness, arm pain and heaviness	Clobetasol propionate
9	53/F	SV	Penicillin NSAIDs	Day 1	14 d	Vesicles on ipsilateral* 5th digit, macules and papules on ipsilateral* arm, axilla and chest, severe pruritus on ipsilateral* arm on the day of vaccination	Prednisone Loratadine, cetirizine Clobetasol
10	47/F	AZ	Nalbuphine	Day 2	2 d	Macules on ipsilateral arm and upper chest (5% TBSA) Arm pain, myalgia	Bilastine
11	24/F	AZ	None	Day 3	14 d	Pityriasis rosea‐like eruption on trunk and extremities with pruritus Injection site pain and heaviness	Cetirizine Betamethasone valerate
12	37/F	AZ	Shrimps	Day 3	4 d	Erythematous macule on injection site, angioedema on the right eye Arm pain and heaviness, runny nose, fever, headache, increase blood pressure	Prednisone Cetirizine
13	31/F	SV	None	Day 4	7 d	Erythematous macules and patches on trunk, axillae, inguinal areas (18% TBSA) Headache, fever before the cutaneous eruption	Bilastine

AZ, AstraZeneca; SV, Sinovac; and d, day *Ipsilateral to the vaccination site