. 2022 Dec 30:10.1111/ejh.13917. Online ahead of print. doi: 10.1111/ejh.13917

TABLE 1.

Epidemiologic characteristics of included cases

Author, year	Age/gender	Vaccine	Dose	REAC. ONSET (days)	PMH/Hematologic PMH	Clinical features	Plt on admission (×10⁹/L)	Plt prior to vaccination (×10⁹/L)	Plt nadir (×10⁹/L)	Antibody profile	Treatment	Hospital admission/hospital stay (days)	Follow‐up Plt (×10⁹/L)
Baba, Y., 2022 ⁴²	90/M	BNT16B2b2 mRNA BNT16B2b2 mRNA	First	7	HTN/DLP/MI	Extensive purpura on the extremities/ICH/duodenal bleeding/impaired consciousness/pallor of palpebral conjunctiva/tarry stool	3	224	NM	Elevated platelet antibodies‐IgG/negative anti PF4	PSL 40 mg/day/ IVIG/TPO‐RA (EPAG)/platelet and RBC transfusion	Yes/67	NM
Sivaramakrishnan, P., 2022 ¹⁷	NM/F	ChAdOx1.	First	30	Previously treated pulmonary TB	Hemoptysis/menorrhagia/fever/streaked sputum	8	NM	NM	NM	Plt transfusion	Yes/7	NM
Sivaramakrishnan, P., 2022 ¹⁷	NM/F	ChAdOx1.	Second	11	NM	Hemoptysis/menorrhagia	10	NM	NM	NM	PSL 80 mg/day	Yes/NM	NM
Chong, K. M., 2022 ⁴³	75/F	mRNA‐1273	First	3	Refractory lung adenocarcinoma	Hemoptysis	7	NM	NM	HBV profile compatible with a previous infection	Plt transfusion/PSL 1 mg/kg/day	Yes/5	NM
Shonai, T., 2022 ⁴⁴	34/F	mRNA‐1273	Second	21	NM	Generalized purpura/irregular vaginal bleeding	11	NM	3	NM	At first: followed without treatment At first week of follow up: PSL 1 mg/kg/day TPO‐RA (EPAG)	Yes/NM	NM
Chanut, M., 2022 ⁴⁵	NM/NM	mRNA‐1273	First	7	IgA kappa (MGUS)/obesity/HTN/hypothyroidism/corticoid‐induced glaucoma/recurrent rheumatic diseases	Extensive bruises/generalized petechiae/ICH/epistaxis	2	287	NM	NM	IVIG 1 g/kg for 2 days	Yes/2	310
Al‐Ahmad, M., 2022 ⁴⁶	54/F	ChAdOx1.	First	17	NM	NM	10	NM	NM	NM	PSL 1 mg/kg/day/IVIG 1 g/kg	Yes/NM	NM
	33/F	ChAdOx1.	First	21	NM	NM	3	NM	NM	NM	PSL 1 mg/kg/day/IVIG 1 g/kg for 2 days/TPO‐RA (Romiplostim)	Yes/NM	NM
	56/F	BNT16B2b2 mRNA	Second	7	NM	NM	2	NM	NM	NM	PSL 1 mg/kg/day/IVIG 1 g/kg for 2 days/TPO‐RA (EPAG)	Yes/NM	NM
Battegay, R., 2021 ⁴⁷	77/M	BNT16B2b2 mRNA	First	8	CAD/AF/HTN/CKD	Wet petechiae	28	126	17	Detectable anti‐SARS‐CoV2 spike(S1) and anti‐RBD specific IgM and IgG Anti‐S1‐IgG seroconversion confirmed in the ELISA assay at day 25 after vaccination	Oral anticoagulant withdrawal/ oral vitamin K/PSL 1.2 mg/kg/day/IVIG 0.48 g/kg for 2 days/TPO‐RA (EPAG)	Yes/NM	NM
Nakamura, T., 2022 ⁴⁸	32/F	BNT16B2b2 mRNA	Second	5	NM	Petechiae and purpura on the extremities/gingival and oral mucosal bleeding/wet purpura	<1	210	NM	Elevated PA‐IgG//negative anti PF4	PSL 50 mg/day	Yes/12	NM
Malayala, S. V., 2021 ⁴⁹	75/F	BNT16B2b2 mRNA	Third/Booster	NM	Mixed connective tissue disease (RA + scleroderma)/HTN/osteopenia	Petechiae	13.9	198	9	NM	Dexamethasone 40 mg/day	Yes/NM	NM
Nutalapati, S., 2021 ¹⁸	25/F	mRNA‐1273	Second	26	well‐controlled bronchial asthma	Generalized scattered petechiae/extensive bruising/intermittent epistaxis/gross hematuria/hematochezia/subconjunctival hemorrhage	1	NL	1	NM	Dexamethasone 40 mg/day/IVIG 2 g/kg for 2 days/tranexamic acid/plt transfusions Mycophenolate mofetil 1 g/TPO‐RA (Romiplostim)	Yes/14	140
Cooper, K. M., 2021 ⁵⁰	24/F	BNT16B2b2 mRNA	First	10	Dysfunctional uterine bleeding secondary to Etonogestrel implant/mild‐controlled asthma/previous allergic reaction to vaccine	Generalized petechiae/menorrhagia/wet petechiae/cutaneous and mucosal bleeding	NM	NM	1	NM	PSL 0.5–2.0 mg/kg/IVIG 1 g/kg	Yes/36	NM
Ogai, A., 2022 ⁵¹	73/F	mRNA‐1273	First	11	HTN/DLP	Generalized petechiae/oral mucosal bleeding/melena	2	230	<1	NM	PSL/IVIG/TPO‐RA (EPAG)	Yes/NM	NM
Hidaka, D., 2022 ⁴⁰	53/F	BNT16B2b2 mRNA	Second	35	Bronchial asthma/Vogt–Koyanagi–Harada disease/Hashimoto	Evans syndrome/mild anemia/icteric skin and bulbar conjunctiva/pallor of palpebral conjunctiva/wheezing/generalized petechiae/oral mucosal bleeding	3.9	NL	30	Positive lupus coagulant/positive ANA with speckled and nucleolar pattern/positive direct and indirect coombs tests/low level of cold agglutinin	PSL 1 mg/kg	Yes/NM	NM
Gardellini, A., 2021 ⁵²	27/M	BNT16B2b2 mRNA	First	10	NM	Hematoma/epistaxis	1	NM	NM	NM	PSL/IVIG dexamethasone	NM/NM	NM
Gardellini, A., 2021 ⁵²	63/M	ChAdOx1.	First	14	DM/HTN	Hematoma/epistaxis	2	NM	NM	NM	PSL	Yes/NM	NM
Jasaraj, R. B., 2021 ⁴¹	67/F	BNT16B2b2 mRNA	Second	2	HTN/D2M/Hypothyroidism/depression/vitamin B12 deficiency/cluster headaches	Generalized petechiae/oral mucosal bleeding/epistaxis/subconjunctival hemorrhage	3	NL	NM	NM	PSL/IVIG/Plt transfusion/aminocaproic acid/rituximab/TPO‐RA (EPAG)	Yes/14 days	200
Kenney, A., 2021 ⁵³	69/F	mRNA‐1273	First	7	Hypothyroidism/primary hyperaldosteronism/osteoporosis/migraine headache	Generalized petechiae/minor bruising/gingival mucosal bleeding	4	NM	NM	NM	PSL/IVIG	Yes/3 days	258
Wong, J. S. Y., 2021 ⁵⁴	86/M	ChAdOx1.	First	2	NM	Gingival mucosal bleeding/wet petechiae/widespread ecchymoses	4	NM	NM	Negative anti PF4	Dexamethasone/IVIG /Plt transfusion/rituximab	Yes/10 days	NL
Wong, J. S. Y., 2021 ⁵⁴	38/F	ChAdOx1.	First	10	NM	Generalized petechiae and purpura/oral mucosal bleeding	3.2	NM	NM	Negative anti PF4	PSL/IVIG	No/−	430
Bennett, C., 2021 ⁵⁵	32/F	mRNA‐1273	First	11	Negative	Bruising/petechiae	1	268	NM	NM	PSL/IVIG/dexamethasone	Yes/3 days	303
Akiyama, H., 2021 ⁵⁶	20/F	BNT16B2b2 mRNA	NM	12	Negative	Generalized subcutaneous hemorrhage/oral mucosal bleeding	16	NL	NM	NM	PSL	Yes/nm	153–343
Koch, M., 2021 ⁵⁷	41/M	ChAdOx1.	First	10	Negative	Petechiae/mocusal bleeding	<1	189	NM	Negative anti PF4	PSL/IVIG	Yes/4 days	80
Hines, A., 2021 ⁵⁸	26/F	mRNA‐1273	First	7	Irregular menses on OCP	Petechiae/bruising	19	NM	NM	NM	PSL/IVIG/dexamethasone	Yes/5 days	213
Vaira, L. A., 2022 ⁵⁹	81/M	BNT16B2b2 mRNA	Second	3	Stage III CKD/hypercholesterolemia	Copious bleeding through the surgical wound/massive hematoma/ecchymosis of the right cheek	4	156	NM	Negative anti PF4	Methylprednisolone/Plt transfusion	Yes/7 days	188
Paulsen, F. O., 2021 ⁶⁰	72/M	ChAdOx1.	First	11	Autoimmune thyroiditis	Petechiae/epistaxis/headache	NM	NM	<5	Negative anti PF4	Glucocorticoid/IVIG	Yes/nm	253
	71/F	ChAdOx1.	First	11	Latent hyperthyroidism/nodular goiter/breast cancer/stroke	Petechiae/hyposphagma	NM	NM	<5	Negative anti PF4	Glucocorticoid/IVIG/TPO‐RA	Yes/nm	71
	66/M	ChAdOx1.	First	2	HTN/mild thrombocytopenia	Petechiae	NM	NM	<5	Negative anti PF4	Corticosteroid	Yes/4	89
	64/F	ChAdOx1.	First	15	HTN/COPD/steatosis hepatitis	None	NM	NM	6	Negative anti PF4	Corticosteroid	Yes/6	121
King, E. R., 2021 ⁶¹	39/F	BNT16B2b2 mRNA	Second	3	PCOS	Petechiae	1	NL	NM	NM	Plt transfusion/IVIG	Yes/3	243
Shah, S. R. A., 2021 ⁶²	53/M	BNT16B2b2 mRNA	Second	8	Crohn's disease	Episodes of high‐grade fever/diffuse myalgia/generalized petechiae	2	254	NM	NM	IVIG/Dexamethasone	Yes/4	NM
Idogun, P. O., 2021 ³⁹	54/F	BNT16B2b2 mRNA	First	7	Congenital epidermal dysplasia/anxiety/CKD/HTN/mild cognitive impairment	Rash	NM	NM	NM	NM	No referral to physician	No/NM	NM
Idogun, P. O., 2021 ³⁹	54/F	BNT16B2b2 mRNA	Second	5	Congenital epidermal dysplasia/Anxiety/CKD/HTN/Mild cognitive impairment	Ecchymosis/petechiae/oral mucosal bleeding	<1	NM	<1	NM	Dexamethasone IVIG Plt transfusion	Yes/14	114
Fueyo‐Rodriguez, O., 2021 ⁶³	41/F	BNT16B2b2 mRNA	First	1	Multiple allergies/hypothyroidism	Petechiae/gingival mucosal bleeding/fever/tachycardia/nausea/malaise/headache/loose stool	65	NL	38	Elevated anti‐dsDNA	Dexamethasone Methyl prednisolone IVIG	Yes/5	629
Julian, J. A., 2021 ⁶⁴	72/F	mRNA‐1273	First	1	Gout/D2M/seasonal contact dermatitis	Petechiae/oral mucosal bleeding/melena/headache	12	NM	1	Positive parvovirus IgG	Methylprednisolone/IVIG/aminocaproic acid/rituximab/Plt transfusion	Yes/NM	NM
Welsh, K. J., 2021 ⁷	56/M	BNT16B2b2 mRNA	First	2	Negative	Petechiae/purpura/gingival mucosal bleeding/scleral hemorrhage/ICH	<1	NM	NM	NM	PSL/platelet and RBC transfusion/TPO‐RA (EPAG)/dexamethasone/cyclosporine/rituximab/IVIG/emergent craniotomy/splenectomy	NM/NM	NM
	22/M	BNT16B2b2 mRNA	First	3	Negative	Petechiae/Epistaxis/gingival mucosal bleeding/scleral hemorrhage/hematuria	2	NM	NM	NM	Dexamethasone/Plt transfusion/IVIG	Yes/NM	NM
	82/F	BNT16B2b2 mRNA	First	NM	NM	Pulmonary embolism/dyspnea/MI	3	NM	NM	NM	NM	NM/NM	NM
	59/M	BNT16B2b2 mRNA	First	NM	Negative	None	3	NM	NM	NM	NM	NM/NM	NM
	39/F	BNT16B2b2 mRNA	First	2	Depression/PCOS	Petechiae/menorrhagia	1	NM	NM	NM	PSL/IVIG/Plt transfusion/methylprednisolone	Yes/NM	NM
	80/M	BNT16B2b2 mRNA	First	6	HTN/DM/DLP/aortic stenosis/diverticulosis	GI bleeding	1	NM	NM	NM	RBC and platelet transfusion	NM/NM	NM
	78/F	BNT16B2b2 mRNA	First	6	AF/essential tremor	Petechiae	6	NM	NM	NM	Dexamethasone/IVIG/Plt transfusion	Yes/NM	NM
	55/F	BNT16B2b2 mRNA	First	4	HTN/DM/arthritis	Petechiae/gingival mucosal bleeding	2	NM	NM	NM	Dexamethasone/IVIG/Plt transfusion	Yes/NM	NM
	43/F	mRNA‐1273	First	8	GERD	Petechiae/bruising	2	NM	NM	NM	PSL/IVIG	Yes/NM	NM
	37/M	mRNA‐1273	First	NM	NM	NM	NM	NM	NM	NM	Plt transfusion	NM/NM	NM
	49/F	mRNA‐1273	First	1	Migraine/psoriasis	Petechiae/shortness of breath	66	NM	NM	NM	NM	NM/NM	NM
Candelli, M., 2021 ⁶⁵	28/M	ChAdOx1.	First	20	Negative	Oral mucosal bleeding/petechiae/purpura/fatigue/fever/headache/trace hematuria	4	NM	2	Positive lupus anti‐coagulant	Dexamethasone	Yes/4	180
Helms, J. M., 2021 ⁶⁶	74/M	mRNA‐1273	First	1	HTN/gout/DLP/Non‐ischemic cardiomyopathy	Epistaxis/purpura/cardiomyopathy/urinary retention/constipation/encephalopathy/dysarthria/AIDP	10	224	NM	NM	Dexamethasone/PSL /Plt transfusion/IVIG /rituximab/TPO‐RA (EPAG) plasma exchange for AIDP	Yes/17	NM
Lee, E. J., 2021 ⁶⁷	36/F	BNT16B2b2 mRNA	First	5	Negative	Menorrhagia/blood blisters/petechiae/epistaxis/weakness	9	NM	NM	NM	NM	Yes/nm	NM
	25/F	mRNA‐1273	First	10	Anxiety	Mucosal bleeding/bruising	3	NM	NM	NM	Corticosteroids/IVIG	Yes/nm	286
	26/F	mRNA‐1273	First	2	Negative	Bruising	2	NM	NM	NM	Corticosteroids/IVIG/Plt transfusion	Yes/NM	142
	73/M	BNT16B2b2 mRNA	First	1	HTN/DLP/DM/hyperthyroidism	Bruising/petechiae	1	NM	NM	NM	Corticosteroids/IVIG/Plt transfusion	Yes/2	38
	53/M	BNT16B2b2 mRNA	First	15	Fatty liver	None	10	NM	NM	NM	Plt transfusion/IVIG	Yes/1	47
	72/F	mRNA‐1273	First	1	Gout/DM	Bruising/petechiae/blood blisters	1	NM	NM	NM	Corticosteroids/IVIG/rituximab/Aminocaproic acid /vincristine/TPO‐RA (Romiplostim)	Yes/NM	71
	50/F	mRNA‐1273	First	23	HTN	Petechiae	2	NM	NM	NM	Corticosteroids IVIG Plt transfusion	Yes/NM	20
	36/F	mRNA‐1273	First	16	Inherited thrombocytopenia	Headache/petechiae/bruising/oral ecchymosis	3	NM	NM	NM	Corticosteroids IVIG	Yes/NM	28
	NM/NM	mRNA‐1273	First	1	NM	Headache/blood blisters	29	NM	NM	NM	Corticosteroids	Yes/NM	45
	41/F	BNT16B2b2 mRNA	First	3	Neuropathy	Chest pain/rash	11	NM	NM	NM	Corticosteroids IVIG	Yes/2	104
	48/F	mRNA‐1273	First	13	HTN/Obesity	Heavy vaginal bleeding	1	NL	NM	NM	Corticosteroids IVIG Plt transfusion	Yes/NM	300
	38/F	mRNA‐1273	Second	2	NM	Headache/myalgia/petechiae	1	NM	NM	Positive antiplatelet antibody	Corticosteroids /IVIG	Yes/NM	60
	53/M	BNT16B2b2 mRNA	First	7	Crohn's disease/HTN/GERD/prediabetic stage	Petechiae/oral mucosal bleeding	2	NM	NM	NM	Corticosteroids /IVIG	Yes/NM	65
	63/M	mRNA‐1273	First	11	DM/HTN/DLP	NM	1	NM	NM	NM	Have not responded to typical ITP therapies	Yes/NM	4
	36/M	mRNA‐1273	First	15	Epilepsy	NM	1	NM	NM	NM	NM	Yes/NM	NM
	39/F	BNT16B2b2 mRNA	First	12	NM	ICH	36	NM	NM	NM	Plt transfusion	Yes/NM	NM
Tarawneh, O., 2021 ⁶⁸	22/M	BNT16B2b2 mRNA	First	3	Negative	Petechiae/gingival mucosal bleeding	2	145	NM	Elevated Sjogren's syndrome antibody/ positive for GP IIb/IIIa and Ia/IIa platelet autoantibodies/low C4	Dexamethasone/IVIG /Plt transfusion	Yes/6	173
Pasin, F., 2022 ⁶⁹	84/M	BNT16B2b2 mRNA	First	3	Essential tremor/localized bladder cancer/mild CKD/paroxysmal AF	Petechiae/bruising	3	220	NM	Negative anti PF4/positive anti GP IIb/IIIa	Apixaban Discontinued /PSL/IVIG Plt transfusion	Yes/NM	63
Liao, P. W., 2021 ⁷⁰	79/M	ChAdOx1.	First	7	Ischemic stroke (2 years bedridden)	None	2	NL	2	Negative anti PF4	Hydrocortisone IV 300 mg/day then oral PSL	Yes/12	114
Al‐Samkari, H., 2021 ⁷¹	71/F	Ad26.COV2.S	First	35	Polymyalgia rheumatica	None	115	429	59	Negative anti PF4/positive for all: anti–GPIIb/IIIa anti–GPIb/IX anti–GP Ia/IIa	No treatment	NM/−	248
Krajewski, P. K.2021 ⁷²	74/M	BNT16B2b2 mRNA	First	1	HTN	Oral and nasal mucosal bleeding/purpuraon the extremities/ecchymosis at injection site	2	NM	NM	NM	Dexamethasone/ Plt transfusion	Yes/NM	NM
Banerjee, S., 2021 ⁷³	63/F	Ad26.COV2.S	First	14	Cervical Cancer/total hysterectomy	Gingival and nasal mucosal bleeding	2	NM	NM	NM	Plt transfusion/ PSL 60 mg/ /Dexamethasone /IVIG	Yes/5	252
Condorelli, A., 2021 ⁷⁴	52/M	ChAdOx1.	First	3	Negative	Oral mucosal bleeding/diffuse cutaneous purpura	1	NM	NM	Anti‐platelet Abs: ‐	PSL	Yes/7	168
	24/M	BNT16B2b2 mRNA	Second	4	CHD/heart transplant/Hodgkin lymphoma (complete remission)	None	15	150	NM	NM	PSL 1 mg/kg/day	Yes/30	102
	73/M	BNT16B2b2 mRNA	Second	2	HTN/DM/DLP/CABG/IDA	Petechiae/oral mucosal bleeding/diffuse ecchymosis	2	256	NM	Anti‐platelet Abs: ‐	Methylprednisolone/ IVIG 0.4 g/kg/ PSL 1 mg/kg/day	Yes/5	140
Bayas, A., 2021 ⁷⁵	55/F	ChAdOx1.	First	10	Negative	None	30	NM	NM	Negative anti PF4/elevated platelets antibodies‐IgG/ positive PSIFT and MAIPA	Dexamethasone IV 40 mg	Yes/26	NM
Kim, G., 2021 ⁷⁶	66/F	ChAdOx1.	First	2	Pulmonary TB	Bruising on the extremities/gingival mucosal bleeding	4	213	NM	Negative anti PF4	Dexamethasone 40 mg/IVIG 1 g/kg for 2 days	Yes/6	100

Abbreviations: AF, atrial fibrillation; AIDP, inflammatory demyelinating polyneuropathy; Anti PF‐4, anti‐platelet factor 4; CABG, coronary artery bypass graft; CAD, coronary artery disease; CKD, chronic kidney disease; DLP, dyslipidemia; DM, diabetes mellitus; EPAG, eltrombopag; GERD, gastroesophageal reflux disease; HTN, hypertension; IDA, iron deficiency anemia; IVIG, intravenous immune globulin; MAIPA, monoclonal antibody‐specific immobilization of platelet antigen; MGUS, monoclonal gammopathy of undetermined significance; NL, within normal range; NM, not mentioned; OCP, oral contraceptive pills; Plt, platelets; PCOS, poly cystic ovary syndrome; PSL, prednisolone; PSIFT, platelet suspension immunofluorescence test; RA, rheumatoid arthritis; TPO‐RA, thrombopoietin receptor agonist.