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Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 555-556

COVID-19 vaccine-related skin rash : A case report


1 Department of Radiation Oncology, Panvel Muncipal Corporation, Navi Mumbai, Maharashtra, India
2 Department of Medicine, Panvel Muncipal Corporation, Navi Mumbai, Maharashtra, India
3 Department of Health, Panvel Muncipal Corporation, Navi Mumbai, Maharashtra, India
4 Department of Medical Oncology, Research and Education in Cancer, Navi Mumbai, Maharashtra, India
5 Department of Medical Administration, Research and Education in Cancer, Navi Mumbai, Maharashtra, India

Date of Submission15-Jun-2021
Date of Decision09-Jul-2021
Date of Acceptance06-Aug-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Sachin Babanrao Dhumal
Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_143_21

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How to cite this article:
Dhumal SB, Patil A, More A, Kamtalwar S, Gosavi A, Chandak M, Khattry N, Gupta S, Bhat P. COVID-19 vaccine-related skin rash : A case report. Cancer Res Stat Treat 2021;4:555-6

How to cite this URL:
Dhumal SB, Patil A, More A, Kamtalwar S, Gosavi A, Chandak M, Khattry N, Gupta S, Bhat P. COVID-19 vaccine-related skin rash : A case report. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Dec 9];4:555-6. Available from: https://www.crstonline.com/text.asp?2021/4/3/555/327758



Wuhan city in the Hubei province of China in December 2019 saw an outbreak of pneumonia of unknown etiology, which later evolved into a public health emergency caused by a novel coronavirus.[1] Infection with SARS-CoV-2 can be prevented by avoiding close contact with an infected person, maintaining social distancing, wearing a mask, and using personal protective equipment. Another way of preventing infection with SARS-CoV-2 is attaining herd immunity by vaccination.[2],[3] The first vaccine against the coronavirus disease 2019 (COVID-19) was approved by the Medicinal Healthcare Regulatory Agency of the United Kingdom.[4] In India, Covaxin (BBV152) – a whole-virion, inactivated SARS-CoV-2 vaccine to be administered intramuscularly – was approved for emergency use by the Central Drug Standard Control Organization on January 3, 2021. The vaccine is developed by Bharat Biotech International Limited in collaboration with the Indian Council of Medical Research.[5],[6]

Here, we present a case of Covaxin-related adverse event in a female beneficiary, who developed a rash 15 min after receiving the first dose of Covaxin.

A 54-year-old woman presented to our vaccination center on April 20, 2021, to receive her first dose of Covaxin. She was a known hypertensive but was not taking antihypertensives for the past 4 months. As she was allergic to sulpha drugs, she was explained the risk of developing an allergic reaction to the vaccine. Thus, high-risk informed consent was obtained. The first dose was administered under strict observation at 4:02 p.m. She developed a skin rash Grade-I as per the Common Terminology Criteria for Adverse Events Version 5.0. The rash manifested as reddening of the skin without itching on both her upper extremities, on the elbow of the right upper extremity, and on the wrist of the left hand at 4:12 p.m. [Figure 1]. She had no difficulty in breathing and did not experience uneasiness. Nonetheless, she was taken to the emergency room at 4:17 p.m. Her blood pressure was 160/100 mm of Hg, oxygen saturation was 98% on room air, pulse was 84 beats per minute, and respiratory rate was 22 breaths per minute. She was administered levocetirizine 5 mg in tablet form at 4:21 p.m. and closely observed for the next 45 min. The rash subsided within 10 min at 4:40 p.m. The adverse effect following immunization (AEFI) was also reported to the Pharmacovigilance Programme of India. The beneficiary was counseled to resume and continue antihypertensive medications and discharged at 4:45 p.m. She was followed up telephonically on April 22, 2021 for any further allergic reactions. She reported no complaints, was doing well, and had restarted her antihypertensive medication; her blood pressure was under control.
Figure 1: Skin rash of the elbow of the the right upper extremity

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AEFIs, such as palpitations and skin rash, were reported in healthcare workers who received the first dose of Covaxin at the All India Institute of Medical Sciences in New Delhi, India. The most common adverse reactions reported after receiving Covaxin included headache, body ache, fever, pain at the injection site, nausea and vomiting, and rashes. The Covaxin contains 6 μg of whole-virion, inactivated SARS-CoV-2 antigen (Strain: NIV-2020-770), along with other inactive ingredients such as 250 μg aluminum hydroxide gel, 15 μg Toll-like receptor 7/8 agonist (imidazoquinoline), 2.5 mg 2-phenoxyethanol, and up to 0.5 ml phosphate-buffered saline; these are likely to cause allergic reactions in beneficiaries.[7],[8] The management of skin rash includes the use of antihistaminics and emollients and, in severe cases, the use of corticosteroids. The patient went on to receive the second dose of Covaxin in another vaccination center, which she received without any skin reaction post-vaccination. According to the operational guidelines issued by the Ministry of Health and Family Welfare of the Government of India (updated on December 28, 2020), an AEFI surveillance system should be maintained at each vaccination center and each beneficiary should be counseled about the possible adverse events before vaccination and observed for 30 min after vaccination to monitor and treat any adverse effects. In addition, all vaccination centers are required to be equipped with an AEFI management kit.[9] Thus, the present case report emphasizes the need for strict monitoring of the beneficiaries after COVID-19 vaccination.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her image and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Pande P, Sharma P, Goyal D, Kulkarni T, Rane S, Mahajan A. COVID-19: A review of the ongoing pandemic. Cancer Res Stat Treat 2020;3:221-32.  Back to cited text no. 1
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Kulkarni T, Sharma P, Pande P, Agrawal R, Rane S, Mahajan A. COVID-19: A review of protective measures. Cancer Res Stat Treat 2020;3:244-53.  Back to cited text no. 2
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Ella R, Vadrevu KM, Jogdand H, Prasad S, Reddy S, Sarangi V, et al. Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBV152: A double-blind, randomised, phase 1 trial. Lancet Infect Dis 2021;21:637-46.  Back to cited text no. 5
    
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