And why it’s important to know them (and their limitations)
Biomedical devices have their limits in understanding the body from the outside. That’s why autopsy— meaning ‘the act of seeing for oneself’ in Greek — remains useful to this day. To know what really happened, we have to understand the body from the inside. An autopsy, thus, dissects the dead body to determine the cause of death or the effects of a disease or treatment.
What happened inside the body of people who died shortly after getting the Covid-19 vaccines then? Was the vaccine involved in the cause of death or not? Knowing this is crucial for reasons such as claiming a pension, ensuring the public that potential vaccine complications are investigated, and evaluating or disproving claims of vaccines killing people.
To answer this question, I searched PubMed, a biomedical literature database, with the keywords
“vaccine AND (covid OR sars-cov-2) AND (autopsy OR postmortem OR necropsy)" and derived 55 papers as of today. But only 11 papers are autopsy research that investigated Covid-19 vaccines. I also searched medRxiv, a preprint server for unpublished biomedical papers, with the same keywords, and got 62 papers, but none is relevant. So, I’ll describe 11 autopsy papers here.
*All vaccines mentioned hereon refer to the Covid-19 vaccines, namely the mRNA and DNA vaccines that are most commonly used. Unless mentioned otherwise, autopsied cases were SARS-CoV-2-negative.
*Vaccine-induced thrombotic thrombocytopenia (VITT) is a known risk of DNA vaccines from AstraZeneca and Johnson & Johnson, especially among younger females, characterized by life-threatening blood clots plus low platelets. Platelets are blood-clotting cells, so their depletion makes one prone to excessive bleeding. VITT also has a specific biomarker: anti-platelet factor 4 (anti-PF4) antibodies.
Autopsy case series
1. Germany (Scheider et al., 2021)
By 31 May 2021 in Germany, 873 post-vaccine deaths — deaths with temporal (time) relation to vaccination — were recorded. But by this date, 15.2 million and 20.9 million people were fully and partially vaccinated, respectively, totaling 36.1 million people. The 873 post-vaccine deaths, thus, represent 0.0024% of the vaccinated population.
Among those deaths, Schneider et al. (2021) autopsied 18 cases, on behalf of the public prosecutor’s offices in Bielefeld, Detmold, and Münster, with the catchment area of ~3.24 million people.
Of those 18 autopsied cases, nine received AstraZeneca’s DNA vaccine (Vaxzevria), five received Pfizer’s mRNA vaccine (Comirnaty), three received Moderna’s mRNA vaccine (Spikevax), and one received Johnson & Johnson’s DNA vaccine (Janssen). Their gender, number of doses, time interval between vaccination and death, place of death, autopsy findings, cause of death, and causal relationship are described in this table:
In 13 out of 18 cases, the cause of death was attributed to pre-existing diseases — mainly cardiovascular diseases, such as coronary artery diseases (plaque build-up in arteries) and myocardial infarction (heart attack) — with no evidence of a causal relationship to vaccination: see cases 1, 2, 4, 5, 7, 8, 9, 10, 11, 13, 15, 16, and 17 in the table above.
In case 6, a 65-year-old male who got one dose of Pfizer’s mRNA vaccine, the cause of death was myocarditis. But the causal relationship to vaccination is deemed ‘possible’ because he had severe pre-existing cardiovascular diseases that might have caused the fatal myocarditis.
In cases 3, 12, 14, and 18, evidence of VITT was found, with positive anti-PF4 antibodies. But VITT was deemed as a ‘very likely’ cause of death in cases 3 and 14 only, ‘unlikely’ in case 12, and ‘possible’ in case 18.
Case 12 had hypoxic brain damage, and case 18 had severe cardiovascular diseases, both of which are also the probable cause of death. Both cases 12 and 18 also lacked autopsy evidence of VITT-specific blood clots and bleeding. After all, VITT is not always fatal, so its molecular signs (i.e., PF4 antibodies) do not guarantee that it caused a certain post-vaccine death.
2. Germany (Edler et al., 2021)
While Scheider et al., covered three cities in Germany — Bielefeld, Detmold, and Münster — Edler et al. (2021) covered Hamburg only. As of February 2021, Edler et al. were aware of 22 post-vaccine deaths from their catchment area in Hamburg, and they autopsied three.
- Case 1: A senior nursing home resident (female, age n/a) died five days after getting Pfizer’s mRNA vaccine. She had pre-existing coronary heart disease, cardiac insufficiency, arterial hypertension, dementia, and hyperthyroidism. An autopsy determined that the cause of death was pulmonary artery embolism, with no causal relationship to vaccination.
- Case 2: A senior nursing home resident (male, age n/a) died seven days after getting Pfizer’s mRNA vaccine. He had pre-existing chronic renal, cardiovascular, and other diseases. He was tested positive for SARS-CoV-2 on the 12th day of vaccination and died of Covid-19 pneumonia. An autopsy confirmed pneumonia as the cause of death, with additional pancreatitis, but no causal relationship to vaccination.
- Case 3: A senior nursing home resident (male, age n/a) died two days after getting Pfizer’s mRNA vaccine. He had pre-existing dementia, heart attack, arterial hypertension, and diabetes. Fatal vaccine complications were suspected. But an autopsy found no such evidence and determined the cause of death as recurrent heart attack with severe arteriosclerosis.
3. Norway (Weidmann et al., 2021)
In Norway, Pfizer’s and Moderna’s mRNA vaccines were used first, followed by AstraZeneca’s DNA vaccine. But by the second week of AstraZeneca’s DNA vaccine roll-out, six cases (5 women and 1 man) of VITT occurred in previously healthy healthcare workers. A total of 132,488 first doses of AstraZeneca’s DNA vaccine were distributed during that period, putting the VITT incidence rate at 0.045% or 1 case per 22,000 vaccinated people.
Weidmann et al. autopsied four diseased VITT cases.
- Case 1: A 34-year-old woman died 11 days after getting AstraZeneca’s DNA vaccine. An autopsy revealed patterns of blood clots and bleeding that represent VITT, which was also the first VITT case in Norway.
- Case 2: A 42-year-old woman was hospitalized ten days after getting AstraZeneca’s DNA vaccine due to VITT. She underwent treatment but died 15 days after hospitalization. Au autopsy found evidence of VITT-related blood clots and bleeding in the brain and lungs.
- Case 3: A 37-year-old woman was hospitalized eight days after getting AstraZeneca’s DNA vaccine due to VITT and died three days later. An autopsy confirmed VITT-related bleeding and blood clots in the brain.
- Case 4: A 54-year-old woman was hospitalized seven days after getting AstraZeneca’s DNA vaccine due to VITT and died two days later. An autopsy verified VITT-specific bleeding and blood clots in the brain and other organs.
4. Italy (Pomara et al., 2021)
Compared to the above three papers, the paper of Pomara et al. is less extensive, covering only two cases in Italy.
- Case 1: A 50-year-old healthy male died 16 days after getting AstraZeneca’s DNA vaccine from severe thrombocytopenia, blood clots, and intracerebral hemorrhage. An autopsy confirmed these diseases, with positive anti-PF4 antibodies, concluding VITT as the cause of death.
- Case 2: A 37-year-old healthy female died 24 days after getting AstraZeneca’s DNA vaccine from severe blood clots and intracerebral hemorrhage. Like case 1, an autopsy confirmed these diseases, with positive anti-PF4, attributing VITT as the cause of death.
Other case reports
Aside from those case series, six individual autopsy case reports on post-vaccine death have also been published.
- Hansen et al. (2021); Germany: An 86-year-old male died 26 days after getting Pfizer’s mRNA vaccine due to renal and respiratory failure, as confirmed by an autopsy. He was also tested positive for SARS-CoV-2 on day 24 after vaccination, and the autopsy detected SARS-CoV-2 RNA in the olfactory mucosa, tongue, brain, trachea, myocardium, kidneys, and lungs. But the autopsy did not find evidence of Covid-19 pneumonia, making it unclear if Covid-19 played a role in the death.
- Choi et al. (2021); South Korea: A 22-year-old healthy male died five days after getting Pfizer’s mRNA vaccine. An autopsy revealed evidence of myocarditis (inflamed heart muscles) and dead heart muscle cells, but no blood clots. Thus, the cause of death was attributed to myocarditis that was likely initiated by the mRNA vaccine.
- Verma et al. (2021); the U.S.: A 42-year-old male died about 2.5 weeks after getting Pfizer’s mRNA vaccine due to cardiogenic shock. He had no pre-existing coronary heart disease. An autopsy determined myocarditis, probably induced by the mRNA vaccine, as the cause of death.
- Mauriello et al. (2021); Italy: A 48-year-old female — with a history of thrombocytopenia (low platelets, making one prone to excessive bleeding) — was hospitalized on day 18 after getting AstraZeneca’s DNA vaccine. Brain surgery was performed on day 23, but comatose occurred. Brain death was declared on day 39. An autopsy found bleeding in the brain, blood clots and tissue damage in the lungs, and megakaryocyte (platelet-producing cells) anomalies. Anti-PF4 antibodies were absent, ruling out VITT. So, the cause of death is probably due to pre-existing thrombocytopenia.
- Permezel et al. (2021); Australia: A 63-year-old man — with pre-existing diabetes and heart diseases — was hospitalized for acute disseminated encephalomyelitis (ADEM) 12 days after getting AstraZeneca’s DNA vaccine and died on day 32 post-vaccination. An autopsy confirmed ADEM as the cause of death, with no evidence of vaccine involvement.
- Bjornstad-Tuveng et al. (2021); Norway: A woman in her 30s died ten days after getting AstraZeneca’s DNA vaccine. Intracerebral hemorrhage (bleeding in the brain) and thrombocytopenia were diagnosed before death. An autopsy later identified the presence of blood clots in the brain and anti-PF4 antibodies, concluding VITT as the cause of death.
What should we be looking for?
If we don’t aim, we won’t hit. Similarly, in an autopsy, if we don’t aim to measure x, we won’t know anything about x. So, what should autopsies aim or look for to determine if the vaccine is involved in the cause of death?
Based on the methods of the autopsy papers described above, they usually look for biomarkers indicative of vaccine-related immune responses in the blood or various organs/tissues in the dead body.
For instance, unusual levels of serum tryptase, IgE, interleukin 6, C-reactive protein, and complement factors 3 and 5 would indicate anaphylaxis, a vaccine-specific severe allergic reaction. For vaccine-induced thrombotic thrombocytopenia (VITT), anti-platelet factor 4 (anti-PF4) antibodies would be present, and the platelet activation test would be positive, as well as tissue damage indicative of blood clots and bleeding, usually in the brain.
Similarly, other causes of death would have their specific patterns of tissue damage and disease biomarkers. For example, ruptured arteries and neutrophil infiltration in the brain would indicate hemorrhagic stroke death. Scarred heart tissues and troponin biomarker would indicate heart attack death. Blood clots and factor VIII and fibrinogen biomarkers in the lungs would indicate pulmonary embolism death.
But here lies a problem: how would we know whether the vaccine might have contributed to such causes of death? How would we know whether the vaccine might have accelerated the disease's progression to death?
As noted, if we don’t aim to measure x, we won’t know anything about x. If x is an unknown mechanism we are unaware of, we would have missed it.
For instance, the Norwegian case report (Bjornstad-Tuveng et al.) performed the autopsy before VITT was discovered. They initially reported the cause of death as inconclusive: “The incident that we describe in this case study is still being investigated by the Norwegian Medicines Agency, and a final conclusion is not yet available.” But when VITT was characterized later, the Norwegian study conducted further analyses and detected anti-PF4 antibodies, concluding the cause of death as VITT.
So, a limitation of the autopsy is biochemical or biomolecular ignorance. An autopsy mainly examines patterns of tissue or organ damage. Whether additional biochemical analyses are conducted or not is optional.
This problem is also due to the knowledge gap: What biomarkers should we even look for? We know what biomarkers to look for when VITT or anaphylaxis is suspected because their vaccine-specific mechanisms have been known. For other unknown mechanisms of vaccine-related complications that might or might not exist, an autopsy won’t be able to find it. This limitation is indeed hard to overcome, but it also doesn’t negate the valuable information autopsies can inform us.
What the autopsies tell us
Of the abovementioned 11 autopsy papers, covering 33 cases of post-vaccine death, the cause of death of:
- 19 cases were unrelated to the vaccine.
- 9 cases were VITT.
- 2 cases were suspected but unconfirmed VITT.
- 2 cases were myocarditis likely induced by the mRNA vaccine.
- 1 case was myocarditis with possible mRNA vaccine involvement.
The U.S. Centers for Disease Control and Prevention (CDC) has also reviewed several autopsy reports — which don’t seem to have been published academically — stating that:
So, the autopsies show that cases of post-vaccine death — which are very rare — are not necessarily caused by the vaccine. Pre-existing diseases, most notably cardiovascular diseases, are usually the cause of death instead.
Sure, the autopsy papers discussed above are limited in sample size and are not sampled at random, thus prone to sampling bias. But such limitations could also work in favor of vaccines. For example, in the study of Schneider et al., the autopsies were requested by prosecutors, most likely because the post-vaccine death was suspicious (otherwise, why even request an autopsy?). Yet, only two out of 18 autopsied cases showed convincing evidence indicating the AstraZeneca’s DNA vaccine as the cause of death.
This finding tells us an important thing: A suspicious or suspected vaccine-related death are usually due to causes unrelated to the vaccine.
The post-vaccine autopsies discussed herein also show that the scientific communities and public health authorities are not hiding autopsy reports for fear of vaccine killing people. As Edler et al. wrote:
“With vaccine hesitancy still high among many people, it is especially important to carefully investigate deaths associated with vaccination and to objectively solve unclear circumstances. Otherwise, people’s confidence in safe vaccination could easily be destroyed by individual cases sensationalized by the media.”
In the end, the vaccine-related autopsy research agrees on the scientific consensus that the Covid-19 vaccines, although not risk-free, are safe for the majority of the population and provide more benefits than harm. Current phase IV large-scale surveillance studies from several countries also support such consensus.