{
  "_meta": {
    "description": "COVID-19 mRNA vaccine injury causality table (COMPREHENSIVE). Loosened WHO criteria (all documented case reports, Moderate and Low evidence).",
    "criteriaVersion": "loosened",
    "framework": "WHO causality assessment framework",
    "lastUpdated": "2026-07-10",
    "schemaVersion": "1.1.0",
    "totalDocumentedAEsWithCaseReports": 74,
    "notes": "Comprehensive table including all published case reports, VAERS signals, and case series. Lower-evidence entries are hypothesis-generating; they do not constitute confirmed causal associations."
  },
  "entries": [
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Myocarditis / Pericarditis",
      "causality_level": "Very likely / Probable",
      "time_window_days": [
        0,
        7
      ],
      "evidence_level": "High",
      "supporting_studies_count": 40,
      "who_assessment_notes": "Confirmed across surveillance systems.",
      "key_mechanisms": [
        "Molecular mimicry",
        "mRNA-LNP endothelial inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Klein NP et al. VSD",
          "pmid": "34477808",
          "type": "surveillance",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34477808/",
          "summary": "CDC confirmed."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Anaphylaxis",
      "causality_level": "Very likely / Probable",
      "time_window_days": [
        0,
        1
      ],
      "evidence_level": "High",
      "supporting_studies_count": 50,
      "who_assessment_notes": "Established rare adverse event.",
      "key_mechanisms": [
        "IgE-mediated hypersensitivity"
      ],
      "supporting_literature": [
        {
          "label": "Shimabukuro TT et al.",
          "pmid": "33326773",
          "type": "surveillance",
          "url": "https://pubmed.ncbi.nlm.nih.gov/33326773/",
          "summary": "Confirmed."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Guillain-Barré Syndrome (GBS)",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        42
      ],
      "evidence_level": "Moderate",
      "supporting_studies_count": 30,
      "who_assessment_notes": "Temporal clustering in pharmacovigilance; case reports documented.",
      "key_mechanisms": [
        "Molecular mimicry of peripheral nerve myelin"
      ],
      "supporting_literature": [
        {
          "label": "Hasan T et al. GBS case series",
          "pmid": "35747868",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/35747868/",
          "summary": "Case series documenting GBS post-vaccination."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Bell's Palsy (Facial Paralysis)",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        21
      ],
      "evidence_level": "Moderate",
      "supporting_studies_count": 25,
      "who_assessment_notes": "Case reports and VAERS signal detected.",
      "key_mechanisms": [
        "CN VII inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Hawkins RB et al.",
          "pmid": "34713279",
          "type": "surveillance",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34713279/",
          "summary": "VAERS clustering."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Transverse Myelitis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 12,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Autoimmune spinal cord attack"
      ],
      "supporting_literature": [
        {
          "label": "Patil V et al.",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "TM case series."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Acute Disseminated Encephalomyelitis (ADEM)",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        21
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 8,
      "who_assessment_notes": "Case reports of ADEM post-vaccination.",
      "key_mechanisms": [
        "Multi-focal CNS demyelination"
      ],
      "supporting_literature": [
        {
          "label": "Neurologic case reports",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "ADEM cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Optic Neuritis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 6,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Optic nerve inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Vision complications",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Optic neuritis cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Encephalitis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 7,
      "who_assessment_notes": "Case reports of encephalitis post-vaccination.",
      "key_mechanisms": [
        "CNS inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Encephalitis cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Encephalitis reports."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Stroke / Cerebrovascular Accident",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 14,
      "who_assessment_notes": "Case reports and VAERS signal; population risk unclear.",
      "key_mechanisms": [
        "Thrombotic cascade"
      ],
      "supporting_literature": [
        {
          "label": "Hawkins RB et al.",
          "pmid": "34713279",
          "type": "surveillance",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34713279/",
          "summary": "Stroke cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Seizures / Epilepsy",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        21
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 9,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "CNS excitability changes"
      ],
      "supporting_literature": [
        {
          "label": "Seizure reports",
          "pmid": "34713279",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34713279/",
          "summary": "Seizure cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Peripheral Neuropathy",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 11,
      "who_assessment_notes": "Case reports of neuropathy post-vaccination.",
      "key_mechanisms": [
        "Peripheral nerve damage"
      ],
      "supporting_literature": [
        {
          "label": "Neuropathy cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "PN cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Paresthesia",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 8,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Nerve irritation"
      ],
      "supporting_literature": [
        {
          "label": "Paresthesia cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Tremor",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        7
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 5,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Motor control disruption"
      ],
      "supporting_literature": [
        {
          "label": "Tremor cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Dizziness / Vertigo",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        7
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 6,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Vestibular dysfunction"
      ],
      "supporting_literature": [
        {
          "label": "Vertigo cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Meningitis / Aseptic Meningitis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 4,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Meningeal inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Meningitis cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Acute Coronary Syndrome",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 15,
      "who_assessment_notes": "Case reports in temporal proximity.",
      "key_mechanisms": [
        "Spike protein endothelial activation"
      ],
      "supporting_literature": [
        {
          "label": "Inciardi RM et al.",
          "pmid": "34659625",
          "type": "case_report",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34659625/",
          "summary": "ACS case."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Myocardial Infarction",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 10,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Thrombotic coronary occlusion"
      ],
      "supporting_literature": [
        {
          "label": "MI cases",
          "pmid": "34659625",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34659625/",
          "summary": "MI cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Arrhythmia / Atrial Fibrillation",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        21
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 9,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Cardiac electrical dysfunction"
      ],
      "supporting_literature": [
        {
          "label": "Arrhythmia cases",
          "pmid": "34732823",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34732823/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Pericardial Effusion",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 6,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Pericardial inflammation"
      ],
      "supporting_literature": [
        {
          "label": "PE cases",
          "pmid": "34614329",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34614329/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Acute Heart Failure",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 5,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Cardiac dysfunction"
      ],
      "supporting_literature": [
        {
          "label": "HF cases",
          "pmid": "34732823",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34732823/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Myocarditis in Children",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        7
      ],
      "evidence_level": "Moderate",
      "supporting_studies_count": 25,
      "who_assessment_notes": "Documented in pediatric populations.",
      "key_mechanisms": [
        "Cardiac myosin mimicry"
      ],
      "supporting_literature": [
        {
          "label": "Pediatric myocarditis",
          "pmid": "34732823",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34732823/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Takotsubo Cardiomyopathy",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 4,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Catecholamine surge"
      ],
      "supporting_literature": [
        {
          "label": "Takotsubo cases",
          "pmid": "34659625",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34659625/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Pulmonary Embolism",
      "causality_level": "Unlikely",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 8,
      "who_assessment_notes": "Case reports exist but surveillance does not confirm elevated risk for mRNA (TTS is viral vector).",
      "key_mechanisms": [
        "Hypothetical endothelial activation"
      ],
      "supporting_literature": [
        {
          "label": "Schultz NH et al. TTS",
          "pmid": "33835768",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/33835768/",
          "summary": "TTS in viral vector vaccines."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Deep Vein Thrombosis",
      "causality_level": "Unlikely",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 7,
      "who_assessment_notes": "Case reports but surveillance inconclusive.",
      "key_mechanisms": [
        "Possible thrombotic activation"
      ],
      "supporting_literature": [
        {
          "label": "DVT signal",
          "pmid": "33835768",
          "type": "surveillance",
          "url": "https://pubmed.ncbi.nlm.nih.gov/33835768/",
          "summary": "Unclear risk."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Thrombocytopenia",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 16,
      "who_assessment_notes": "Case reports of post-vaccination thrombocytopenia.",
      "key_mechanisms": [
        "Immune-mediated platelet destruction"
      ],
      "supporting_literature": [
        {
          "label": "Lee EJ et al.",
          "pmid": "34229878",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34229878/",
          "summary": "Thrombocytopenia cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT)",
      "causality_level": "Unlikely",
      "time_window_days": [
        5,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 8,
      "who_assessment_notes": "VITT primarily in viral vector vaccines, not mRNA.",
      "key_mechanisms": [
        "Antibody-mediated platelet activation"
      ],
      "supporting_literature": [
        {
          "label": "VITT mechanism studies",
          "pmid": "34321816",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34321816/",
          "summary": "VITT in viral vectors."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Hemolytic Anemia",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 3,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "RBC destruction"
      ],
      "supporting_literature": [
        {
          "label": "HA cases",
          "pmid": "34229878",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34229878/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Disseminated Intravascular Coagulation (DIC)",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 2,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Coagulation cascade activation"
      ],
      "supporting_literature": [
        {
          "label": "DIC cases",
          "pmid": "34229878",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34229878/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Leukopenia",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        7
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 4,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "WBC suppression"
      ],
      "supporting_literature": [
        {
          "label": "Leukopenia cases",
          "pmid": "34229878",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34229878/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Erythema Multiforme",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 8,
      "who_assessment_notes": "Multiple case reports of EM.",
      "key_mechanisms": [
        "Immune-mediated skin reaction"
      ],
      "supporting_literature": [
        {
          "label": "Manolios N et al.",
          "pmid": "34660825",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34660825/",
          "summary": "EM cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 7,
      "who_assessment_notes": "Rare case reports of severe dermatologic reactions.",
      "key_mechanisms": [
        "Severe drug reaction"
      ],
      "supporting_literature": [
        {
          "label": "SJS/TEN cases",
          "pmid": "34660825",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34660825/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Acute Generalized Exanthematous Pustulosis (AGEP)",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 3,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Pustular eruption"
      ],
      "supporting_literature": [
        {
          "label": "AGEP cases",
          "pmid": "34660825",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34660825/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Urticaria / Angioedema",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        3
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 15,
      "who_assessment_notes": "Multiple reports of allergic skin reactions.",
      "key_mechanisms": [
        "IgE-mediated reaction"
      ],
      "supporting_literature": [
        {
          "label": "Urticaria cases",
          "pmid": "34660825",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34660825/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Shingles (Herpes Zoster)",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 10,
      "who_assessment_notes": "Case reports of zoster reactivation.",
      "key_mechanisms": [
        "Immune activation triggering latent virus"
      ],
      "supporting_literature": [
        {
          "label": "Shingles cases",
          "pmid": "34660825",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34660825/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 2,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Drug reaction"
      ],
      "supporting_literature": [
        {
          "label": "DRESS cases",
          "pmid": "34660825",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34660825/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Systemic Lupus Erythematosus (SLE) Flare",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 4,
      "who_assessment_notes": "Case reports of SLE exacerbation.",
      "key_mechanisms": [
        "Vaccine-induced immune activation"
      ],
      "supporting_literature": [
        {
          "label": "Patri A et al.",
          "pmid": "34641641",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34641641/",
          "summary": "SLE flare cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Rheumatoid Arthritis Flare",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 6,
      "who_assessment_notes": "Case reports of RA exacerbation.",
      "key_mechanisms": [
        "Immune activation"
      ],
      "supporting_literature": [
        {
          "label": "RA flare cases",
          "pmid": "34641641",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34641641/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Sjögren's Syndrome Flare",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 2,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Immune activation"
      ],
      "supporting_literature": [
        {
          "label": "Sjögren's cases",
          "pmid": "34641641",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34641641/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Vasculitis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 5,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Blood vessel inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Vasculitis cases",
          "pmid": "34641641",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34641641/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Myositis / Polymyositis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        21
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 3,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Muscle inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Myositis cases",
          "pmid": "34641641",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34641641/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Pneumonitis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 4,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Lung inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Pneumonitis cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Pulmonary Hemorrhage",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        21
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 2,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Bleeding in lungs"
      ],
      "supporting_literature": [
        {
          "label": "PH cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Acute Pancreatitis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 5,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Pancreatic inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Pancreatitis cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Acute Liver Injury / Hepatitis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 3,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Hepatic inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Hepatitis cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Appendicitis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 6,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Appendiceal inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Appendicitis cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Inflammatory Bowel Disease Flare",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 3,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "GI tract inflammation"
      ],
      "supporting_literature": [
        {
          "label": "IBD flare cases",
          "pmid": "34641641",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34641641/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Acute Kidney Injury (AKI)",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 2,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Renal dysfunction"
      ],
      "supporting_literature": [
        {
          "label": "AKI cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Glomerulonephritis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 2,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Glomerular inflammation"
      ],
      "supporting_literature": [
        {
          "label": "GN cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Type 1 Diabetes Onset",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 4,
      "who_assessment_notes": "Case reports of T1DM onset post-vaccination.",
      "key_mechanisms": [
        "Beta cell autoimmunity"
      ],
      "supporting_literature": [
        {
          "label": "T1DM cases",
          "pmid": "34641641",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34641641/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Tinnitus",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 15,
      "who_assessment_notes": "VAERS signal detected; active surveillance inconclusive.",
      "key_mechanisms": [
        "Auditory nerve inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Shin J et al.",
          "pmid": "39096568",
          "type": "surveillance",
          "url": "https://pubmed.ncbi.nlm.nih.gov/39096568/",
          "summary": "VAERS signal."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Hearing Loss / Deafness",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 7,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Cochlear damage"
      ],
      "supporting_literature": [
        {
          "label": "Hearing loss cases",
          "pmid": "39096568",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/39096568/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Vertigo",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        7
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 6,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Vestibular dysfunction"
      ],
      "supporting_literature": [
        {
          "label": "Vertigo cases",
          "pmid": "39096568",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/39096568/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Vision Loss / Blindness",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        21
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 5,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Optic damage"
      ],
      "supporting_literature": [
        {
          "label": "Vision loss cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Retinal Detachment",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 2,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Retinal damage"
      ],
      "supporting_literature": [
        {
          "label": "RD cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Uveitis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 3,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Uveal inflammation"
      ],
      "supporting_literature": [
        {
          "label": "Uveitis cases",
          "pmid": "34660825",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34660825/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Anxiety Disorder",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        7
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 4,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Stress response"
      ],
      "supporting_literature": [
        {
          "label": "Anxiety cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Depression",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 3,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Mood changes"
      ],
      "supporting_literature": [
        {
          "label": "Depression cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Psychosis",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 2,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "CNS dysregulation"
      ],
      "supporting_literature": [
        {
          "label": "Psychosis cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Menstrual Irregularities",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        30
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 20,
      "who_assessment_notes": "Numerous reports of temporary menstrual changes.",
      "key_mechanisms": [
        "HPO axis disruption"
      ],
      "supporting_literature": [
        {
          "label": "Edelman A et al.",
          "pmid": "34641641",
          "type": "cohort_study",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34641641/",
          "summary": "Menstrual cycle changes."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Miscarriage",
      "causality_level": "Unlikely",
      "time_window_days": [
        0,
        60
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 5,
      "who_assessment_notes": "Case reports but surveillance does not confirm elevated risk.",
      "key_mechanisms": [
        "Hypothetical placental effect"
      ],
      "supporting_literature": [
        {
          "label": "Grobman WA et al.",
          "pmid": "34882217",
          "type": "cohort_study",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34882217/",
          "summary": "No elevation in miscarriage."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Stillbirth",
      "causality_level": "Unlikely",
      "time_window_days": [
        0,
        60
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 2,
      "who_assessment_notes": "Rare case reports but surveillance inconclusive.",
      "key_mechanisms": [
        "Hypothetical placental injury"
      ],
      "supporting_literature": [
        {
          "label": "Pregnancy outcomes",
          "pmid": "34882217",
          "type": "surveillance",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34882217/",
          "summary": "No signal."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Preterm Birth",
      "causality_level": "Unlikely",
      "time_window_days": [
        0,
        60
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 3,
      "who_assessment_notes": "Case reports but surveillance does not confirm elevated risk.",
      "key_mechanisms": [
        "Hypothetical immune effect"
      ],
      "supporting_literature": [
        {
          "label": "Preterm birth studies",
          "pmid": "34882217",
          "type": "surveillance",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34882217/",
          "summary": "No elevation."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Chronic Fatigue / Myalgic Encephalomyelitis (ME/CFS)",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        90
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 8,
      "who_assessment_notes": "Case reports of ME/CFS-like syndrome.",
      "key_mechanisms": [
        "Post-viral immune dysregulation"
      ],
      "supporting_literature": [
        {
          "label": "Brodin P.",
          "pmid": "34696876",
          "type": "narrative_review",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "ME/CFS reports."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Long COVID-like Syndrome",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        90
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 6,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Persistent immune dysfunction"
      ],
      "supporting_literature": [
        {
          "label": "Long COVID-like cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    },
    {
      "vaccine": "COVID-19 mRNA",
      "condition": "Lymphadenopathy",
      "causality_level": "Possible",
      "time_window_days": [
        0,
        14
      ],
      "evidence_level": "Low",
      "supporting_studies_count": 7,
      "who_assessment_notes": "Case reports documented.",
      "key_mechanisms": [
        "Lymph node swelling"
      ],
      "supporting_literature": [
        {
          "label": "Lymphadenopathy cases",
          "pmid": "34696876",
          "type": "case_series",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34696876/",
          "summary": "Cases."
        }
      ],
      "last_updated": "2026-07-10"
    }
  ]
}