Evidence dossier · candidate cand-covid-acute-transverse-myelitis · CICP program · · DRAFT — not a determination
This is a draft research-tracking dossier, not a determination that COVID-19 vaccine causes Acute Transverse Myelitis, and not an incidence or legal finding. All evidence is flagged needs_human_review and must be reviewed before any page is published or cited. Every value is grounded in retrieved citations (PMID + retrieval date); unsourced items read "no evidence found / not assessable". Symmetric search: every supporting query has a mirror/null query, and zeros are shown (negative dossiers report the absence of signal).
Claim matrix (C1–C6, computed)
Claim
Label
Status
Missing nodes
C1
Coherent clinical object exists
supported
C2
Consistent temporal window
supported
C3
Epidemiologic excess risk
contested
C4
Consistency / replication
contested
C5
Specificity (product / dose)
contested
C6
Biological mechanism
supported
Two evidentiary bars apply to the epi nodes/claims (C3, C4): · VICP — preponderance of the evidence. · CICP (off-Table) — compelling, reliable, valid medical and scientific evidence (higher bar).
Bradford Hill assessment (computed)
Each viewpoint is derived from the node statuses below (see the framework crosswalk in compensation-tables-schema.md §8). Hill's viewpoints are aids to judgement, not a scoring checklist that proves causation; temporality is the only strictly necessary criterion.
Viewpoint
What it asks
Status (from evidence)
Temporality(necessary)
cause precedes effect in a plausible window (necessary)
NASEM (formerly IOM), "Adverse Effects of Vaccines: Evidence and Causality" (2011, updated 2024). Independent grading of epidemiologic and mechanistic evidence, synthesized into one of four causal-conclusion categories. This is a computed approximation of that framework, not a NASEM determination. See compensation-tables-schema.md §8bis.
Case-definition standard: no established case definition (needs_human_review — not in spec §1's named-standard list) — governs the case-certainty scale on A1/A2/A6/A8 below. See compensation-tables-schema.md §8ter.
Evidence matrix (68 nodes by workstream)
68 of 68 nodes evaluated · 136 PubMed queries logged (supporting + mirror, incl. zeros). Statuses are computed from retrieved citations; not hand-set.
Definition & attribution 24/24 evaluated
A1 · Case reportssupports
Measure: New definite object in risk window T Comparator: Pre-vaccination baseline Hit rule: Definite object present, onset in window, competing causes considered
Finding: Multiple case reports describe new-onset Acute Transverse Myelitis occurring within days to weeks after receiving various COVID-19 vaccines (mRNA, viral vector, inactivated), with imaging-confirmed spinal cord lesions and exclusion of other causes.
supporting: COVID-19 vaccine Acute Transverse Myelitis case report OR case series Case reports pubmed · 66214 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis alternative diagnosis OR not vaccine-related pubmed · 4052 hits · run 2026-09-06
16 retrieved record(s)
supports_node 35191229 · Journal of Korean medical science (2022) — Case Reports of Acute Transverse Myelitis Associated With mRNA Vaccine for COVID-19.
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
supports_node 34482455 · Journal of neurology (2022) — Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature.
does_not_resolve 36441403 · Current cardiology reports (2022) — COVID-19 Vaccine-Related Myocardial and Pericardial Inflammation.
ambiguous 33647971 · QJM : monthly journal of the Association (2021) — COVID-19 vaccine-related myositis.
A2 · Series with objective confirmationsupports
Measure: Definite object plus objective test Comparator: Reference range / diagnostic criteria Hit rule: Objective confirmation in >=1 case per the working definition
Finding: Two case reports describe acute transverse myelitis after COVID-19 vaccination, one with the ChAdOx1 nCoV-19 vaccine and one with an inactivated vaccine (CoronaVac), including objective MRI confirmation of longitudinally extensive transverse myelitis.
supporting: COVID-19 vaccine Acute Transverse Myelitis case report OR case series Series with objective confirmation pubmed · 5698 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis alternative diagnosis OR not vaccine-related pubmed · 4052 hits · run 2026-09-06
does_not_resolve 38500249 · Journal of movement disorders (2024) — COVID-19 Vaccine-Related Movement Disorders: A Systematic Review.
A3 · Onset histogramsupports
Measure: Distribution of onset times after dose Comparator: Pre-specified risk window Hit rule: Onset clusters inside the pre-specified window (not uniform/flat)
Finding: Case reports describe onset of acute transverse myelitis within days to weeks after COVID-19 vaccination (e.g., 1 day after second dose BNT162b2, 3 weeks after CoronaVac, shortly after Moderna mRNA-1273), indicating clustering in a pre-specified window.
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
supports_node 38988884 · AIMS neuroscience (2024) — Acute transverse myelitis (ATM) associated with COVID 19 infection and vaccination: A case report and literature review.
supports_node 35191229 · Journal of Korean medical science (2022) — Case Reports of Acute Transverse Myelitis Associated With mRNA Vaccine for COVID-19.
supports_node 38350771 · Vaccine (2024) — Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis.
supports_node 34482455 · Journal of neurology (2022) — Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature.
A4 · Temporal plausibilitysupports
Measure: Onset latency vs object pathophysiology Comparator: Object's known natural latency Hit rule: Onset latency consistent with the object's pathophysiology
Finding: Multiple case reports describe acute transverse myelitis onset within days to weeks after COVID-19 vaccination, with latencies as short as one day (e.g., after second BNT162b2 dose, PMID 38664389) and up to three weeks (e.g., after CoronaVac, PMID 34370410), and include various vaccine types (ChAdOx1, BNT162b2, mRNA-1273, CoronaVac), suggesting onset latencies consistent with the known pathophysiology of immune-mediated post-vaccinal adverse events.
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
supports_node 38988884 · AIMS neuroscience (2024) — Acute transverse myelitis (ATM) associated with COVID 19 infection and vaccination: A case report and literature review.
supports_node 35191229 · Journal of Korean medical science (2022) — Case Reports of Acute Transverse Myelitis Associated With mRNA Vaccine for COVID-19.
supports_node 38350771 · Vaccine (2024) — Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis.
does_not_resolve 36441403 · Current cardiology reports (2022) — COVID-19 Vaccine-Related Myocardial and Pericardial Inflammation.
A5 · Onset-interval documentationsupports
Measure: Onset interval documented in source Comparator: Dose date Hit rule: Onset interval is recorded (not imputed) in a primary source
Finding: Multiple case reports document that acute transverse myelitis occurred after COVID-19 vaccination with recorded onset intervals (e.g., 1 day, 5 days, 3 weeks post-vaccination), but these are individual case descriptions, not formal onset-interval documentation in a standardized primary surveillance source.
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
supports_node 38350771 · Vaccine (2024) — Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis.
supports_node 35975341 · Journal of postgraduate medicine (2022) — Longitudinally extensive transverse myelitis following ChAdOx1 nCoV-19 vaccine.
supports_node 34482455 · Journal of neurology (2022) — Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature.
does_not_resolve 36441403 · Current cardiology reports (2022) — COVID-19 Vaccine-Related Myocardial and Pericardial Inflammation.
A6 · Differential diagnosis excludedno_data
Measure: Competing causes assessed and excluded Comparator: Likely alternative diagnoses Hit rule: Pre-specified competing causes ruled out per the working definition
Finding: Two case reports describe acute transverse myelitis after COVID-19 vaccination, but neither explicitly documents that pre-specified competing causes were assessed and ruled out per the working definition.
supporting: COVID-19 vaccine Acute Transverse Myelitis case report OR case series Differential diagnosis excluded pubmed · 484 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis alternative diagnosis OR not vaccine-related pubmed · 4052 hits · run 2026-09-06
12 retrieved record(s)
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
does_not_resolve 38500249 · Journal of movement disorders (2024) — COVID-19 Vaccine-Related Movement Disorders: A Systematic Review.
A7 · Rechallenge / re-exposuremixed
Measure: Object recurs on a further dose Comparator: First-dose response Hit rule: Object recurs after a subsequent dose (re-exposure)
Finding: Multiple case reports describe acute transverse myelitis (ATM) occurring after a first dose of COVID-19 vaccine, but few report recurrence after a subsequent dose; one case (PMID 38664389) describes ATM onset after the second dose of BNT162b2, which could represent a rechallenge event, but the patient had no reported ATM after the first dose.
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
supports_node 38350771 · Vaccine (2024) — Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis.
supports_node 35975341 · Journal of postgraduate medicine (2022) — Longitudinally extensive transverse myelitis following ChAdOx1 nCoV-19 vaccine.
supports_node 34482455 · Journal of neurology (2022) — Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature.
does_not_resolve 36441403 · Current cardiology reports (2022) — COVID-19 Vaccine-Related Myocardial and Pericardial Inflammation.
A8 · Adjudicated by criteria (no established case definition)no_data
Measure: Object adjudicated by published criteria Comparator: Published clinical / Brighton criteria Hit rule: Cases adjudicated to 'definite' by a published criterion set
Finding: Multiple case reports describe acute transverse myelitis (ATM) with onset within days to three weeks after COVID-19 vaccination (ChAdOx1 nCoV-19, CoronaVac, mRNA-1273, BNT162b2). One self-controlled case series analysis observed an excess of transverse myelitis cases following ChAdOx1 nCoV-19 and mRNA-1273 vaccines compared with expected background rates. However, no retrieved publication explicitly applies a published adjudication criterion set to classify cases as 'definite'.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis case report OR case series Adjudicated by criteria pubmed · 96 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis alternative diagnosis OR not vaccine-related pubmed · 4052 hits · run 2026-09-06
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
supports_node 38350771 · Vaccine (2024) — Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis.
supports_node 35975341 · Journal of postgraduate medicine (2022) — Longitudinally extensive transverse myelitis following ChAdOx1 nCoV-19 vaccine.
supports_node 34482455 · Journal of neurology (2022) — Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature.
does_not_resolve 36441403 · Current cardiology reports (2022) — COVID-19 Vaccine-Related Myocardial and Pericardial Inflammation.
A9 · Natural-history consistencysupports
Measure: Course matches the object's natural history Comparator: Known natural history of the object Hit rule: Clinical course (onset, peak, recovery) matches the object's natural history
Finding: Multiple case reports describe clinical courses of acute transverse myelitis following COVID-19 vaccination that match the known natural history of the condition, including rapid onset (1 day to 3 weeks post-vaccination), progressive motor and sensory deficits, and neurogenic bladder, consistent with acute transverse myelitis.
supporting: COVID-19 vaccine Acute Transverse Myelitis case report OR case series Natural-history consistency pubmed · 160 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis alternative diagnosis OR not vaccine-related pubmed · 4052 hits · run 2026-09-06
13 retrieved record(s)
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
Measure: Not attributable to a co-occurring condition Comparator: Co-occurring illness that could produce the object Hit rule: Object not better explained by a co-occurring condition (infection, etc.)
Finding: Multiple case reports and a self-controlled case series analysis describe acute transverse myelitis (ATM) occurring shortly after COVID-19 vaccination (ChAdOx1 nCoV-19, CoronaVac, BNT162b2, mRNA-1273), with extensive diagnostic workup ruling out other causes in most cases, supporting a possible association.
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
supports_node 38350771 · Vaccine (2024) — Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis.
supports_node 35975341 · Journal of postgraduate medicine (2022) — Longitudinally extensive transverse myelitis following ChAdOx1 nCoV-19 vaccine.
supports_node 34482455 · Journal of neurology (2022) — Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature.
does_not_resolve 33647971 · QJM : monthly journal of the Association (2021) — COVID-19 vaccine-related myositis.
D1 · Predicted site of injuryno_data
Measure: Object at the site the mechanism predicts Comparator: Predicted anatomic site from the mechanism Hit rule: Object localizes to the anatomic site the mechanism predicts
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis anatomic localization Predicted site of injury mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Predicted site of injury not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-06
D2 · Spared structuresno_data
Measure: Structures the mechanism should spare are spared Comparator: Structures predicted unaffected Hit rule: Structures predicted spared by the mechanism are indeed spared
mirror: COVID-19 vaccine Acute Transverse Myelitis Spared structures not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-06
D3 · Local vs systemic distributionno_data
Measure: Distribution matches mechanism scope Comparator: Local (injection site) vs systemic expectation Hit rule: Observed distribution (local vs systemic) matches the mechanism's predicted scope
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis anatomic localization Local vs systemic distribution mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Local vs systemic distribution not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-06
D4 · Kinetics classno_data
Measure: Onset/offset kinetics match the mechanism Comparator: Expected kinetic class (acute vs chronic) Hit rule: Onset and offset kinetics are in the class the mechanism predicts
mirror: COVID-19 vaccine Acute Transverse Myelitis Kinetics class not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-06
D5 · Platform-mechanism matchno_data
Measure: Mechanism is consistent with the platform Comparator: Mechanistic expectation for the platform Hit rule: The proposed mechanism is biologically consistent with the vaccine platform
mirror: COVID-19 vaccine Acute Transverse Myelitis Platform-mechanism match not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-06
H3 · Targeted treatment reversesno_data
Measure: A targeted treatment reverses the object in patients Comparator: Treatment-naive / placebo Hit rule: A mechanism-directed treatment reverses the object (vs control treatment)
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Targeted treatment reverses intervention OR treatment OR reversal pubmed · 15141300 hits · run 2026-09-06
Measure: No node's finding contradicts another Comparator: Internal consistency across nodes Hit rule: No evaluated node directly contradicts another (coherence)
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis No internal contradiction coherence OR latency OR susceptibility pubmed · 870020 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis No internal contradiction inconsistent OR contradicts pubmed · 27612 hits · run 2026-09-06
I2 · Analogy to a known objectno_data
Measure: Object analogous to a well-established analog Comparator: Established analog's profile Hit rule: The object's profile matches a well-established analog on key features
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Analogy to a known object coherence OR latency OR susceptibility pubmed · 870020 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Analogy to a known object inconsistent OR contradicts pubmed · 27612 hits · run 2026-09-06
I5 · Latency coherenceno_data
Measure: Observed latency matches the mechanism's latency Comparator: Mechanism-predicted latency Hit rule: Observed onset latency is coherent with the mechanism's predicted latency
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Latency coherence coherence OR latency OR susceptibility pubmed · 870020 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Latency coherence inconsistent OR contradicts pubmed · 27612 hits · run 2026-09-06
J1 · Pre-specificationno_data
Measure: Window/hit-rule pre-specified before data Comparator: Pre-specified vs post-hoc Hit rule: The risk window, object, and hit rule were pre-specified before data were seen
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Pre-specification pre-specified OR adjudicated pubmed · 13548 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Pre-specification post-hoc OR hypothesis-generating only pubmed · 1698 hits · run 2026-09-06
2 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
does_not_resolve 35412949 · Human vaccines & immunotherapeutics (2022) — Explaining COVID-19 postvaccination-related immune thrombotic thrombocytopenia: a hypothesis-generating in-silico approach.
J2 · Contrary-evidence logno_data
Measure: Contrary evidence is logged, not omitted Comparator: Support-only dossier Hit rule: Contrary / null / refuting findings are logged and shown alongside support
Finding: No evidence retrieved directly addresses contrary, null, or refuting findings for the specific pair of COVID-19 vaccine and Acute Transverse Myelitis; PMID 39226489 discusses LLM detection of immune-related adverse events from immune checkpoint inhibitors, PMID 42147508 analyzes immunosuppressive regimens after pancreas-kidney transplantation, and PMID 35412949 hypothesizes mechanisms for post-vaccination thrombotic thrombocytopenia, none of which involve Acute Transverse Myelitis.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Contrary-evidence log pre-specified OR adjudicated pubmed · 13548 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Contrary-evidence log post-hoc OR hypothesis-generating only pubmed · 1698 hits · run 2026-09-06
3 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
does_not_resolve 42147508 · Cureus (2026) — Hypothesis-Generating Analysis of Four Immunosuppressive Regimens After Simultaneous Pancreas-Kidney Transplantation Using the United States Food and Drug Admin
does_not_resolve 35412949 · Human vaccines & immunotherapeutics (2022) — Explaining COVID-19 postvaccination-related immune thrombotic thrombocytopenia: a hypothesis-generating in-silico approach.
J3 · No temporality-only claimno_data
Measure: Claim not based on temporality alone Comparator: Sequence-only evidence Hit rule: The claim is not supported by temporal sequence alone (independent evidence exists)
Finding: No retrieved evidence addresses acute transverse myelitis following COVID-19 vaccination; the two studies focus on immune-related adverse events from immune checkpoint inhibitors and on vaccine-induced immune thrombotic thrombocytopenia, respectively.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis No temporality-only claim pre-specified OR adjudicated pubmed · 13549 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis No temporality-only claim post-hoc OR hypothesis-generating only pubmed · 1698 hits · run 2026-09-06
2 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
does_not_resolve 35412949 · Human vaccines & immunotherapeutics (2022) — Explaining COVID-19 postvaccination-related immune thrombotic thrombocytopenia: a hypothesis-generating in-silico approach.
J4 · Passive-surveillance roleno_data
Measure: Passive-surveillance findings bounded correctly Comparator: Active-surveillance confirmation Hit rule: Passive-surveillance signals are framed as hypothesis-generating, not confirmatory
Finding: The retrieved evidence includes a hypothesis-generating in-silico analysis of postvaccination thrombotic thrombocytopenia (PMID 35412949) and a study on LLM-based detection of immune-related adverse events (PMID 39226489), but neither addresses Acute Transverse Myelitis after COVID-19 vaccination. No evidence directly relevant to this node was found.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Passive-surveillance role pre-specified OR adjudicated pubmed · 13548 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Passive-surveillance role post-hoc OR hypothesis-generating only pubmed · 1698 hits · run 2026-09-06
3 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
does_not_resolve 42147508 · Cureus (2026) — Hypothesis-Generating Analysis of Four Immunosuppressive Regimens After Simultaneous Pancreas-Kidney Transplantation Using the United States Food and Drug Admin
does_not_resolve 35412949 · Human vaccines & immunotherapeutics (2022) — Explaining COVID-19 postvaccination-related immune thrombotic thrombocytopenia: a hypothesis-generating in-silico approach.
J5 · Dose mappingno_data
Measure: Dose/lot exposure mapped to the object Comparator: Unmapped exposure Hit rule: Dose / lot exposure is mapped to the object where the mechanism predicts it
Finding: No evidence retrieved pertains to dose or lot exposure mapping for acute transverse myelitis following COVID-19 vaccination.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Dose mapping pre-specified OR adjudicated pubmed · 13548 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Dose mapping post-hoc OR hypothesis-generating only pubmed · 1698 hits · run 2026-09-06
2 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
does_not_resolve 35412949 · Human vaccines & immunotherapeutics (2022) — Explaining COVID-19 postvaccination-related immune thrombotic thrombocytopenia: a hypothesis-generating in-silico approach.
Epidemiologic chassis 13/13 evaluated
B1 · Excess vs baselineno_data
Measure: RR/IRR vs unexposed or prior window Comparator: Unvaccinated person-time or pre-vaccination window Hit rule: RR/IRR > 1 with CI excluding 1 after pre-specified confounders
Finding: PMID 40664645 (2025) lists transverse myelitis as one of 15 adverse events assessed following XBB.1.5-containing COVID-19 mRNA vaccines but does not report any specific result for transverse myelitis or the pair COVID-19 vaccine → acute transverse myelitis. No other retrieved PMIDs address acute transverse myelitis after COVID-19 vaccination.
supporting: COVID-19 vaccine Acute Transverse Myelitis Excess vs baseline incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no association OR null OR no increased risk Excess vs baseline pubmed · 88554 hits · run 2026-09-06
10 retrieved record(s)
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
does_not_resolve 42661284 · Expert review of vaccines (2026) — Stroke risk following BNT162b2 vaccination: a systematic review and meta-analysis of self-controlled case series studies.
does_not_resolve 41284649 · PloS one (2025) — Risk of neurologic or immune-mediated adverse events after COVID-19 diagnosis in the United States.
B2 · SCCSno_data
Measure: Self-controlled case series risk ratio Comparator: Individuals' own risk intervals (no-event) Hit rule: SCCS risk ratio > 1 in the post-vaccination window, CI excluding 1
Finding: PMID 40664645 (2025) explicitly includes transverse myelitis as an adverse event assessed via SCCS for XBB.1.5-containing COVID-19 mRNA vaccines, but no specific risk estimate or CI for transverse myelitis is provided in the abstract. Other retrieved SCCS studies focus on Guillain-Barré syndrome, myasthenia gravis, arrhythmias, mortality, rotavirus, shingles, or neurologic/immune-mediated events after COVID-19 diagnosis, not acute transverse myelitis following COVID-19 vaccination.
supporting: COVID-19 vaccine Acute Transverse Myelitis SCCS incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no association OR null OR no increased risk SCCS pubmed · 88661 hits · run 2026-09-06
13 retrieved record(s)
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
Measure: Incidence rate ratio in defined window Comparator: Pre-specified risk vs comparison interval Hit rule: IRR > 1 in the pre-specified window, CI excluding 1, stratified by age/sex
Finding: PMID 38350771 reported a self-controlled case series analysis that observed an excess of transverse myelitis following adenoviral vectored ChAdOx1 nCoV-19 and mRNA-1273 vaccines, but did not provide an IRR stratified by age/sex with CI excluding 1 for a pre-specified window. No other retrieved evidence provides an IRR > 1 with CI excluding 1 stratified by age/sex for acute transverse myelitis after COVID-19 vaccination.
supporting: COVID-19 vaccine Acute Transverse Myelitis Cohort / risk-interval incidence risk cohort OR self-controlled case series pubmed · 946 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no association OR null OR no increased risk Cohort / risk-interval pubmed · 88162 hits · run 2026-09-06
10 retrieved record(s)
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 41284649 · PloS one (2025) — Risk of neurologic or immune-mediated adverse events after COVID-19 diagnosis in the United States.
ambiguous 41902725 · Expert review of vaccines (2026) — Beyond aggregate estimates: stratified self-controlled case series analyses and insights into COVID-19 vaccine safety.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
supports_node 36087300 · Zeitschrift fur Naturforschung. C, Journ (2023) — Covid-19 vaccines and neurological complications: a systematic review.
B4 · Meta-analysis / poolingno_data
Measure: Pooled effect across studies Comparator: Pooled estimate with heterogeneity Hit rule: Pooled estimate > 1 (or < 1) with quantified heterogeneity (I2)
Finding: Among the retrieved evidence, one self-controlled case series study (PMID 40664645) explicitly evaluated transverse myelitis as an adverse event following COVID-19 vaccination, reporting a relative risk estimate, but no pooled meta-analysis estimate with quantified heterogeneity (I2) for acute transverse myelitis was found.
supporting: COVID-19 vaccine Acute Transverse Myelitis Meta-analysis / pooling incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no association OR null OR no increased risk Meta-analysis / pooling pubmed · 111993 hits · run 2026-09-06
8 retrieved record(s)
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 37468475 · Nature communications (2023) — Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 29402646 · Journal of the American Medical Director (2018) — Fall-Risk-Increasing Drugs: A Systematic Review and Meta-analysis: III. Others.
supports_node 36087300 · Zeitschrift fur Naturforschung. C, Journ (2023) — Covid-19 vaccines and neurological complications: a systematic review.
does_not_resolve 41284649 · PloS one (2025) — Risk of neurologic or immune-mediated adverse events after COVID-19 diagnosis in the United States.
B5 · Negative-control outcomesno_data
Measure: No excess for outcomes the vaccine should not cause Comparator: Negative-control outcomes (unaffected by mechanism) Hit rule: Null for negative-control outcomes while target outcome is positive (specificity)
Finding: No evidence was found in the retrieved abstracts that specifically addresses acute transverse myelitis as a negative-control outcome following COVID-19 vaccination, or that provides null results for this outcome while the target outcome is positive.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Negative-control outcomes incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no association OR null OR no increased risk Negative-control outcomes pubmed · 88365 hits · run 2026-09-06
8 retrieved record(s)
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 37468475 · Nature communications (2023) — Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 41284649 · PloS one (2025) — Risk of neurologic or immune-mediated adverse events after COVID-19 diagnosis in the United States.
does_not_resolve 38833248 · JAMA network open (2024) — Valproate Use During Spermatogenesis and Risk to Offspring.
B6 · Other-antigen comparisonmixed
Measure: Risk vs a different-antigen comparator Comparator: Comparator product with a different antigen Hit rule: Risk specific to the target antigen, not shared with the comparator antigen
Finding: PMID 38350771 reports a self-controlled case series analysis observing an excess of transverse myelitis following ChAdOx1 and mRNA-1273 vaccines. Other retrieved studies either do not address acute transverse myelitis as an outcome, evaluate different vaccines or populations, or are case reports not generalizable to antigen-specific risk.
supporting: COVID-19 vaccine Acute Transverse Myelitis Other-antigen comparison incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no association OR null OR no increased risk Other-antigen comparison pubmed · 88127 hits · run 2026-09-06
11 retrieved record(s)
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 37468475 · Nature communications (2023) — Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 41284649 · PloS one (2025) — Risk of neurologic or immune-mediated adverse events after COVID-19 diagnosis in the United States.
does_not_resolve 32188413 · BMC medical genetics (2020) — Glutathione S-transferase M1 and T1 genes deletion polymorphisms and risk of developing essential hypertension: a case-control study in Burkina Faso population
supports_node 36087300 · Zeitschrift fur Naturforschung. C, Journ (2023) — Covid-19 vaccines and neurological complications: a systematic review.
B7 · Absolute riskno_data
Measure: Per-100k risk in window Comparator: Absolute incidence per 100k Hit rule: Absolute risk reported and stable across the window (not an artifact of rarity)
Finding: No retrieved evidence specifically reports absolute risk (per-100k in window) of acute transverse myelitis after COVID-19 vaccination; one SCCS study (PMID 40664645) includes transverse myelitis as an adverse event and reports a relative risk but does not provide absolute risk estimates.
supporting: COVID-19 vaccine Acute Transverse Myelitis Absolute risk incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no association OR null OR no increased risk Absolute risk pubmed · 111392 hits · run 2026-09-06
11 retrieved record(s)
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 36813998 · Eye (London, England) (2023) — Risk of retinal vein occlusion following COVID-19 vaccination: a self-controlled case series.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 29211679 · The New England journal of medicine (2017) — Contemporary Hormonal Contraception and the Risk of Breast Cancer.
does_not_resolve 23484825 · The New England journal of medicine (2013) — Risk of ischemic heart disease in women after radiotherapy for breast cancer.
does_not_resolve 41284649 · PloS one (2025) — Risk of neurologic or immune-mediated adverse events after COVID-19 diagnosis in the United States.
B8 · Platform splitno_data
Measure: Risk by vaccine platform / product Comparator: Platform (mRNA vs viral vector, etc.) Hit rule: Risk attributable to a specific platform, not to 'a vaccine' generally
Finding: No retrieved evidence directly addresses the risk of Acute Transverse Myelitis attributable to a specific vaccine platform (e.g., mRNA vs. adenoviral) after COVID-19 vaccination; one study [PMID 40664645 2025] lists 'transverse myelitis' as an adverse event assessed for XBB.1.5-containing mRNA vaccines but does not report platform-specific risk estimates or results for this outcome.
supporting: COVID-19 vaccine Acute Transverse Myelitis Platform split incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no association OR null OR no increased risk Platform split pubmed · 88192 hits · run 2026-09-06
7 retrieved record(s)
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 36813998 · Eye (London, England) (2023) — Risk of retinal vein occlusion following COVID-19 vaccination: a self-controlled case series.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 41284649 · PloS one (2025) — Risk of neurologic or immune-mediated adverse events after COVID-19 diagnosis in the United States.
does_not_resolve 32188413 · BMC medical genetics (2020) — Glutathione S-transferase M1 and T1 genes deletion polymorphisms and risk of developing essential hypertension: a case-control study in Burkina Faso population
B9 · Host-structure stratificationno_data
Measure: Risk by age / sex / host structure Comparator: Unstratified estimate Hit rule: Risk concentrated in a defined host subgroup (e.g. young males), stable across sources
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Host-structure stratification incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no association OR null OR no increased risk Host-structure stratification pubmed · 88125 hits · run 2026-09-06
10 retrieved record(s)
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
Measure: Risk tracks a formulation change Comparator: Pre- vs post-change formulation Hit rule: Risk change tracks a documented formulation / component change over time
Finding: No retrieved evidence directly addresses whether the risk of acute transverse myelitis after COVID-19 vaccination tracks a documented formulation or component change over time.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Formulation / component change incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no association OR null OR no increased risk Formulation / component change pubmed · 88287 hits · run 2026-09-06
8 retrieved record(s)
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
Measure: Risk shifts with a formulation change in the field Comparator: Pre- vs post-change formulation Hit rule: Observed risk tracks a real-world formulation change (natural experiment)
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Formulation natural experiment intervention OR treatment OR reversal pubmed · 15141300 hits · run 2026-09-06
Measure: Risk signal appears/disappears across a pause or policy change Comparator: Pre- vs post-pause period Hit rule: The signal appears or disappears coherently with a rollout / pause (H4)
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Policy / pause signal intervention OR treatment OR reversal pubmed · 15141300 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Policy / pause signal no effect intervention pubmed · 0 hits (0 hits — negative) · run 2026-09-06
I3 · Infection coherenceno_data
Measure: Pattern is coherent with or distinct from infection Comparator: Infection-matched comparison Hit rule: The post-vaccine pattern is coherent with (or clearly distinct from) the infection pattern
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Infection coherence coherence OR latency OR susceptibility pubmed · 870020 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Infection coherence inconsistent OR contradicts pubmed · 27612 hits · run 2026-09-06
Mediator & biological gradient 24/24 evaluated
C1n · Dose strength gradientno_data
Measure: Risk vs dose strength (dose size) Comparator: Lower dose strength Hit rule: Monotonic dose-response in dose strength (larger dose -> higher risk)
Finding: No retrieved evidence examines dose-strength gradient for acute transverse myelitis after COVID-19 vaccination; the available studies assess overall risk or case series without comparing different dose sizes or strengths.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Dose strength gradient dose-response OR dose effect pubmed · 1299126 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no dose effect OR no dose-response Dose strength gradient pubmed · 141 hits · run 2026-09-06
7 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
does_not_resolve 36090988 · Frontiers in immunology (2022) — A comprehensive analysis of the efficacy and effectiveness of COVID-19 vaccines.
does_not_resolve 38382130 · Clinical neurology and neurosurgery (2024) — COVID-19 vaccine response in Neuromyelitis Optica Spectrum Disorder.
supports_node 39739424 · European journal of neurology (2025) — The association between acute transverse myelitis and COVID-19 vaccination in Korea: Self-controlled case series study.
supports_node 38350771 · Vaccine (2024) — Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis.
supports_node 36586226 · Journal of clinical neuroscience : offic (2023) — Co-VAN study: COVID-19 vaccine associated neurological diseases- an experience from an apex neurosciences centre and review of the literature.
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
C2n · Dose number gradientno_data
Measure: Risk vs dose number (1st vs 2nd vs 3rd) Comparator: First dose Hit rule: Risk increases (or shows a defined pattern) with dose number
Finding: The retrieved evidence includes a self-controlled case series study (PMID 39739424) that investigated the association between COVID-19 vaccination and acute transverse myelitis, but analysis of a dose-number gradient (risk by 1st vs 2nd vs 3rd dose) is not reported. Two other relevant studies (PMID 38350771, 35715350) examined acute transverse myelitis following COVID-19 vaccination but did not provide risk estimates stratified by dose number.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Dose number gradient dose-response OR dose effect pubmed · 1299126 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no dose effect OR no dose-response Dose number gradient pubmed · 585 hits · run 2026-09-06
8 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
does_not_resolve 36090988 · Frontiers in immunology (2022) — A comprehensive analysis of the efficacy and effectiveness of COVID-19 vaccines.
does_not_resolve 38382130 · Clinical neurology and neurosurgery (2024) — COVID-19 vaccine response in Neuromyelitis Optica Spectrum Disorder.
supports_node 38350771 · Vaccine (2024) — Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis.
supports_node 39739424 · European journal of neurology (2025) — The association between acute transverse myelitis and COVID-19 vaccination in Korea: Self-controlled case series study.
refutes_node 35715350 · Vaccine (2022) — Safety of COVID-19 vaccination and acute neurological events: A self-controlled case series in England using the OpenSAFELY platform.
supports_node 36586226 · Journal of clinical neuroscience : offic (2023) — Co-VAN study: COVID-19 vaccine associated neurological diseases- an experience from an apex neurosciences centre and review of the literature.
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
C3n · Measured-exposure tertilesno_data
Measure: Risk vs measured exposure tertile Comparator: Lowest-exposure tertile Hit rule: Risk ordered by measured-exposure tertile (high > mid > low)
Finding: The retrieved evidence includes multiple case reports and self-controlled case series linking COVID-19 vaccination to acute transverse myelitis (ATM), but none of the studies report or analyze risk stratified by measured-exposure tertiles. The evidence does not address the specific node definition of risk ordered by high, mid, or low measured-exposure tertile.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Measured-exposure tertiles dose-response OR dose effect pubmed · 1299126 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no dose effect OR no dose-response Measured-exposure tertiles pubmed · 30 hits · run 2026-09-06
10 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
does_not_resolve 36090988 · Frontiers in immunology (2022) — A comprehensive analysis of the efficacy and effectiveness of COVID-19 vaccines.
does_not_resolve 38382130 · Clinical neurology and neurosurgery (2024) — COVID-19 vaccine response in Neuromyelitis Optica Spectrum Disorder.
supports_node 38350771 · Vaccine (2024) — Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis.
supports_node 36586226 · Journal of clinical neuroscience : offic (2023) — Co-VAN study: COVID-19 vaccine associated neurological diseases- an experience from an apex neurosciences centre and review of the literature.
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
supports_node 39739424 · European journal of neurology (2025) — The association between acute transverse myelitis and COVID-19 vaccination in Korea: Self-controlled case series study.
refutes_node 37897023 · Vaccines (2023) — NEURO-COVAX: An Italian Population-Based Study of Neurological Complications after COVID-19 Vaccinations.
C4n · Organoid concentration curveno_data
Measure: Effect vs antigen concentration in organoid Comparator: Vehicle / zero antigen Hit rule: Dose-dependent effect across a graded concentration curve
Finding: Multiple self-controlled case series studies and case reports describe an association between COVID-19 vaccination and acute transverse myelitis, including dose-specific analyses for different vaccine brands and a study specifically examining onset within a 1–42 day risk window after vaccination, but none of the retrieved evidence provides organoid-based concentration-response data (effect vs antigen concentration in organoids) as required by this node's hit rule.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Organoid concentration curve dose-response OR dose effect pubmed · 1299126 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no dose effect OR no dose-response Organoid concentration curve pubmed · 41 hits · run 2026-09-06
9 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
does_not_resolve 36090988 · Frontiers in immunology (2022) — A comprehensive analysis of the efficacy and effectiveness of COVID-19 vaccines.
does_not_resolve 38382130 · Clinical neurology and neurosurgery (2024) — COVID-19 vaccine response in Neuromyelitis Optica Spectrum Disorder.
supports_node 38350771 · Vaccine (2024) — Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis.
supports_node 39739424 · European journal of neurology (2025) — The association between acute transverse myelitis and COVID-19 vaccination in Korea: Self-controlled case series study.
refutes_node 35715350 · Vaccine (2022) — Safety of COVID-19 vaccination and acute neurological events: A self-controlled case series in England using the OpenSAFELY platform.
supports_node 36586226 · Journal of clinical neuroscience : offic (2023) — Co-VAN study: COVID-19 vaccine associated neurological diseases- an experience from an apex neurosciences centre and review of the literature.
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
C5n · EC50 vs Cmax coherenceno_data
Measure: Measured exposure reaches effect threshold Comparator: Pharmacokinetic Cmax vs EC50 Hit rule: Achieved exposure (Cmax/tissue) plausibly reaches the in-vitro EC50
Finding: No retrieved evidence reports measured in-vivo Cmax or tissue exposure for COVID-19 vaccines reaching an in-vitro EC50 for acute transverse myelitis; the available studies are epidemiological or case-report based and do not provide pharmacokinetic/pharmacodynamic data for this node.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis EC50 vs Cmax coherence dose-response OR dose effect pubmed · 1299126 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis no dose effect OR no dose-response EC50 vs Cmax coherence pubmed · 30 hits · run 2026-09-06
10 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
does_not_resolve 36090988 · Frontiers in immunology (2022) — A comprehensive analysis of the efficacy and effectiveness of COVID-19 vaccines.
does_not_resolve 38382130 · Clinical neurology and neurosurgery (2024) — COVID-19 vaccine response in Neuromyelitis Optica Spectrum Disorder.
supports_node 38350771 · Vaccine (2024) — Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis.
supports_node 39739424 · European journal of neurology (2025) — The association between acute transverse myelitis and COVID-19 vaccination in Korea: Self-controlled case series study.
refutes_node 35715350 · Vaccine (2022) — Safety of COVID-19 vaccination and acute neurological events: A self-controlled case series in England using the OpenSAFELY platform.
supports_node 36586226 · Journal of clinical neuroscience : offic (2023) — Co-VAN study: COVID-19 vaccine associated neurological diseases- an experience from an apex neurosciences centre and review of the literature.
supports_node 38664389 · Spinal cord series and cases (2024) — A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.
E1 · Mediator identified in casesno_data
Measure: Mediator present in affected tissue/cells Comparator: Unaffected tissue / control Hit rule: The hypothesized mediator is detected in the affected compartment and not (or less) in control
Finding: A self-controlled case series analysis reported an excess of transverse myelitis cases following ChAdOx1 nCoV-19 and mRNA-1273 vaccines, but the abstract does not report detection of any specific mediator in affected tissue or cells.
supporting: COVID-19 vaccine Acute Transverse Myelitis mechanism Mediator identified in cases in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Mediator identified in cases not associated mechanism pubmed · 2 hits · run 2026-09-06
1 retrieved record(s)
supports_node 38350771 · Vaccine (2024) — Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination - A self-controlled case series analysis.
E2 · Mediator in healthy vaccineesno_data
Measure: Mediator detectable after vaccination Comparator: Pre-vaccination baseline Hit rule: Mediator appears after vaccination and tracks the exposure window
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis mechanism Mediator in healthy vaccinees in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Mediator in healthy vaccinees not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-06
E3 · Infection contrastno_data
Measure: Mediator absent/low after natural infection Comparator: Recovered natural infection Hit rule: Mediator signal is specific to vaccination vs a comparable natural-infection control
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis mechanism Infection contrast in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Infection contrast not associated mechanism pubmed · 2 hits · run 2026-09-06
E4 · Transfer to recipientno_data
Measure: Phenotype/mediator transferred to a recipient system Comparator: Control transfer Hit rule: The effect / mediator transfers to a naive recipient system
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis mechanism Transfer to recipient in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Transfer to recipient not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-06
E5 · Transfer specificityno_data
Measure: Transfer requires the specific mediator Comparator: Transfer with mediator present Hit rule: Transfer effect is lost when the specific mediator is removed
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis mechanism Transfer specificity in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Transfer specificity not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-06
E6 · Depletion / knockdownno_data
Measure: Removing the mediator reduces the effect Comparator: Non-targeted knockdown Hit rule: Knockdown / depletion of the mediator reduces the phenotype
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis mechanism Depletion / knockdown in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-06
Measure: Adding the mediator restores the effect Comparator: Add-back of a control protein Hit rule: Adding back the mediator (not a control) restores the phenotype
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis mechanism Add-back rescue in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-06
Measure: Neutralizing the mediator blocks the effect Comparator: Isotype control Hit rule: Neutralization of the mediator (not an isotype control) blocks the phenotype
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis mechanism Neutralization in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Neutralization not associated mechanism pubmed · 1 hits · run 2026-09-06
E9 · Isotype controlno_data
Measure: Isotype control does not reproduce the effect Comparator: Active antibody Hit rule: An isotype control fails to reproduce the block/activation
Finding: No evidence retrieved directly addresses isotype control; the papers discuss NMOSD cases and risk after COVID-19 vaccination but do not mention or test isotype control blocking or activation.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis mechanism Isotype control in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Isotype control not associated mechanism pubmed · 5 hits · run 2026-09-06
3 retrieved record(s)
supports_node 36289118 · Neurological sciences : official journal (2023) — First manifestation of AQP4-IgG-positive neuromyelitis optica spectrum disorder following the COVID-19 mRNA vaccine BNT162b2.
does_not_resolve 35421782 · Multiple sclerosis and related disorders (2022) — Humoral response to SARS-CoV-2 infection and vaccines against COVID-19 in patients with neuromyelitis optica spectrum disorders: Impact of immunosuppressive tre
does_not_resolve 35216793 · Multiple sclerosis and related disorders (2022) — Risk of disease relapse following COVID-19 vaccination in patients with AQP4-IgG-positive NMOSD and MOGAD.
F1 · Full product reproducesno_data
Measure: Full vaccine product reproduces the effect Comparator: No-product control Hit rule: The full product (not a subcomponent) reproduces the effect
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Full product reproduces component OR antigen OR vector pubmed · 2045211 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Full product reproduces no effect component isolation pubmed · 0 hits (0 hits — negative) · run 2026-09-06
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F2 · Empty vector / particleno_data
Measure: Vector/particle without antigen reproduces (or not) Comparator: Full product Hit rule: Effect attributed to (or excluded from) the vector/particle backbone alone
Finding: The retrieved evidence discusses virus-vectored and bacterial vector vaccine platforms, but none address acute transverse myelitis or adverse events from COVID-19 vaccine vector/particle backbones; no evidence is found linking the empty vector/particle to acute transverse myelitis.
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Empty vector / particle component OR antigen OR vector pubmed · 2045211 hits · run 2026-09-06
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F4 · Irrelevant cargono_data
Measure: Irrelevant cargo does not reproduce the effect Comparator: Vector with the target antigen Hit rule: Irrelevant cargo fails to reproduce the effect (specificity)
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Irrelevant cargo component OR antigen OR vector pubmed · 2045211 hits · run 2026-09-06
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F5 · Infection preparationno_data
Measure: Infection preparation vs product comparison Comparator: Product-derived preparation Hit rule: Effect compares correctly between infection and product preparations
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Infection preparation component OR antigen OR vector pubmed · 2045211 hits · run 2026-09-06
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F6 · Cytokine / adjuvant mixno_data
Measure: Cytokine/adjuvant mix alone reproduces (or not) Comparator: Individual components Hit rule: The effect is (or is not) reproducible by the cytokine/adjuvant mix alone
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Cytokine / adjuvant mix component OR antigen OR vector pubmed · 2045211 hits · run 2026-09-06
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F7 · Component combinationno_data
Measure: Defined component combination reproduces the effect Comparator: Single components Hit rule: A defined combination reproduces the effect that single components do not
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Component combination component OR antigen OR vector pubmed · 2045211 hits · run 2026-09-06
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
G1 · 2D human cellsno_data
Measure: Effect reproduced in 2D human cell culture Comparator: Untreated / control cells Hit rule: Effect reproduced in 2D primary human cells
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis 2D human cells animal OR organoid OR cell model pubmed · 1818469 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis 2D human cells not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-06
G2 · Organoid / chipno_data
Measure: Effect reproduced in organoid / organ-on-chip Comparator: Unexposed organoid Hit rule: Effect reproduced in a 3D organoid / organ-on-chip system
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Organoid / chip animal OR organoid OR cell model pubmed · 1818469 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Organoid / chip not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-06
H1 · Block in vitro / in vivono_data
Measure: Blocking the mediator/mechanism prevents the effect Comparator: Control intervention Hit rule: Blocking the mechanism prevents or reverses the effect (not with a control intervention)
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Block in vitro / in vivo intervention OR treatment OR reversal pubmed · 15141300 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Block in vitro / in vivo no effect intervention pubmed · 0 hits (0 hits — negative) · run 2026-09-06
Clinical / animal / host 7/7 evaluated
E10 · Host-line dependenceno_data
Measure: Effect depends on host line/cell type Comparator: Susceptible host line Hit rule: Effect is restricted to a defined host line / genotype, not universal
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis mechanism Host-line dependence in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-06
Measure: Effect in animal via the clinical route of administration Comparator: Vehicle, same route Hit rule: Effect reproduced in an animal using the clinical route of administration
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Animal, clinical route animal OR organoid OR cell model pubmed · 1818470 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Animal, clinical route not reproduced model pubmed · 1 hits · run 2026-09-06
G4 · Susceptible animalno_data
Measure: Effect in a susceptible animal model Comparator: Non-susceptible model Hit rule: Effect in a defined susceptible animal model
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Susceptible animal animal OR organoid OR cell model pubmed · 1818470 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Susceptible animal not reproduced model pubmed · 1 hits · run 2026-09-06
G5 · Replication across labsno_data
Measure: Effect replicated in an independent lab Comparator: Original result Hit rule: The key effect is replicated in an independent laboratory
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Replication across labs animal OR organoid OR cell model pubmed · 1818469 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Replication across labs not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-06
G6 · Blinded scoringno_data
Measure: Outcomes scored blinded Comparator: Unblinded reference Hit rule: Primary outcomes scored by a blinded assessor
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Blinded scoring animal OR organoid OR cell model pubmed · 1818469 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Blinded scoring not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-06
G7 · Experimental time courseno_data
Measure: Effect follows a defined experimental time course Comparator: No-exposure time course Hit rule: The effect's onset/offset follows a defined experimental time course
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Experimental time course animal OR organoid OR cell model pubmed · 1818469 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Experimental time course not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-06
I4 · Susceptibility traitno_data
Measure: A host trait / marker defines susceptibility Comparator: Trait-negative hosts Hit rule: A defined host trait / marker enriches for susceptibility
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Acute Transverse Myelitis Susceptibility trait coherence OR latency OR susceptibility pubmed · 870020 hits · run 2026-09-06
mirror: COVID-19 vaccine Acute Transverse Myelitis Susceptibility trait inconsistent OR contradicts pubmed · 27612 hits · run 2026-09-06
How this was built
Per node: a supporting and a mirror PubMed query built from the node's measure / population / comparator / hit_rule; top hits fetched (title + abstract); each record classified (supports / refutes / ambiguous) by xAI with a heuristic fallback; a per-node synthesis is generated strictly from the retrieved PMIDs; the node status is then rolled up to C1–C6. Full query provenance is shown per node above. Reproduce the build: python -m evidence_run. Data: data/evidence_run/state.json.