Temporal association between COVID-19 vaccination and Raynaud’s phenomenon: A case series

Figures & data

Figure 1. Representative female participant with new onset of Raynaud´s phenomenon after COVID-19 vaccination. a. Well-demarcated, white-pale, cold fourth toe of the right foot. b. Affected index and third finger of the right hand with sharp demarcation of skin pallor. c. Nailfold capillaroscopic image of the affected third finger of the right hand, showing dilatation, torsion and reduced capillary density, but lack of megacapillaries. d and e. Optical pulse oscillograms of the index (d) and the third finger (e) of the affected right hand (red) and the unaffected left hand (blue-green) revealing regular oscillations.

Table 1. Demographic data of 19 individuals with Raynaud’s phenomenon.

Patient number	Age, years	Sex	Localization	RP prior to COVID-19 vaccination	COVID-19 infection before onset of RP	Possible predisposing factors for RP	Country of residence
1	31	F	H, T	No	No	No	U.S.A.
2	44	F	H	No	No	Former smoker	U.S.A.
3	63	M	H, T	No	No	History of frostbite (hands) and surgery (arms, foot)	U.S.A.
4	63	M	H	No	No	Beta blockers	U.S.A.
5	32	F	H, T	No	Yes	No	Argentina
6	42	F	H, T	No	No	ANAs	Austria
7	47	F	H	No	Yes	Goiter	U.K.
8	31	F	H	No	No	Hashimoto’s disease	Poland
9	31	F	H	No	No	No	Austria
10	41	F	H, T	No	No	Former smoker, beta blockers, ANAs	Austria
11	39	M	H	No	No	No	U.S.A.
12	62	M	H	No	No	History of frostbite (hand)	Switzerland
13	54	M	H	No	No	No	U.S.A.
14	31	M	H	No	Yes	Hypothyroidism, anti-cardiolipin antibodies	Austria
15	52	F	H, T	No	No	ANAs	Austria
16	60	F	H	Yes	No	Former smoker, low BMI	U.K.
17	25	F	T	Yes	No	Smoker, Hashimoto’s disease	Austria
18	56	F	H, T	Yes	No	Strumectomy, beta blockers, triptans	Austria
19	48	F	H, T	Yes	No	No	U.S.A.

RP: Raynaud’s Phenomenon, F: female, M: male, H: hands, T: toes, ANAs: antinuclear antibodies, BMI: body mass index.

Table 2. Main characteristics of 15 individuals with new-onset Raynaud’s phenomenon.

Patient No.	RP after 1^st vaccination				RP after 2^nd vaccination				RP after 3^rd vaccination
	VAX	RP	Days to onset	Number of attacks	VAX	RP	Days to onset	Number of attacks	VAX		RP	Days to onset	Number of attacks
1	S	No	NA	NA	S	Yes	17	>50	S		Yes	2	>50
2	S	No	NA	NA	S	Yes	14	31–50	No		NA	NA	NA
3	C	No	NA	NA	C	Yes	180	?	No		NA	NA	NA
4^a	C	No	NA	NA	C	No	NA	NA	C		Yes	112	1–5
5	V	Yes	14	1–5	V	Yes	7	16–20	S		Yes	7	1–5
6	V	No	NA	NA	V	Yes	126	>50	C		No	NA	NA
7	S	Yes	21	1–5	S	No	NA	NA	C		Yes	35	1–5
8	C	Yes	14	1–5	C	No	NA	NA	C		Yes	4	1–5
9	V	Yes	7–14	6–10	V	Yes	?	6–10	C		Yes	?	6–10
10	C	No	NA	NA	C	No	NA	NA	C		Yes	35	21–30
11	C	No	NA	NA	C	No	NA	NA	S		Yes	1	1–5
12	C	No	NA	NA	C	Yes	3	>50	No		NA	NA	NA
13	S	Yes	>1	6–10	S	Yes	>1	31–50	No		NA	NA	NA
14	C	No	NA	NA	C	No	NA	NA	C		Yes	30–60	1–5
15	V	Yes	5	11–15	V	Yes	56	11–15	C		Yes	<1	21–30

RP: Raynaud’s Phenomenon, VAX: COVID-19 vaccine, NA: not applicable, S: mRNA-1273, C: BNT162b2, V: ChAdOx1, ?: unknown.

^aThe details of Raynaud’s Phenomenon after the fourth vaccination are not listed, as the only participant (Patient 4), who had received a fourth dose, did not report the occurrence of attacks at this time point.