{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:08:07Z","timestamp":1790687287924,"version":"4.1.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Head-to-head safety comparisons of the mRNA vaccines for SARS-CoV-2 are needed for decision making; however, current evidence generalizes poorly to older adults, lacks sufficient adjustment, and inadequately captures events shortly after vaccination. Additionally, no studies to date have explored potential variation in comparative vaccine safety across subgroups with frailty or an increased risk of adverse events, information that would be useful for tailoring clinical decisions.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare the risk of adverse events between mRNA vaccines for COVID-19 (mRNA-1273 and BNT162b2) overall, by frailty level, and by prior history of the adverse events of interest.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study was conducted between December 11, 2020, and July 11, 2021, with 28 days of follow-up following the week of vaccination. A novel linked database of community pharmacy and Medicare claims data was used, representing more than 50% of the US Medicare population. Community-dwelling, fee-for-service beneficiaries aged 66 years or older who received mRNA-1273 vs BNT162b2 as their first COVID-19 vaccine were identified. Data analysis began on October 18, 2022.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Dose 1 of mRNA-1273 vs BNT162b2 vaccine.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Twelve potential adverse events (eg, pulmonary embolism, thrombocytopenia purpura, and myocarditis) were assessed individually. Frailty was measured using a claims-based frailty index, with beneficiaries being categorized as nonfrail, prefrail, and frail. The risk of diagnosed COVID-19 was assessed as a secondary outcome. Generalized linear models estimated covariate-adjusted risk ratios (RRs) and risk differences (RDs) with 95% CIs.<\/jats:p><\/jats:sec>Results<\/jats:title>This study included 6\u202f388\u202f196 eligible individuals who received the mRNA-1273 or BNT162b2 vaccine. Their mean (SD) age was 76.3 (7.5) years, 59.4% were women, and 86.5% were White. A total of 38.1% of individuals were categorized as prefrail and 6.0% as frail. The risk of all outcomes was low in both vaccine groups. In adjusted models, the mRNA-1273 vaccine was associated with a lower risk of pulmonary embolism (RR, 0.96 [95% CI, 0.93-1.00]; RD, 9 [95% CI, 1-16] events per 100\u202f000 persons) and other adverse events in subgroup analyses (eg, 11.0% lower risk of thrombocytopenia purpura among individuals categorized as nonfrail). The mRNA-1273 vaccine was also associated with a lower risk of diagnosed COVID-19 (RR, 0.86 [95% CI, 0.83-0.87]), a benefit that was attenuated by frailty level (frail: RR, 0.94 [95% CI, 0.89-0.99]).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of older US adults, the mRNA-1273 vaccine was associated with a slightly lower risk of several adverse events compared with BNT162b2, possibly due to greater protection against COVID-19. Future research should seek to formally disentangle differences in vaccine safety and effectiveness and consider the role of frailty in assessments of COVID-19 vaccine performance.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.26852","type":"journal-article","created":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T15:02:31Z","timestamp":1690988551000},"page":"e2326852","source":"Crossref","is-referenced-by-count":32,"title":["Comparative Risks of Potential Adverse Events Following COVID-19 mRNA Vaccination Among Older US Adults"],"prefix":"10.1001","volume":"6","author":[{"given":"Daniel A.","family":"Harris","sequence":"first","affiliation":[{"name":"Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island"},{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleen 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Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen P.","family":"McCarthy","sequence":"additional","affiliation":[{"name":"Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts"},{"name":"Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Djeneba Audrey","family":"Djibo","sequence":"additional","affiliation":[{"name":"CVS Health Clinical Trial Services, Bell, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl N.","family":"McMahill-Walraven","sequence":"additional","affiliation":[{"name":"CVS Health Clinical Trial Services, Bell, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Gravenstein","sequence":"additional","affiliation":[{"name":"Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island"},{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island"},{"name":"Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,8,2]]},"reference":[{"issue":"7","key":"zoi230773r1","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1038\/s41562-021-01122-8","article-title":"A global database of COVID-19 vaccinations.","volume":"5","author":"Mathieu","year":"2021","journal-title":"Nat Hum 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