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Countries by income: low (\u2264$1145), lower-middle ($1146-4515), upper-middle ($4516-14,005), high (&gt;$14,005). Inter-reviewer agreement assessed by kappa (0.684). Risk of bias evaluated with Cochrane RoB 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Analysis<\/jats:title>\n                    <jats:p>\n                      Mantel-Haenszel random-effects models estimated relative risks (RR) with 95% confidence intervals. Heterogeneity assessed by I\n                      <jats:sup>2<\/jats:sup>\n                      . Subgroup analyses by income and dose.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>AEFI incidence was consistently higher in high-income vs upper-middle-income countries, especially after dose 2. Injection-site pain (68.1 vs 26.3 per 100), headache (45.7 vs 14.1), myalgia (42.5 vs 9.2), and fatigue (33.8 vs 11.4) were most common. Meta-analyses showed higher pooled RR in high-income settings: any AEFI after dose 1, RR = 1.83 (95% CI: 1.39-2.42); local, RR = 3.15; systemic, RR = 2.05. After dose 2, overall RR reached 2.94; local, 4.37; systemic, 2.48. All subgroup differences were significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher-income countries showed a greater incidence of mostly mild adverse events, particularly after the second dose. mRNA vaccines had the highest rates. Findings reveal income-based disparities and inform equitable post-vaccination monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08901171251365229","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T02:34:49Z","timestamp":1754447689000},"page":"240-252","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["COVID-19 Vaccine Adverse Events by Country Income Level: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8497-6833","authenticated-orcid":false,"given":"Poliana do Carmo","family":"Pimenta","sequence":"first","affiliation":[{"name":"Graduate Program in Biological Sciences, Federal University of Alfenas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8303-0867","authenticated-orcid":false,"given":"Thais Cristina","family":"de Aquino Lima","sequence":"additional","affiliation":[{"name":"School of Medicine, Federal University of Alfenas, Alfenas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7246-5470","authenticated-orcid":false,"given":"Vitoria Gabriele Souza","family":"Geraldine","sequence":"additional","affiliation":[{"name":"School of Medicine, Federal University of Alfenas, Alfenas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6232-6845","authenticated-orcid":false,"given":"Fillipe Silva","family":"Tourinho","sequence":"additional","affiliation":[{"name":"School of Medicine, Federal University of Alfenas, Alfenas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3436-2654","authenticated-orcid":false,"given":"Murilo C\u00e9sar","family":"do Nascimento","sequence":"additional","affiliation":[{"name":"School of Medicine, Federal University of Alfenas, Alfenas, Brazil"},{"name":"Graduate Program in Nursing, School of Nursing, Federal University of Alfenas, Alfenas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3186-5328","authenticated-orcid":false,"given":"R\u00f4mulo Dias","family":"Novaes","sequence":"additional","affiliation":[{"name":"Graduate Program in Biological Sciences, Federal University of Alfenas, Brazil"},{"name":"Graduate Program in Biosciences Applied to Health, Federal University of Alfenas, Alfenas, Brazil"},{"name":"Graduate Program in Biological Sciences, Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3347-4494","authenticated-orcid":false,"given":"L\u00edvia Maris Ribeiro Parana\u00edba","family":"Dias","sequence":"additional","affiliation":[{"name":"Graduate Program in Biological Sciences, Federal University of Alfenas, Brazil"},{"name":"Graduate Program in Biological Sciences, Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"e_1_3_7_2_2","volume-title":"Coronavirus disease (COVID-19)","author":"WHO","year":"2023","unstructured":"WHO. 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