{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T05:22:42Z","timestamp":1787376162383,"version":"build-2736575974"},"reference-count":52,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"crossref","award":["UL1TR001436"],"award-info":[{"award-number":["UL1TR001436"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]},{"award":["UL1TR001436"],"award-info":[{"award-number":["UL1TR001436"]}],"id":[{"id":"https:\/\/ror.org\/04pw6fb54","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Objective: It is commonly believed in the public health community that the mRNA vaccines from Pfizer and Moderna were broadly similar in preventing COVID-19 mortality, with perhaps a small advantage for Moderna. We revisit this question, using a research design that controls for healthy-vaccinee bias. Methods: We studied deaths among persons aged 15 years or greater from January 2021 through December 2022 in Indiana, linked to vaccination records, using an outcome measure, namely COVID-19 Excess Mortality Percentage (CEMP), which uses non-COVID natural mortality to control for HVB. Results: We find both large healthy-vaccinee bias for both vaccines, and larger bias for Pfizervaccinees: Pfizer recipients were healthier and thus would have faced lower COVID-19 mortality without vaccination. For ages 60+, we find almost 50% higher COVID-19 remaining mortality risk (RMR) for Pfizer vaccinees receiving primary vaccination over a \u201ccore period\u201d from 2Q2021 through 1Q2022: the average Pfizer\/Moderna RMR ratio was 1.49. For ages 15\u201359, this ratio was 1.25, but was not statistically significant. For booster dose for ages 60+, the average Pfizer\/Moderna RMR ratio was 1.34. For 2Q2022 through 4Q2022, after the major Omicron wave, we find much lower vaccine effectiveness and no significant Pfizer\u2013Moderna difference. Conclusions: During the period with both good vaccine availability and high COVID-19 mortality (2Q-2021\u20131Q2022), the Moderna vaccine was associated with lower COVID-19 mortality, relative to the Pfizer vaccine. A possible explanation is the higher Moderna dose (100 \u03bcg vs. 30 for Pfizer). After that period, a high percentage of the population had natural immunity from prior COVID-19 infection; we find only small mortality gains from vaccination, with no significant Pfizer\u2013Moderna difference. Policy Implications: Controlling for healthy-vaccinee bias, Moderna was associated with lower COVID-19 mortality, relative to Pfizer. This difference was not known in real-time due to the failure of the available studies to address healthy-vaccinee bias. Controlling for such bias is vital when making vaccination policy.<\/jats:p>","DOI":"10.3390\/vaccines14080717","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T10:55:18Z","timestamp":1787223318000},"page":"717","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pfizer Versus Moderna COVID-19 Vaccine Effectiveness Against Mortality: Evidence from Linked Mortality and Vaccination Records in Indiana"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7674-4124","authenticated-orcid":false,"given":"Sadia","family":"Farzana","sequence":"first","affiliation":[{"name":"Pritzker School of Law, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8574-8458","authenticated-orcid":false,"given":"Francesco Maria","family":"Rossi","sequence":"additional","affiliation":[{"name":"Pritzker School of Law, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian Eric","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC 20053, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff","family":"Whittle","sequence":"additional","affiliation":[{"name":"Department of Medicine, Medical College of Wisconsin, Wauwatosa, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4843-6837","authenticated-orcid":false,"given":"Kevin","family":"McGurk","sequence":"additional","affiliation":[{"name":"Department of Medicine, Medical College of Wisconsin, Wauwatosa, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin W.","family":"Weston","sequence":"additional","affiliation":[{"name":"Department of Medicine, Medical College of Wisconsin, Wauwatosa, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy Ye","family":"Yuan","sequence":"additional","affiliation":[{"name":"Levin College of Law, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Moghtaderi","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC 20053, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1893-6187","authenticated-orcid":false,"given":"Vladimir","family":"Atanasov","sequence":"additional","affiliation":[{"name":"Raymond A. Mason School of Business, William & Mary, Williamsburg, VA 23185, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6499-0600","authenticated-orcid":false,"given":"Bernard S.","family":"Black","sequence":"additional","affiliation":[{"name":"Pritzker School of Law, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/S0140-6736(22)00152-0","article-title":"Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease: Results of a systematic review and meta-regression","volume":"399","author":"Feikin","year":"2022","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Black, B., and Thaw, D.B. (2023). Vaccinating against a Novel Pathogen: A Critical Review of COVID-19 Vaccine Effectiveness Evidence. Microorganisms, 12.","DOI":"10.2139\/ssrn.4659854"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1056\/NEJMoa2115463","article-title":"Comparative Effectiveness of BNT162b2 and mRNA-1273 Vaccines in U.S. Veterans","volume":"386","author":"Dickerman","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1126\/science.abm0620","article-title":"SARS-CoV-2 vaccine protection and deaths among US veterans during 2021","volume":"375","author":"Cohn","year":"2022","journal-title":"Science"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"101326","DOI":"10.1016\/j.eclinm.2022.101326","article-title":"Comparison of Moderna versus Pfizer-BioNTech COVID-19 vaccine outcomes: A target trial emulation study in the U.S. Veterans Affairs healthcare system","volume":"45","author":"Ioannou","year":"2022","journal-title":"eClinicalMedicine"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Atanasov, V., Barreto, N., Whittle, J., Meurer, J., Weston, B.W., Luo, Q., Yuan, A.Y., Franchi, L., Zhang, R., and Black, B. (2023). Selection Effects and COVID-19 Mortality Risk after Pfizer vs. Moderna Vaccination: Evidence from Linked Mortality and Vaccination Records. Vaccines, 11.","DOI":"10.2139\/ssrn.4321768"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Atanasov, V., Barreto, N., Whittle, J., Meurer, J., Weston, B.W., Luo, Q., Franchi, L., Yuan, A.Y., Zhang, R., and Black, B. (2023). Understanding COVID-19 Vaccine Effectiveness against Death Using a Novel Measure: COVID Excess Mortality Percentage. Vaccines, 11.","DOI":"10.3390\/vaccines11020379"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Farzana, S., Rossi, F.M., Allen, K.S., Luo, Q., Whittle, J., McGurk, K., Weston, B.W., Yuan, A.Y., Moghtaderi, A., and Atanasov, V. (2025). COVID-19 Vaccine Effectiveness Against Mortality in the Omicron Period: Evidence from Linked Mortality and Vaccination Records. Vaccines, 13.","DOI":"10.2139\/ssrn.5641750"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"16634","DOI":"10.20452\/pamw.16634","article-title":"Healthy vaccinee effect: A bias not to be forgotten in observational studies on COVID-19 vaccine effectiveness","volume":"134","author":"Furst","year":"2024","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1056\/NEJMc2306683","article-title":"Potential \u201cHealthy Vaccinee Bias\u201d in a Study of BNT162b2 Vaccine against COVID-19","volume":"389","author":"Duriseti","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1007\/s11606-010-1609-1","article-title":"Healthy User and Related Biases in Observational Studies of Preventive Interventions: A Primer for Physicians","volume":"26","author":"Shrank","year":"2011","journal-title":"J. Gen. Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"16750","DOI":"10.20452\/pamw.16750","article-title":"Healthy vaccinee effect in practice","volume":"134","author":"Straka","year":"2024","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Atanasov, V., Barreto, N., Franchi, L., Whittle, J., Meurer, J., Weston, B.W., Luo, Q.E., Yuan, A.Y., Zhang, R., and Black, B. (2024). Evidence on COVID-19 Mortality and Disparities Using a Novel Measure, COVID excess mortality percentage: Evidence from Indiana, Wisconsin, and Illinois. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0295936"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1377\/hlthaff.2023.00718","article-title":"COVID-19 Boosters: If The US Had Matched Israel\u2019s Speed and Take-Up, An Estimated 29,000 US Lives Would Have Been Saved","volume":"42","author":"Black","year":"2023","journal-title":"Health Aff."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1093\/aje\/kwae007","article-title":"Racial\/Ethnic Disparities in COVID-19 Mortality: National Evidence from Death Certificates","volume":"193","author":"Yuan","year":"2024","journal-title":"Am. J. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/S0140-6736(22)00462-7","article-title":"Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: A cohort study","volume":"399","author":"Nyberg","year":"2022","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1056\/NEJMoa2114255","article-title":"Protection of BNT162b2 Vaccine Booster against COVID-19 in Israel","volume":"385","author":"Goldberg","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1056\/NEJMoa2117128","article-title":"Effectiveness of COVID-19 Vaccines over a 9-Month Period in North Carolina","volume":"386","author":"Lin","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Kiss, Z., Wittmann, I., Polivka, L., Surj\u00e1n, G., Surj\u00e1n, O., Barcza, Z., Moln\u00e1r, G.A., Nagy, D., M\u00fcller, V., and Bogos, K. (2022). Nationwide Effectiveness of First and Second SARS-CoV2 Booster Vaccines During the Delta and Omicron Pandemic Waves in Hungary (HUN-VE 2 Study). Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.905585"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1038\/s41591-022-01699-1","article-title":"Effectiveness of COVID-19 booster vaccines against COVID-19-related symptoms, hospitalization and death in England","volume":"28","author":"Andrews","year":"2022","journal-title":"Nat. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2413","DOI":"10.1056\/NEJMoa2115624","article-title":"BNT162b2 Vaccine Booster and Mortality Due to COVID-19","volume":"385","author":"Arbel","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1016\/S0140-6736(21)02249-2","article-title":"Effectiveness of a third dose of the BNT162b2 mRNA COVID-19 vaccine for preventing severe outcomes in Israel: An observational study","volume":"398","author":"Barda","year":"2021","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.1038\/s41467-022-30059-3","article-title":"Comparative effectiveness over time of the mRNA-1273 (Moderna) vaccine and the BNT162b2 (Pfizer-BioNTech) vaccine","volume":"13","author":"Islam","year":"2022","journal-title":"Nat. Commun."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"ofac311","DOI":"10.1093\/ofid\/ofac311","article-title":"Comparative COVID-19 Vaccine Effectiveness over Time in Veterans","volume":"9","author":"Mayr","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1056\/NEJMoa2510226","article-title":"Association of 2024\u20132025 COVID-19 Vaccine with COVID-19 Outcomes in U.S. Veterans","volume":"393","author":"Cai","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1001\/jama.2020.19328","article-title":"Postlicensure Evaluation of COVID-19 Vaccines","volume":"324","author":"Patel","year":"2020","journal-title":"JAMA"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1001\/jama.2024.5633","article-title":"Test-Negative Study Designs for Evaluating Vaccine Effectiveness","volume":"332","author":"Dean","year":"2024","journal-title":"JAMA"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e103690","DOI":"10.7554\/eLife.103690","article-title":"Assessing healthy vaccinee effect in COVID-19 vaccine effectiveness studies: A national cohort study in Qatar","volume":"14","author":"Chemaitelly","year":"2025","journal-title":"eLife"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1111\/j.1475-6773.2012.01449.x","article-title":"Measures of Social Deprivation That Predict Health Care Access and Need within a Rational Area of Primary Care Service Delivery","volume":"48","author":"Butler","year":"2012","journal-title":"Health Serv. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1001\/jama.2021.5199","article-title":"Excess Deaths from COVID-19 and Other Causes in the US, March 1, 2020, to January 2, 2021","volume":"325","author":"Woolf","year":"2021","journal-title":"JAMA"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e2313661121","DOI":"10.1073\/pnas.2313661121","article-title":"Excess natural-cause mortality in US counties and its association with reported COVID-19 deaths","volume":"121","author":"Paglino","year":"2024","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"27850","DOI":"10.1038\/s41598-024-76946-1","article-title":"The disappearing COVID-Na\u00efve Population and comparative Roche vs. Abbott Test sensitivity: Evidence from antibody seroprevalence in Milwaukee County, Wisconsin","volume":"14","author":"Franchi","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_33","unstructured":"Centers for Disease Control and Prevention (CDC) (2026, April 07). Staying up to Date with COVID-19 Vaccines, Available online: https:\/\/www.cdc.gov\/covid\/vaccines\/stay-up-to-date.html?."},{"key":"ref_34","unstructured":"United Kingdom Government (2026, April 07). JCVI Statement on COVID-19 Vaccination in 2025 and Spring 2026, Available online: https:\/\/www.gov.uk\/government\/publications\/covid-19-vaccination-in-2025-and-spring-2026-jcvi-advice\/jcvi-statement-on-covid-19-vaccination-in-2025-and-spring-2026."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1377\/hlthaff.2025.00050","article-title":"Comparing COVID-19 Acute and Postacute Medical Spending by Vaccination Status for Child and Adult Medicaid Enrollees: Article examines medical expenditures by COVID-19 vaccination status for child and adult Medicaid enrollees","volume":"44","author":"Pike","year":"2025","journal-title":"Health Aff."},{"key":"ref_36","first-page":"100212","article-title":"Effectiveness estimates of three COVID-19 vaccines based on observational data from Puerto Rico","volume":"9","author":"Nieves","year":"2022","journal-title":"Lancet Reg. Health\u2014Am."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"5044","DOI":"10.1002\/jmv.27934","article-title":"Comparative effectiveness and durability of COVID-19 vaccination against death and severe disease in an ongoing nationwide mass vaccination campaign","volume":"94","author":"Lytras","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Berec, L., \u0160m\u00edd, M., P\u0159ibylov\u00e1, L., M\u00e1jek, O., Pavl\u00edk, T., Jarkovsk\u00fd, J., Zaj\u00ed\u010dek, M., Weiner, J., Barusov\u00e1, T., and Trnka, J. (2022). Protection provided by vaccination, booster doses and previous infection against COVID-19 infection, hospitalisation or death over time in Czechia. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0270801"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1038\/s41564-022-01272-z","article-title":"Comparative effectiveness of third doses of mRNA-based COVID-19 vaccines in US veterans","volume":"8","author":"Dickerman","year":"2023","journal-title":"Nat. Microbiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"500","DOI":"10.15585\/mmwr.mm7432a2","article-title":"Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices\u2014United States, 2025\u20132026Influenza Season","volume":"74","author":"Grohskopf","year":"2025","journal-title":"Mmwr-Morb. Mortal. Wkly. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Par\u00e9s-Badell, O., Mart\u00ednez-G\u00f3mez, X., Pin\u00f3s, L., Borras-Bermejo, B., Uriona, S., Otero-Romero, S., Rodrigo-Pend\u00e1s, J.\u00c1., Cossio-Gil, Y., Agust\u00ed, A., and Aguilera, C. (2021). Local and Systemic Adverse Reactions to mRNA COVID-19 Vaccines Comparing Two Vaccine Types and Occurrence of Previous COVID-19 Infection. Vaccines, 9.","DOI":"10.3390\/vaccines9121463"},{"key":"ref_42","first-page":"9","article-title":"Reactogenicity of Heterologous Mrna-Based COVID-19 Vaccine Booster in Young Adults in Indonesia-A Short Communication: COVID-19 vaccine booster reactogenicity in young adults","volume":"17","author":"Suryadinata","year":"2023","journal-title":"Afr. J. Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1001\/jama.2021.5374","article-title":"Reactogenicity Following Receipt of mRNA-Based COVID-19 Vaccines","volume":"325","author":"Gee","year":"2021","journal-title":"JAMA"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"5153","DOI":"10.1016\/j.vaccine.2022.07.007","article-title":"Risk of myocarditis and pericarditis following BNT162b2 and mRNA-1273 COVID-19 vaccination","volume":"40","author":"Goddard","year":"2022","journal-title":"Vaccine"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1016\/S0140-6736(22)00791-7","article-title":"Risk of myocarditis and pericarditis after the COVID-19 mRNA vaccination in the USA: A cohort study in claims databases","volume":"399","author":"Wong","year":"2022","journal-title":"Lancet"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"4663","DOI":"10.1016\/j.vaccine.2022.05.048","article-title":"Myocarditis and\/or pericarditis risk after mRNA COVID-19 vaccination: A Canadian head to head comparison of BNT162b2 and mRNA-1273 vaccines","volume":"40","author":"Abraham","year":"2022","journal-title":"Vaccine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1016\/j.jacc.2022.08.799","article-title":"Comparative Risk of Myocarditis\/Pericarditis Following Second Doses of BNT162b2 and mRNA-1273 Coronavirus Vaccines","volume":"80","author":"Naveed","year":"2022","journal-title":"JACC"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1001\/jama.2021.21699","article-title":"Myocardial Infarction, Stroke, and Pulmonary Embolism After BNT162b2 mRNA COVID-19 Vaccine in People Aged 75 Years or Older","volume":"327","author":"Jabagi","year":"2021","journal-title":"JAMA"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1001\/jama.2021.3976","article-title":"Acute Allergic Reactions to mRNA COVID-19 Vaccines","volume":"325","author":"Blumenthal","year":"2021","journal-title":"JAMA"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"4407","DOI":"10.1016\/j.vaccine.2021.06.058","article-title":"Relationship Between Pre-Existing Allergies and Anaphylactic Reactions post mRNA COVID-19 Vaccine Administration","volume":"39","author":"Desai","year":"2021","journal-title":"Vaccine"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1038\/s41591-022-01689-3","article-title":"Long-term cardiovascular outcomes of COVID-19","volume":"28","author":"Xie","year":"2022","journal-title":"Nat. Med."},{"key":"ref_52","first-page":"367","article-title":"Has the first year of the COVID-19 pandemic reversed the trends in CV mortality between 1999 and 2019 in the United States?","volume":"9","author":"Kobo","year":"2022","journal-title":"Eur. Heart J.-Qual. Care Clin. Outcomes"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/8\/717\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T04:22:47Z","timestamp":1787372567000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/8\/717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":52,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["vaccines14080717"],"URL":"https:\/\/doi.org\/10.3390\/vaccines14080717","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]}}}