What are the treatment options for anemia and COVID-19? The clonal expansion of effector T cells was also reported to occur following vaccination [20]. N Engl J Med. You can learn more about how we ensure our content is accurate and current by reading our. The vaccine developers report that some people experience pain where they were injected; body aches; headaches or fever, Five with Evans syndrome, all preexisting. All Rights Reserved. BMT, bone marrow transplantation; COVID-19, coronavirus disease 2019; CyA, cyclosporine A; TAC, tacrolimus. (2023). Ashok Shenoy K., Prabha Adhikari M.R., Chakrapani M., Shenoy D., Pillai A. Pancytopenia after recombinant hepatitis B vaccine--an Indian case report. See this image and copyright information in PMC. Before Al-kuraishy HM, et al. The only change in has been receiving the vaccine. COVID-19 can lead to a variety of blood-related issues, including blood clots and changes in white blood cell or platelet counts. Federal government websites often end in .gov or .mil. After my doctor/lab tests came back, my hemoglobin / hemocrit / ferritin was extremely low, ferritin is "3" hemoglobin "9". Complement has emerged as a likely driver of the immune response and end-organ damage in COVID-19. 2021;96:534537. Talk with your doctor and family members or friends about deciding to join a study. Connect with thousands of patients and caregivers for support, practical information, and answers. Appendix ASupplementary data to this article can be found online at https://doi.org/10.1016/j.jaut.2021.102782. Introduction. Bergamaschi G, et al. HHS Vulnerability Disclosure, Help Search for other works by this author on: Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Int J Hematol. COVID-19 Posing Grim Challenge Aplastic Anemia 2023 May-Jun;43:79-84. doi: 10.1016/j.ijmmb.2022.10.012. COVID-19 Vaccines Symptoms of submucosal fibroids include: 3. Epub 2021 Nov 10. Before Recent data suggest the SARS-CoV-2 spike protein binds heparan sulfate on nucleated cells9 and amplifies the alternative pathway of complement through interference with the binding of CFH, an alternative pathway inhibitor.5 However, CFH primarily binds sialic acid on human erythrocytes,10 and mature erythrocytes express little heparan sulfate.11. mRNA-1345 is a single messenger RNA (mRNA) sequence encoding for a stabilized prefusion F glycoprotein, using the same lipid nanoparticles as the companys Tacrolimus and short-term methotrexate were used as a prophylaxis against graft-versus-host disease (GVHD). It found that people who were readmitted were more likely to have had moderate to severe anemia while they had COVID-19. Analysis of hematologic adverse events reported to a national surveillance system following COVID-19 bivalent booster vaccination. [Chinese consensus on severe acute respiratory syndrome coronavirus-2 vaccination in adult patients with hematological diseases (2023)]. The transplanted cells collected from the donor's bone marrow were transfused into the patient after the removal of red blood cells and plasma. No association between new-onset AA and SARS-CoV-2 vaccines has been reported. An official website of the United States government. However, rare cases of adverse immunological reactions to SARS-CoV-2 vaccines have been reported, including cases involving immune-mediated disease [[1], [2], [3]]. There is no established method for examining the relationships between vaccines and the development of autoimmune diseases. In this patient, antibodies against the SARS-CoV-2 spike protein were detected both before and after the HSCT. I have zero history of anemia. Beta Thalassemia Bergman P, Blennow O, Hansson L, Mielke S, Nowak P, Chen P, Sderdahl G, sterborg A, Smith CIE, Wullimann D, Vesterbacka J, Lindgren G, Blixt L, Friman G, Wahren-Borgstrm E, Nordlander A, Gomez AC, Akber M, Valentini D, Norlin AC, Thalme A, Bogdanovic G, Muschiol S, Nilsson P, Hober S, Lor K, Chen MS, Buggert M, Ljunggren HG, Ljungman P, Aleman S; COVAXID-collaborator group (shown separately). National Library of Medicine If you donate a Power Red, you lose twice that amount, about 470 mg of iron. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. The .gov means its official. Adverse events, including severe allergic reactions, after COVID-19 vaccination are rare but can happen.For this reason, everyone who receives a COVID-19 vaccine is monitored by their vaccination provider for at least 15 minutes. Iron and iron-related proteins in COVID-19. She had a favorable clinical 2021 May 15;13(5):e15035. Two messenger RNA (mRNA)-based vaccines that lead to transient expression of the SARS-CoV-2 spike protein are highly efficacious in preventing severe infection.6,7 Reactions to these vaccines are generally mild; however, increased complement amplification could theoretically lead to more severe effects in diseases like paroxysmal nocturnal hemoglobinuria (PNH), where blood cells lack complement regulatory proteins.8 Here, we describe significant adverse reactions to COVID-19 vaccines in 4 patients with PNH. Why Should I Register and Submit Results? Careers. Your comment will be reviewed and published at the journal's discretion. COVID-19 vaccine. We report the case of a 29-year-old female that developed AA after being hospitalized for COVID-19. Clipboard, Search History, and several other advanced features are temporarily unavailable. government site. and transmitted securely. As a library, NLM provides access to scientific literature. Thirty-six with autoimmune thrombocytopenia, all were preexisting. Lee E.J., Cines D.B., Gernsheimer T., Kessler C., Michel M., Tarantino M.D., et al. The FDA has granted breakthrough therapy designation to an investigational respiratory syncytial virus vaccine candidate, mRNA-1345 from Moderna, for individuals 60 years and older. Heavy and prolonged menstrual bleeding between or during periods. Aplastic anemia; Bone marrow transplantation; COVID-19; SARS-CoV-2; Vaccination. The remaining authors declare no competing financial interests. Please enable it to take advantage of the complete set of features! Conflict-of-interest disclosure: R.A.B. Gregorio Campos-Cabrera, Francisco-Gerardo Torres-Salgado, Salvador Campos-Cabrera, Jose-Luis Campos-Villagomez, Virginia Campos-Cabrera; Autoimmune Cytopenias and Covid-19 Vaccination: Relapse and Suggested Treatment. doi: 10.7759/cureus.35020. Bookshelf MYTH: The side effects of the COVID-19 vaccine are dangerous. Iron Info For Frequent Donors | Red Cross Blood Services. denotes no information is available; AST, aspartate amino transferase; LDH, lactate dehydrogenase; N/A, not applicable; RBC red blood cell. Prognostic role of anemia in COVID-19 patients: A meta-analysis. His iron, ferritin and red blood cell count is extremely low. Aplastic anemia (AA), a bone marrow failure syndrome, appears to be immune-mediated [4,5]. BMT, bone marrow transplantation; COVID-19, coronavirus disease 2019; CyA, cyclosporine A; TAC, tacrolimus. Ann Hematol. Online ahead of print. Therefore, it is important to collect information about their adverse events. parameters. However, autoantibodies specific to AA and the role of autoantibodies for the pathogenesis of AA are unclear. sharing sensitive information, make sure youre on a federal Twenty-three patients with autoimmune thrombocytopenia did not develop any fall in the platelet count. Submucosal Fibroids: Symptoms, Causes, and Treatment National Library of Medicine Am J Clin Pathol. (2021). Acquired severe aplastic anemia after H1N1 influenza virus vaccination successfully treated with allogeneic bone marrow transplantation. Although causality was not proven in this case, further evaluations are warranted to assess the associations between vaccines and AA. Viallard J.F., Boiron J.M., Parrens M., Moreau J.F., Ranchin V., Reiffers J., et al. We also wish to thank Dr. Takashi Ozaki and Mr. Masaya Morimoto from Kinan Hospital for their helpful diagnostic support. Vaccination and autoimmune disease: what is the evidence? This is according to The Red Cross blood services. Radwi M., Farsi S. A case report of acquired hemophilia following COVID-19 vaccine. She missed 2 doses of danicopan immediately after her second vaccination due to concerns that the drug may interfere with vaccine potency; therefore, danicopan was not at therapeutic levels at the time of her reaction. Various cases of autoimmune disease have been reported after SARS-CoV-2 vaccine administration, including autoimmune hepatitis, type 1 diabetes mellitus, immune thrombocytopenia, and acquired hemophilia [3,[13], [14], [15]]. This site needs JavaScript to work properly. Among patients with SARSCoV2 infection (also known as COVID19), pneumonia, respiratory failure and acute respiratory distress syndrome are frequently encountered complications. ). ). Cureus. To treat the low blood counts, early treatment involves easing symptoms. Elsevier Public Health Emergency Collection, https://doi.org/10.1016/j.jaut.2021.102782, https://doi:10.1046/j.1365-2141.2000.02171.x, https://doi:10.1046/j.1365-2141.2001.03006-2.x, https://doi:10.1016/S1473-3099(20)30130-4, https://doi:10.1016/S0140-6736(03)14802-7, https://doi:10.1182/bloodadvances.2019000853. No relevant conflicts of interest to declare. COVID-19 The pathogenetic mechanisms by which vaccines cause the development of autoimmune disease are still unclear. The remaining 7 patients with preexisting autoimmune anemia developed hemolysis; five with Hb levels above 7 and recovery without any treatment; two had Hb levels below 7 and received the same treatment with full recovery and complete remission. -, Nagashima T, Minota S. Autoimmune hemolytic anemia induced by adalimumab. In addition to T cells and cytokines, autoantibodies are one of the factors that contribute to the pathogenesis of AA [4]. Vaccines often underperform in Africa compared to high-income countries. COVID-19 can lead to a variety of Four of 6 patients reported fever. The efficacies of the Covid-19 vaccines have not been as high as initially reported. Disclaimer. Last medically reviewed on March 9, 2023. Sometimes there are coincidences. Spike Antibody Titers Evaluation after a 2-Dose Regimen of BNT162b2 Vaccination in Healthcare Workers Previously Infected with SARS-CoV-2. Anemia in patients with COVID-19: Pathogenesis and clinical significance. 2022 Sep 28;3(4):1442-1444. doi: 10.1002/jha2.570. Baden LR, El Sahly HM, Essink B, et al.. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. WebStep 1: Find a location and schedule your appointment. Copyright 2023 by American Society of Hematology, Aplastic anemia, transfusion dependence, microvascular small bowel thrombosis, renal failure, smooth muscle dystonia, Transfusion dependence, hemoglobinuria, smooth muscle dystonia, Hemoglobinuria, fatigue, extravascular hemolysis with transfusion dependence on C5 inhibition, Last dose ravulizumab prior to vaccination, Fever, myalgia, headache, fatigue, hemoglobinuria, Fever, fatigue, dark urine, vomiting, diarrhea. After the patient's hematopoietic stem cells were replaced through HSCT, his AA improved despite the presence of anti-SARS-CoV-2 antibodies. staining (x400) showed the replacement of hematopoietic cells by fat and a few nucleated cells. In patients with severe disease, deposition of terminal complement and microthrombosis have been observed in the lung, skin, kidney, and heart.14 Recently, we demonstrated that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein leads to amplification of the alternative pathway of complement on cell surfaces through competition with complement factor H (CFH) for binding heparan sulfate.5 Thus, in vitro, the SARS-CoV-2 spike protein can convert an inactivator surface to an activator surface on nucleated cells. Zuin M, et al. Free-Text Entries for Other Vaccine Aplastic anemia (AA) is an immune-mediated bone marrow failure syndrome. Further evaluations in large cohorts are warranted to elucidate the associations between AA and SARS-CoV-2 vaccines. Eur J Haematol. A position paper from the SAAWP of the EBMT, Complement inhibition at the level of C3 or C5: mechanistic reasons for ongoing terminal pathway activity, Incomplete inhibition by eculizumab: mechanistic evidence for residual C5 activity during strong complement activation, Thrombotic events with Neisseria meningitidis vaccination in patients with paroxysmal nocturnal hemoglobinuria, UK experience [abstract], Characterization of breakthrough hemolysis events observed in the phase 3 randomized studies of ravulizumab versus eculizumab in adults with paroxysmal nocturnal hemoglobinuria, Complementopathies and precision medicine, 2021 by The American Society of Hematology. COVID; COVID vaccine; autoimmune hemolytic anemia; hematology oncology; hemolysis; rheumatology. This case suggests that the measurement of vaccine antibody titers before and after allogeneic HSCT may provide clues to the pathogenesis of vaccine-related autoimmune diseases. We also present 2 patients with PNH who received the vaccine without significant adverse effects or hemolysis. Panel B: H.E. What vaccines should be administered to adult patients who Water (H2O) serves as a positive control. Studies a U.S. FDA-regulated Drug Product: Studies a U.S. FDA-regulated Device Product: Antibody avidity index [TimeFrame:day 35], Antibody avidity index [TimeFrame:day 63], antiviral immunoglobulin G response antiviral immunoglobulin G response antiviral immunoglobulin G response antiviral immunoglobulin G response [TimeFrame:day 0], antiviral immunoglobulin G response antiviral immunoglobulin G response antiviral immunoglobulin G response antiviral immunoglobulin G response [TimeFrame:day 7], antiviral immunoglobulin G response antiviral immunoglobulin G response antiviral immunoglobulin G response antiviral immunoglobulin G response [TimeFrame:day 35], antiviral immunoglobulin G response antiviral immunoglobulin G response antiviral immunoglobulin G response antiviral immunoglobulin G response [TimeFrame:day 63], immune cell populations [TimeFrame:day 0], immune cell populations [TimeFrame:day 7], immune cell populations [TimeFrame:day 35], immune cell populations [TimeFrame:day63], Immune cell cytokine secretion [TimeFrame:day 7], Immune cell cytokine secretion [TimeFrame:day 35], Transferrin receptor [TimeFrame:day 0], Transferrin receptor [TimeFrame:day 7], Transferrin receptor [TimeFrame:day 35], Transferrin receptor [TimeFrame:day 63], Transferrin saturation [TimeFrame:day 0], Transferrin saturation [TimeFrame:day 7], Transferrin saturation [TimeFrame:day 35], Transferrin saturation [TimeFrame:day 63], C-reactive protein [TimeFrame:day 35], C-reactive protein [TimeFrame:day 63], Alpha-glycoprotein [TimeFrame:day 35], Alpha-glycoprotein [TimeFrame:day 63], retinol binding protein [TimeFrame:day 0], retinol binding protein [TimeFrame:day 7], retinol binding protein [TimeFrame:day 35], retinol binding protein [TimeFrame:day 63]. Conversely, there is quite a bit of information on the importance of not going into the vaccine with iron deficiency due to the way in which the vaccine works. We report a case of severe AA that arose after the administration of a COVID-19 vaccine (the Pfizer-BioNTech mRNA vaccine), which was treated with allogeneic hematopoietic stem cell transplantation (HSCT). Smoking may cause the opposite of anemia symptoms elevated hemoglobin levels. Hsu CM, Weiner DE, Manley HJ, Aweh GN, Ladik V, Frament J, Miskulin D, Argyropoulos C, Abreo K, Chin A, Gladish R, Salman L, Johnson D, Lacson EK Jr. Clin J Am Soc Nephrol. Shah C., Lemke S., Singh V., Gentile T. Case reports of aplastic anemia after vaccine administration. There is scanty material about relapse of autoimmune hematological diseases after vaccination for COVID-19 (Blood Adv 2021;13:2794-2798). pharmacytimes.com eCollection 2023 Feb. Jacobs JW, Booth GS, Guarente J, Schlafer D, Zheng L, Adkins BD. The allogeneic HSCT replaces the recipient's hematopoietic and associated immune systems with those of the donor. Twenty-one days after the HSCT, neutrophil engraftment was achieved. Postvaccination graft dysfunction/aplastic anemia relapse with massive clonal expansion of autologous CD8+ lymphocytes. The allogeneic BMT was conducted at 34 days after the 2nd dose of the COVID-19 vaccine was administered. The titers of antibodies against SARS-CoV-2 were measured before and after the HSCT to examine the association between the SARS-CoV-2 vaccine the patient received and the development of AA. and T32 HL 007525 (G.F.G. Transfusion. These events and reported side-effects could be simply temporally related rather than directly attributable to vaccination. Its also possible for anemia of inflammation in COVID-19 to be associated with deficiencies in iron and in vitamins like vitamin B12 or folate. COVID-19 Connect with thousands of patients and caregivers for support and answers. With COVID-19, its believed to occur due to an autoimmune effect or direct injury to RBCs, according to 2022 research. He saw his physician and she suspected some type of internal bleeding based on the blood test, He had an upper and lower endoscopy. There are two main types of thalassemia: alpha and beta. COVID-19 Vaccine Type and Adverse Effects Following Has there been any reports of iron depletion in the blood after receiving the Pfizer vaccine? Here, we report a case of AA that developed after the administration of a SARS-CoV-2 vaccine and discuss the association between AA and vaccination. doi: 10.7759/cureus.15035. Visit. Severe autoimmune hemolytic anemia following receipt of SARS-CoV-2 mRNA vaccine. Because the function of RBCs is to deliver oxygen, having anemia means that the organs and tissues of your body arent getting enough oxygen. He saw his physician and she suspected some type of internal bleeding based on the blood test, He had an upper and lower endoscopy. The efficacies of the Covid-19 vaccines have not been as high as initially reported. He began feeling more tired over the next two months. Patrizio A., Ferrari S.M., Antonelli A., Fallahi P. A case of Graves' disease and type 1 diabetes mellitus following SARS-CoV-2 vaccination. Anemia Healthline Media does not provide medical advice, diagnosis, or treatment. Tao Z, et al. They are going to try the camera endoscopy next week. Anemia is associated with severe illness in COVID‐19: A retrospective cohort study. 2022 Dec;133:102915. doi: 10.1016/j.jaut.2022.102915. The article examines the relationship between anemia and COVID-19 and what you can do if you develop anemia along with COVID-19. Epub 2021 Oct 3. WebIt measures white and red blood cells, platelets, hemoglobin (cells that carry oxygen) and hematocrit (volume of red blood cells). Symptoms. Searching PubMed for tinnitus and Covid-19 vaccine does yield a handful of case reports, allergies, an acoustic neuroma, other growths, anemia, We report a case of severe AA that arose after the administration of a COVID-19 vaccine (the Unauthorized use of these marks is strictly prohibited. COVID-19 Vaccines Plus, inflammation in the body can reduce the production of new RBCs in the bone marrow. I fed him an iron rich diet the week prior to him giving blood. Anemia - What Is Anemia? | NHLBI, NIH - National Institutes of These results suggest that the AA was ameliorated by the allogeneic HSCT even though anti-SARS-CoV-2 spike protein antibodies continued to be detected after the HSCT. However, no method for assessing the relationships between vaccines and the development of autoimmune diseases has been established. UConn previously required all students to be COVID-19 vaccinated starting in 2021 during a surge of the pandemic to maintain the health and safety of the UConn community. Anemia SARS-CoV-2 Infection in Aplastic Anaemia. Although many vaccines can lead to hemolysis and thrombosis in PNH, this effect is mitigated in most patients on complement inhibitors.15 Ravulizumab, a new C5 inhibitor with a half-life 4 times longer than eculizumab, is reported to have significantly fewer instances of pharmacokinetic breakthrough hemolysis.16 Furthermore, 3 instances of breakthrough hemolysis occurred 4 weeks from the last ravulizumab infusion, making suboptimal C5 inhibition unlikely. Federal government websites often end in .gov or .mil. Its important to note that most of the research into outcomes for COVID-19 and anemia has been done in hospitalized individuals. Anemia of inflammation can also happen with a variety of other conditions associated with inflammation in the body, including autoimmune diseases and cancer. I also couldn't find anything that suggests a link between Pfizer vaccines and low iron. WebThere are two main types of thalassemia: alpha and beta. They actually wouldn't take his blood because the iron content was so low. Characteristics of COVID-19 Citizen Science Study Participants eTable 2. Vuille-Lessard E., Montani M., Bosch J., Semmo N. Autoimmune hepatitis triggered by SARS-CoV-2 vaccination. For general information, Learn About Clinical Studies. COVID-19 Anemia can affect your weight, whether due to its impact on your appetite and activity levels or its underlying cause. 19 Vaccine Autoimmun. Do you have a history of anemia or another blood disorder? Efficacy of anti-severe acute respiratory syndrome coronavirus 2 mRNA vaccines in adults with severe acquired aplastic anemia with or without allogeneic hematopoietic stem cell transplantation. COVID-19 Vaccines: Myth Versus Fact Rinsho Ketsueki. The CDC recommends one bivalent booster dose: For everyone ages 5 years and older if it Our study objective is to assess whether iron deficiency anaemia in young women impairs their immune response to the COVID-19 vaccine, and whether iron My husband's various blood levels also declined after the vaccine. In your husband's place, I would not assume it was related to the vaccine and keep looking for the cause. Patients were identified based on self-report of receiving the vaccine. It found that changes in iron dynamics could last for at least two months after COVID-19 and were associated with continued lung problems and lower physical performance. Ritz C., Meng W., Stanley N.L., Baroja M.L., Xu C., Yan P., et al. Published April 20, 2023 at 8:20 AM EDT. Post-transplant cyclophosphamide was not administered because the patient's HLA-A, C, and DR were homologous, which would not increase the risk of GVHD. Brito S, Ferreira N, Mateus S, Bernardo M, Pinto B, Loureno A, Grenho F. Cureus. However, it is not clear whether antibodies derived from the SARS-CoV-2 vaccine directly contributed to the development of AA because the anti-SARS-CoV-2 antibodies remained after the patient's pancytopenia had been ameliorated by the allogeneic HSCT. If you have anemia, your body does not get Anemia, coupled with the other effects of COVID-19, can lead to potentially serious complications. Information provided by (Responsible Party): Prof Simon Karanja, Jomo Kenyatta University of Agriculture and Technology. 2021;138:293298. Search for other works by this author on: 2021 by The American Society of Hematology. Chakravarthy R., Murphy M.L., Ann Thompson M., McDaniel H.L., Zarnegar-Lumley S., Borinstein S.C. SARS-CoV-2 infection coincident with newly diagnosed severe aplastic anemia: a report of two cases. (See "COVID-19: Vaccines".) Monitoring Anemia with COVID-19 It's been found that, in general, people who have COVID-19 often have significantly reduced hemoglobin levels, especially with severe disease. D-dimer was elevated to 0.73 g/mL fibrinogen-equivalent units from 0.21 g/mL. PMC -, Gaignard ME, Lieberherr S, Schoenenberger A, Benz R. Autoimmune hematologic disorders in two patients after mRNA COVID-19 vaccine. Iron supplements and drugs that stimulate RBC production may also sometimes be recommended. They often share similar symptoms but have different causes as well as different treatments and severity. Normal Iron and Hemoglobin Levels Are Needed for Optimizing the Response to COVID-19 Vaccination: He underwent an allogeneic hematopoietic stem cell transplantation (HSCT) from an HLA haploidentical related donor (Fig. The major hypotheses relating to such immunological reactions involve epitope mimicry [18,19]. Study record managers: refer to the Data Element Definitions if submitting registration or results information. In spite of the administration of cyclosporine and eltrombopag, his pancytopenia progressed. Aplastic anemia can be treated with medications, blood transfusions, and even bone marrow stem cell transplants. Available vaccines have proven highly safe and effective. The state of vaccine safety science: systematic reviews of the evidence. (2020). The .gov means its official. My husband gives blood regularly. This work was supported by National Institutes of Health, National Heart, Lung, and Blood Institute grants R01 HL 133113 (R.A.B.) Histological findings of the bone marrow biopsy specimen at diagnosis. Sustainable Health Development in the Post-pandemic Era: Taiwan vaccine WebSickle cell anemia is a common cause of splenic atrophy and eventual asplenia. Wraith D.C., Goldman M., Lambert P.H. Can You Get a COVID Vaccine If You Have Beta Thalassemia? intravenous iron carboxymaltose before vaccination, no intravenous iron carboxymaltose before vaccination, percentage of antibodies that remain bound to beads. Severe pancytopenia triggered by recombinant hepatitis B vaccine. Covid-19 (2021). Thanks, I checked the VAERS data could not find any reports of iron deficiency after vaccine. The disease causes fever and chills and in severe cases anemia, seizures, and respiratory problems. However, no method for assessing the relationships between vaccines and the development of autoimmune diseases has been established. Hemoglobin is the protein that allows RBCs to carry oxygen. The site is secure. aNHS preincubated with and without S1 was added to the erythrocytes. Patient 1 is a 25-year-old man diagnosed with PNH 6 months prior in the setting of hemoglobinuria and had limited disease manifestations not requiring PNH-directed therapy. He began feeling more tired over the next two months. Inclusion in an NLM database does not imply endorsement of, or agreement with, Histological findings of the bone marrow biopsy specimen at diagnosis. None of these patients were previously transfused in the past year. He had an 1 g/dL hemoglobin decrease on laboratory tests 3 days following his first vaccination.
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