Despite the evidence of effectiveness of vaccines in preventing SARS-CoV-2 infection-associated serious illness, hospitalization, and death, there is some hesitation towards COVID-19 vaccination in young adults because of concerns regarding adverse events. A retrospective cohort study was conducted in Gifu University students receiving the mRNA-1273 vaccine and boosters to elucidate the real incidence of adverse events and factors that prevent them. We examined the adverse events and identified potential risk factors through a self-administered questionnaire reporting their physical condition after COVID-19 vaccination. A higher number of vaccinations, female sex, and low body mass index were significantly associated with the occurrence of adverse events on the day of or after receiving the COVID-19 vaccine. Regular breakfast consumption was significantly associated with a decreased incidence of post-vaccination itching, abdominal pain, and diarrhea. Sufficient sleep duration was significantly associated with a decreased incidence of post-vaccination abdominal pain and diarrhea. Focal/systemic adverse events were highly frequent among university students after receiving the COVID-19 vaccine, with no life-threatening cases or hospitalizations. A higher number of vaccinations, female sex, and lower body mass index were associated with an increased incidence of adverse events. Contrastingly, regular breakfast and sufficient sleep were associated with fewer adverse events.
Article
Adverse events of COVID-19 vaccination among Japanese University Students suppressed by breakfast consumption and favorable sleeping habits
https://doi.org/10.21203/rs.3.rs-3108220/v1
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The clinical vaccine for coronavirus disease (COVID-19) was developed after the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in December 2019, that is causing global devastation. One of the COVID-19 vaccines, mRNA-1273 (Moderna), showed 94.1% efficacy in preventing COVID-19 illness[1] for more than 5 months, without safety concerns[2]. After the vaccine received the Emergency Use Authorization by the US Food and Drug Administration (FDA) as a 2-dose series, frequent local and systemic reactions were reported in surveillance conducted by the Centers for Disease Control and Prevention (CDC)[3]. Among adolescents (12–17 years of age), frequent injection site reactions, including pain, and systemic reactions, including headache and fatigue, were reported[4]. However, little is known about the real frequency of adverse events associated with the COVID-19 vaccine among young adults.
Although the efficacy, safety, and immunogenicity of the COVID-19 vaccines and booster vaccines are established[5,6], a substantial percentage of people have concerns[7], hesitation[8], and fear[9] worldwide. As the younger generation is more concerned and hesitant, concerns about adverse events may become barriers and decrease the COVID-19 vaccine/booster shot rate in young adults. Real data on adverse events, with frequency and life-threatening levels and their associated factors, should be provided to the young population in the attempt to reduce these unfavorable feelings. However, little is known about the factors associated with adverse events in young adults.
In this study, we analyzed the adverse event surveillance data of Japanese university students who received the first, second, and third booster shots of the mRNA-1273 SARS-CoV-2 vaccine to analyze the real reactogenicity among young adults. Additionally, to determine the factors associated with the prevention of the adverse events, we analyzed the information on health backgrounds collected from the annual health check data and selected the factors that should be considered before vaccination based on the associations between the physical information on lifestyle and adverse events.
The COVID-19 vaccination program at Gifu University and the participants
The COVID-19 vaccination program at Gifu University involved three rounds of vaccination: 4,214, 4,180, and 2,517 individuals underwent the first, second, and third rounds, respectively. Only a portion of these individuals responded to the questionnaire, with 2,329 (55.3%) respondents from the first round; 1,631 (39.0%) from the second; and 615 (24.4%) from the third. In total, 2,687 individuals responded to the post-vaccination survey. Among them, 829 individuals with missing annual health checkup data were excluded. The analysis included the respondents who received an annual health checkup from 2021–2022, which comprised 1,626 (38.6%) from the first round; 1,215 (29.1%) from the second; and 456 (18.1%), from the third (Figure 1).
Background characteristics of the participants
The background characteristics of the participants are listed in Table 1. The median age was 20 years (Interquartile Range [IQR]; 18–22), 854 (46.0%) participants were women, and the median body mass index (BMI) was 20.3 (IQR; 18.8–22.2). A history of allergies was reported by 110 participants (5.9%). The median sleep duration was 7 hours (IQR; 6.0–7.0). Exercise frequency was reported as zero in 552 (29.7%) participants; once a week in 539 (29.0%); 2–5 times a week in 669 (36.0%); and 6–7 times a week in 97 (5.2%). The frequency of consuming breakfast was less than once a week in 165 participants (8.9%); 2–3 times a week in 194 participants (10.4%); 4–5 times a week in 375 participants (20.2%); and daily in 1,123 participants (60.5%). The background characteristics of the group of students at Gifu University who underwent health checkups during the 2021–2022 season but did not respond to the questionnaire are shown in Supplementary Table S1. There were no significant differences in the background characteristics between the participants who responded to the questionnaire and those who did not.
[Table 1]
Table 1. Characteristics of participants.
|
Characteristics |
First dose, |
Second dose, |
Third dose, |
Total, |
|
Age |
20 (18, 22) |
20 (18, 22) |
20 (18, 22) |
20 (18, 22) |
|
Gender |
|
|
|
|
|
Female |
739 (45.4%) |
557 (45.8%) |
228 (50.0%) |
854 (46.0%) |
|
Male |
887 (54.6%) |
658 (54.2%) |
228 (50.0%) |
1,004 (54.0%) |
|
BMI |
20.3 (18.8, 22.2) |
20.3 (18.7, 22.2) |
20.3 (18.7, 22.0) |
20.3 (18.8, 22.2) |
|
BMI category |
|
|
|
|
|
<18.5 |
338 (20.8%) |
260 (21.4%) |
96 (21.1%) |
384 (20.7%) |
|
18.5-24.9 |
1,161 (71.4%) |
859 (70.7%) |
324 (71.1%) |
1,332 (71.7%) |
|
>25.0 |
127 (7.8%) |
96 (7.9%) |
36 (7.9%) |
142 (7.6%) |
|
History of allergy |
89 (5.5%) |
73 (6.0%) |
25 (5.5%) |
110 (5.9%) |
|
Hours of sleep |
7.0 (6.0, 7.0) |
7.0 (6.0, 7.0) |
6.0 (6.0, 7.0) |
7.0 (6.0, 7.0) |
|
Exercise habits |
|
|
|
|
|
None |
484 (29.8%) |
366 (30.1%) |
151 (33.1%) |
552 (29.7%) |
|
Once a week |
482 (29.7%) |
360 (29.7%) |
114 (25.0%) |
539 (29.0%) |
|
2-5 times a week |
573 (35.3%) |
422 (34.8%) |
165 (36.2%) |
669 (36.0%) |
|
6-7 times a week |
86 (5.3%) |
66 (5.4%) |
26 (5.7%) |
97 (5.2%) |
|
Habit of consuming breakfast |
|
|
|
|
|
Less than once a week |
148 (9.1%) |
92 (7.6%) |
42 (9.2%) |
165 (8.9%) |
|
2-3 times a week |
158 (9.7%) |
125 (10.3%) |
41 (9.0%) |
194 (10.4%) |
|
4-5 times a week |
327 (20.1%) |
242 (19.9%) |
96 (21.1%) |
375 (20.2%) |
|
Every day |
992 (61.0%) |
756 (62.2%) |
277 (60.7%) |
1,123 (60.5%) |
|
Values are presented as numbers (percentage) or median (IQR; Interquartile range); BMI body mass index |
||||
The incidence of participants who experienced local and systemic symptoms on the day of and the day after vaccination
The symptoms observed on the day of or day after vaccination are summarized in Table 2. Among all the respondents, on the day after and the day of vaccination, local symptoms and systemic symptoms were observed in 1,666 (89.7%) and 1,195 (64.3%) participants, respectively. On the day of vaccination, local and systemic symptoms were observed in 1,534 (82.6%) and 816 participants (43.9%), respectively. The second vaccination was associated with a higher incidence of symptoms than the first, particularly systemic symptoms, whereas the third vaccination was associated with a higher incidence of local adverse reactions than the second, but a lower incidence of systemic symptoms (Table 2). There were no life-threatening cases or hospitalizations in any of the students who received the vaccine.
[Table 2]
Table 2. Symptoms on the day of or the day after receiving the COVID-19 vaccine.
Factors associated with post-vaccination local and systemic symptoms on the day of or the day after COVID-19 vaccination
The incidence of local symptoms on the day of or after vaccination was higher among those who received multiple doses (odds ratio [OR], 1.355; 95% confidence interval [CI], 1.153–1.592; P < 0.001) and among women (OR, 2.436; 95% CI, 1.797–3.302; P < 0.001) (Table 3). In contrast, receiving multiple doses (OR, 4.046; 95% CI, 3.321–4.928; P < 0.001), being a woman (OR, 1.610; 95% CI, 1.340–1.935; P < 0.001), and increased BMI (OR, 0.956; 95% CI, 0.929-0.984; P < 0.001) were associated with a lower incidence of systemic symptoms on the day of and the day after vaccination (Table 3).
[Table 3]
Table 3. Factors associated with symptoms on the day of or the day after receiving the COVID-19 vaccine.
|
OR |
(95% CI) |
P values |
|
|
Vaccination site symptoms |
|||
|
Number of vaccinations |
1.355 |
(1.153-1.592) |
0.0002227 |
|
Female |
2.436 |
(1.797-3.302) |
0.0000000 |
|
BMI |
0.994 |
(0.946-1.045) |
0.8140887 |
|
Exercise habits |
|||
|
once a week |
0.824 |
(0.575-1.181) |
0.2911814 |
|
2-5 times a week |
0.919 |
(0.641-1.317) |
0.6444743 |
|
6-7 times a week |
0.853 |
(0.456-1.596) |
0.6194931 |
|
Habit of consuming breakfast |
|||
|
2-3 times a week |
1.724 |
(0.856-3.470) |
0.1271389 |
|
4-5 times a week |
1.039 |
(0.605-1.784) |
0.8903627 |
|
every day |
0.962 |
(0.594-1.558) |
0.8737705 |
|
History of allergy |
1.133 |
(0.623-2.058) |
0.6827524 |
|
Hours of sleep |
0.944 |
(0.799-1.115) |
0.4950654 |
|
Systemic symptoms |
|||
|
Number of vaccinations |
4.046 |
(3.321-4.928) |
0.0000000 |
|
Female |
1.610 |
(1.340-1.935) |
0.0000004 |
|
BMI |
0.956 |
(0.929-0.984) |
0.0021541 |
|
Exercise habits |
|||
|
once a week |
1.022 |
(0.810-1.290) |
0.8515382 |
|
2-5 times a week |
0.938 |
(0.748-1.175) |
0.5763181 |
|
6-7 times a week |
1.193 |
(0.784-1.817) |
0.4103748 |
|
Habit of consuming breakfast |
|||
|
2-3 times a week |
1.218 |
(0.808-1.836) |
0.3458340 |
|
4-5 times a week |
1.012 |
(0.708-1.447) |
0.9470765 |
|
every day |
0.896 |
(0.652-1.232) |
0.4992428 |
|
History of allergy |
0.877 |
(0.609-1.264) |
0.4821920 |
|
Hours of sleep |
1.026 |
(0.929-1.133) |
0.6105489 |
|
Analyses were performed using generalized estimating equations; CI confidence interval |
|||
The incidence of local symptoms on the day of vaccination was higher among those who received multiple doses (OR, 1.264; 95% CI, 1.119–1.427; P < 0.001) and among women (OR, 2.269; 95% CI, 1.803-2.857; P < 0.001). In addition, receiving multiple doses (OR, 1.923; 95% CI, 1.737–2.129; P < 0.001), belonging to the female sex (OR, 1.656; 95% CI 1.412–1.943; P < 0.001), and increased BMI (OR, 0.965; 95% CI, 0.940–0.991; P < 0.008) were also associated with a lower incidence of systemic symptoms on the day of vaccination (Table 4). A higher frequency of breakfast consumption was associated with a lower incidence of systemic symptoms.
[Table 4]
Table 4. Factors associated with symptoms on the day of COVID-19 vaccination.
|
OR |
(95% CI) |
P values |
|
|
Vaccination site symptoms |
|||
|
Number of vaccinations |
1.264 |
(1.119-1.427) |
0.0001599 |
|
Female |
2.269 |
(1.803-2.857) |
0.0000000 |
|
BMI |
0.999 |
(0.962-1.038) |
0.9625247 |
|
Exercise habits |
|||
|
once a week |
0.756 |
(0.568-1.005) |
0.0540284 |
|
2-5 times a week |
0.902 |
(0.680-1.196) |
0.4747457 |
|
6-7 times a week |
0.961 |
(0.571-1.617) |
0.8808609 |
|
Habit of consuming breakfast |
|||
|
2-3 times a week |
1.132 |
(0.683-1.876) |
0.6306479 |
|
4-5 times a week |
0.955 |
(0.615-1.484) |
0.8379198 |
|
every day |
0.823 |
(0.559-1.213) |
0.3249342 |
|
History of allergy |
1.120 |
(0.710-1.765) |
0.6266272 |
|
Hours of sleep |
0.948 |
(0.837-1.073) |
0.3965009 |
|
Systemic symptoms |
|||
|
Number of vaccinations |
1.923 |
(1.737-2.129) |
0.0000000 |
|
Female |
1.656 |
(1.412-1.943) |
0.0000000 |
|
BMI |
0.965 |
(0.940-0.991) |
0.0079193 |
|
Exercise habits |
|||
|
once a week |
1.053 |
(0.862-1.287) |
0.6121398 |
|
2-5 times a week |
0.976 |
(0.802-1.189) |
0.8123390 |
|
6-7 times a week |
1.096 |
(0.766-1.568) |
0.6175356 |
|
Habit of consuming breakfast |
|||
|
2-3 times a week |
0.941 |
(0.660-1.343) |
0.7391639 |
|
4-5 times a week |
0.742 |
(0.544-1.012) |
0.0590817 |
|
every day |
0.687 |
(0.520-0.906) |
0.0078537 |
|
History of allergy |
1.006 |
(0.731-1.385) |
0.9686985 |
|
Hours of sleep |
0.920 |
(0.844-1.002) |
0.0556020 |
|
Analyses were performed using generalized estimating equations; CI confidence interval |
|||
Factors associated with each local and systemic symptom after vaccination
As BMI increased, there were significant decreases in the incidence of local redness at the injection site, post-vaccination symptoms, headache, and fever (Figure 2). Consuming breakfast at least twice a week was significantly associated with a reduced incidence of pruritus at the injection site following COVID-19 vaccination (Figure 3). A higher frequency of breakfast consumption was associated with a greater reduction in the incidence of post-vaccination symptoms, including itching, abdominal pain, and diarrhea (Figure 3). A longer sleep duration was significantly associated with a lower incidence of systemic symptoms such as abdominal pain/diarrhea after the COVID-19 vaccination (Figure 4). A history of allergic symptoms showed a significant association with an increased occurrence of focal redness as a local symptom (Figure S1).
This study is the first to analyze the occurrence of COVID-19 vaccine adverse events precisely and determine the factors related to adverse events including not only shot times, sex, BMI, and allergic history, but also lifestyle factors, including exercise, eating habits, and sleeping time among Japanese university students.
Adverse events following COVID-19 vaccination among young adults in Japan
We identified adverse events specific to Japanese university students and young adults. Although a few reports worldwide have demonstrated the adverse events following mRNA-based COVID-19 vaccinations[4–6, 10] in a wide variety of populations, there were only two reports analyzing the adverse events among university students. One study was conducted among various universities in the Czech Republic, which demonstrated that the majority from 539 students (18–30 years old) reported at least one side effect including injection site pain (91.8%), fatigue (62.5%), headache (36.4%), and muscle pain (34.9%)[11]. Another cross-sectional study report on 144 medical clerkship students showed that 45% and 67% participants reported localized pain, and 36% and 41% participants reported malaise, after the first and booster doses, respectively. Although there was no mention of the participants’ ages in the manuscript, we suspect that the participants were young adults[12]. The frequency and characteristics of the adverse events showed the same trend as those in our study data.
Within two days of vaccination, 89.7% and 64.3% of the students had local and systemic symptoms, respectively. Although these levels were almost the same as those in the data among adolescents[4] and university students in the Czech Republic[11], they were relatively higher than previous reports[3, 13, 14]. We suspect that the risk of non-life-threatening adverse events increases in the younger generation, as demonstrated in several previous studies[15–20]. In this study, there were significant relationships between dose, sex, and local and systemic adverse events. The risk of adverse events was significantly higher in the second dose than that in the first dose, and in women than that in men, as shown in university students in the Czech Republic[11]. We also demonstrated that the third dose significantly increased the risk of adverse events. Several studies have demonstrated increased incidence of adverse events with an increase in the number of doses of mRNA-based vaccines[3,11,17,18,21−23]. According to our data, women may experience more adverse events than men, as also demonstrated by previous surveys[11, 16–20, 22, 24].
Furthermore, we demonstrated that a decreased BMI increased the risk of systemic adverse events, especially headache/fever and local symptoms of redness. As the mean BMI in our study was 20, and the distribution of lean (less than 18.5 kg/m2), normal (18.5–24.9 kg/m2), and obese (over 25.0 kg/m2) was 20.7%, 71.7%, and 7.6%, respectively, “decreased BMI increased the risk” might mean that adverse events were less likely to occur as BMI increased from the lean to the normal BMI group. Iguacel et al. reported no significant association between adverse events and BMI in a Spanish population[20]. However, the distribution of lean (less than 18.5 kg/m2), normal (18.5–24.9 kg/m2), and obese (over 25.0 kg/m2) in their study was 1.9%, 58.0%, and 36.8%, respectively, in the target group aged 18 to > 65 years. We demonstrated that the lean status may be associated with a higher risk of adverse events in young Japanese adults. To the best of our knowledge, this is the first report of BMI and the adverse events of vaccination in young Japanese adults.
Association between lifestyle factors and adverse events following COVID-19 vaccination
Breakfast consumption significantly decreased the risk of systemic adverse events including stomach pain, diarrhea, and local symptoms of itchiness. Sufficient sleep duration also significantly suppressed local heat sensation and stomach symptoms. A history of allergy was associated with an increased risk of local adverse events such as redness. A favorable lifestyle that includes breakfast/good sleep and education regarding the possibility of local reactions, especially in people with an allergy history, might decrease the frequency and level of adverse events. This study demonstrates this valuable finding in young adults for the first time worldwide .
Our finding that good sleep/regular meal intake habits and a normal BMI may minimize the risk of adverse events should be very reasonable, as a good lifestyle contributes to maintaining healthy body weight while avoiding a decrease in BMI. Therefore, health education to maintain a healthy lifestyle may be important for reducing the level and frequency of adverse events to RNA-based COVID-19 vaccines. Few studies have examined the relationship between lifestyle or other physiological factors and the occurrence of adverse events. Therefore, further studies are required.
Many reports, including clinical trials[1–6], have revealed that most of the adverse events are not serious and resolve within three days[11, 17]. Many researchers have reported significant factors associated with adverse events, such as history of allergic reactions or anaphylaxis[17], vaccine dose[11,17,18,21−23], vaccine brand[3, 17], age[15–20], female sex[11, 16–20, 22, 24], and having a COVID-19 infection before vaccination[17]. These findings support our data and provide crucial information to medical professionals who provide COVID-19 vaccines[25].
This study had several limitations. First, this study only detected adverse events that occurred on the day of and day after the administration of the COVID-19 vaccine. We were unable to investigate the association between adverse events occurring after the third day of vaccination, long-term adverse events, health examination information, or lifestyle factors. Second, we were only able to extract information on the symptoms covered by the questionnaire used in this study, which allowed for standardization of adverse events and ensured the quality of the study. We did not intend to find very rare events, except life-threatening events. Third, this study included only subjects who received the mRNA-1273 vaccine from Moderna. However, there are other COVID-19 vaccines, such as the BNT162b2 mRNA COVID-19 vaccine that uses the same mRNA technology, and many other vaccines that use different mechanisms. Therefore, it may be necessary to conduct studies on adverse events following vaccination with different types of vaccines.
This study is the first to determine the real frequency and significant association between lifestyle factors (breakfast, sleep, and body weight) and local and systemic adverse events to an mRNA-based COVID-19 vaccine among university students in Japan. Based on the study results, we suggest that specific knowledge about adverse events and healthy lifestyle education may prevent and decrease adverse events and avoid meaningless fear or anxiety associated with vaccination.
This study revealed a high frequency of adverse events without life-threatening cases, which had a significant association with lifestyle factors. Healthy food/sleep habits and maintaining an ideal body weight may reduce adverse events to mRNA-based COVID-19 vaccines among university students in Japan.
Here, we demonstrated a high frequency of focal/systemic adverse events after administration of the COVID-19 mRNA-1273 vaccine among university students in Japan; however, there were no life-threatening cases or hospitalizations. A higher number of shots, female sex, and decreased BMI were associated with a higher incidence of adverse events. Furthermore, regular breakfast consumption and longer sleep duration were associated with a decreased incidence of adverse events.
All study procedures complied with the ethical requirements of the national and institutional committees that oversee human studies and with the 1964 Declaration of Helsinki and its later revisions. The study design was reviewed and approved by the Ethical Review Committee of the Graduate School of Medicine, Gifu University, Japan (no. 2021-B160), the requirement of obtaining informed consent was waived. However, the research details were made accessible to the participants, and they were provided with the opportunity to decline participation in this study.
Participants, questionnaire, and vaccination procedures
All students were vaccinated with mRNA-1273 (Moderna) at Gifu University in three rounds: the first from July 12, 2021 to July 21, 2021; second, August 9, 2021 to August 20, 2021; and, third from March 15, 2022 to March 23, 2022. Participants were invited to complete a questionnaire related to the post-vaccination physical condition using Microsoft Forms on the day of vaccination and the following day. The first, second, and third post-vaccination questionnaires were administered from July 12, 2021 to July 30, 2021; August 9, 2021 to August 27, 2021; and March 14, 2022 to March 31, 2022; respectively. Responding was voluntary, and there was no compensation for completing the questionnaire. Symptoms after vaccination (local reactions including redness/swelling/induration/pain/heat sensation/itch and systemic reactions including headache/general fatigue/fever/nausea/joint, muscle pain/abdominal pain, and diarrhea on the vaccination day and/or the next day) were collected using a questionnaire in a digital form according to a systematic review of adverse events reports[10].
Participants’ health background
Participants’ health backgrounds (self-reported sex, age, and past history/present illness), and BMI, calculated as measured body weight (kg)÷[measured height (m)]2, were collected during the annual health check-up, which is mandated by the Japanese School Health and Safety Act for all students in Japan. Information on lifestyle including exercise/breakfast habits, sleeping duration, and allergy were also recorded at the annual health checkup as responses to the following questions: “How often did you exercise till you got sweaty, including walking for approximately > 30 min, per week in the previous month?” (choices: 0 d, 1 d, 2–5 days, 6–7 days = almost every day), “How often did you have breakfast per week in the previous month?” (choices: less than one day, 2–3 days, 4–5 days, 6–7 days = almost every day), “How long did you typically sleep on weekdays in the previous month?” (choices: less than 5 hours, 6 hours, 7 hours, 8 hours, 9 hours, 10 hours, more than 11 hours), and “Have you ever had food/drug allergies or anaphylaxis?” (choices: no, yes; if yes (description)).
Statistical analyses
The characteristics of the participants are summarized using the median and interquartile ranges (IQR) for continuous variables. Categorical variables are summarized by frequency. Generalized estimating equations (GEE) were used to confirm the association of risk factors, such as the number of vaccinations, sex, BMI, exercise habits, frequency of breakfast consumption per week, history of allergies and anaphylaxis, and hours of sleep per day, with the self-reported presence of at least one symptom related to the vaccination site and systemic symptoms on the day of or the day after vaccination. Statistical significance was defined as a two-sided P value < 0.05. All statistical analyses were performed using the R software (version 4.2.1; http://www.r-project.org, The R Project for Statistical Computing).
Author contributions
NT and MY conceived and designed the study. NT, KS, and MY collected the data. NT and TI analyzed and interpreted the data. NT, KS, TI and MY wrote the manuscript. KS, TM, ST, MA, RH and TF significantly revised the manuscript. All the authors have approved the final manuscript.
Data availability statement
The data supporting the findings of this study are available from the corresponding author, NT, upon reasonable request.
Additional Information
Ethics declarations and Approval for human experiments
All study procedures complied with the ethical requirements of the national and institutional committees that oversee human studies and with the 1964 Declaration of Helsinki and its later revisions. The study design was reviewed and approved by the Ethical Review Committee of the Graduate School of Medicine, Gifu University, Japan (no. 2021-B160).
Competing interests
The authors declare no competing interests.
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No competing interests reported.
- FigureS1.tif
Figure S1. A forest plot of various symptoms on the day of or the day after COVID-19 vaccination and history of allergies. If there was a history of allergies, the incidence of local redness was significantly lower, as was the incidence of fever.
- TableS1.CharacteristicsofstudentshealthcheckupdatawhohaveCOVID19vaccine.pptx
Supplementary Information Table S1. Comparison of characteristics of students who received COVID-19 vaccination and underwent health checkups who responded and did not respond to the questionnaire.