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Joint Statement By CDC & FDA Recommending a `Pause' On J&J Vaccine Administration Over Blood Clot Concerns

Michael Coston

Editor, Senior Moderator
Joint Statement By CDC & FDA Recommending a `Pause' On J&J Vaccine Administration Over Blood Clot Concerns





#15,908

Less than an hour ago the FDA announced (see twitter thread above) that they and the CDC are recommending a temporary halt in the administration of the J&J COVID vaccine while they investigate 6 reported cases of a rare, and severe, blood clot disorder in recent vaccine recipients.

These reports are remarkably similar to those we've previously seen with the AstraZeneca vaccine in Europe and Canada (see Canada: NACI Statement Recommending Halt Of AstraZeneca Vaccine For Those Under 55).

Although the incidence of these adverse reactions have been exceedingly low, they are concerning enough that the CDC and FDA are urging (but not mandating) a pause in administering the J&J vaccine while they investigate the problem.

Tomorrow ACIP (Advisory Committee on Immunization Practices) will hold an unscheduled meeting to address these concerns.​


The full joint statement from the CDC/FDA follows:

Joint CDC and FDA Statement on Johnson & Johnson COVID-19 Vaccine

The following statement is attributed to Dr. Peter Marks, director of the FDA?s Center for Biologics Evaluation and Research and Dr. Anne Schuchat, Principal Deputy Director of the CDC

For Immediate Release:April 13, 2021
Statement From:
Director - Center for Biologics Evaluation and Research (CBER)
Peter Marks M.D., PhD.



As of April 12, more than 6.8 million doses of the Johnson & Johnson (Janssen) vaccine have been administered in the U.S. CDC and FDA are reviewing data involving six reported U.S. cases of a rare and severe type of blood clot in individuals after receiving the J&J vaccine. In these cases, a type of blood clot called cerebral venous sinus thrombosis (CVST) was seen in combination with low levels of blood platelets (thrombocytopenia). All six cases occurred among women between the ages of 18 and 48, and symptoms occurred 6 to 13 days after vaccination. Treatment of this specific type of blood clot is different from the treatment that might typically be administered. Usually, an anticoagulant drug called heparin is used to treat blood clots. In this setting, administration of heparin may be dangerous, and alternative treatments need to be given.

CDC will convene a meeting of the Advisory Committee on Immunization Practices (ACIP) on Wednesday to further review these cases and assess their potential significance. FDA will review that analysis as it also investigates these cases. Until that process is complete, we are recommending a pause in the use of this vaccine out of an abundance of caution. This is important, in part, to ensure that the health care provider community is aware of the potential for these adverse events and can plan for proper recognition and management due to the unique treatment required with this type of blood clot.

Right now, these adverse events appear to be extremely rare. COVID-19 vaccine safety is a top priority for the federal government, and we take all reports of health problems following COVID-19 vaccination very seriously. People who have received the J&J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider. Health care providers are asked to report adverse events to the Vaccine Adverse Event Reporting System at
https://vaers.hhs.gov/reportevent.html.

CDC and FDA will provide additional information and answer questions later today at a media briefing. A recording of that media call will be available on the FDA?s YouTube channel.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation?s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.





https://afludiary.blogspot.com/2021/...ommending.html
 
FDA STATEMENT
Joint CDC and FDA Statement on Johnson & Johnson COVID-19 Vaccine

The following statement is attributed to Dr. Peter Marks, director of the FDA?s Center for Biologics Evaluation and Research and Dr. Anne Schuchat, Principal Deputy Director of the CDC

Date Release: April 13, 2021
Statement From: Director - Center for Biologics Evaluation and Research (CBER)
Peter Marks M.D., PhD.

... CDC will convene a meeting of the Advisory Committee on Immunization Practices (ACIP) on Wednesday to further review these cases and assess their potential significance. FDA will review that analysis as it also investigates these cases. Until that process is complete, we are recommending a pause in the use of this vaccine out of an abundance of caution.

... In these cases, a type of blood clot called cerebral venous sinus thrombosis (CVST) was seen in combination with low levels of blood platelets (thrombocytopenia). ... Treatment of this specific type of blood clot is different from the treatment that might typically be administered. Usually, an anticoagulant drug called heparin is used to treat blood clots. In this setting, administration of heparin may be dangerous, and alternative treatments need to be given.

https://www.fda.gov/news-events/pre...da-statement-johnson-johnson-covid-19-vaccine
 
COVID?19 patients often show high?titer non?platelet?activating anti?PF4/heparin IgG antibodies

First published: 07 February 2021
https://doi.org/10.1111/jth.15262

Justine Brodard, Johanna A. Kremer Hovinga, Pierre Fontana, Jan?Dirk Studt, Yves Gruel, Andreas Greinache

Abstract

Background
Heparin?induced thrombocytopenia (HIT) is a severe adverse reaction to heparin caused by heparin?dependent, platelet?activating anti?platelet factor 4 (PF4)/heparin antibodies. Heparin is a cornerstone of treatment in critically ill COVID?19 patients. HIT antibodies can be detected by antigen tests and functional tests. Often strong reactivity in the antigen test is used as a surrogate marker for the presence of clinically relevant, platelet?activating antibodies. We observed an unexpectedly high percentage of COVID?19 patients, clinically suspected to have HIT, with high titer anti?PF4/heparin antibodies, but a negative functional test.

Objective
We investigated whether in COVID?19 patients a serum?derived factor inhibits the heparin?induced platelet activation test (HIPA).

Methods and Results
Twelve COVID?19 patients with suspected HIT were tested. Three samples tested negative in all assays; nine samples tested positive by antigen tests, among which only three tested also positive by HIPA. When we spiked COVID?19 serum or control serum with the human HIT antibody like monoclonal antibody 5B9, reactivity of 5B9 remained the same. Also, the purified IgG fractions of COVID?19 sera testing strongly positive in the PF4/heparin antigen test but negative in the functional test did not show increased reactivity in the functional test in comparison to the original serum. Both results make a functionally inhibitory factor in the serum/plasma of COVID?19 patients highly unlikely.

Conclusion
COVID?19 patients often present with strong reactivity in PF4/heparin antigen tests without the presence of platelet?activating antibodies. Diagnosis of HIT requires confirmation of heparin?dependent, platelets activating antibodies to avoid overdiagnosis and overtreatment with non?heparin anticoagulants.

https://onlinelibrary.wiley.com/doi/full/10.1111/jth.15262
 
Are all the cases women? If so, they may be able to use the vaccine in men, (who aren't using hormone treatment to fight cancer or for gender reassignment.)

They'll need to do something about the situation in Michigan.
https://www.freep.com/story/news/po...vid-vaccine-michigan-peter-meijer/7205481002/
Rep. Meijer rips FDA, CDC over Johnson & Johnson COVID-19 vaccine pause


I don't agree at all with his criticisms of FDA/CDC - the situation is not their fault, (though if people already immune from natural infection weren't being advised to get vaccinated it could free up vaccine for others.)

https://www.cbsnews.com/news/michig...ottlieb-biden-administration-face-the-nation/
By Kimani Hayes CBS News April 11, 2021, 1:52 PM
Gottlieb says Biden administration should have surged vaccines to Michigan "weeks ago"
 
Tweet: Antibiotic Steward Bassam Ghanem

The first case report of extensive thrombosis & thrombocytopenia and disseminated intravascular coagulation that resembled autoimmune heparin-induced thrombocytopenia in a patient who had received the Ad26.COV2.S vaccine (Johnson & Johnson)
@NEJM #VITT
https://twitter.com/ABsteward


Thrombotic Thrombocytopenia after Ad26.COV2.S Vaccination

... We describe a case of extensive thrombosis associated with severe thrombocytopenia and disseminated intravascular coagulation that resembled autoimmune heparin-induced thrombocytopenia[SUP]3[/SUP] in a patient who had received the Ad26.COV2.S vaccine (Johnson & Johnson/Janssen), a recombinant adenovirus serotype 26 vector encoding the SARS-CoV-2 spike glycoprotein.

A 48-year-old White woman with an unremarkable medical history presented to the emergency department with a 3-day history of malaise and abdominal pain. The initial evaluation at another hospital showed mild anemia and severe thrombocytopenia (platelet count, 13,000 per cubic millimeter [reference range, 150,000 to 400,000]).

... The administration of unfractionated heparin was initiated, but despite this treatment, the patient had progressive thrombosis with hemorrhagic stroke evident on magnetic resonance imaging and magnetic resonance venography of the brain. Repeat CT angiography showed new thrombus involving the right hepatic and splenic veins. ...

https://www.nejm.org/doi/full/10.1056/NEJMc2105869
 
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