As global vaccination efforts continue, a small number of autopsy-based studies have investigated fatal adverse events following COVID-19 vaccination. These cases are some of the emerging harms, and they offer valuable insight into potential mechanisms of damage—particularly in the lungs and heart—and underscore the importance of continued safety monitoring.
🫁 Lung Pathology: Pulmonary Hemorrhage and Congestion
A 2025 case report published in the Journal of Innovative Research in Medical Science described a 47-year-old man who died unexpectedly from massive pulmonary hemorrhage more than a year after completing the Pfizer-BioNTech vaccine series.
Key Autopsy Findings:
- Lung weights: Right lung 1552g, left lung 1333g (normal: ~250–300g), indicating severe congestion
- No pulmonary embolism or infection detected
- Profuse bleeding from the mouth during cardiac arrest
- Normal heart size and no myocardial infarction
The authors proposed that the hemorrhage may have been linked to batch-specific vaccine variability, suggesting that certain lots may carry higher risk profiles. They also recommended updated autopsy protocols to detect vaccine-related components such as spike protein or mRNA.
❤️ Heart Pathology: Myocarditis and Stress Cardiomyopathy
Multiple autopsy studies have examined myocarditis following mRNA vaccination, particularly in young males.
🔹 Archives of Pathology & Laboratory Medicine (2022)
- Two teenage boys died within days of receiving their second Pfizer dose
- Histology showed contraction band necrosis and catecholamine-induced injury, not typical lymphocytic myocarditis
- Findings resembled stress cardiomyopathy, possibly triggered by cytokine surges
🔹 Clinical Research in Cardiology (2023)
- Among 25 autopsied individuals, four showed acute myocarditis with CD4+ T-cell infiltration
- No other underlying conditions were found
- Cause of death was attributed to arrhythmogenic cardiac failure
🔹 ESC Heart Failure (2024) Systematic Review
- Reviewed 28 autopsy cases of vaccine-induced myocarditis
- Mean time from vaccination to death: 6.2 days
- Most cases involved mRNA vaccines
- Findings supported a causal link using Bradford Hill criteria
🧠 Mechanisms Under Investigation
Researchers have proposed several biological pathways that may explain these rare outcomes:
- Spike protein persistence: May trigger immune dysregulation or endothelial damage
- Catecholamine surges: Linked to stress cardiomyopathy and cardiac stunning
- Autoimmune activation: T-cell infiltration and inflammatory cytokines may damage cardiac tissue
🧭 Implications and Next Steps
While these cases are exceptionally rare, they highlight the need for:
- Standardized autopsy protocols to detect vaccine-related pathology
- Batch-level safety analysis to identify high-risk lots
- Long-term surveillance of cardiac and pulmonary outcomes
- Transparent reporting and independent review of adverse events