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The COVID-19 vaccines are considered safe and effective in preventing severe illness and death. While most side effects are typically mild and temporary, some people have reported experiencing muscle weakness after receiving a COVID-19 vaccine. In rare cases, the COVID-19 vaccine may cause Guillain-Barré syndrome (GBS), a disorder where the immune system attacks healthy nerve cells, resulting in muscle weakness or even paralysis. Other reported side effects include myocarditis, pericarditis, and, in extremely rare cases, anaphylaxis. However, these side effects are not common, and the benefits of vaccination in preventing serious illness and death from COVID-19 far outweigh the risks.
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What You'll Learn
Rare cases of muscle weakness post-vaccination
While COVID-19 vaccines are considered safe, in rare cases, they may cause Long Covid–like symptoms, including severe muscle weakness. For instance, Brianne Dressen, a former rock climber, experienced severe muscle weakness and other debilitating symptoms after receiving her COVID-19 vaccine. She is not alone, as researchers at the National Institutes of Health (NIH) have come across similar reports and have started investigating these rare, long-lasting side effects.
Guillain-Barré syndrome (GBS) is one such rare side effect, affecting approximately 5 individuals per million vaccinated. GBS occurs when the immune system attacks healthy nerve cells, resulting in muscle weakness and sometimes paralysis. Another rare side effect is myocarditis, an inflammation of the heart muscle, which has predominantly been observed in young adult males within a week of receiving their second mRNA vaccine dose.
In extremely rare cases, COVID-19 vaccines have been associated with the development of neurological conditions such as Bell's Palsy, brachial neuritis, OMS, encephalitis, and encephalopathy. These conditions can cause a range of symptoms, including weakness or paralysis on one side of the face, severe shoulder pain and numbness, uncontrolled eye movements, involuntary muscle jerks, seizures, and behavioural changes.
It is important to note that the occurrence of these rare side effects does not outweigh the benefits of COVID-19 vaccines in preventing serious disease and protecting individuals from severe COVID-19. The CDC continuously monitors the safety of COVID-19 vaccines and works to identify any potential side effects.
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Myasthenia gravis and COVID
While the side effects of the COVID-19 vaccines are typically mild and require little more than rest, there have been rare cases of long-COVID-like symptoms, including severe muscle weakness. However, the benefits of COVID-19 vaccination far outweigh the risks.
In a rare case, a 77-year-old man experienced a myasthenia gravis (MG) crisis attributed to the Moderna COVID-19 vaccine. The patient had a history of MG and was on stable treatment with steroids and muscle strengtheners. Following the vaccination, he presented with abnormal breathing, a fast heart rate, and low blood oxygen levels. Examinations indicated kidney failure, likely due to difficulty ingesting food and liquids. The researchers suggested that this rare adverse effect occurred several days after vaccination, highlighting the need for extended monitoring of MG patients who receive COVID-19 vaccines.
COVID-19 infection itself can also directly damage motor neurons and adjacent muscles, leading to acute Guillain-Barré syndrome or prolonged muscle weakness. Additionally, COVID-19 can cause anterior spinal cord damage, resulting in myelopathy and a range of motor and sensory symptoms.
MG patients with immunosuppressive drugs, younger onset, longer MG duration, or comorbidities are more susceptible to severe COVID-19. In a study of 104 MG patients without vaccination, 20.19% exhibited severe COVID-19 symptoms. The lack of COVID-19 vaccination was identified as an independent risk factor for exacerbation in MG patients with COVID-19. Therefore, it is crucial to carefully assess patients with post-COVID muscle weakness to differentiate between long COVID weakness and other muscle pathologies triggered by COVID-19 infection.
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Guillain-Barré syndrome
While side effects from COVID-19 vaccines are typically mild, there have been rare cases of Guillain-Barré syndrome (GBS) following vaccination. GBS is a condition that causes rapid-onset muscle weakness due to the immune system erroneously attacking the peripheral nervous system. The syndrome has been associated with "long COVID" or persistent viral symptoms in previous studies.
The risk of developing GBS after receiving a COVID-19 vaccine is small, estimated at 1 to 2 cases per 100,000 person-years. However, this risk is slightly higher with the Johnson & Johnson (Janssen) vaccine, with 6 cases reported per 100,000 recipients within three weeks of vaccine administration. For the Moderna and Pfizer-BioNTech vaccines, the rate was 1.3 cases per 100,000 doses. The highest number of reported cases were associated with the AstraZeneca vaccine.
A study published in April 2022 analyzed side effect data for various COVID-19 vaccines. Among over 480,000 recipients of the Johnson & Johnson vaccine, 11 cases of GBS were reported. For the two-shot mRNA vaccines from Moderna and Pfizer-BioNTech, there were 36 reported cases. The study suggests that the Johnson & Johnson vaccine may carry a 20% higher risk of GBS as a complication.
The Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) subtype was the most commonly reported form of GBS post-vaccination. Dysesthesias was the most prevalent sensory complication, affecting 60% of patients. Most cases of GBS occurred more than 12-13 days after vaccination, with a higher risk associated with this delayed onset.
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Myocarditis and pericarditis
The risk of myocarditis following mRNA vaccination is present but very low. The risk is lower with the Comirnaty/BioNTech vaccine than with the Spikevax/Moderna vaccine. It affects more young men under 30 than women, with the highest risk between 15 and 29 years. Symptoms usually occur within a few days after the second dose. The course of the disease is generally mild, with no consequential damage. The CDC has published studies with clinical information about myocarditis and pericarditis after COVID-19 vaccination.
The German Heart Foundation states that the health risk from a COVID-19 infection is much higher than the risk of myocarditis from mRNA vaccination in every age group. According to the PEI, most patients with myocarditis/pericarditis after vaccination with mRNA vaccines respond well to treatment and rest and feel better quickly. However, more severe cases have been observed in individual cases. Patients and doctors should be vigilant for signs of myocardial inflammation after a COVID-19 vaccination. There is no single leading symptom of myocarditis/pericarditis. Symptoms to look out for include shortness of breath, palpitations, heart pain, unexplained tiredness and fatigue, and physical weakness.
In the case of suspected myocarditis, intensive sporting activities should be avoided for around six months, and a cardiological check-up is recommended before resuming such activities. The long-term prognosis after acute viral myocarditis with no significant complications is favourable, with complete recovery assumed in around 70% of patients. However, mild symptoms may persist due to scarring in the heart muscle, including mild arrhythmia.
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Long-term effects of muscle weakness
While the typical side effects of the COVID-19 vaccine are usually mild, some individuals have reported experiencing muscle weakness after receiving a COVID-19 vaccine. However, it is important to note that these cases are rare and not well-established.
In rare cases, individuals have reported experiencing long-lasting health problems and severe muscle weakness after receiving a COVID-19 vaccine. For instance, Jana Ruhrländer, a microbiology graduate student, experienced muscle weakness after receiving a single dose of the Moderna vaccine. She described her experience as terrifying, as she felt unable to control her muscles and was unsure if she was having seizures or a stroke.
Another individual, Brianne Dressen, experienced severe muscle weakness and other debilitating symptoms after receiving a COVID-19 vaccine. By January 2021, researchers at the National Institutes of Health (NIH) began investigating these reports and brought affected individuals to their headquarters for testing and treatment. However, the research was small-scale and did not conclude whether the vaccines caused these rare, lasting health issues.
While the exact mechanisms are not fully understood, there are a few possible explanations for the reported muscle weakness following COVID-19 vaccination. One possibility is the development of Guillain-Barré syndrome (GBS), a rare disorder where the immune system attacks healthy nerve cells, leading to muscle weakness and sometimes paralysis. Another possibility is brachial neuritis, which is associated with severe shoulder pain, weakness, and numbness due to inflammation of the brachial plexus, a network of nerves in the shoulder and arm.
It is important to note that muscle weakness is also a common symptom of Long COVID, affecting up to 60% of those with the condition. Patients with Long COVID often describe a fluctuating pattern of muscle weakness, which can be triggered by exercise or fatigue. This muscle weakness can significantly impact their ability to perform daily activities and may last for an extended period.
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Frequently asked questions
In rare cases, the COVID vaccine may cause muscle weakness. However, the overall risk is low, and the benefits of vaccines in preventing serious diseases usually outweigh the potential risks of these rare side effects.
Typical side effects for all COVID-19 vaccines are mild and may include symptoms such as fatigue, headache, fever, or pain at the injection site. Some people may also experience myocarditis or pericarditis, though these are rare side effects.
If you experience any concerning symptoms following vaccination, including muscle weakness, it is important to seek medical attention. A doctor can help determine the cause of your symptoms and provide appropriate treatment or advice.
While muscle weakness has been reported as a side effect of the COVID vaccine, it is important to note that it is rare. The CDC continuously monitors the safety of COVID-19 vaccines and works to identify any potential side effects.
