Talk:Embolic and thrombotic events after COVID-19 vaccination/Archive 1

References vs Further reading and request to restore CGPHA ref
Thanks, User:Alexbrn. I do understand the hair-trigger reaction on COVID-related subjects, as I indicated in my edit summary. As noted, I was unsure of the (perfectly respectable pre-print, carefully weighed down with warnings, etc.) ref I put it, and that source's compliance with WP:MEDRS when placed only in the "further reading" section, but can see the need to be very cautious. However, could you please restore the Canadian government's Public Health agency's announcement? That is at least as appropriate as the European Medicine Agency's communique - currently the only citation -  even if added by an IP and not a registered user. Thanks. 49.177.61.250 (talk) 10:09, 2 April 2021 (UTC)
 * We mustn't use unreliable sources for biomedical content, and Wikipedia doesn't do disclaimers. I've put the Canada stuff back. Alexbrn (talk) 10:38, 2 April 2021 (UTC)


 * Yes, of course, we mustn't add unreliable sources, that's why I asked for advice; Wikipeadia wasn't doing the disclaimer, Research Square was. Also, not really an unreliable source as such, just not in line with WP policy - which is fine, and I accept completely. We should strive to be accurate though, even in our communications: Not adhering to WP requirements is one thing - which of course I accept and understand, as I said from the very first - but unreliable, it is not.
 * Thank you for adding back the Canadian Public Health Agency source. I was only trying to help, as there was an 'additional sources needed' maintenance tag. The going gets hard, though, when the baby's thrown out with the bathwater, and even while trying to demonstrate a degree of responsibility, and some reasonable level of understanding of the need to reliably cite, one is put in the "ignorant" or "clueless" basket, as amply communicated by the "insta-revert" and non-responsiveness to well-meant enquiries. Cheers 49.177.61.250 (talk) 11:30, 2 April 2021 (UTC)
 * IMPORTANT: The below reference is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. The posting of a preprint on the Research Square server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.

edit conflict - As mentioned, above is the note that was included under 'further reading' section with the Greinacher pre-print. Can you advise if WP:MEDRS definitely applies for 'further reading' when the ref is not used as a source cited in support of a statement, and is clearly not a shonky source. (While Science Mag is only a popular science publication, and I wouldn't put in it in a medical article, it does not amplify charlatans or dubious researchers.) Also, see confirming the lead author Andreas Greinacher, MD, is professor of transfusion medicine at the Greifswald University Clinic, Greifswald, Germany, for example. I added the preprint in the belief that it would tend to mitigate against overeaction to media reports and panic, and as an antidote to the avalanche of scare tactics and unscientific misinformation, but if that is not in line with the WP policy or consensus, I understand.49.177.61.250 (talk) 11:12, 2 April 2021 (UTC)

Normally, further reading sources need to be reliable - but in the case of COVID-19 the requirements are extra-stringent: see WP:GS/COVID19. While I am sure Greifswald is a fine fellow and it's a good impulse to include his calming views, remember it is not Wikipedia's purpose to WP:RGW and I am sure you can see how, if we allowed editors to determine somebody was wise and their views needed including, that would descend into chaos ... even more than the COVID-19 topics already have { ! Alexbrn (talk) 11:39, 2 April 2021 (UTC)


 * I don't really have an axe to grind. In my world pre-prints, when there's little info around, are a life line. It's fine that it's OUT - I am not arguing for it to be IN. It just a little startling, well - the reversion and the response here comes off as if it was the most atrocious piece of quackery around. I quite see that it might not be suitable for WP, hence MY INITIAL SUGGESTION in my edit summary THAT IT MIGHT NEED TO BE TAKEN OUT.
 * We just seem to be at cross-purposes: I was asking: is ok or not ok, tip-toeing, "whada ya think", etc. ? The response is (seemed): NO we don't do that! Please do not do that that, don't put that kind of stuff in, it is not in policy, just as if I had not ALREADY tried to discern, as best I was able - whether it would fit with policy or not, and then mildly enquired about it, as well.


 * And I can SEE there was no real consideration of the question I posed, just an automatic reflex - otherwise the CGPHA ref would not have been summarily deleted. No doubt all you old hands are sick of getting rid of the COVID-19 junk, and must be overwhelmed.
 * Also, no idea if what's-his-name is a good researcher or not, just trying to say he's demonstrably NOT a Dr McQuack from State Charlatan University of Shonkiness and Woo Practice. Again, not a plea to keep it in, just saying there's levels, and I'm aware of them. You can't really be asserting that WP:MERDS is that clear-cut, that all should be obvious from an initial, even careful, reading? It really is not. 49.177.61.250 (talk) 12:15, 2 April 2021 (UTC)
 * Automatic reflex is right - it's just a core feature of the way Wikipedia needs to have WP:Verifiably reliable content. I've no idea about the preprint's intellectual worth (not even having looked at it) but Wikipedia is an encyclopedia - it does not directly have articles on topics, but contains merely summaries of what the top-most sources have said about those topics. Start at WP:5P if you're interested in the Project's aims. Alexbrn (talk) 12:38, 2 April 2021 (UTC)
 * Unresponsive (to what I actually said, and asked). Again, I'm not interested in getting the ref IN, just explaining. I understand WP's aims fairly well. Also "automatic reflex" is understandable, but should consider WP:BABY which is kinda my point . 49.177.61.250 (talk) 12:59, 2 April 2021 (UTC)

Apologies for: References vs Further reading and request to restore CGPHA ref redux
Regarding "Restored revision 1016111612 by Alexbrn (talk): What the hell? please do not copy my comments in some fictionalized exchange undo Tags: Undo Twinkle", my genuinely sincere apologies. I honestly did not see it as anything other than just trying to make a point-by- point explanation of where I thought I had poorly represented my arguments / was misunderstood what I was attempting to say. I never imagined it could be seen as some underhand attempt to insert a "fictionalised exchange". I did not mean anything like that, and I am mortified that's how it looks. There was no attempt to try to make anything up - I thought it would be clear what the sequence and the intention was to anyone who viewed the page. Obviously I was hideously, and judging by your edit summary, offensively, wrong. I can only say sorry, in the hope you will accept my apology. 49.177.61.250 (talk) 15:00, 5 April 2021 (UTC)

Understanding of WP:MEDRS by beginners and dismissive responses
The above to-and-fro was discussion around one of my first experiences adding anything substantive to an article. As it's a biomedical article, I tried to do my WP research very carefully, and approach it conscientiously. As it stood before I made my first edit, it had one source, and an "additional cites needed" tag, so I thought I could assist in a small way.

At 09:50, I made a tentative edit adding a Government Public Health Agency of Canada source, which clearly complied with MEDRS and - with some reservations - a pre-print article by a well-known Haematologist, that at the time was being widely discussed by reputable Health media (e.g. Medscape, Science, BMJ News, UptoDate). I was aware this did not meet the WP:MEDRS standard, but wondered whether it would be suitable as a "Further reading" source. I was not sure. My edit summary made that specific point: (Added 1x cite and 1x further reading. (If the Greinacher preprint ref is not considered suitable here, please remove - uncertain.) ) [Colour emphasis added].

These additions were immediately reverted in full, with the edit summary: (Restored revision 1015443975 by AnomieBOT (talk): Would need WP:MEDRS)

I thought at least the editor would put back the “good” cite. Nothing happened, so I mentioned it on Talk page at 10:09; which elicited this response on Talk after about half an hour: ''We mustn't use unreliable sources for biomedical content, and Wikipedia doesn't do disclaimers. I've put the Canada stuff back.'' At 10:38, Reverting editor  restored PHACG source, as requested.

Anyway, I’m rehashing this all here for my own peace of mind. What followed as above, was an unhelpful exchange that seemed to go strangely. The reverting editor did not seem to be reading or taking in what I was saying or asking. Or I was wildly mis-reading. My clumsy attempts to get to the bottom of things ended up with me committing an apparently enormous faux pas. Aghast and exasperated removal followed. This was very rattling. Feeling dumb, I left it. But it still nagged at me, and I thought about it a lot - because i enjoyed the editing, I knew I was well-intentioned, and have a reasonable level of competence, and, what's more, an ability and desire to learn from my mistakes. But it's off-putting to be so out of sync with others, and unable to communicate clearly...

The end of it is this: me stupidly, ridiculously, writing an essay-length summary of the exchange - longer than the originating matter! It can moulder here in archive obscurity for ever, and I can refer back to it for my own guidance, and as an antidote to (probably accidental) gas-lighting.

So, the following are excerpts from the reverting editor's Talk page messages, and below each point, my intended responses to those specific points. ''' We mustn't use unreliable sources for biomedical content, ...
 * Which is why the question was asked, both in edit summary, and again, here, in the first entry on this talk page.

 ... and Wikipedia doesn't do disclaimers.
 * Wikipedia wasn't doing the disclaimer, Research Square was: it's their standard disclaimer that's printed on their articles.

 While I am sure Greifswald is a fine fellow and it's a good impulse to include his calming views, ...
 * The paper's authors do not really have a POV, as such, it's just a factual case series of possible VIPIT in German patients.

 ... remember it is not Wikipedia's purpose to WP:RGW
 * In no way attempting to RGWs, just trying to address a gap in an article, and therefore ensure a full coverage, which, only as a natural consequence, might tend to reduce overreaction. Did not mean to suggest in any way WP should attempt to add information to arrive at a specific goal.

 ... and I am sure you can see how, if we allowed editors to determine somebody was wise ...
 * Not saying he's wise, just reputable enough to be summarised in Science and on Medscape, which I realise is not of sufficient level to meet WP:MEDRS to cite a biomedical fact, but wondered if it was useful as a "further reading"; it contained no startling or novel assertions. I accept your view that it does not.

 ...and their views
 * Not "views" as such, he and co-authors proffer none, beyond interim suggestions for research directions and present management; it's just a straightforward scientific account of some relevant case series

 ... needed including
 * Don't think that it "needs" including, just wondered if it was possibly useful, which is why I asked the questions I did

 Automatic reflex is right – ...
 * By automatic reflex, I was referring to the reverter not looking at the information - that there were two references (don't mean reading the source, just eyeballing the cite), not looking at the editor's question, and throwing out a perfectly useful, verifiable and reliable reference, without deigning to consider or respond (to the query); was NOT referring to a quick-fire response needed to ensure misinformation does not proliferate on WP.

 ... it's just a core feature
 * The latter is a core feature of WP, needed for Verifiable, reliable content, not the former, which is WP:BABY.

 I've no idea about the preprint's intellectual worth (not even having looked at it)
 * Also have no idea preprint's "intellectual worth", just that it has had some reputable attention.'''

That's me, getting it off my chest. BTW, I noticed one other (also IP) editor on the article and Talk page has decided to throw in the towel, also seeming to feel it's a little to easy to get on the wrong side of others. They seemed like a thoughtful, helpful editor. 49.177.64.138 (talk) 11:30, 25 April 2021 (UTC)

April 2021
With EHRA statement yesterday this article will need to expand to start or 'C' class. I've had a quick go at a couple of things, and may dip in and out for a couple of days. I've put a Template:Under construction with notready=yes so people can peer review stuff. I've added mostly UK references but they are fairly balanced on not uncontroversial I'm sure. We need to emphasize the rare events of blood blots here. To some extent I could compare having a AZ jab to putting a seat belt on in a car ... In some crashes wearing the seat beat would have killed me whereas I would have survived not wearing one; but in the vast proportion of crash senarios the seat belt will save me whereas otherwise I would have died. I'm keen to keep the AstraZeneca name out of first sentence in lede so as the describe the second, but to introduce it in the second, in case other similar vaccines have the same issue: see Adenoviridae. The way to treat this will become clear as things evolve. Thankyou.Djm-leighpark (talk) 15:01, 3 April 2021 (UTC) And feel free to collaberativelty edit while Template:under construction is in place: (Template:In use is for temporary exclusive access if absolutely needed but I'd suggest best avoided here). Djm-leighpark (talk) 15:04, 3 April 2021 (UTC)
 * this link contains the 7 April EMA statement to update the article. Maybe better than a link to the youtube video of the meeting -- https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vaccine-ema-finds-possible-link-very-rare-cases-unusual-blood-clots-low-blood JuanTamad (talk) 01:36, 9 April 2021 (UTC)

German
The Gesellschaft für Thrombose- und Hämostaseforschung (German thrombosis and haemostasis research society) has issued the following guidance: https://www.thieme-connect.de/products/ejournals/html/10.1055/a-1469-7481 JFW &#124; T@lk  12:32, 5 April 2021 (UTC)


 * This is from the UK haematology society: https://b-s-h.org.uk/about-us/news/guidance-produced-from-the-expert-haematology-panel-ehp-focussed-on-syndrome-of-thrombosis-and-thrombocytopenia-occurring-after-coronavirus-vaccination/ JFW &#124; T@lk  12:33, 5 April 2021 (UTC)

Given how dynamic this subject is, I am getting useful stuff on Twitter from Prof Michael Makris (Sheffield). JFW &#124; T@lk  12:35, 5 April 2021 (UTC)
 * I'm not sure it's wise going with preprints; shouldn't we be a bit more cautious? Alexbrn (talk) 12:40, 5 April 2021 (UTC)
 * There're interesting posts on twitter, but citing a twitter post doesn't seem like a good idea either. Twitter posts might be a source of good links to sources that can be used as a reference. JuanTamad (talk) 01:42, 9 April 2021 (UTC)

Characterising clinical features, incl. similarities to HIT
Scanty literature atm, and this one does not meet WP:MEDRS. Noting this case series report here, though, for when it progresses to fully peer reviewed (when it may be useful - possibly?) There is also this Society of Thrombosis and Haemostasis Research guidance. I hope this is in order for me to put here. No nuisance or other problem or insult meant.49.177.61.250 (talk) 10:09, 6 April 2021 (UTC)
 * Cooke herself in the 7 April 20221 meeting actually used words at 8m or 9m in to the 8m meeting acutally used mentioned similarites to HIT and as a plausible explanation but I'd have to recheck the transcript and context before adding it. Its on my todo list to look at but so is a lot of other stuff.Djm-leighpark (talk) 06:52, 8 April 2021 (UTC)
 * Thanks, User:Djm-leighpark. Hope you did not think I was talking about this article when I said "scanty literature". Only because it's a new and rapidly developing situation, there is little around of WP:MERDS quality anywhere yet, making it all the harder to expand the page. You are doing an amazing job - adding to article quality with useful info, (along with other editors, too) very quickly. Thank you. 49.177.61.250 (talk) 03:21, 9 April 2021 (UTC)
 * @: Thanks for complementary comments, and thank you for your contributions. At times I find attempting to contribute to this difficult and overwhelming and I have sometimes prepared contributions for an hour before electing the result was not in a fit state to publish! I have RL stuff again to do today but I understand WHO are likely to do a briefing on the subject today and that may influence the next contributions I make.10:00, 9 April 2021 (UTC)

9 April 2021
I'm currently doing a slow refactor of the article and there is some duplication of stuff at the moment. I expect "Regulatory response" and "Observations" sections to be reworked and out of it to at least describe the syndromes with the best information available and also go into explaining the benefit-risk/age which seems especially neatly put by MHRA/wintoncentre. I'm trying to keep the "history" section in the "background" as a brief easy to read timeline of how the reports led into the possible side effect without getting overly stuck into detail. Thanks to people who have contributed and who have corrected my errors. I will be re-working the lede when I get the chance; always keeping the emphasis on the rareness of this event and benefit/risk ratios. Thankyou.Djm-leighpark (talk) 22:27, 9 April 2021 (UTC)
 * , thanks for your work on this - if consensus is to keep this as a separate article I think your work has been good at trying to make it as little of a POVFORK as possible. My recommendation (which I would do if I had more time right now) is that the "responses" could be condensed into one section - nobody really cares (encyclopedically speaking) whether it's a "regulatory" response or a "deployment" response, they just care what the responses are. I think it's likely best to wait on the lead to see if this is merged or not - because if it's not, this article will require great expansion to be complete before the lead can begin to be discussed (as the lead summarizes the body, and if it's not merged the body is seriously lacking in comprehensiveness). Regards -bɜ:ʳkənhɪmez (User/say hi!) 01:38, 10 April 2021 (UTC)
 * @: Thankyou for your comments, it does not mean that I agree with all of them. A power cut from the Drayton boyos which caused me to lose a new section called "Event characteristics" this morning with from past experience risk of brownies and spikies this afternoon (actually there weren't any) by the same boyos has sort of scuppered my plans for the day.  The article as it stands has multiple issues: the title will need either Covid-19 or e.g. AstraZeneca in it at some point for starters, I think with recent events Covid-19 is more generic whichever way thing develop, but in the event the rest of the title is also perhaps open to change.  Thankyou. Djm-leighpark (talk) 21:37, 10 April 2021 (UTC)
 * My thoughts are that "Regulatory response" will eventually morph into "Regulatory status"(possibly under a different name) to give the status for handling the event. I tend to agree most people coming to this article will want to know "where are we?" status viewpoint, fewer will wish to know the chronological history unfolded  though it i actually of some significance in my opinion.Djm-leighpark (talk) 08:35, 11 April 2021 (UTC)

re: Section Outcomes
That gives me the idea that (with greatest care of course!) something should also be said about therapy. (No MD lets the condition run its course without intervention.) Greinacher et al. made some first suggestions. University Greifswald releases And what about the urgent warning against giving Heparin without prior testing, which could be fatal? - I think this Contraindication is already established knowledge now for the syndrome (cf. flowchart Greinacher et al. see ref #8 already in the article), and a much stronger statement than: "... has recommended against ...", → article section Regional and national responses.) Of interest for WP would also be what had been tried and what were failures. - But all this is a very touchy business of great responsability and care: only firstclass verified sources must be used (with the restrictions of WP gudelines for med. articles). - Perhaps the section then will turn out to become Outcomes and Therapy? --89.15.239.212 (talk) 20:51, 12 April 2021 (UTC)


 * The section naming this article will compliant with is Wikipedia:Manual of Style/Medicine-related articles per WP:MEDSECTIONS. So some stuff here may go into e.g. "Treatment" or possibly "Prevention".  But needs very good WP:MEDRS and needs to be very balanced. Djm-leighpark (talk) 22:23, 12 April 2021 (UTC)
 * Agree 100%. (And please excuse me, I'm not so familiar with the WP styles.)--89.15.239.212 (talk) 22:34, 12 April 2021 (UTC)

The Gesellschaft für Thrombose- und Hämostaseforschung (i.e. Society on Thrombosis and Haemostasis; Germany, Austria and Switzerland) provides its statement (treatment recommendations) here (also in english) with updates as matters evolve, cautioning readers explicitly to observe the issue date. (Please note: Though it's reliable, this is only additional info for experts here. Not yet for the article.) --89.15.239.212 (talk) 01:29, 13 April 2021 (UTC)

Cerebral Venous Thrombosis, also in Pfizer and Moderna vaccines
According a recent study made by the University of Oxford, the possibility of Cerebral Venous Thrombosis (CVT) as a secondary effect is also present in the mRNA vaccines:

"In this study of over 500,000 COVID-19 patients, CVT occurred in 39 in a million patients. In over 480,000 people receiving a COVID-19 mRNA vaccine (Pfizer or Moderna), CVT occurred in 4 in a million. CVT has been reported to occur in about 5 in a million people after first dose of the AZ-Oxford COVID-19 vaccine."

(Here is the PDF)

This seems to confirm previous cases. See this March article in Science:

"A somewhat similar blood disorder, called immune thrombocytopenia (ITP), has been seen in at least 36 people in the United States who had received the Pfizer and Moderna vaccines against COVID-19, The New York Times recently reported."

I'm thinking to add this information to the article. What do you think ? Alexcalamaro (talk) 05:29, 16 April 2021 (UTC)


 * Immediate problem of the Oxford Uni study is COI (though I am willing to assume good faith). If this ratified through to the EMA thats another matter.  I think the MHRA in their rigorous study of (?yellow card) ratio'd at from memory 3 or of 79 cases related to Pfizer vaccinated people, that in the context of about half the UK population of 30m being vaccinated in an about 12:18 Pfizer/AZD1222 split.(My stuff here is from memory).  Using y WP:CRYSTAL BALL I suspect more may emerge with time and personally I'd prefer the article was written to allow easy expansion if such thing do occur whilst avoiding speculation.  Thankyou.Djm-leighpark (talk) 08:19, 16 April 2021 (UTC)


 * Yeah, I also believe that more information will emerge with time. Lets wait. Alexcalamaro (talk) 12:28, 16 April 2021 (UTC)


 * Covid causes clots, and during a Covid pandemic some vaccinated persons will contract the Covid virus and have symptoms of the disease, which must not be sloppily attributed as side effects of the vaccine.

Covid causes death and organ failure by clotting (the "Happy Hypoxics.") The rate in patients is much, much higher than in the vaccinated.

It would be surprising if during a pandemic of a virus that causes clotting, clotting was not observed, including among those vaccinated.

To tease out whether Covid or vaccination is more likely to result in clots, anyone reporting clots should be tested both for antibodies from vaccination and separately for antibodies from vaccine, whether they report being vaccinated or not.

As it is, absent such testing, hundreds of thousands of people catch Covid daily. Some Covid infections are shaken off with very few initial symptoms. Even severe infection typically begin with a 5- to 7-day symptom-free period in which some of these people may get a vaccine. Symptoms following the vaccination caused by the Covid infection (including clotting) will be attributed to the vaccine unless the epidemilogists and clinicians are careful and thorough.

Immediately after the first of two vaccinations, there is little immunity. So a person might catch Covid after vaccination. Many cases appear mild, yet mild cases are more common in "Long Covid" patients.

The AstraZeneca/Oxford vaccine is only 60% effective, and the others are in the 90% range, but even 90% is not 100%. So it is possible to contract the pandemic virus after partial or full vaccination, and then experience clotting from the virus, which might well be attributed to the vaccine, especially if the course of the virus happened to be mild.

Since fully vaccinated persons have far better chances of not getting or passing on Covid, of having a mild case if infected, of staying out of the hospital, and the tiny minority that are admitted have improved chances of staying off oxygen, of staying out of intensive care, and of leaving alive. These advantages of vaccination are so important that they should not be clouded by sloppy case workup in each case of atypical clots or other symptoms during a pandemic. — Preceding unsigned comment added by Ocdcntx (talk • contribs) 18:57, 18 April 2021 (UTC)

Merge proposal
I proposed a merge of this article into Oxford–AstraZeneca COVID-19 vaccine on its talk page - you can find the discussion here. Comments are welcome at that location. Regards -bɜ:ʳkənhɪmez (User/say hi!) 19:48, 5 April 2021 (UTC)

Non-MEDRS information
As part of this merge proposal, I have removed biomedical information sourced to non-MEDRS (such as preprints/news articles) and have put it here for re-use if/when the articles are fully reviewed/better sourcing can be found. -bɜ:ʳkənhɪmez (User/say hi!) 21:21, 5 April 2021 (UTC)
 * A German research team has demonstrated that the phenomenon is mediated by antibodies against the cytokine platelet factor 4. (preprint)
 * Article now peer reviewed and published in NEJM. Yay! (Just in case anyone is looking here.) 49.177.61.250 (talk) 04:10, 11 April 2021 (UTC)


 * Vogel (magazine article not a journal article)
 * The related disorder immune thrombocytopenia has been very reported iished in the United States following administration of the Pfizer–BioNTech and Moderna COVID-19 vaccines but the rate of occurrence is said by the U.S. Food and Drug Administration to be the same as expected in the unvaccinated population.
 * This phenomenon usually occurs after exposure to heparin, in which case the condition is called heparin-induced thrombocytopenia.
 * Both conditions are associated with an increased risk of thrombosis.

Beyond that, the "regulatory response" section seems like it's duplicating content that, if it's not already in the main AZ vaccine article, should be there. I left it here for now as it seems to pass MEDRS. -bɜ:ʳkənhɪmez (User/say hi!) 21:21, 5 April 2021 (UTC)

Dispute re VIPIT
My understanding from general reading is that the term vaccine-induced prothrombotic immune thrombocytopenia and associated name issue is twofold. The most important revolves around that it may encompass only a subset of the post-vaccination embolic and thrombotic events under current consideration and the second is that the term may not be in widespread usage. I have a concern in this regard and my view may be incorrect, but I believe the concern is valid. Thankyou. Djm-leighpark (talk) 21:59, 5 April 2021 (UTC)
 * Possibly the most common use of "VIPIT" comes/originates from Canada: e.g. This: from Public Health Agency of Canada. Djm-leighpark (talk) 23:55, 5 April 2021 (UTC)


 * I think this term seems to be picking up steam (for better or worse). For example:
 * "Suspected Vaccine Induced Prothrombotic Immune Thrombocytopenia (VIPIT): THANZ Advisory Statement (check for weekly updates)"
 * (From the Thrombosis and Haemostasis Society of Australia and New Zealand website.) 203.1.80.1 (talk) 03:53, 8 April 2021 (UTC)

The term is also used (by the UN) in a recent document here: ''Interim Guidelines: Diagnosis and Management of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following AstraZeneca COVID-19 Vaccinations. 9 April 2021'' https://www.un.org/sites/un2.un.org/files/coronavirus_vipitguidance.pdf --89.15.237.46 (talk) 20:25, 10 April 2021 (UTC)


 * That is an very useful document, and obviously contains very informative information and links to other information. My only issue is that given just the URL on a filesystem the author of the document and its provenance is a little unclear, yes it is on the UN website but as far as I can tell there is no information within the document (or stamps or certificates) so I think it probably needs document linking to it to give metadata about it authoritiveness otherwise if might for instance be a draft document requiring peer review. (Compare for example with a document it links to:  ). I must point out I am not a medical professional/expert, but I will mull over things and other peoples input is important.Djm-leighpark (talk) 21:10, 10 April 2021 (UTC)
 * Sry, don't have much further Information. It's from here:
 * COVID-19 Vaccination for UN Personnel, Section UN Healthcare Worker Resources --89.15.237.46 (talk) 21:32, 10 April 2021 (UTC)
 * And that PDF doc you link to, from the British Society for Haematology uses "VIIT" rather than "VIPIT", so it might end up being one of those dual or "multi-choice" terms. Good thought to have both versions in article - at least until one or other (or something else) ends up dominant.
 * In similar vein - no pun intended - here's some med journalism that uses both terms in the headline: medpageToday 49.177.61.250 (talk) 05:22, 11 April 2021 (UTC)
 * Yes, it seems to me the scientific community is discussing how to name the baby. Greinacher suggests VITT. - In the long run maybe it all could become a separate topic and the vaccinations were only the first instances where they observed this new pathomechanism. - For WP that means the name of the article could change over time and redirects and ambiguations would be usefull, e.g. for VITT. (Now there is only an article "Vitt" about a tiny german village, which certainly is not what most readers are looking for these days.) --89.15.238.63 (talk) 12:39, 12 April 2021 (UTC)

Could we say that consensus has been reached to keep both names (VIPIT and VITT) for the time being and remove the tag "disputed"? --89.15.236.207 (talk) 17:11, 13 April 2021 (UTC)

Denmark changes guideline for intramuscular injection
Aspiration before i.m. injection

As a precautionary measure to ensure that the vaccine might not accidentially be injected into bloodvessel, the Danish SSI (Statens Serum Institut) has changed its vaccination guidelines on March 18th as follows:

''Usually one does not need to aspirate before injecting a vaccine. However, in connection with the investigation of a possible association between the injection of covid-19 vaccine from AstraZeneca and the occurrence of rare but severe cases of blood clots and bleeding, SSI recommends, for the time being, on a precautionary principle, to aspirate before administration. This applies to all the approved covid-19 vaccines, both for injection into the deltoid muscle, but also for the alternative option of injection into the vastus lateral muscle, if injection into the deltoid muscle is not possible.'' (Google translation, text danish) source:

https://www.ssi.dk/vaccinationer/injektionsteknik/intramuskulaer-injektion-beorn-og-voksne

--89.15.236.166 (talk) 13:28, 10 April 2021 (UTC)
 * Would be interesting to know whether it all starts with injection into a bloodvessel, and that could be avoided so easily. (Most countries don't recommend aspiration. But the sole reason for this is reduction of pain in child-vaccination.)--89.15.236.166 (talk) 13:47, 10 April 2021 (UTC)


 * Thankyou for your comments and interesting. I have have not examined in depth but at a glance it may be possible this could be included if not given any WP:UNDUE weight and as a statement of fact of an approach.  Speculation about whether these events correlate to injections into a bloodvessel is not really for here, and I assume the investigations are considering that.  Silly question: Am I correct in understanding the recommendation is to have the injection in the backside rather than the arm .... and the thoughts of that outcome having the UK Prime Minister having his backside done live on TV is ... well ... Djm-leighpark (talk) 21:47, 10 April 2021 (UTC)

Squabble over POVs

 * Regarding: "None of the agencies found a confirmed causal link between the vaccine and these incidents at the time, but were listing them out of an abundance of caution.". If you want to continue your spat please sort it or take it to WP:ANI rather than continuing it on this article. @Huasteca: To be quite clear wheter you are right or wrong I am of the opinion you are on ultra thin ice ignoring the covid general sanctions you have been made aware.  @‎Berchanhimez: The phrase "but were listing them out of an abundance of caution" as written reads to me as more of a WP:OPINION rather than sourced from the articles (and it may have been sourceable from each of the three articles but in my opinion that wasn't a great way of putting it) and while not perhaps your intent to lay ‎WP:GOADing bait that perhaps what happened.  I'd suggest both of you leave that as it is and hopefully a third party neutral will sort it or I may rework that paragraph at some point anyway(  either as it comes up near the top of my todo list or as i am reviewing the three sources for some other reason).  Thankyou. Djm-leighpark (talk) 03:26, 11 April 2021 (UTC)
 * , if you can think of a better way to make clear that's what they were doing (and each clearly stated that's why they were doing so), please do. Per WP:NPOV we cannot state one part of something without clarifying the viewpoint they had on the issue. -bɜ:ʳkənhɪmez (User/say hi!) 03:31, 11 April 2021 (UTC)
 * Djm-leighpark That is what I did. In the face of a barrage of personal attacks on the noticeboard, I stopped editing this article altogether. The aim was to get me blocked or topic banned as they stated clearly themselves from the beginning, presumably by goading me into responding rudely. I didn't, which made them more furious. Anyhow, good luck dealing with this and trying to WP:AGF.--Huasteca (talk) 08:18, 13 April 2021 (UTC)
 * Anyways, since I was dragged back into these articles, the official EMA position is as follows: https://www.ema.europa.eu/en/documents/dhpc/direct-healthcare-professional-communication-dhpc-vaxzevria-previously-covid-19-vaccine-astrazeneca_en-0.pdf

The causal relationship is now "plausible" not "possible" or "cannot be ruled out". It also exceeds what is expected in the general population. I have edited the lead accordingly. Huasteca (talk) 14:34, 13 April 2021 (UTC)
 * This change that says: "although such adverse reactions are very rare, they exceeded what would be expected in the general population" seems to go a bit further than the sources cited in support.
 * Maybe I am looking at the wrong one, but they mostly say something on these lines:

"The data suggest there is a slightly higher incidence reported in the younger adult age groups and the MHRA advises that this evolving evidence should be taken into account when considering the use of the vaccine.[Emphasis added]"
 * so I just don't see that the sources allow us to state unequivocally, and baldly, a causal relationship. All the sources I can see are much more cautious - evidence is suggestive, and perhaps strengthening, but nothing so definitive yet.
 * A "plausible causal relationship" is mentioned, with attribution, in another section already, anyway: "causal relationship" is "plausible but is not confirmed", so it may be redundant to repeat it here, and, I believe, possibly less balanced and probably not as reflective of sources.
 * And this addition: "Early reports indicate the outcome is fatal in a proportion of cases, for example the UK MHRA reporting regards ADZ1222 to 31 March 2021 recording 19 deaths out of 79 cases in the context of 20.2 million doses administered." was already covered too, with those statistics directly quoted with the cite.
 * I am quite worried that the emphasis and tone of these edits is not warranted. Could these changes please be reconsidered? 49.177.64.138 (talk) 17:13, 13 April 2021 (UTC)
 * I agree with you and I will be fixing this shortly. User:Huasteca: "plausible" means virtually the same as "possible", just with the added condition that for something to be "plausible" it must be "reasonable" (whereas something can be "possible but not reasonable" if it hasn't been disproven). Plausible does not mean what you try to say it does, and the sources you use still do not support the edits you're making. -bɜ:ʳkənhɪmez (User/say hi!) 17:24, 13 April 2021 (UTC)
 * Or to put it even more precisely, in the summary the EMA says "is considered plausible". (Meaning that is their expert opinion as things stand.) - I think it's best to cite it exactly so. We should not add our judgement, stressing it to the one side or the other. --89.15.236.207 (talk) 18:08, 13 April 2021 (UTC)
 * This edit is blatant POV pushing by say hi! directly contradicting and blatantly distorting the content of an EMA communication. This is getting serious and we need admin intervention here. I rarely request such things but I think a topic ban is in order here. Huasteca (talk) 18:39, 13 April 2021 (UTC)
 * Your verbatim quote from the source: "Although such adverse reactions are very rare, they exceeded what would be expected in the general population." is fully OK with me and should be kept in the article. Perhaps there was some confusion, since you left it without quotationmarks before. But on the other hand, that's no excuse either for the other contributors to push back before even having it compared with the ref. --89.15.236.207 (talk) 18:55, 13 April 2021 (UTC)
 * User talk:89.15.236.207: I don't think there was any confusion and I gave up on assuming good faith from certain editors here. Changing "Although such adverse reactions are very rare, they exceeded what would be expected in the general population" to ''"Although such adverse reactions are very rare" (followed by a full-stop) is a blatant willful manipulation of sources to push for a certain POV. There is no room for confusion or mistake in this case. Its systematic - this is why I took this issue to a POV noticeboard in the first place. Huasteca (talk) 21:23, 13 April 2021 (UTC)
 * Oh indeed, I failed to see this. That's really strange. - But I hope you can see that my intention is WP:AGF and fairness on all sides, calming down the somewhat toxic atmosphere. --89.15.236.207 (talk) 21:52, 13 April 2021 (UTC)

I don't know what the correct wording in the lead should be, just that I was hoping we could reflect the sources collectively when introducing the topic, in giving an overview. Delineating the specifics of the different sources, including direct (and full) quotes is an excellent way of being faithful to the source, but I was thinking the ideal is to have the lead summarise all the authoritative views. If that's not how it should work, then I'm sorry to have raised it. I only put my comments here for discussion.

And some of that direct summation of various individual sources was already in the body of article, so it seemed restating it at the top was giving it an over-emphasis. Anyway, I hope it's all worked out in a way that doesn't cause editors stress. (FWIW it's (to me) very scary here. It is hard to clearly understand what is actually going on. If I have sparked any hard feelings in or problems for anyone, please accept my apologies. Best wishes. 49.177.64.138 (talk) 03:08, 14 April 2021 (UTC)

Possible "further reading" sources
Just putting a few cites here, as the come to hand, that might be useful at some point.
 * Statement from International Society on Thrombosis and Haemostasis
 * The BMJ News 49.177.61.250 (talk) 11:00, 11 April 2021 (UTC)
 * This
 * THANZ advisory statement cited above. 49.177.61.250 (talk) 11:16, 11 April 2021 (UTC) addition 49.177.64.138 (talk) 12:03, 14 April 2021 (UTC)

Suggest change of citation style.to Havard
As the article was not created by myself I did not select the citation style, though I've extended the article heavily myself. I've used Vancouver system to keep consistency with  In an edit this evening I found it really heavy going not having key sources listed in order at the end of the article (and in fact I think I may have mixed the EMA/PRAC references from 7April2021 up at one point though they do have a high degree of compatibility.  Per WP:CITEVAR I am suggesting switch to Harvard citation with WP:SFN short referencing which can be good for more precise within source location identification which assists WP:V.  The style will compatibility mix standard referencing though that would have to be resolved longer term, short term at C-Class its not too much of an issue really.  The Astute may notice I've already used Harvard once to precisely note a two different points in an AV media.  A slight  If  disadvantage can be not too many people are familiar with the style and I understand it may not work so well with the visual editor. It does however reduce clutter in the text, more important if one is not (like me) using the visual editor. I tend to keep the source citations is last1,first1,...lastn,firstn|date|title to keep the order easily mappable to the sfn paramet order. If anyone really objects please let know per WP:CITEVAR. If I hear noting I will probably do it in a few days. Thankyou. — Preceding unsigned comment added by Djm-leighpark (talk • contribs) 22:36, 11 April 2021 (UTC)
 * I prefer Wikipedia's citation templates with CS1 (Wikipedia style), but I am okay with Vancouver style given it's a simple extra parameter in CS1 templates. I do not support any other method of citations in articles overall, thus I don't support citations with SFN referencing, as I feel those are harder for readers to understand. -bɜ:ʳkənhɪmez (User/say hi!) 23:43, 11 April 2021 (UTC)
 * Obviously I have to take that as a blocking action. You will perhaps forgive me on the additional work I may thus have to do which may impact on my RL of family RL an article you are attempting to squash and have a COI on makes me wonder if you are just saying this for hounding or disruptive purposes but I AGF that is not the case.  If you are going to place what now seems like empty, smary and pontificating words "I hope you will continue to contribute" on user talk pages in future please be aware it may show like a pattern if who then continue to nip at peoples heels. Djm-leighpark (talk) 06:48, 12 April 2021 (UTC)
 * , I'm not saying it to attempt to be disruptive - I recognize that per WP:CITEVAR there are at least half a dozen vastly different forms of citations used in Wikipedia and that there is no consensus that one should be forced - but I think that Harvard citations and SFNs are much harder for readers to understand - and the CS1 templates (even if the parameter is used to form Vanc style) are easy to use with multiple gadgets (ex: WP:REFTOOLBAR which allows citing with just a DOI or similar identifier) to enable them to be added. I'm not attempting to "squash" anything nor do I have any COI aside from a real life interest in the topic. -bɜ:ʳkənhɪmez (User/say hi!) 17:35, 12 April 2021 (UTC)
 * I haven't looked at this article, let alone commented on its talk page in days. So I find someone telling me I'm on ultra thin ice over a conversation I'm not involved in is a little bit over the top. Huasteca (talk) 22:27, 12 April 2021 (UTC)
 * @: Please express you concerns, mitigations, and defence at WP:ANI. Thankyou.Djm-leighpark (talk) 22:36, 12 April 2021 (UTC)
 * @:What concerns? I have no concerns. As I said I'm not actively involved in this article anymore. Huasteca (talk) 22:52, 12 April 2021 (UTC)
 * @: That's good news. Since all this you started here is worlds off topic from the thread.--89.15.239.212 (talk) 23:06, 12 April 2021 (UTC)
 * @: Look. I'm fucked doing with this article at the moment. totally fucked.  I'm fucked by working on a article that's an AFD under MERGE clothing.  Absolutely fucked.  Totally fucked.  I'll self enforce a fucking 12 hour wikibreak.  That will fucking stop people to calm down and take a self enforced fucking wikibreak until I've "calmed done" so the lead section can be fucked about with.  Thankyou. Djm-leighpark (talk) 21:44, 13 April 2021 (UTC)


 * Reluctantly per WP:CITEVAR . I'll redact further comments. Djm-leighpark (talk) 06:48, 12 April 2021 (UTC)
 * I think we all need to remain calm. In my experience, although other referencing systems have their advantages (particularly for non-science articles) in practice for a newish article that is likely to grow, like this one, plain old inline/CS1 is what newly-arriving editors will use, so it's best to stick to that to avoid the extra work of dealing with reconciling their changes. And don't even think about the Visual Editor. Alexbrn (talk) 07:09, 12 April 2021 (UTC)

VIPIT and VITT in lead section
I advise caution in the exact wording of VIIT and VIPIT at the start of the lead section. The emphasis on these acronyms may be WP:UNDUE, may fail WP:MEDRS in the nature of the surrounding wording giving not confirmed causal link to my knowledge at this time, and it may be that, the association with the immune system is likely probable but not totally confirmed (my words), and VIIT/VIPIT may not include every event within scope. Now I'm not a medical expect but I'm looking for say WHO adoption and contexting of these terms before we and making specific assertions in the lead sections. I have no objection to noting further down in the lead section to avoid WP:SURPRISE from a re-direct. Thankyou. Djm-leighpark (talk) 22:57, 19 April 2021 (UTC)
 * If you are referring to my latest edit, the only reason was to give exactly what the sources say. (Of course I don't doubt your knowledge about the WP rules, and I did not want to take sides stressing any opinion. That's for sure. So I leave it for others to decide.) - Jfdwolff seems to have the best experience about the topic and I would appreciate any good advice. - Afaik it is already a well established fact that an immune reaction (i.e. the presence of anti-PF4 antibodies) causes the condition → Section Causes, but what exactly is the trigger for this unfortunate immune reaction remains still very much unclear and is now the focus of research. (The hot topic is this: Clinicians had seen such syndrome caused by heparin before, but here it is NOT.) --89.15.237.230 (talk) 23:38, 19 April 2021 (UTC)
 * Also re these anti-PF4 antibodies. - UK guidelines by the British Society for Haematology say ("Management", p. 2) as #1: Give intravenous immunoglobulin urgently as this is the treatment most likely to influence the disease process. (My comment: Reason is, to get the pathogenic antibodies out of the way. As section → Management already in the article. Which is correct.) - So, both for diagnosis and treatment, the association with the immune system seems quite a bit more than merely plausible, I would say. - Although, as I said before, I'm open-minded and don't push my informed opinion. (I just think it's always best to let it frankly be known, so as to avoid any controversies or suspicions.) --89.15.237.230 (talk) 02:14, 20 April 2021 (UTC)


 * If a source can be provided that thrombotic risk is increased in the absence of thrombocytopenia and anti-PF4 ELISA then a distinction should be made in the introduction. Alternatively, VIPIT and VITT should be mentioned in the current context. JFW &#124; T@lk  15:14, 20 April 2021 (UTC)

ISTH
Management guidelines just released: https://isth.informz.net/ISTH/data/images/ISTH%20VITT%20Guidance%20on%20Letterhead.pdf JFW &#124; T@lk  15:19, 20 April 2021 (UTC)


 * News page on the ISTH website: https://www.isth.org/news/561406/ JFW &#124; T@lk  15:44, 20 April 2021 (UTC)


 * Formal outputs from the ISTH SSC: 10.1111/jth.15341 JFW &#124; T@lk  21:26, 24 April 2021 (UTC)

Causes: Greinacher et al., April 20
Information: "Conclusions: ChAdOx1 nCoV-19 vaccine constituents (i) form antigenic complexes with PF4, (ii) EDTA increases microvascular permeability, and (iii) vaccine components cause acute inflammatory reactions. Antigen formation in a proinflammatory milieu offers an explanation for anti-PF4 antibody production. High-titer anti-PF4 antibodies activate platelets and induce neutrophil activation and NETs formation, fueling the VITT prothrombotic response." Note: this is a pre-print paper. --89.15.238.41 (talk) 15:53, 20 April 2021 (UTC)
 * Related News: https://idw-online.de/en/news767147 --89.15.238.41 (talk) 16:02, 20 April 2021 (UTC)

OK, no further worries. I'm out of here, and I mean it. Bye! --89.15.238.41 (talk) 18:56, 20 April 2021 (UTC)
 * This comment by 89.15.238.41 is likely in the context of this - Djm-leighpark (talk) 19:46, 20 April 2021 (UTC)


 * I think we have reasons to be cautious with this preprint. Other hypotheses have also been aired: on the BBC PM programme last week a science journalist called Kai Kupferschmidt discussed the theory that negatively charged DNA in the vaccine was responsible (analogous to the negatively charged heparin in bona fide HITT). Another concern is that EDTA is used clinically in the treatment of heavy metal poisoning, but I could not find evidence that it caused genuine thrombocytopenia (although it can cause platelet clumping and falsely decreased platelet counts in the laboratory). JFW &#124; T@lk  19:49, 20 April 2021 (UTC)

Australian authorities' latest statements
In case this might be of some use for the article I am placing refs about some recent post-vaccination events in Aus. This initial news media report gives an overview, or this one.
 * The TGA convened a Vaccine Safety Investigation Group (VSIG) meeting to review three newly reported cases of suspected thrombosis with thrombocytopenia syndrome. This is their statement.
 * In reviewing these recent cases, they base their level of certainty regarding any link between the event and vaccine on the WHO's "internationally accepted method" of assessment.
 * Updated ATAGI statement
 * Regarding the naming of the syndrome discussion, and what its settled label will be: possibly worth noting that these Australian agencies seem to be going with "TTS" for the moment. 49.177.64.138 (talk) 11:06, 24 April 2021 (UTC)

Source for recommendation for management without Heparin
There is a "better source needed" tag on a sentence in the lead, saying, Maybe we should not generalise and use a UK Medical Society instead? The source cited - and used again in the Management section - is from British Society for Haematology. What do others think? Can we remove this tag? I'm not quite clear on the tagging Editor's meaning - could always find more medical societies' guidance on not using Heparin, but don't want to add lots of sources saying the same thing, just for the sake of it. Or maybe something else is meant by this ... 49.177.64.138 (talk) 12:56, 25 April 2021 (UTC)


 * This is part of the formal ISTH international guidance, 10.1111/jth.15341. I have added the reference under the name "ISTHSSC" so it can be cited elsewhere in the article. JFW &#124; T@lk  13:25, 28 April 2021 (UTC)


 * Thanks for doing that. International guidance even better, and will be useful for article elsewhere, too. 49.177.64.138 (talk) 09:08, 29 April 2021 (UTC)


 * Perhaps, although following it to the letter will put huge demand on imaging services. JFW &#124; T@lk  12:25, 29 April 2021 (UTC)

Adenoviruses only?
As far as I'm aware, and please correct me if I'm wrong, these have only been associated with adenovirus vector vaccines for COVID-19 (as opposed to other vaccines such as mRNA). I'm not "officially" proposing a move at this time, but it may be better to replace the "post-vaccination" part with something such as "Adenovirus associated" or something like that - because as the article states right now: it "has been consistently reported" after administration of adenoviral gene transfer vectors - which leads me to believe that, while only observed in humans after COVID-19 vaccines, it's not the vaccines that are the problem so much as the technology. Furthermore, could a more concise way of saying "embolic and thrombotic events" be formulated, such as "clotting disorders" or similar? My goal here is not to delete/remove the article, because it's clear now that this is a notable topic in and of itself - not just related to vaccines - but I think the title could be improved. On a side note, I'd like to thank all of the editors who've worked on this article and bringing it to the level it's at. -bɜ:ʳkənhɪmez (User/say hi!) 19:54, 30 April 2021 (UTC)
 * It would be great to have info for Russia's Sputnik V COVID-19 vaccine & China's Convidecia (Only just coming on stream in quantity?). Apart from Pfizer/Moderna/J&J/Sputnik V/AZD1222 and CoronaVac (inactivated) have anything else been deployed at comparable scale in Quarter 1 of 2021 (especially anywhere there they are anywhere on top of keeping their data) ?  A report a while back from the UK MHRA did identify Pfizer vaccinated persons with rare clots but well below the AZ levels and perhaps indistinguishable from background.  I haven't looked at the latest UK MHRA data ... though that is basically Pfizer/AZD1222 only (Maybe Moderna too but likely too early).  I am sure its important to track EMA and WHO language very very carefully on this and see  what they are saying in totality to ensure we have the right scope - I haven't being doing that for a few days.Djm-leighpark (talk) 22:40, 30 April 2021 (UTC)

AHA/ASA/CSL guideline for VITT-CVST
10.1161/STROKEAHA.121.035564 JFW &#124; T@lk  13:28, 2 May 2021 (UTC)

Balance
The almost complete omission of necessary context regarding the benefits of vaccination throughout this page make it a piece of ammo for misinformation-based vaccine hesitancy and anti-vax disinformation, because it stresses a slight risk while holding silent on the great benefits of vaccination.

As it is, this page discusses only the risks of vaccination, and omits to mention that the risks of coagulation from pandemic COVID-19 are many-fold higher. This lack of necessary context misdirects the attention of persons needing to weigh the benefits, as well as the costs, of vaccination, by denying those who read this article and stop reading the information most salient to a vaccinate/don't vaccinate decision.

This page should, near the beginning, lay out and document the recommendation of scientific, governmental, and world health bodies regarding the desirability of vaccination.

This page should followup and explain those recommendations, and how they are based on giving due weight to the risks of non-vaccination, including hyper-coagulation, caused by COVID-19 and risked by those failing to get vaccinated. These risks should be shown as ongoing into the future for the un-vaccinated individual, as wave after wave of increasingly contagious and virulent COVID virus pass through world society. — Preceding unsigned comment added by Ocdcntx (talk • contribs) 18:30, 22 May 2021 (UTC)


 * This page isn't about the vaccines as a whole. It's about the post-vaccination clotting events. Pages for the COVID-19 vaccines as a whole and the individual ones implicated are linked in the first paragraph of the lead. No matter how noble the cause of wanting everyone to get vaccinated is, we don't violate/ignore our policies and guidelines on how to craft articles to do so. You may also wish to see our rule on including "disclaimers" in articles (such as what you suggest adding to this article). -bɜ:ʳkənhɪmez (User/say hi!) 17:57, 22 May 2021 (UTC)