Autopsy findings after SARS-CoV-2 vaccination: a German national registry study

Autopsies are the foundation of evidence-based medicine and gold standard for determining causes of death. A potential causal relationship between COVID-19 vaccination and death remains a subject of debate, however multidisciplinary, multicentric national autopsy studies are missing. N = 486 eligible SARS-CoV-2 vaccinated autopsy cases from 14 German pathology, neuropathology and legal medicine university centres between 2021 and 2024 were available via the German National Autopsy Registry. For comparison COVID-19 autopsies were included (n = 385 cases, all performed before the vaccination campaign in Germany started). A previously established causality algorithm was applied in a consensus assessment of potential causality between vaccine administration and an adverse event following immunization (AEFI). N = 176 cases with a post vaccination interval ≤ 28d were included into analyses. In a single case of allergic reaction, in 5/8 cases of either myocarditis (n = 4 cases) or perimyocarditis (n = 1 case), and 9/26 cases of thromboembolism, the consensus process resulted in a potential AEFI in these cases, but no definite causality. In n = 3 cases in which the cause of death remained unclear after autopsy, no potential AEFI could be established. In SARS-CoV-2 positive autopsy cases without vaccination, thromboembolism was documented as cause of death in 18/385 cases and myocarditis in 2/385 cases. In conclusion, autopsies are a valuable tool to assess adverse effects. Currently, post vaccination autopsy numbers are too low to draw conclusions on the general population or to identify rare AEFI signals. As part of pandemic preparedness, international guidelines for post vaccination autopsy procedures, diagnostics and interpretation are necessary. Autopsy registries can support this collective effort.

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Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin
Published
2026-11-07
DOI
https://doi.org/10.1007/s00428-026-04754-1
Primary Topic
SARS-CoV-2 and COVID-19 Research
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article
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article

Autopsy findings after SARS-CoV-2 vaccination: a German national registry study

Christoph Römmele, Olaf Holotiuk, Helena Radbruch, Ulf Titze et al.
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Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin
SARS-CoV-2 and COVID-19 Research
article

Autopsy findings after SARS-CoV-2 vaccination: a German national registry study

Christoph Römmele, Olaf Holotiuk, Helena Radbruch, Ulf Titze, Christoph G. Birngruber, Julia Schädler, Jenny Meinhardt, Philip Eichhorn, Florian Haller, Jakob Matschke, Anna Katharina Kuderna, Jan Wienströer, Raphael W. Majeed, Eva Grill, Bruno Märkl, Gregor Weirich, Johann Zwirner, Claire Delbridge, Rainer Röhrig, Dustin Möbius, Elisabeth Kling, Simon Streit, Susanne Krasemann, Éva Sipos, Reinhard B Dettmeyer, Saskia Freifrau von Stillfried, Fabian Heinrich, Roland Coras, Benjamin Ondruschka, Klaus Püschel, Susanne Pfefferle, Christine Dhillon, Klaus Hirschbühl, Linna Sommer, Peter Boor, Julia Hilsenbeck, Carolin Edler, Kerstin Amann, Juliane Bremer, Fabienne Lange, Jessica Pablik, Matthias Meinhardt, Martin Aepfelbacher, Tina Schaller, Inga Kniep, Jana Böcker, Elise Gradhand, Tobias Huter, Martin Werner, Meike Meinel, Rainer Claus, Atsuko Kasajima, Sefer Elezkurtaj, Thomas J. Kröncke, Antonia Fitzek, Markus Glatzel, Svenja Windeck, Christopher Werlein, Peer‐Hendrik Kuhn, Pauline Tholen, Roman David Bülow, Graziano Domenico Luigi Crudele, Jan‐Peter Sperhake, Georg Braun, Larissa Lohner, Maximilian Seidl, Daniela Fröb, Dorothea Langer, Dustin Thewes, Joachim Weis, Stephanie Strobl, Ann Sophie Schröder, Axel Heinemann, Torsten Hansen, Rainer Maria Bohle, Oliver Spring, Anke Klein, Eric Dietz, Julia Bley, Marc Lütgehetmann, Muhannad Al Kallaa, Irene Esposito, Gustavo Baretton, Martin T. Strauch, Danny Jonigk, Wilfried Roth, Frank L. Heppner, Michael Wittmann, Ruth Knüchel, Fidelis Flockerzi, Johannes Hohneck, Lukas Triefenbach, Arndt Hartmann, Anja Harder, Christine Fathke, Verena Gassenmeier, NAREG Collaborators# for the German National Autopsy Registry (NAREG), Nicole Fischer, Kevin Smith, Nina Mahlke
article en

Abstract

Autopsies are the foundation of evidence-based medicine and gold standard for determining causes of death. A potential causal relationship between COVID-19 vaccination and death remains a subject of debate, however multidisciplinary, multicentric national autopsy studies are missing. N = 486 eligible SARS-CoV-2 vaccinated autopsy cases from 14 German pathology, neuropathology and legal medicine university centres between 2021 and 2024 were available via the German National Autopsy Registry. For comparison COVID-19 autopsies were included (n = 385 cases, all performed before the vaccination campaign in Germany started). A previously established causality algorithm was applied in a consensus assessment of potential causality between vaccine administration and an adverse event following immunization (AEFI). N = 176 cases with a post vaccination interval ≤ 28d were included into analyses. In a single case of allergic reaction, in 5/8 cases of either myocarditis (n = 4 cases) or perimyocarditis (n = 1 case), and 9/26 cases of thromboembolism, the consensus process resulted in a potential AEFI in these cases, but no definite causality. In n = 3 cases in which the cause of death remained unclear after autopsy, no potential AEFI could be established. In SARS-CoV-2 positive autopsy cases without vaccination, thromboembolism was documented as cause of death in 18/385 cases and myocarditis in 2/385 cases. In conclusion, autopsies are a valuable tool to assess adverse effects. Currently, post vaccination autopsy numbers are too low to draw conclusions on the general population or to identify rare AEFI signals. As part of pandemic preparedness, international guidelines for post vaccination autopsy procedures, diagnostics and interpretation are necessary. Autopsy registries can support this collective effort.

Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin
Universität Hamburg (DE), University of Augsburg (DE), Justus-Liebig-Universität Gießen (DE), Bielefeld University (DE), Universitätsklinikum Gießen und Marburg (DE), University Medical Center Freiburg (DE), German Center for Neurodegenerative Diseases (DE), University Hospital Augsburg (DE), Medizinische Hochschule Hannover (DE), Humboldt-Universität zu Berlin (DE), Universitätsklinikum Erlangen (DE), Düsseldorf University Hospital (DE), University Medical Center of the Johannes Gutenberg University Mainz (DE), Universitätsklinikum Tübingen (DE), Universitätsklinikum des Saarlandes (DE), Klinikum Magdeburg (DE), University Medical Center Hamburg-Eppendorf (DE), Universitätsklinikum Aachen (DE), German Center for Lung Research (DE), University Hospital Frankfurt (DE), University Hospital Magdeburg (DE), University Hospital in Halle (DE), University Hospital Carl Gustav Carus (DE), Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (DE), Heinrich Heine University Düsseldorf (DE), Technical University of Munich (DE), Technische Universität Dresden (DE), Charité - Universitätsmedizin Berlin (DE), University of Tübingen (DE), Ludwig-Maximilians-Universität München (DE), RWTH Aachen University (DE)
Bundesministerium für Gesundheit, RWTH Aachen University
Good health and well-being
Openalex Percentile: Top 14%
SARS-CoV-2 and COVID-19 Research
DOIOpen Access PDFOpenAlex
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