5 It is a common infection with an estimated health burden of 14.5 million cases costing $3.7 billion per year in the United States. Cellulitis is a bacterial infection of the skin, manifesting as acute inflammation that can rapidly expand if untreated. These presumed delayed hypersensitivity reactions can mimic and be confused with other skin conditions such as cellulitis (see Table 1). 3 These reactions are described as tender, erythematous, and indurated and they mostly resolve within 5 days. 3 Delayed injection-site reactions (onset on or after day 8) occurred in 0.8% of participants after the first dose and 0.2% of participants after the second dose and was colloquially termed “COVID arm.” 3 As the first and second doses of the Moderna and Pfizer vaccines are respectively identical, it is not yet known why there has been varying cutaneous reactions between the doses. 2, 3 In a Phase 3 clinical trial of the Moderna vaccine, injection-site reactions occurred in 84.2% of participants after the first dose. 1 - 4 The SARS-CoV-2 vaccines are administered intramuscularly in 1 or 2 doses with injection-site pain and tenderness as the most common local adverse reactions usually reported within 48 h of vaccination. ![]() 1 Due to characteristics of SARS-CoV-2, the Moderna and Pfizer-BioNTech SARS-CoV-2 vaccines utilized novel lipid-nanoparticle-encapsulated mRNA technology to provide immunity by encoding for the spike protein necessary for viral entry, while the Janssen Johnson & Johnson (J&J) vaccine utilized adenovirus as a viral vector to provide immunity, similar to vaccines previously used to target Ebola and Zika outbreaks. Among all vaccines, there are 6 main types: live-attenuated, inactivated, subunit/recombinant, toxoid, messenger ribonucleic acid (mRNA), and viral vector. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread quickly after emerging in 2019, and rapid development of SARS-CoV-2 vaccines soon followed.
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