Immunization Stress-Related Responses: Mitigating Patient Fears and Associated Side Effects Amidst a Global Vaccination Effort




medication safety, immunizations, COVID-19, immunization stress-related responses, anxiety, adverse events following immunization, cluster events, Janssen, Johnson & Johnson


The event of receiving a vaccine can lead to feelings of stress and anxiety for many patients and may present as adverse events. With coronavirus disease 2019 (COVID-19) mass vaccination efforts, adverse events following immunization, including immunization stress-related reactions (ISRR), have subsequently increased. Traditionally rare, but increasingly common, cluster events have also become a concern. Demonstrated in recent publications by Hause et al. concerning Janssen (Johnson & Johnson) COVID-19 vaccine clinics, these adverse events can lead to personal apprehension towards receiving vaccines, as well as public distrust towards the immunization process. To combat ISRRs, mass vaccination clinics across the United States must create administration protocols to mitigate these responses. Anticipation and swift management can play a substantial role in minimizing frequency and severity of these reactions and prevent future vaccine hesitancy.

Author Biographies

Michael Mast, University of Pittsburgh School of Pharmacy

Michael Mast ( is a fourth-year student pharmacist at the University of Pittsburgh School of Pharmacy. He is enrolled in the Geriatrics and Palliative Care Area of Concentration and hopes to pursue residency training following graduation in the field of health-system administration and leadership with potential for master’s coursework. His current areas of interest include automation and quality improvement.

Mast is employed by the UPMC South Side COVID-19 Vaccine Center and has been instrumental as a community vaccinator in helping families across 10 different counties in Western Pennsylvania achieve full-immunization status. Throughout his time in pharmacy school, Mast has been involved in several quality improvement projects directed toward electronic alert system optimization in both the inpatient and transitions of care settings. He has co-authored a manuscript concerning drug-induced acute kidney injury (AKI) alerting systems, pending approval and publication.

As he approaches graduation, Mast has had the privilege of developing and leading several premiere student organizations at the University of Pittsburgh. Serving as president of the Kappa Psi Beta Kappa Chapter, he has the distinct honor of leading a 107-member organization in receiving international recognition as Top Performing Chapter with individual awards in the categories of COVID-19 Pandemic Advocacy, Philanthropy, and outstanding contributions. Mast also co-founded the first national chapter of the Student Society of Cannabis Pharmacists at the University of Pittsburgh, and has since worked to substantially expand the realm of cannabis education.

Yihan Li, University of Pittsburgh School of Pharmacy

Yihan Li is a fourth-year Doctor of Pharmacy candidate at the University of Pittsburgh School of Pharmacy with an area of concentration in the Pharmacotherapy Scholars track. Her areas of interest include critical care and inpatient pharmacy leadership. Her postgraduate goals include completing a PGY1 and a PGY2 in critical care.

Li’s recent research projects include evaluating the efficacy of aldosterone antagonists in heart failure with preserved ejection fraction, the performance of an electronic alert system for drug-induced acute kidney failure, and the use of symptom-based benzodiazepine treatment versus phenobarbital prophylaxis in alcohol withdrawal patients.

Li also has a variety of pharmacy leadership involvement. She is a National Member-at-Large of Phi Lambda Sigma Pharmacy Leadership Society and priorly was the president of her local chapter. She has been extensively involved in American Pharmacists Association Academy of Student Pharmacists (APhA-ASP), in which she was the chapter patient care vice president. Li is also a chief pharmacy intern at UPMC Presbyterian Hospital.


Centers for Disease Control and Prevention. COVID Data Tracker. CDC website. Accessed October 11, 2021.

Gold MS, MacDonald NE, McMurtry CM, et al. Immunization Stress-Related Response - Redefining Immunization Anxiety-Related Reaction as an Adverse Event Following Immunization. Vaccine. 2020;38(14):3015-3020.

Vaccine Adverse Event Reporting System. Report an Adverse Event to VAERS. Accessed October 11, 2021.

Loharikar A, Suragh TA, MacDonald NE, et al. Anxiety-Related Adverse Events Following Immunization (AEFI): A Systematic Review of Published Clusters of Illness. Vaccine. 2018; 4;36(2):299-305.

Hause AM, Gee J, Johnson T, et al. Anxiety-Related Adverse Event Clusters After Janssen COVID-19 Vaccination - Five U.S. Mass Vaccination Sites. MMWR Morb Mortal Wkly Rep. 2021;70(18):685-688.

Centers for Disease Control and Prevention. V-Safe After Vaccination Health Checker. CDC website. Accessed October 11, 2021.

U.S. Food and Drug Administration. FDA Approves First COVID-19 Vaccine. FDA website. Accessed October 11, 2021.

People in waiting room, with masks on, waiting to be vaccinated.



How to Cite

Mast, M., & Li, Y. (2022). Immunization Stress-Related Responses: Mitigating Patient Fears and Associated Side Effects Amidst a Global Vaccination Effort. Patient Safety, 4(SI), 36–41.
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