key: cord-0807616-xv67v4yc authors: Gruenstein, Diana; Levitt, Jacob title: Skin necrosis at both COVID-19 vaccine injection sites. date: 2021-07-27 journal: JAAD Case Rep DOI: 10.1016/j.jdcr.2021.07.022 sha: 5a63d21a08bd0b7abac2f17e7b72f8939e11813d doc_id: 807616 cord_uid: xv67v4yc nan Delayed injection-site reactions (occurring 8 days or more after vaccination) are seen 28 with the COVID-19 vaccine. Typically, the reaction is characterized by pain, erythema and 29 induration near the injection site that resolves within 5 days. 1 We report a case of necrotic 30 eschars appearing one week after the second dose of the COVID-19 BNT162b2 (Pfizer) vaccine 31 at the injection sites. The case reported here is unique in that the reaction appeared to be thrombotic in nature, 61 with a morphology similar to the retiform purpura of calciphylaxis. COVID-19 disease itself is 62 characterized by thrombosis, felt to be due to increased angiotensin II and tissue factor. 4 The Safety of the mRNA-1273 SARS-CoV-2 Vaccine Efficacy 90 and Safety of the mRNA-1273 SARS-CoV-2 Vaccine Delayed Large Local Reactions to 94