BCHHS Public Health Provider Alert: COVID-19 Vaccine Availability & CDC Clinician Call Today at 2pm on J&J COVID-19 Vaccine and Cerebral Venous Sinus Thrombosis with Thrombocytopenia

April 15, 2021

Please review the attached (also found here) CDC Advisory about cases of cerebral venous sinus thrombosis (CVST) with thrombocytopenia following receipt of the Johnson & Johnson (J&J; Janssen) COVID-19 vaccine.

  • As of April 12, 2021, ~6.85 million doses of the J&J COVID-19 vaccine have been administered in the United States.
  • The CDC and FDA are reviewing data involving 6 cases of cerebral venous sinus thrombosis (CVST) in individuals after receiving the J&J COVID-19 vaccine in the US.
  • These cases were reported to the Vaccine Adverse Event Reporting System (VAERS). (This shows the importance and utility of the vaccine safety monitoring systems that are in place in our country.)
  • In these cases, CSVT was seen in combination with thrombocytopenia, which is not a typical association.
  • All 6 cases occurred among women aged 18–48 years. The interval from vaccine receipt to symptom onset ranged from 6–13 days. One patient died.
  • These reports following the J&J COVID-19 vaccine are similar to reports of thrombotic events with thrombocytopenia after receipt of the AstraZeneca COVID-19 vaccine in Europe. Both vaccines contain replication-incompetent adenoviral vectors that encode the spike glycoprotein of SARS-CoV-2, the virus that causes COVID-19.
  • There are no concerns about this type of blood clot in people who receive the Pfizer or Moderna COVID-19 vaccines. (182 million doses of mRNA COVID-19 vaccines have been administered with no reported cases of CSVT to date.)
    • Everyone in NC who is 16 years of age and older is now eligible for COVID-19 vaccination in NC. Please continue to encourage vaccination with mRNA COVID-19 vaccines (Pfizer for 16 & older and Moderna for 18+).
    • 1st dose appointments through Buncombe County are available online at www.buncombeready.org or by calling 828-419-0095 (Mon-Fri. 8a-8p). There is no longer a waitlist.
      • If you know of individuals living in Buncombe County who are homebound and want to be vaccinated, they or their caregiver can call 828-419-0095 to be put on the county’s homebound vaccination list. Their caregivers also can be added to the list to be vaccinated at the same time.
    • Other vaccine providers can be found at myspot.nc.gov.

The public has been encouraged to contact their healthcare provider or seek medical care if they develop severe headache, abdominal pain, leg pain, or shortness of breath within 3 weeks after receiving the J&J COVID-19 vaccine.

Recommendations For Clinicians

  1. Pause the use of the J&J COVID-19 vaccine until the ACIP is able to further review these CVST cases in the context of thrombocytopenia and assess their potential significance.
  2. Maintain a high index of suspicion for symptoms that might represent serious thrombotic events or thrombocytopenia in patients who have recently received the J&J COVID-19 vaccine, including severe headache, backache, new neurologic symptoms, severe abdominal pain, shortness of breath, leg swelling, petechiae (tiny red spots on the skin), or new or easy bruising. Obtain platelet counts and screen for evidence of immune thrombotic thrombocytopenia.
  3. In patients with a thrombotic event and thrombocytopenia after the J&J COVID-19 vaccine, evaluate initially with a screening PF4 enzyme-linked immunosorbent (ELISA) assay as would be performed for autoimmune HIT. Consultation with a hematologist is strongly recommended.
  4. Do not treat patients with thrombotic events and thrombocytopenia following receipt of J&J COVID-19 vaccine with heparin, unless HIT testing is negative.
  5. If HIT testing is positive or unable to be performed in patient with thrombotic events and thrombocytopenia following receipt of J&J COVID-19 vaccine, non-heparin anticoagulants and high-dose intravenous immune globulin should be strongly considered.
  6. Report adverse events to VAERS, including serious and life-threatening adverse events and deaths in patients following receipt of COVID-19 vaccines as required under the Emergency Use Authorizations for COVID-19 vaccines.
    • All clinically important adverse events that occur after vaccination of adults and children should be reported to VAERS, even if you are not sure whether the vaccine caused the adverse event.

Please see the information below about a clinician call today from 2-3pm on detection and treatment of CVST with thrombocytopenia.


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Johnson & Johnson/Janssen COVID-19 Vaccine and Cerebral Venous Sinus Thrombosis with Thrombocytopenia – Update for Clinicians on Early Detection and Treatment


You may participate in this COCA Call via Zoom





This COCA Call will present the latest evidence on cerebral venous sinus thrombosis (CVST) with thrombocytopenia associated with the administration of the Johnson & Johnson/Janssen COVID-19 vaccine. Speakers will discuss what is known about CVST, the importance of early detection, and updated vaccine recommendations.


If you are unable to attend the live COCA Call, the recording will be available for viewing on the COCA Call webpage a few hours after the live event ends.


The slide set will be available under "Call Materials" on the COCA Call webpage the day of the call.


Continuing Education (CE) will not be provided for this call.


Advanced registration is not required.

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Date: Thursday, April 15, 2021


Time: 2:00 pm - 3:00 pm (ET)


A few minutes before the webinar starts, please click on the Zoom link below to join: https://www.zoomgov.com/j/




Or iPhone one-tap : 

US: +16692545252,,1614336614#,,,,*160026# 

or +16468287666,,1614336614#,,,,*160026#


Or Telephone: Dial (for higher quality, dial a number based on your current location): 

US +1 669 254 5252 or

+1 646 828 7666 or

+1 551 285 1373 or

+1 669 216 1590


Webinar ID: 161 433 6614




International numbers available: https://www.zoomgov.com/u/acVEZz9i4e



COCA Call Objectives


At the conclusion of the session, the participant will be able to accomplish the following—


  1. Cite background information on the topic covered during the presentation.
  2. Discuss CDC’s role in the topic covered during the presentation.
  3. Describe the topic’s implications for clinicians.
  4. Discuss concerns and/or issues related to preparedness for and/or response to urgent public health threats.
  5. Promote health improvement, wellness, and disease prevention in cooperation with patients, communities, at-risk populations, and other members of an interprofessional team of healthcare providers.




Sara Oliver, MD

LCDR, U.S. Public Health Service

Co-lead, Advisory Committee for Immunization Practices COVID-19 Vaccines Work Group

COVID-19 Response

Centers for Disease Control and Prevention


Tom Shimabukuro, MD, MPH, MBA

CAPT, U.S. Public Health Service

Vaccine Safety Team Lead

COVID-19 Response

Centers for Disease Control and Prevention





The Emergency Risk Communication Branch in the Division of Emergency Operations, Center for Preparedness and Response is responsible for the management of all COCA products.

For information about this update or other clinical issues, or to send your feedback, please contact us at coca@cdc.gov



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