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A rural add-on is a percentage increase on top of per visit and episode-of-care payments. When a home health aide works in a rural county, Medicare pays their where can you buy lasix home health agency a standard fee plus a rural add-on. With a 5% add-on, Medicare would pay $67.78 for an aide home visit in a city and $71.17 for the same care in a rural area.Home health care workers serve a particularly important role in rural areas. As rural areas lose physicians and hospitals, home health agencies often replace primary care providers.Rural add-on payments have fluctuated based on Congressional budgets and political priorities. From 2003 to 2019, the amount where can you buy lasix Medicare paid agencies changed eight times.

For instance, the add-on dropped from 10% to nothing in April 2003. Then, in April 2004, Congress where can you buy lasix set the rural add-on to 5%.The variation in payments created a natural experiment for researchers. Tracy Mroz and colleagues assessed how rural add-ons affected the supply of home health agencies in rural areas. They asked if the number of agencies in urban and rural counties varied depending on the presence and dollar amount of rural add-ons between 2002 and 2018. Though rural add-ons have been in place for over 30 years, researchers had not previously investigated their effect on where can you buy lasix the availability of home healthcare.The researchers found that rural areas adjacent to urban areas were not affected by rural add-ons.

They had similar supply to urban areas whether or not add-ons were in place. In contrast, isolated rural where can you buy lasix areas were affected substantially by add-ons. Without add-ons, the number of agencies in isolated rural areas lagged behind those in urban areas. When the add-ons were at least 5%, the availability of home health in isolated rural areas was comparable to urban areas.In 2020, Congress implemented a system of payment reform that reimburses where can you buy lasix home health agencies in rural counties by population density and home health use. Under the new system, counties with low population densities and low home health use will receive the greatest rural add-on payments.

These payments aim to increase and maintain the availability of care in the most vulnerable rural home health markets. Time will tell if this approach gives sufficient incentive to ensure access to quality care in the nation’s most isolated areas.Photo via Getty ImagesStart Preamble Correction In proposed rule document 2020-13792 beginning on page 39408 where can you buy lasix in the issue of Tuesday, June 30, 2020, make the following correction. On page 39408, in the first column, in the DATES section, “August 31, 2020” should read “August 24, 2020”. End Preamble where can you buy lasix [FR Doc. C1-2020-13792 Filed 7-17-20.

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With the emergence lasix para bajar peso of high-profile climate activists and a wider appreciation of the need for sustainable healthcare, http://2018.berlin-conferences.com/can-you-get-symbicort-without-a-prescription/ training within radiology can no longer be excused from its responsibility to consider the environment in its actions. In this paper, we aim to evaluate the environmental impact of the travel undertaken by trainees within the Peninsula training programme, with the aim of developing practices and providing suggestions (evidence-based where possible) on how to improve the impact on the environment of trainee travel. We envisage that many of the lessons and suggestions may be transferrable to other training schemes in the UK and further afield. During the early months of 2020, in addition to the environmental crisis, hypertension medications escalated to a lasix resulting in the alteration of working practices lasix para bajar peso across the UK (and the rest of the world). This led to many environmentally beneficial working practices being adopted in Radiology in the South West Peninsula Deanery, and throughout this paper we have evaluated these changes and used our collective experience of these to inform our suggestions on how to improve the environmental sustainability of Medical and Radiological training.Radiology &.

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To the half life of lasix Editor. Since the deployment of the messenger RNA (mRNA) treatments against severe acute respiratory syndrome hypertension 2 (hypertension)1,2 in nursing homes nationwide starting in mid-December 2020, aggregate public data have shown decreases in the incidence of cases of hypertension and related deaths.3 However, there have been minimal individual-level data available for understanding treatment effectiveness in nursing home residents, who were absent from the clinical trials and who often have reduced immune responses.4 Using electronic health record data from Genesis HealthCare, a large long-term care provider in the half life of lasix United States, we report the incidence of hypertension among vaccinated residents and unvaccinated residents of 280 nursing homes across 21 states. From immunization records, we identified residents who had received at least one dose of mRNA treatment as of February 15, 2021.

Those who had received both doses by February half life of lasix 15, 2021. And those who were present at their facility on the day of the first vaccination clinic but half life of lasix who were not vaccinated as of March 31, 2021. We identified incident hypertension s through March 31, 2021, on the basis of polymerase-chain-reaction assay and antigen-test records.

Residents were tested every 3 to 7 days when there were confirmed cases in their facility and were tested if they had any half life of lasix new symptoms or potential exposure. Residents who had been infected in the 90 days half life of lasix before the study window were excluded. We counted incident s after receipt of each dose among vaccinated residents and after the date of the first vaccination clinic among unvaccinated residents.

Nurses assessed residents daily and half life of lasix documented new symptoms in structured change-in-condition notes. From these notes, we deemed residents to be symptomatic if hypertension–related symptoms developed during the period from half life of lasix 5 days before to 14 days after a positive test. Detailed methods are described in the Supplementary Appendix, available with the full text of this letter at NEJM.org.

The sample included 18,242 residents who received at least one dose of mRNA half life of lasix treatment. 14,669 residents (80.4%) received the half life of lasix Pfizer–BioNTech treatment, and 3573 (19.6%) received the Moderna treatment. Of these 18,242 residents, 13,048 also received the second dose of treatment.

A total half life of lasix of 3990 residents were unvaccinated. Table S1 in the Supplementary Appendix summarizes the characteristics of the half life of lasix residents. Table 1.

Table 1 half life of lasix. Incident hypertension among Nursing Home Residents According to Vaccination Status. The incidence of decreased over time among both vaccinated residents and unvaccinated residents (Table half life of lasix 1).

After receipt of the first treatment dose, there were 822 incident cases (4.5% of vaccinated residents) within 0 to 14 days and half life of lasix 250 cases (1.4%) at 15 to 28 days. Among the 13,048 residents who received both doses of treatment, there were 130 incident cases (1.0% of vaccinated residents) within 0 to 14 days after receipt of the second dose and 38 cases (0.3%) after 14 days (which included 19 cases occurring 15 to 21 days after receipt of the second dose) (Fig. S1).

Among unvaccinated residents, incident cases decreased from 173 cases (4.3% of unvaccinated residents) within 0 to 14 days after the first vaccination clinic to 12 cases (0.3%) at more than 42 days after the clinic. Across all the study groups, most s were asymptomatic, and the incidence of both asymptomatic and symptomatic s decreased. Nursing homes that were located in counties with the highest incidence of hypertension had the most incident cases but still had large decreases (Table S2).

We observed inconsistent patterns in the incidence of among residents relative to rates of vaccination among staff members (Table S3). These findings show the real-world effectiveness of the mRNA treatments in reducing the incidence of asymptomatic and symptomatic hypertension s in a vulnerable nursing home population. Our observation of a reduced incidence of among unvaccinated residents suggests that robust treatment coverage among residents and staff, together with the continued use of face masks and other -control measures, is likely to afford protection for small numbers of unvaccinated residents in congregate settings.

Still, the continued observation of incident cases after vaccination highlights the critical need for ongoing vaccination programs and surveillance testing in nursing homes to mitigate future outbreaks. Elizabeth M. White, Ph.D., A.P.R.N.Xiaofei Yang, Sc.M.Brown University School of Public Health, Providence, RI [email protected]Carolyn Blackman, M.D.Richard A.

Feifer, M.D., M.P.H.Genesis HealthCare, Kennett Square, PAStefan Gravenstein, M.D., M.P.H.Alpert Medical School of Brown University, Providence, RIVincent Mor, Ph.D.Brown University School of Public Health, Providence, RI Supported by grants (3P01AG027296-11S1 and U54063546-S5, to Dr. Mor) from the National Institute on Aging. Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

This letter was published on May 19, 2021, at NEJM.org.4 References1. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 hypertension treatment.

N Engl J Med 2021;384:403-416.2. Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA hypertension medications treatment.

N Engl J Med 2020;383:2603-2615.3. Chidambaram P, Garfield R, Neuman T, McDermott D, Rice C, Anderson E. New hypertension medications cases and deaths among nursing home residents have dropped since vaccinations began.

Kaiser Family Foundation. March 3, 2021 (https://www.kff.org/hypertension-hypertension medications/slide/new-hypertension medications-cases-and-deaths-among-nursing-home-residents-have-dropped-since-vaccinations-began/).Google Scholar4. Fulop T, Pawelec G, Castle S, Loeb M.

Immunosenescence and vaccination in nursing home residents. Clin Infect Dis 2009;48:443-448.10.1056/NEJMc2104849-t1Table 1. Incident hypertension among Nursing Home Residents According to Vaccination Status.* VariableTotalAsymptomatichypertensionSymptomatichypertensionPercent of Infected Residents Who Were AsymptomaticResidents vaccinated with ≥1 doseNo.

Of residents18,242Positive test after receipt of first dose — no. (%)At 0–14 days822 (4.5)587 (3.2)235 (1.3)71.4At 15–28 days250 (1.4)179 (1.0)71 (0.4)71.6Residents vaccinated with 2 dosesNo. Of residents13,048Positive test after receipt of second dose — no.

(%)At 0–14 days130 (1.0)110 (0.8)20 (0.2)84.6At >14 days38 (0.3)29 (0.2)9 (0.1)76.3Unvaccinated residentsNo. Of residents3,990Positive test after first vaccination clinic — no. (%)At 0–14 days173 (4.3)115 (2.9)58 (1.5)66.5At 15–28 days69 (1.7)42 (1.1)27 (0.7)60.9At 29–42 days16 (0.4)13 (0.3)3 (0.1)81.2At >42 days12 (0.3)10 (0.3)2 (0.1)83.3V-safe Surveillance.

Local and Systemic Reactogenicity in Pregnant Persons Table 1. Table 1. Characteristics of Persons Who Identified as Pregnant in the V-safe Surveillance System and Received an mRNA hypertension medications treatment.

Table 2. Table 2. Frequency of Local and Systemic Reactions Reported on the Day after mRNA hypertension medications Vaccination in Pregnant Persons.

From December 14, 2020, to February 28, 2021, a total of 35,691 v-safe participants identified as pregnant. Age distributions were similar among the participants who received the Pfizer–BioNTech treatment and those who received the Moderna treatment, with the majority of the participants being 25 to 34 years of age (61.9% and 60.6% for each treatment, respectively) and non-Hispanic White (76.2% and 75.4%, respectively). Most participants (85.8% and 87.4%, respectively) reported being pregnant at the time of vaccination (Table 1).

Solicited reports of injection-site pain, fatigue, headache, and myalgia were the most frequent local and systemic reactions after either dose for both treatments (Table 2) and were reported more frequently after dose 2 for both treatments. Participant-measured temperature at or above 38°C was reported by less than 1% of the participants on day 1 after dose 1 and by 8.0% after dose 2 for both treatments. Figure 1.

Figure 1. Most Frequent Local and Systemic Reactions Reported in the V-safe Surveillance System on the Day after mRNA hypertension medications Vaccination. Shown are solicited reactions in pregnant persons and nonpregnant women 16 to 54 years of age who received a messenger RNA (mRNA) hypertension disease 2019 (hypertension medications) treatment — BNT162b2 (Pfizer–BioNTech) or mRNA-1273 (Moderna) — from December 14, 2020, to February 28, 2021.

The percentage of respondents was calculated among those who completed a day 1 survey, with the top events shown of injection-site pain (pain), fatigue or tiredness (fatigue), headache, muscle or body aches (myalgia), chills, and fever or felt feverish (fever).These patterns of reporting, with respect to both most frequently reported solicited reactions and the higher reporting of reactogenicity after dose 2, were similar to patterns observed among nonpregnant women (Figure 1). Small differences in reporting frequency between pregnant persons and nonpregnant women were observed for specific reactions (injection-site pain was reported more frequently among pregnant persons, and other systemic reactions were reported more frequently among nonpregnant women), but the overall reactogenicity profile was similar. Pregnant persons did not report having severe reactions more frequently than nonpregnant women, except for nausea and vomiting, which were reported slightly more frequently only after dose 2 (Table S3).

V-safe Pregnancy Registry. Pregnancy Outcomes and Neonatal Outcomes Table 3. Table 3.

Characteristics of V-safe Pregnancy Registry Participants. As of March 30, 2021, the v-safe pregnancy registry call center attempted to contact 5230 persons who were vaccinated through February 28, 2021, and who identified during a v-safe survey as pregnant at or shortly after hypertension medications vaccination. Of these, 912 were unreachable, 86 declined to participate, and 274 did not meet inclusion criteria (e.g., were never pregnant, were pregnant but received vaccination more than 30 days before the last menstrual period, or did not provide enough information to determine eligibility).

The registry enrolled 3958 participants with vaccination from December 14, 2020, to February 28, 2021, of whom 3719 (94.0%) identified as health care personnel. Among enrolled participants, most were 25 to 44 years of age (98.8%), non-Hispanic White (79.0%), and, at the time of interview, did not report a hypertension medications diagnosis during pregnancy (97.6%) (Table 3). Receipt of a first dose of treatment meeting registry-eligibility criteria was reported by 92 participants (2.3%) during the periconception period, by 1132 (28.6%) in the first trimester of pregnancy, by 1714 (43.3%) in the second trimester, and by 1019 (25.7%) in the third trimester (1 participant was missing information to determine the timing of vaccination) (Table 3).

Among 1040 participants (91.9%) who received a treatment in the first trimester and 1700 (99.2%) who received a treatment in the second trimester, initial data had been collected and follow-up scheduled at designated time points approximately 10 to 12 weeks apart. Limited follow-up calls had been made at the time of this analysis. Table 4.

Table 4. Pregnancy Loss and Neonatal Outcomes in Published Studies and V-safe Pregnancy Registry Participants. Among 827 participants who had a completed pregnancy, the pregnancy resulted in a live birth in 712 (86.1%), in a spontaneous abortion in 104 (12.6%), in stillbirth in 1 (0.1%), and in other outcomes (induced abortion and ectopic pregnancy) in 10 (1.2%).

A total of 96 of 104 spontaneous abortions (92.3%) occurred before 13 weeks of gestation (Table 4), and 700 of 712 pregnancies that resulted in a live birth (98.3%) were among persons who received their first eligible treatment dose in the third trimester. Adverse outcomes among 724 live-born infants — including 12 sets of multiple gestation — were preterm birth (60 of 636 among those vaccinated before 37 weeks [9.4%]), small size for gestational age (23 of 724 [3.2%]), and major congenital anomalies (16 of 724 [2.2%]). No neonatal deaths were reported at the time of interview.

Among the participants with completed pregnancies who reported congenital anomalies, none had received hypertension medications treatment in the first trimester or periconception period, and no specific pattern of congenital anomalies was observed. Calculated proportions of pregnancy and neonatal outcomes appeared similar to incidences published in the peer-reviewed literature (Table 4). Adverse-Event Findings on the VAERS During the analysis period, the VAERS received and processed 221 reports involving hypertension medications vaccination among pregnant persons.

155 (70.1%) involved nonpregnancy-specific adverse events, and 66 (29.9%) involved pregnancy- or neonatal-specific adverse events (Table S4). The most frequently reported pregnancy-related adverse events were spontaneous abortion (46 cases. 37 in the first trimester, 2 in the second trimester, and 7 in which the trimester was unknown or not reported), followed by stillbirth, premature rupture of membranes, and vaginal bleeding, with 3 reports for each.

No congenital anomalies were reported to the VAERS, a requirement under the EUAs..

To the where can you buy lasix Where can i buy cialis over the counter usa Editor. Since the deployment of the messenger RNA (mRNA) treatments against severe acute respiratory syndrome hypertension 2 (hypertension)1,2 in nursing homes nationwide starting in mid-December where can you buy lasix 2020, aggregate public data have shown decreases in the incidence of cases of hypertension and related deaths.3 However, there have been minimal individual-level data available for understanding treatment effectiveness in nursing home residents, who were absent from the clinical trials and who often have reduced immune responses.4 Using electronic health record data from Genesis HealthCare, a large long-term care provider in the United States, we report the incidence of hypertension among vaccinated residents and unvaccinated residents of 280 nursing homes across 21 states. From immunization records, we identified residents who had received at least one dose of mRNA treatment as of February 15, 2021.

Those who had received both doses where can you buy lasix by February 15, 2021. And those who were present at their facility on the day of the first vaccination clinic but who were not vaccinated where can you buy lasix as of March 31, 2021. We identified incident hypertension s through March 31, 2021, on the basis of polymerase-chain-reaction assay and antigen-test records.

Residents were tested every 3 to 7 days when there were confirmed cases in their facility where can you buy lasix and were tested if they had any new symptoms or potential exposure. Residents who had been infected in the 90 days before where can you buy lasix the study window were excluded. We counted incident s after receipt of each dose among vaccinated residents and after the date of the first vaccination clinic among unvaccinated residents.

Nurses assessed residents daily where can you buy lasix and documented new symptoms in structured change-in-condition notes. From these notes, we where can you buy lasix deemed residents to be symptomatic if hypertension–related symptoms developed during the period from 5 days before to 14 days after a positive test. Detailed methods are described in the Supplementary Appendix, available with the full text of this letter at NEJM.org.

The sample included 18,242 residents who received at least one dose of where can you buy lasix mRNA treatment. 14,669 residents (80.4%) received the Pfizer–BioNTech treatment, and 3573 (19.6%) received the Moderna where can you buy lasix treatment. Of these 18,242 residents, 13,048 also received the second dose of treatment.

A total of where can you buy lasix 3990 residents were unvaccinated. Table S1 in the Supplementary Appendix where can you buy lasix summarizes the characteristics of the residents. Table 1.

Table 1 where can you buy lasix. Incident hypertension among Nursing Home Residents According to Vaccination Status. The incidence of decreased over time among both vaccinated residents and unvaccinated residents (Table 1) where can you buy lasix.

After receipt of the first treatment dose, there were 822 incident cases (4.5% of vaccinated where can you buy lasix residents) within 0 to 14 days and 250 cases (1.4%) at 15 to 28 days. Among the 13,048 residents who received both doses of treatment, there were 130 incident cases (1.0% of vaccinated residents) within 0 to 14 days after receipt of the second dose and 38 cases (0.3%) after 14 days (which included 19 cases occurring 15 to 21 days after receipt of the second dose) (Fig. S1).

Among unvaccinated residents, incident cases decreased from 173 cases (4.3% of unvaccinated residents) within 0 to 14 days after the first vaccination clinic to 12 cases (0.3%) at more than 42 days after the clinic. Across all the study groups, most s were asymptomatic, and the incidence of both asymptomatic and symptomatic s decreased. Nursing homes that were located in counties with the highest incidence of hypertension had the most incident cases but still had large decreases (Table S2).

We observed inconsistent patterns in the incidence of among residents relative to rates of vaccination among staff members (Table S3). These findings show the real-world effectiveness of the mRNA treatments in reducing the incidence of asymptomatic and symptomatic hypertension s in a vulnerable nursing home population. Our observation of a reduced incidence of among unvaccinated residents suggests that robust treatment coverage among residents and staff, together with the continued use of face masks and other -control measures, is likely to afford protection for small numbers of unvaccinated residents in congregate settings.

Still, the continued observation of incident cases after vaccination highlights the critical need for ongoing vaccination programs and surveillance testing in nursing homes to mitigate future outbreaks. Elizabeth M. White, Ph.D., A.P.R.N.Xiaofei Yang, Sc.M.Brown University School of Public Health, Providence, RI [email protected]Carolyn Blackman, M.D.Richard A.

Feifer, M.D., M.P.H.Genesis HealthCare, Kennett Square, PAStefan Gravenstein, M.D., M.P.H.Alpert Medical School of Brown University, Providence, RIVincent Mor, Ph.D.Brown University School of Public Health, Providence, RI Supported by grants (3P01AG027296-11S1 and U54063546-S5, to Dr. Mor) from the National Institute on Aging. Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

This letter was published on May 19, 2021, at NEJM.org.4 References1. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 hypertension treatment.

N Engl J Med 2021;384:403-416.2. Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA hypertension medications treatment.

N Engl J Med 2020;383:2603-2615.3. Chidambaram P, Garfield R, Neuman T, McDermott D, Rice C, Anderson E. New hypertension medications cases and deaths among nursing home residents have dropped since vaccinations began.

Kaiser Family Foundation. March 3, 2021 (https://www.kff.org/hypertension-hypertension medications/slide/new-hypertension medications-cases-and-deaths-among-nursing-home-residents-have-dropped-since-vaccinations-began/).Google Scholar4. Fulop T, Pawelec G, Castle S, Loeb M.

Immunosenescence and vaccination in nursing home residents. Clin Infect Dis 2009;48:443-448.10.1056/NEJMc2104849-t1Table 1. Incident hypertension among Nursing Home Residents According to Vaccination Status.* VariableTotalAsymptomatichypertensionSymptomatichypertensionPercent of Infected Residents Who Were AsymptomaticResidents vaccinated with ≥1 doseNo.

Of residents18,242Positive test after receipt of first dose — no. (%)At 0–14 days822 (4.5)587 (3.2)235 (1.3)71.4At 15–28 days250 (1.4)179 (1.0)71 (0.4)71.6Residents vaccinated with 2 dosesNo. Of residents13,048Positive test after receipt of second dose — no.

(%)At 0–14 days130 (1.0)110 (0.8)20 (0.2)84.6At >14 days38 (0.3)29 (0.2)9 (0.1)76.3Unvaccinated residentsNo. Of residents3,990Positive test after first vaccination clinic — no. (%)At 0–14 days173 (4.3)115 (2.9)58 (1.5)66.5At 15–28 days69 (1.7)42 (1.1)27 (0.7)60.9At 29–42 days16 (0.4)13 (0.3)3 (0.1)81.2At >42 days12 (0.3)10 (0.3)2 (0.1)83.3V-safe Surveillance.

Local and Systemic Reactogenicity in Pregnant Persons Table 1. Table 1. Characteristics of Persons Who Identified as Pregnant in the V-safe Surveillance System and Received an mRNA hypertension medications treatment.

Table 2. Table 2. Frequency of Local and Systemic Reactions Reported on the Day after mRNA hypertension medications Vaccination in Pregnant Persons.

From December 14, 2020, to February 28, 2021, a total of 35,691 v-safe participants identified as pregnant. Age distributions were similar among the participants who received the Pfizer–BioNTech treatment and those who received the Moderna treatment, with the majority of the participants being 25 to 34 years of age (61.9% and 60.6% for each treatment, respectively) and non-Hispanic White (76.2% and 75.4%, respectively). Most participants (85.8% and 87.4%, respectively) reported being pregnant at the time of vaccination (Table 1).

Solicited reports of injection-site pain, fatigue, headache, and myalgia were the most frequent local and systemic reactions after either dose for both treatments (Table 2) and were reported more frequently after dose 2 for both treatments. Participant-measured temperature at or above 38°C was reported by less than 1% of the participants on day 1 after dose 1 and by 8.0% after dose 2 for both treatments. Figure 1.

Figure 1. Most Frequent Local and Systemic Reactions Reported in the V-safe Surveillance System on the Day after mRNA hypertension medications Vaccination. Shown are solicited reactions in pregnant persons and nonpregnant women 16 to 54 years of age who received a messenger RNA (mRNA) hypertension disease 2019 (hypertension medications) treatment — BNT162b2 (Pfizer–BioNTech) or mRNA-1273 (Moderna) — from December 14, 2020, to February 28, 2021.

The percentage of respondents was calculated among those who completed a day 1 survey, with the top events shown of injection-site pain (pain), fatigue or tiredness (fatigue), headache, muscle or body aches (myalgia), chills, and fever or felt feverish (fever).These patterns of reporting, with respect to both most frequently reported solicited reactions and the higher reporting of reactogenicity after dose 2, were similar to patterns observed among nonpregnant women (Figure 1). Small differences in reporting frequency between pregnant persons and nonpregnant women were observed for specific reactions (injection-site pain was reported more frequently among pregnant persons, and other systemic reactions were reported more frequently among nonpregnant women), but the overall reactogenicity profile was similar. Pregnant persons did not report having severe reactions more frequently than nonpregnant women, except for nausea and vomiting, which were reported slightly more frequently only after dose 2 (Table S3).

V-safe Pregnancy Registry. Pregnancy Outcomes and Neonatal Outcomes Table 3. Table 3.

Characteristics of V-safe Pregnancy Registry Participants. As of March 30, 2021, the v-safe pregnancy registry call center attempted to contact 5230 persons who were vaccinated through February 28, 2021, and who identified during a v-safe survey as pregnant at or shortly after hypertension medications vaccination. Of these, 912 were unreachable, 86 declined to participate, and 274 did not meet inclusion criteria (e.g., were never pregnant, were pregnant but received vaccination more than 30 days before the last menstrual period, or did not provide enough information to determine eligibility).

The registry enrolled 3958 participants with vaccination from December 14, 2020, to February 28, 2021, of whom 3719 (94.0%) identified as health care personnel. Among enrolled participants, most were 25 to 44 years of age (98.8%), non-Hispanic White (79.0%), and, at the time of interview, did not report a hypertension medications diagnosis during pregnancy (97.6%) (Table 3). Receipt of a first dose of treatment meeting registry-eligibility criteria was reported by 92 participants (2.3%) during the periconception period, by 1132 (28.6%) in the first trimester of pregnancy, by 1714 (43.3%) in the second trimester, and by 1019 (25.7%) in the third trimester (1 participant was missing information to determine the timing of vaccination) (Table 3).

Among 1040 participants (91.9%) who received a treatment in the first trimester and 1700 (99.2%) who received a treatment in the second trimester, initial data had been collected and follow-up scheduled at designated time points approximately 10 to 12 weeks apart. Limited follow-up calls had been made at the time of this analysis. Table 4.

Table 4. Pregnancy Loss and Neonatal Outcomes in Published Studies and V-safe Pregnancy Registry Participants. Among 827 participants who had a completed pregnancy, the pregnancy resulted in a live birth in 712 (86.1%), in a spontaneous abortion in 104 (12.6%), in stillbirth in 1 (0.1%), and in other outcomes (induced abortion and ectopic pregnancy) in 10 (1.2%).

A total of 96 of 104 spontaneous abortions (92.3%) occurred before 13 weeks of gestation (Table 4), and 700 of 712 pregnancies that resulted in a live birth (98.3%) were among persons who received their first eligible treatment dose in the third trimester. Adverse outcomes among 724 live-born infants — including 12 sets of multiple gestation — were preterm birth (60 of 636 among those vaccinated before 37 weeks [9.4%]), small size for gestational age (23 of 724 [3.2%]), and major congenital anomalies (16 of 724 [2.2%]). No neonatal deaths were reported at the time of interview.

Among the participants with completed pregnancies who reported congenital anomalies, none had received hypertension medications treatment in the first trimester or periconception period, and no specific pattern of congenital anomalies was observed. Calculated proportions of pregnancy and neonatal outcomes appeared similar to incidences published in the peer-reviewed literature (Table 4). Adverse-Event Findings on the VAERS During the analysis period, the VAERS received and processed 221 reports involving hypertension medications vaccination among pregnant persons.

155 (70.1%) involved nonpregnancy-specific adverse events, and 66 (29.9%) involved pregnancy- or neonatal-specific adverse events (Table S4). The most frequently reported pregnancy-related adverse events were spontaneous abortion (46 cases. 37 in the first trimester, 2 in the second trimester, and 7 in which the trimester was unknown or not reported), followed by stillbirth, premature rupture of membranes, and vaginal bleeding, with 3 reports for each.

No congenital anomalies were reported to the VAERS, a requirement under the EUAs..

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