# paper.pdf ## Metadata - PDFFormatVersion=1.3 - IsLinearized=false - IsAcroFormPresent=false - IsXFAPresent=false - IsCollectionPresent=false - IsSignaturesPresent=false - Producer=macOS Version 15.5 (Build 24F74) Quartz PDFContext - CreationDate=D:20260422185820Z00'00' - ModDate=D:20260422185820Z00'00' ## Contents ### Page 1 Supplementary Tables Supplementary Tables Title Page1 Diagnostic, laboratory, and procedural codes used to define study cohorts. 2-15 2 Diagnostic and procedural code definitions for all 50 outcomes. 16-17 3 Outcomes in male infected, unvaccinated individuals compared to naive controls (Group 2 vs Group 1) across four post-exposure time windows. 18-21 4 Outcomes in female infected, unvaccinated individuals compared to naive controls (Group 2 vs Group 1) across four post-exposure time windows. 22-25 5 Outcomes in male in vaccinated individuals without prior infection compared to naive controls (Group 3 vs Group 1) across four post-exposure time windows. 26-29 6 Outcomes in female vaccinated individuals without prior infection compared to naive controls (Group 3 vs Group 1) across four post-exposure time windows. 30-33 7 Outcomes in male in infected, vaccinated individuals compared to infected, unvaccinated individuals (Group 4 vs Group 2) across four post-exposure time windows. 34-38 8 Outcomes in female in infected, vaccinated individuals compared to infected, unvaccinated individuals (Group 4 vs Group 2) across four post-exposure time windows. 39-42 9 Outcomes in male vaccinated individuals without infection compared to infected, unvaccinated individuals (Group 3 vs Group 2) across four post-exposure time windows. 43-46 10 Outcomes in female vaccinated individuals without infection compared to infected, unvaccinated individuals (Group 3 vs Group 2) across four post-exposure time windows. 47-50 11 Dose-dependent protection against cardiovascular events during the acute phase following Pfizer- BioNTech vaccination. 51-54 12 Risk differences (RDs) with 95% confidence intervals and temporal trend p-values for six primary outcomes across four pairwise cohort comparisons, stratified by sex and four post-exposure time windows (0–3, 3–6, 6–9, and >9 months). 55-58 ### Page 2 Supplementary Table 1. Diagnostic, laboratory, and procedural codes used to define study cohorts.Study Group Criterion Type System Code Description All study cohorts InclusionDemographics HL7 V3.0 F/M Female gender or Male gender HL7 V3.0 1002-5 American Indian or Alaska Native HL7 V3.0 2028-9 Asian HL7 V3.0 2054-5 Black or African American HL7 V3.0 2076-8 Native Hawaiian or Other Pacific Islander HL7 V3.0 2106-3 White Healthcare utilization Visit count ≥2 visits At least 2 healthcare visits, Dec 1, 2020- Dec 31, 2024ExclusionClinical trials LNC 82786-5 Identifier Clinical trial protocol ICD-10-CM Z00.6 Encounter for examination for normal comparison and control in clinical research program LNC 35522-2 Clinical trial protocol Quality control and quality assurance section HCPCS S9996 Meals for clinical trial participant and one caregiver/companion HCPCS S9988 Services provided as part of a phase i clinical trial HCPCS S9990 Services provided as part of a phase ii clinical trial HCPCS S9991 Services provided as part of a phase iii clinical trial HCPCS G9537 Imaging needed as part of a clinical trial; or other clinician ordered the study Recent cardio/cerebral conditions last 12 months ICD-10-CM I20 Angina pectoris ICD-10-CM I21 Acute myocardial infarction ICD-10-CM I22 Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction ICD-10-CM I24.9 Acute ischemic heart disease, unspecified ICD-10-CM I25 Chronic ischemic heart disease ICD-10-CM I26-I28 Pulmonary heart disease and diseases of pulmonary circulation ICD-10-CM I26-I28 Pulmonary embolism ICD-10-CM I30 Acute pericarditis ICD-10-CM I31 Other diseases of pericardium ICD-10-CM I32 Pericarditis in diseases classified elsewhere ICD-10-CM I40 Acute myocarditis ICD-10-CM I41 Myocarditis in diseases classified elsewhere ICD-10-CM I42 Cardiomyopathy ICD-10-CM I47 Paroxysmal tachycardia ICD-10-CM I48 Atrial fibrillation and flutter ICD-10-CM I49 Other cardiac arrhythmias ICD-10-CM I50 Heart failure ICD-10-CM I51.4 Myocarditis, unspecified ICD-10-CM I51.7 Cardiomegaly ICD-10-CM I60-I69 Cerebrovascular diseases ICD-10-CM I61 Nontraumatic intracerebral hemorrhage ICD-10-CM I63 Cerebral infarction ICD-10-CM R00.0 Tachycardia, unspecified ICD-10-CM R00.1 Bradycardia, unspecified Congenital Heart Disease ICD-10-CM Q20 Congenital malformations of cardiac chambers and connections ICD-10-CM Q21 Congenital malformations of cardiac septa ICD-10-CM Q22 Congenital malformations of pulmonary and tricuspid valves ICD-10-CM Q23 Congenital malformations of aortic and mitral valves ICD-10-CM Q24 Other congenital malformations of heart ICD-10-CM Q25 Congenital malformations of great arteries ICD-10-CM Q26 Congenital malformations of great veins Neoplasm last 12 months ICD-10-CM C00-C14 Malignant neoplasms of lip, oral cavity and pharynx ICD-10-CM C15-C26 Malignant neoplasms of digestive organs ### Page 3 ICD-10-CM C30-C39 Malignant neoplasms of respiratory and intrathoracic organs ICD-10-CM C40-C41 Malignant neoplasms of bone and articular cartilage ICD-10-CM C43-C44 Melanoma and other malignant neoplasms of skin ICD-10-CM C45-C49 Malignant neoplasms of mesothelial and soft tissue ICD-10-CM C50-C50 Malignant neoplasms of breast (C50) ICD-10-CM C51-C58 Malignant neoplasms of female genital organs ICD-10-CM C60-C63 Malignant neoplasms of male genital organs ICD-10-CM C64-C68 Malignant neoplasms of urinary tract ICD-10-CM C69-C72 Malignant neoplasms of eye, brain and other parts of central nervous system ICD-10-CM C73-C75 Malignant neoplasms of thyroid and other endocrine glands ICD-10-CM C76-C80 Malignant neoplasms of ill-defined, other secondary and unspecified sites ICD-10-CM C7A-C7A Malignant neuroendocrine tumors (C7A) ICD-10-CM C7B-C7B Secondary neuroendocrine tumors (C7B) ICD-10-CM C81-C96 Malignant neoplasms of lymphoid, hematopoietic and related tissue Recent substance use disorders last 3 months ICD-10-CM F10 Alcohol related disorders ICD-10-CM F11 Opioid related disorders ICD-10-CM F12 Cannabis related disorders ICD-10-CM F13 Sedative, hypnotic, or anxiolytic related disorders ICD-10-CM F14 Cocaine related disorders ICD-10-CM F15 Other stimulant related disorders ICD-10-CM F16 Hallucinogen related disorders ICD-10-CM F19 Other psychoactive substance related disorders BMI outside desired range TNX 9083 BMI (at least 40.00 kg/m2 (most recent occurrence)) LNC 3915 Body Mass Index (at least 40.00 kg/m2 (most recent occurrence)) Pregnancy (past 9 months) ICD-10-CM Z33.1 Pregnant state, incidental ICD-10-CM O00-O9A Pregnancy, childbirth and the puerperium (all codes) ECOG performance status score outside desired range TNX 2002 ECOG Performance Status (at least 2.00 {score} (most recent occurrence)) LNC 89247-1 ECOG Performance Status score (at least 2.00 {score} (most recent occurrence)) Live vaccine within last 3 month CPT 90476 Adenovirus vaccine, type 4, live, for oral use CPT 90477 Adenovirus vaccine, type 7, live, for oral use RxNorm 221050 BCG, live, Tice strain CPT 90585 Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use CPT 90586 Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use CPT 90625 Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use RxNorm 798286 human-bovine reassortant rotavirus strain G1 vaccine RxNorm 798288 human-bovine reassortant rotavirus strain G2 vaccine RxNorm 798290 human-bovine reassortant rotavirus strain G3 vaccine RxNorm 798292 human-bovine reassortant rotavirus strain G4 vaccine RxNorm 798294 human-bovine reassortant rotavirus strain P1A[8] vaccine CPT 90660 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use CPT 90664 Influenza virus vaccine, live (LAIV), pandemic formulation, for intranasal use CPT 90672 Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use CPT 90673 Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein ### Page 4 only, preservative and antibiotic free, for intramuscular use RxNorm 1005911 influenza virus vaccine, live attenuated, A-Perth-16- 2009 (H3N2) strain RxNorm 1005909 Influenza Virus Vaccine, Live Attenuated, A- California-7-2009 (H1N1) strain (deprecated 2016) CPT 90705 Measles virus vaccine, live, for subcutaneous use (deprecated 2018) CPT 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use CPT 90710 Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use CPT 90708 Measles and rubella virus vaccine, live, for subcutaneous use (deprecated 2018) RxNorm 804179 measles virus vaccine live, Enders' attenuated Edmonston strain RxNorm 2603499 measles virus vaccine live, attenuated Schwarz strain SNOMED 5.72481E+14 Administration of live attenuated measles vaccine CPT 90704 Mumps virus vaccine, live, for subcutaneous use (deprecated 2018) RxNorm 798372 mumps virus vaccine live, Jeryl Lynn strain CPT 90712 Poliovirus vaccine, (any type[s]) (OPV), live, for oral use (deprecated 2018) RxNorm OMOP1004329 Poliomyelitis Virus Type 2 (Sabin Strain (P712, Ch, 2ab)) Live Attenuated Oral Vaccine RxNorm OMOP1004287 Poliomyelitis Virus Type 3 (Sabin Strain (Leon 12a1b)) Live Attenuated Oral Vaccine CPT 90680 Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use CPT 90681 Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use RxNorm 805573 rotavirus vaccine, live attenuated, G1P[8] human 89- 12 strain CPT 90706 Rubella virus vaccine, live, for subcutaneous use (deprecated 2018) RxNorm 762817 rubella virus vaccine live (Wistar RA 27-3 strain) RxNorm 762595 Salmonella typhi Ty21a live antigen CPT 90690 Typhoid vaccine, live, oral RxNorm 807219 typhoid Vi polysaccharide vaccine, S typhi Ty2 strain CPT 90716 Varicella virus vaccine (VAR), live, for subcutaneous use RxNorm 1292422 varicella-zoster virus vaccine live (Oka-Merck) strain CPT 90717 Yellow fever vaccine, live, for subcutaneous use RxNorm 804187 yellow fever virus strain 17D-204 live antigen CPT 90736 Zoster (shingles) vaccine (HZV), live, for subcutaneous injection Influenza flu last 12 months LNC 34487-9 Influenza virus A RNA [Presence] in Specimen by NAA with probe detection (labResult: Positive) LNC 38381-0 Influenza virus A cDNA [Presence] in Specimen by NAA with probe detection (labResult: Positive) LNC 38382-8 Influenza virus B [Presence] in Specimen by Organism specific culture (labResult: Positive) LNC 48310-7 Influenza virus A [Presence] in Specimen by Organism specific culture (labResult: Positive) LNC 49523-4 Influenza virus A H3 RNA [Presence] in Isolate by NAA with probe detection (labResult: Positive) LNC 49531-7 Influenza virus A RNA [Presence] in Isolate by NAA with probe detection (labResult: Positive) LNC 49535-8 Influenza virus B RNA [Presence] in Isolate by NAA with probe detection (labResult: Positive) LNC 49520-0 Influenza virus A H1 RNA [Presence] in Isolate by NAA with probe detection (labResult: Positive) ### Page 5 LNC 76078-5 Influenza virus A RNA [Presence] in Nasopharynx by NAA with probe detection (labResult: Positive) LNC 80588-7 Influenza virus A M gene [Presence] in Nasopharynx by NAA with probe detection (labResult: Positive) LNC 80590-3 Influenza virus A H3 HA gene [Presence] in Nasopharynx by NAA with probe detection (labResult: Positive) LNC 82166-0 Influenza virus A RNA [Presence] in Nasopharynx by NAA with non-probe detection (labResult: Positive) LNC 49521-8 Influenza virus A H1 RNA [Presence] in Specimen by NAA with probe detection (labResult: Positive) LNC 49524-2 Influenza virus A H3 RNA [Presence] in Specimen by NAA with probe detection (labResult: Positive) LNC 76079-3 Influenza virus B RNA [Presence] in Bronchoalveolar lavage by NAA with probe detection (labResult: Positive) LNC 76080-1 Influenza virus B RNA [Presence] in Nasopharynx by NAA with probe detection (labResult: Positive) LNC 77026-3 Influenza virus A H1 RNA [Presence] in Nasopharynx by NAA with probe detection (labResult: Positive) LNC 77027-1 Influenza virus A H3 RNA [Presence] in Nasopharynx by NAA with probe detection (labResult: Positive) LNC 82167-8 Influenza virus A H1 RNA [Presence] in Nasopharynx by NAA with non-probe detection (labResult: Positive) LNC 82169-4 Influenza virus A H3 RNA [Presence] in Nasopharynx by NAA with non-probe detection (labResult: Positive) LNC 82170-2 Influenza virus B RNA [Presence] in Nasopharynx by NAA with non-probe detection (labResult: Positive) LNC 92142-9 Influenza virus A RNA [Presence] in Respiratory system specimen by NAA with probe detection (labResult: Positive) LNC 40982-1 Influenza virus B RNA [Presence] in Specimen by NAA with probe detection (labResult: Positive) LNC 62462-7 Influenza virus A+B RNA [Presence] in Specimen by NAA with probe detection (labResult: Positive) HCV diagnosis + viral labs last 12 months LNC 5012-0 Hepatitis C virus RNA [Presence] in Specimen by NAA with probe detection (labResult: Positive) LNC 5010-4 Hepatitis C virus RNA [Presence] in Blood by NAA with probe detection (labResult: Positive) LNC 48576-3 Hepatitis C virus RNA [Presence] in Specimen by Probe with signal amplification (labResult: Positive) LNC 11259-9 Hepatitis C virus RNA [Presence] in Serum or Plasma by NAA with probe detection (labResult: Positive) LNC 49379-1 Hepatitis C virus RNA [Units/volume] (viral load) in Tissue by NAA with probe detection (at least 15.00 [IU]/mL (most recent occurrence)) LNC 49376-7 Hepatitis C virus RNA [Units/volume] (viral load) in Specimen by NAA with probe detection (at least 15.00 [IU]/mL (most recent occurrence)) LNC 49380-9 Hepatitis C virus RNA [#/volume] (viral load) in Specimen by NAA with probe detection (at least 50.00 {copies}/mL (most recent occurrence)) LNC 10676-5 Hepatitis C virus RNA [Units/volume] (viral load) in Serum or Plasma by Probe with amplification (at least 15.00 [IU]/mL (most recent occurrence)) LNC 49375-9 Hepatitis C virus RNA [Log #/volume] (viral load) in Tissue by NAA with probe detection (at least 1.10 {Log_copies}/mL (most recent occurrence)) LNC 50023-1 Hepatitis C virus RNA panel (viral load) in Serum or Plasma by NAA with probe detection (at least 15.00 units (most recent occurrence)) ### Page 6 LNC 20571-6 Hepatitis C virus RNA [#/volume] (viral load) in Serum or Plasma by Probe with signal amplification LNC 29609-5 Hepatitis C virus RNA [Units/volume] (viral load) in Serum or Plasma by Probe with signal amplification (at least 15.00 [IU]/mL (most recent occurrence)) LNC 20416-4 Hepatitis C virus RNA [#/volume] (viral load) in Serum or Plasma by NAA with probe detection (at least 50.00 {copies}/mL (most recent occurrence)) LNC 11011-4 Hepatitis C virus RNA [Units/volume] (viral load) in Serum or Plasma by NAA with probe detection (at least 15.00 [IU]/mL (most recent occurrence)) LNC 49605-9 Hepatitis C virus RNA [log units/volume] (viral load) in Specimen by NAA with probe detection (at least 1.10 {Log_IU}/mL (most recent occurrence)) LNC 38180-6 Hepatitis C virus RNA [log units/volume] (viral load) in Serum or Plasma by NAA with probe detection (at least 1.10 {Log_IU}/mL (most recent occurrence)) LNC 47252-2 Hepatitis C virus RNA [Log #/volume] (viral load) in Serum or Plasma by NAA with probe detection (at least 1.10 {log_copies}/mL (most recent occurrence)) LNC 42617-1 Hepatitis C virus RNA [log units/volume] (viral load) in Serum or Plasma by Probe with signal amplification (at least 1.10 {Log_IU}/mL (most recent occurrence)) LNC 49372-6 Hepatitis C virus RNA [Log #/volume] (viral load) in Specimen by NAA with probe detection (at least 1.10 {Log_copies}/mL (most recent occurrence)) LNC 49758-6 Hepatitis C virus RNA [Units/volume] (viral load) in Serum or Plasma by Probe and target amplification method detection limit = 5 iU/mL (at least 15.00 [IU]/mL (most recent occurrence)) LNC 34704-7 Hepatitis C virus RNA [Units/volume] (viral load) in Serum or Plasma by Probe and target amplification method detection limit = 50 iU/mL (at least 15.00 [IU]/mL (most recent occurrence)) CPT 87902 Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus CPT 81596 Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2- macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver CPT 86804 Hepatitis C antibody; confirmatory test (eg, immunoblot) CPT 86803 Hepatitis C antibody CPT 1014274 Hepatitis C antibody SNOMED 395197008 Hepatitis C viral load SNOMED 64411004 Hepatitis C antibody measurement SNOMED 397662006 Hepatitis C virus genotype determination RXNORM OMOP5179608 HEPATITIS C IMMUNE GLOBULIN (HUMAN) ICD-10-CM B17.10 Acute hepatitis C without hepatic coma ICD-10-CM B17.11 Acute hepatitis C with hepatic coma ICD-10-CM B17.1 Acute hepatitis C ICD-10-CM B18.2 Chronic viral hepatitis C ICD-10-CM B19.20 Unspecified viral hepatitis C without hepatic coma ICD-10-CM B19.21 Unspecified viral hepatitis C with hepatic coma Hepatitis B last 12 months ICD-10-CM B16 Acute hepatitis B ICD-10-CM B16.1 Acute hepatitis B with delta-agent without hepatic coma ICD-10-CM B19.1 Unspecified viral hepatitis B ICD-10-CM B19.10 Unspecified viral hepatitis B without hepatic coma ICD-10-CM B19.11 Unspecified viral hepatitis B with hepatic coma ### Page 7 ICD-10-CM Z22.51 Carrier of viral hepatitis B (deprecated 2018) ICD-10-CM B18.1 Chronic viral hepatitis B without delta-agent TNX 9059 Hepatitis B virus surface Ab [Units/volume] in Serum (at least 0.00 m[IU]/mL (most recent occurrence)) LNC 5195-3 Hepatitis B virus surface Ag [Presence] in Serum (labResult: Positive) HIV diagnosis or viral labs last 12 months ICD-10-CM B20 Human immunodeficiency virus [HIV] disease ICD-10-CM B20-B20 Human immunodeficiency virus [HIV] disease (B20) ICD-10-CM Z21 Asymptomatic human immunodeficiency virus [HIV] infection status ICD-10-CM O98.71 Human immunodeficiency virus [HIV] disease complicating pregnancy ICD-10-CM O98.72 Human immunodeficiency virus [HIV] disease complicating childbirth ICD-10-CM B97.35 Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere BIOM 3918|1 Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) BIOM 3859|1 Associated with HIV/AIDS HIV positive BIOM 3859 HIV Status SNOMED 315124004 HIV viral load SNOMED 446987006 HIV 1 genotyping LNC 59052-1 HIV 1+Hepatitis C virus RNA+Hepatitis B virus DNA [Presence] in Serum or Plasma by NAA with probe detection (labResult: Positive) LNC 48558-1 HIV genotype [Susceptibility] LNC 45182-3 HIV phenotype [Susceptibility] LNC 48346-1 HIV 1+O+2 Ab [Units/volume] in Serum or Plasma LNC 49573-9 HIV genotype [Susceptibility] in Isolate by Genotype method Narrative LNC 22358-6 HIV 2 Ab [Units/volume] in Serum LNC 83101-6 HIV 1+2 Ab and HIV1 p24 Ag panel- Serum or Plasma by Immunoassay LNC 85380-4 HIV immunoassay testing algorithm interpretation in Serum, Plasma or Blood LNC 73658-7 HIV 1 subtype in Specimen by NAA with probe detection LNC 29539-4 HIV 1 RNA [Log #/volume] (viral load) in Plasma by Probe with signal amplification (at least 1.30 {log_copies}/mL (most recent occurrence)) LNC 21008-8 HIV 1 RNA [#/volume] (viral load) in Serum or Plasma by Probe (at least 20.00 {copies}/mL (most recent occurrence)) LNC 23876-6 HIV 1 RNA [Units/volume] (viral load) in Plasma by Probe with signal amplification (at least 20.00 [IU]/mL (most recent occurrence)) LNC 10351-5 HIV 1 RNA [Units/volume] (viral load) in Serum or Plasma by Probe with amplification (at least 20.00 [IU]/mL (most recent occurrence)) LNC 59419-2 HIV 1 RNA [#/volume] (viral load) in Plasma by Probe with signal amplification (at least 20.00 {copies}/mL (most recent occurrence)) LNC 29541-0 HIV 1 RNA [Log #/volume] (viral load) in Serum or Plasma by NAA with probe detection (at least 1.30 {log_copies}/mL (most recent occurrence)) LNC 41498-7 HIV 1 RNA [#/volume] (viral load) in Cerebral spinal fluid by NAA with probe detection (at least 20.00 {copies}/mL (most recent occurrence)) LNC 41497-9 HIV 1 RNA [Log #/volume] (viral load) in Cerebral spinal fluid by NAA with probe detection (at least 1.30 {Log_copies}/mL (most recent occurrence)) LNC 70241-5 HIV 1 RNA [#/volume] (viral load) in Plasma by Probe and target amplification method detection limit ### Page 8 = 20 copies/mL (at least 20.00 {copies}/mL (most recent occurrence)) LNC 51780-5 HIV 1 RNA [Log #/volume] (viral load) in Serum or Plasma by Probe and target amplification method detection limit = 0.5 log copies/mL (at least 1.30 {Log_copies}/mL (most recent occurrence)) LNC 25835-0 HIV 1 RNA [Presence] in Serum or Plasma by NAA with probe detection (labResult: Positive) LNC 5018-7 HIV 1 RNA [Presence] in Specimen by NAA with probe detection (labResult: Positive) LNC 47359-5 HIV 1 RNA [Presence] in Serum or Plasma from Donor by Probe with amplification (labResult: Positive) LNC 42917-5 HIV 1 RNA [Presence] in Cerebral spinal fluid by NAA with probe detection (labResult: Positive) LNC 41513-3 HIV 1 RNA [#/volume] (viral load) in Serum or Plasma by Probe with amplification detection limit = 400 copies/mL (at least 20.00 {copies}/mL (most recent occurrence)) LNC 41514-1 HIV 1 RNA [Log #/volume] (viral load) in Serum or Plasma by Probe with amplification detection limit = 2.6 log copies/mL (at least 1.30 {Log_copies}/mL (most recent occurrence)) LNC 41515-8 HIV 1 RNA [#/volume] (viral load) in Serum or Plasma by Probe with amplification detection limit = 75 copies/mL (at least 20.00 {copies}/mL (most recent occurrence)) LNC 41516-6 HIV 1 RNA [Log #/volume] (viral load) in Serum or Plasma by Probe with amplification detection limit = 1.9 log copies/mL (at least 1.30 {Log_copies}/mL (most recent occurrence)) LNC 48510-2 HIV 1 RNA [Log #/volume] (viral load) in Serum or Plasma by Probe and target amplification method detection limit = 1.7 log copies/mL (at least 1.30 {Log_copies}/mL (most recent occurrence)) LNC 48511-0 HIV 1 RNA [#/volume] (viral load) in Serum or Plasma by Probe and target amplification method detection limit = 50 copies/mL (at least 20.00 {copies}/mL (most recent occurrence)) LNC 48552-4 HIV 1 RNA [Log #/volume] (viral load) in Serum or Plasma by Probe and target amplification method detection limit = 2.6 log copies/mL (at least 1.30 {Log_copies}/mL (most recent occurrence)) LNC 21333-0 HIV 1 RNA [#/volume] in Serum (at least 20.00 {copies}/mL (most recent occurrence)) LNC 62469-2 HIV 1 RNA [Units/volume] (viral load) in Serum or Plasma by NAA with probe detection (at least 20.00 [IU]/mL (most recent occurrence)) LNC 49890-7 HIV 1 RNA [Log #/volume] (viral load) in Specimen by NAA with probe detection (at least 1.30 {Log_copies}/mL (most recent occurrence)) LNC 25836-8 HIV 1 RNA [#/volume] (viral load) in Specimen by NAA with probe detection (at least 20.00 {copies}/mL (most recent occurrence)) LNC 20447-9 HIV 1 RNA [#/volume] (viral load) in Serum or Plasma by NAA with probe detection (at least 20.00 {copies}/mL (most recent occurrence)) TB within last 12 months ICD-10-CM A15-A19 Tuberculosis Influenza vaccinate last 12 months CPT 90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use CPT 90654 Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use ### Page 9 CPT 90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use CPT 90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use CPT 90657 Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use CPT 90658 Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use CPT 90660 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use CPT 90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use CPT 90662 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use CPT 90664 Influenza virus vaccine, live (LAIV), pandemic formulation, for intranasal use CPT 90666 Influenza virus vaccine (IIV), pandemic formulation, split virus, preservative free, for intramuscular use CPT 90667 Influenza virus vaccine (IIV), pandemic formulation, split virus, adjuvanted, for intramuscular use CPT 90668 Influenza virus vaccine (IIV), pandemic formulation, split virus, for intramuscular use CPT 90672 Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use CPT 90673 Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use CPT 90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use CPT 90682 Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use CPT 90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use CPT 90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use CPT 90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use CPT 90689 Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use CPT 90694 Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use CPT 90756 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use SNOMED 86198006 Administration of influenza vaccine ICD-10-PCS 3E02340 Introduction of Influenza Vaccine into Muscle, Percutaneous Approach Ever received non-Pfizer COVID vaccinateAstraZeneca (viral vector)CPT 91302 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus ### Page 10 Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5 mL dosage, for intramuscular use (deprecated 2024) CPT 0021A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5 mL dosage; first dose (deprecated 2024)Janssen (Johnson & Johnson) viral vector vaccinesCPT 91303 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5 mL dosage, for intramuscular use (deprecated 2024) CPT 0031A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5 mL dosage; single dose (deprecated 2024) CPT 0034A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5 mL dosage; booster dose (deprecated 2024)Moderna mRNA vaccinesCPT 91301 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage, for intramuscular use (deprecated 2024) CPT 0011A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; first dose (deprecated 2024) CPT 0012A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; second dose (deprecated 2024) CPT 0013A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; third dose (deprecated 2024) CPT 0094A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage; booster dose, when administered to individuals 18 years and over (deprecated 2024) CPT 0134A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, ### Page 11 bivalent, preservative free, 50 mcg/0.5 mL dosage, booster dose (deprecated 2024)Novavax (Protein Subunit)CPT 91304 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular useOther (Adjuvanted)CPT 0042A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage; second dose (deprecated 2024)Group 1: Naive (Uninfected/ Unvaccinated) ExclusionCOVID-19 infectionVarious See Group 2 No documented COVID-19 infection (all codes from Group 2) COVID-19 vaccination Various See Group 3 No documented COVID-19 vaccination (all codes from Group 3)Group 2: Infected, Unvaccinated InclusionCOVID-19 diagnosisICD-10-CM U07.1 COVID-19 ICD-10-CM U07.2 COVID-19, virus not identified (WHO) ICD-10-CM B97.2 Coronavirus as the cause of diseases classified elsewhere ICD-10-CM B34.2 Coronavirus infection, unspecified ICD-10-CM J12.81 Pneumonia due to SARS-associated coronavirus ICD-10-CM J12.82 Pneumonia due to coronavirus disease 2019 COVID-19 laboratory LOINC 94309-2 SARS-CoV-2 RNA [Presence] in Specimen by NAA with probe detection (Positive) LOINC 94500-6 SARS-CoV-2 RNA [Presence] in Respiratory system specimen by NAA with probe detection (Positive) LOINC 94308-4 SARS-CoV-2 N gene [Presence] in Specimen by NAA using CDC primer-probe set N2 (Positive) LOINC 94533-7 SARS-CoV-2 N gene [Presence] in Respiratory system specimen by NAA with probe detection (Positive) LOINC 94534-5 SARS-CoV-2 RdRp gene [Presence] in Respiratory system specimen by NAA with probe detection (Positive) LOINC 94559-2 SARS-CoV-2 ORF1ab region [Presence] in Respiratory system specimen by NAA with probe detection (Positive) LOINC 94745-7 SARS-CoV-2 RNA [Cycle Threshold #] in Respiratory system specimen by NAA with probe detection LOINC 94746-5 SARS-CoV-2 RNA [Cycle Threshold #] in Specimen by NAA with probe detection TriNetX 9088 SARS coronavirus 2 and related RNA [Presence] (Positive) TriNetX 9089 SARS coronavirus 2 IgG IgM Ab [Presence] in Serum or Plasma (Positive)ExclusionCOVID-19 vaccinationVarious See Group 3 No documented COVID-19 vaccination (all codes from Group 3)Group 3: Vaccinated Only (No Prior Infection) InclusionPfizer-BioNTech mRNA vaccinesFirst or second dose of monovalent vaccineCPT 91309 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use (deprecated 2024) ### Page 12 CPT 91308 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris- sucrose formulation, for intramuscular use (deprecated 2024) CPT 91305 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use (deprecated 2024) CPT 91306 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, for intramuscular use (deprecated 2024) CPT 91307 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris- sucrose formulation, for intramuscular use (deprecated 2024) CPT 91300 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted, for intramuscular use (deprecated 2024) CPT 0001A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; first dose (deprecated 2024) CPT 0002A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; second dose (deprecated 2024) CPT 0111A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage; first dose (deprecated 2024) CPT 0112A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage; second dose (deprecated 2024) CPT 0081A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose (deprecated 2024) CPT 0082A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent ### Page 13 reconstituted, tris-sucrose formulation; second dose (deprecated 2024) CPT 0071A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose (deprecated 2024) CPT 0072A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose (deprecated 2024) CPT 0051A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; first dose (deprecated 2024) CPT 0052A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; second dose (deprecated 2024)Booster dose of monovalent vaccineCPT 0053A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; third dose (deprecated 2024) CPT 0054A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; booster dose (deprecated 2024) CPT 0073A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; third dose (deprecated 2024) CPT 0074A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; booster dose (deprecated 2024) CPT 0094A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage; booster dose, when administered to individuals 18 years and over (deprecated 2024) CPT 0003A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease ### Page 14 [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; third dose (deprecated 2024) CPT 0004A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; booster dose (deprecated 2024)Bivalent vaccine CPT 0173A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, third dose CPT 91314 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use (deprecated 2024) CPT 91311 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use (deprecated 2024) CPT 91312 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use (deprecated 2024) CPT 0164A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 10 mcg/0.2 mL dosage, booster dose CPT 0154A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, booster dose (deprecated 2024) CPT 0144A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, booster dose (deprecated 2024) CPT 0124A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris- sucrose formulation, booster dose (deprecated 2024) CPT 91315 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use (deprecated 2024)Exclusion ### Page 15 COVID-19 infectionVarious See Group 2 No documented COVID-19 infection (all codes from Group 2)Group 4: Infected, Vaccinated InclusionCOVID-19 infectionVarious See Group 2 All COVID-19 diagnostic and laboratory codes from Group 2 COVID-19 vaccination Various See Group 3 All COVID-19 vaccine codes from Group 3 All outcomes were defined using validated ICD-10-CM diagnosis codes, SNOMED CT concepts, CPT procedure codes, and laboratory values. ### Page 16 Supplementary Table 2. Diagnostic and procedural code definitions for all 50 outcomes.Outcome Term System Code DescriptionCardiovascular EventsMajor adverse cardiovascular events ICD-10-CM I21 Acute myocardial infarction ICD-10-CM I22 Subsequent STEMI and NSTEMI ICD-10-CM I24 Other acute ischemic heart diseases ICD-10-CM I25.5 Ischemic cardiomyopathy ICD-10-CM I20 Angina pectoris ICD-10-CM I20-I25 Ischemic heart diseases ICD-10-CM I50 Heart failure ICD-10-CM I42 Cardiomyopathy ICD-10-CM I46 Cardiac arrest ICD-10-CM R56.0 Febrile convulsions ICD-10-CM R57.0 Cardiogenic shock ICD-10-CM I63 Cerebral infarction ICD-10-CM I65 Occlusion/stenosis of precerebral arteries ICD-10-CM I66 Occlusion/stenosis of cerebral arteries ICD-10-CM G45 Transient cerebral ischemic attacks ICD-10-CM I60 Nontraumatic subarachnoid hemorrhage ICD-10-CM I61 Nontraumatic intracerebral hemorrhage Cardiovascular disease ICD-10-CM I20-I25 Ischemic heart diseases ICD-10-CM I48 Atrial fibrillation and flutter ICD-10-CM I47 Paroxysmal tachycardia ICD-10-CM I49 Other cardiac arrhythmias ICD-10-CM I50 Heart failure ICD-10-CM I42 Cardiomyopathy ICD-10-CM I46 Cardiac arrest ICD-10-CM R57.0 Cardiogenic shock ICD-10-CM I30 Acute pericarditis ICD-10-CM I31 Other diseases of pericardium ICD-10-CM I32 Pericarditis in diseases classified elsewhere ICD-10-CM I40 Acute myocarditis ICD-10-CM I41 Myocarditis in diseases classified elsewhere ICD-10-CM I51.4 Myocarditis, unspecified ICD-10-CM I11 Hypertensive heart disease ICD-10-CM I26 Pulmonary embolism ICD-10-CM I82 Other venous embolism and thrombosis ICD-10-CM D75.84 Platelet-activating anti-PF4 disorders Ischemic heart disease ICD-10-CM I20-I25 Ischemic heart diseases Angina ICD-10-CM I20 Angina pectoris Acute coronary syndrome ICD-10-CM I24 Other acute ischemic heart diseases Myocardial infarction ICD-10-CM I21 Acute myocardial infarction ICD-10-CM I22 Subsequent STEMI and NSTEMI Ischemic cardiomyopathy ICD-10-CM I25.5 Ischemic cardiomyopathy Other cardiac diseases ICD-10-CM I51 Complications and ill-defined heart disease Cardiac ArrhythmiasArrhythmias (any) ICD-10-CM I48 Atrial fibrillation and flutter ICD-10-CM I47 Paroxysmal tachycardia ICD-10-CM I49 Other cardiac arrhythmias ICD-10-CM R00 Abnormalities of heart beat Atrial fibrillation and flutter ICD-10-CM I48 Atrial fibrillation and flutter Paroxysmal tachycardia ICD-10-CM I47 Paroxysmal tachycardia Other cardiac arrhythmias ICD-10-CM I49 Other cardiac arrhythmias Inflammatory Heart Disease Inflammatory heart disease ICD-10-CM I30 Acute pericarditis ICD-10-CM I31 Other diseases of pericardium ICD-10-CM I32 Pericarditis in diseases classified elsewhere ### Page 17 ICD-10-CM I40 Acute myocarditis ICD-10-CM I41 Myocarditis in diseases classified elsewhere ICD-10-CM I51.4 Myocarditis, unspecified ICD-10-CM I38 Endocarditis, valve unspecified ICD-10-CM I39 Endocarditis in diseases classified elsewhere Pericarditis ICD-10-CM I30 Acute pericarditis ICD-10-CM I31 Other diseases of pericardium ICD-10-CM I32 Pericarditis in diseases classified elsewhere Myocarditis ICD-10-CM I40 Acute myocarditis ICD-10-CM I41 Myocarditis in diseases classified elsewhere ICD-10-CM I51.4 Myocarditis, unspecified Endocarditis ICD-10-CM I38 Endocarditis, valve unspecified ICD-10-CM I39 Endocarditis in diseases classified elsewhere Heart Failure and Cardiomyopathy Hypertensive heart disease ICD-10-CM I11 Hypertensive heart disease Pulmonary heart diseases ICD-10-CM I26 Pulmonary embolism ICD-10-CM I27 Other pulmonary heart diseases ICD-10-CM I28 Other diseases of pulmonary vessels Heart failure ICD-10-CM I50 Heart failure Cardiomyopathy ICD-10-CM I42 Cardiomyopathy Cardiomegaly ICD-10-CM I51.7 Cardiomegaly Cardiogenic shock ICD-10-CM R57.0 Cardiogenic shock Cardiac arrest ICD-10-CM I46 Cardiac arrest Thrombotic Events Thrombotic disorders ICD-10-CM I26 Pulmonary embolism ICD-10-CM I82 Other venous embolism and thrombosis ICD-10-CM D75.84 Platelet-activating anti-PF4 disorders Pulmonary embolism ICD-10-CM I26 Pulmonary embolism Deep vein thrombosis ICD-10-CM I82 Other venous embolism and thrombosis Thrombosis with thrombocytopenia ICD-10-CM D75.84 Platelet-activating anti-PF4 disorders Cerebrovascular Events Cerebrovascular disease ICD-10-CM I60-I69 Cerebrovascular diseases ICD-10-CM G45 Transient cerebral ischemic attacks Transient ischemic attacks ICD-10-CM G45 Transient cerebral ischemic attacks Cerebral infarction ICD-10-CM I63 Cerebral infarction Cerebral occlusion/stenosis ICD-10-CM I65 Occlusion/stenosis of precerebral arteries ICD-10-CM I66 Occlusion/stenosis of cerebral arteries Intracerebral hemorrhage ICD-10-CM I61 Nontraumatic intracerebral hemorrhage Subarachnoid hemorrhage ICD-10-CM I60 Nontraumatic subarachnoid hemorrhage Lipid Profile Dyslipidemia ICD-10-CM E78 Disorders of lipoprotein metabolism Triglycerides ≥150 mg/dL LOINC 2571-8 Triglyceride [Mass/volume] in Serum or Plasma LOINC 3043-7 Triglyceride [Mass/volume] in Blood LOINC 12951-0 Triglyceride [Mass/volume] in Capillary blood Total cholesterol ≥200 mg/dL LOINC 2093-3 Cholesterol [Mass/volume] in Serum or Plasma LOINC 35200-5 Cholesterol [Mass/volume] in Serum or Plasma by VAP LDL cholesterol ≥130 mg/dL LOINC 2089-1 Cholesterol in LDL [Mass/volume] in Serum or Plasma LOINC 13457-7 Cholesterol in LDL [Mass/volume] in Serum or Plasma by calculation LOINC 18262-6 Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay HDL cholesterol <50 mg/dL LOINC 2085-9 Cholesterol in HDL [Mass/volume] in Serum or Plasma Cardiac Biomarkers Elevated Troponin I LOINC 10839-9 Troponin I.cardiac [Mass/volume] in Serum or Plasma LOINC 42757-5 Troponin I.cardiac [Mass/volume] in Blood ### Page 18 LOINC 89579-7 Troponin I.cardiac [Mass/volume] in Serum or Plasma by High sensitivity method LOINC 6598-7 Troponin I.cardiac [Mass/volume] in Serum or Plasma by Detection limit <= 0.01 ng/mL Elevated Natriuretic peptide B/prohormone LOINC 42637-9 Natriuretic peptide B [Mass/volume] in Blood LOINC 30934-4 Natriuretic peptide B [Mass/volume] in Serum or Plasma LOINC 35257-5 Natriuretic peptide B [Mass or Moles/volume] in Serum or Plasma LOINC 33762-6 NT-proBNP [Mass/volume] in Serum or Plasma LOINC 83107-3 NT-proBNP [Mass/volume] in Serum or Plasma by Immunoassay LOINC 33763-4 NT-proBNP [Moles/volume] in Serum or Plasma Healthcare Utilization Hospital admissions Visit Type Inpatient Inpatient hospital admission Emergency department visits Visit Type Emergency Emergency department encounter Outpatient encounters Visit Type Outpatient Outpatient clinic visit Intensive care unit admission SNOMED 305351004 Admission to intensive care unit SNOMED 309904001 Intensive care unit SNOMED 309905000 Admission to critical care unit Mechanical ventilation ICD-10-PCS 5A09 Assistance with Respiratory Ventilation ICD-10-PCS 5A19 Performance of Respiratory Ventilation CPT 94002 Ventilation assist and management, initiation of pressure or volume preset ventilators CPT 94003 Ventilation assist and management, hospital inpatient/observation, subsequent days CPT 94004 Ventilation assist and management, nursing facility, per day CPT 94005 Home ventilator management care plan oversight Extracorporeal membrane oxygenation CPT 33946-33989 Extracorporeal membrane oxygenation (ECMO) procedures ICD-10-PCS 5A15 Extracorporeal oxygenation Cardiology referrals SNOMED 183856001 Referral to cardiology service SNOMED 183857005 Referral to cardiologist Neurology referrals SNOMED 183866006 Referral to neurology service Referral to NEJM Custom N/A Study-specific referral query Mortality All-cause mortality Demographics Deceased Deceased status indicator ICD-10-CM R99 Ill-defined and unknown cause of mortality International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), Logical Observation Identifiers Names and Codes (LOINC), and Current Procedural Terminology (CPT) codes used to define study outcomes. ### Page 19 Supplementary Table 3. Outcomes in male infected, unvaccinated individuals compared to naive controls (Group 2 vs Group 1) across four post-exposure time windows.Time Outcome Group 2 (n=848,176)Group 1 (n=11,954,643) p-value RR (95%CI)Follow-up (months) 22 ± 16.2 22.7 ± 17.70-3 mo Major adverse cardiovascular events 9663 (1.1%) 140795 (1.2%) 0.001 0.97 (0.95-0.99) Cardiovascular disease 14202 (1.8%) 180094 (1.5%) <0.001 1.14 (1.12-1.16) Ischemic heart disease 6710 (0.8%) 92874 (0.8%) 0.795 1 (0.97-1.02) Myocardial angina 610 (0.1%) 9759 (0.1%) <0.001 0.83 (0.76-0.9) Acute coronary disease 1222 (0.1%) 5504 (0%) <0.001 2.94 (2.77-3.13) Myocardial infarction 3121 (0.3%) 21770 (0.2%) <0.001 1.92 (1.85-1.99) Ischemic cardiomyopathy 926 (0.1%) 9681 (0.1%) <0.001 1.27 (1.18-1.35) Arrythmias 15915 (2%) 160962 (1.4%) <0.001 1.45 (1.42-1.47) Atrial fibrillation and flutter 4822 (0.5%) 50869 (0.4%) <0.001 1.28 (1.25-1.32) Paroxysmal tachycardia 2557 (0.3%) 18336 (0.1%) <0.001 1.86 (1.78-1.94) Other cardiac arrythmias 6379 (0.7%) 53063 (0.4%) <0.001 1.64 (1.59-1.68) Inflammatory heart disease 2327 (0.2%) 13209 (0.1%) <0.001 2.34 (2.24-2.44) Pericarditis 1495 (0.2%) 8668 (0.1%) <0.001 2.28 (2.16-2.41) Myocarditis 279 (0%) 829 (0%) <0.001 4.44 (3.87-5.08) Endocarditis 752 (0.1%) 4448 (0%) <0.001 2.23 (2.07-2.41) Hypertensive heart disease 12479 (1.8%) 290424 (2.7%) <0.001 0.66 (0.65-0.67) Pulmonary heart diseases 5033 (0.5%) 23437 (0.2%) <0.001 2.88 (2.79-2.96) Heart Failure 4924 (0.5%) 46519 (0.4%) <0.001 1.43 (1.39-1.48) Cardiomyopathy 2362 (0.2%) 24400 (0.2%) <0.001 1.29 (1.24-1.35) Cardiomegaly 5574 (0.6%) 34686 (0.3%) <0.001 2.16 (2.1-2.22) Cardiogenic shock 752 (0.1%) 4453 (0%) <0.001 2.23 (2.06-2.41) Cardiac arrest 1832 (0.2%) 9581 (0.1%) <0.001 2.53 (2.4-2.66) Thrombotic disorders 6092 (0.6%) 28124 (0.2%) <0.001 2.91 (2.83-2.99) Pulmonary embolism 3384 (0.4%) 10927 (0.1%) <0.001 4.12 (3.96-4.28) Deep and superficial thrombosis 3921 (0.4%) 21826 (0.2%) <0.001 2.4 (2.32-2.48) Thrombosis with Thrombocytopenia 0 (0%) 10 (0%) 0.384 NA Elevated Troponin I 4359 (0.5%) 22633 (0.2%) <0.001 2.57 (2.49-2.66) Elevated Natriuretic peptide B 10193 (1.1%) 44289 (0.4%) <0.001 3.14 (3.07-3.21) Dyslipidemia 21348 (3.5%) 431563 (4.2%) <0.001 0.83 (0.82-0.84) Triglyceride ≥150 mg/dl 12159 (1.5%) 131864 (1.1%) <0.001 1.33 (1.31-1.36) Total cholesterol ≥200 mg/dl 6476 (0.8%) 126853 (1.1%) <0.001 0.73 (0.71-0.75) LDL-cholesterol ≥130 mg/dl 5758 (0.7%) 109241 (0.9%) <0.001 0.74 (0.72-0.76) HDL-cholesterol <50 mg/dl 18373 (2.5%) 276818 (2.5%) <0.001 1.03 (1.02-1.05) Cerebrovascular disease 4289 (0.5%) 55073 (0.4%) 0.001 1.05 (1.02-1.09) Transient ischemic attacks 771 (0.1%) 8266 (0.1%) <0.001 1.24 (1.15-1.33) Cerebral infarction 2146 (0.2%) 22595 (0.2%) <0.001 1.27 (1.21-1.32) Cerebral occlusion without infarction 1543 (0.2%) 19444 (0.2%) 0.041 1.06 (1-1.11) Intracerebral hemorrhage 585 (0.1%) 6089 (0%) <0.001 1.27 (1.16-1.38) Subarachnoid hemorrhage 329 (0%) 4263 (0%) 0.762 1.02 (0.91-1.14) Hospital admission 19728 (2.9%) 378635 (3.6%) <0.001 0.79 (0.78-0.8) Emergency visits 18523 (4.5%) 300448 (3.7%) <0.001 1.22 (1.2-1.24) Outpatient encounters 23366 (4.8%) 912680 (10.9%) <0.001 0.44 (0.44-0.45) Intensive care unit admission 1744 (0.2%) 37232 (0.3%) <0.001 0.63 (0.6-0.66) Mechanical ventilation 10711 (1.1%) 36860 (0.3%) <0.001 3.88 (3.8-3.97) Referral to Cardio services 10 (0%) 22 (0%) <0.001 5.99 (2.84-12.6) Referral to Neuro services 26 (0%) 247 (0%) 0.111 1.39 (0.93- 2.08) ECMO 289 (0%) 645 (0%) <0.001 5.9 (5.14-6.78) ECMO-VV 240 (0%) 233 (0%) <0.001 13.57 (11.3-16.2) ECMO-VA 98 (0%) 450 (0%) <0.001 2.87 (2.31-3.57) Mortality 25841 (2.7%) 75197 (0.6%) <0.001 4.53 (4.46-4.59) 3-6mo Major adverse cardiovascular events 3424 (0.4%) 47122 (0.4%) 0.184 1.02 (0.99-1.06) Cardiovascular disease 4189 (0.5%) 59611 (0.5%) 0.24 1.02 (0.99-1.05) Ischemic heart disease 2392 (0.3%) 31336 (0.3%) 0.015 1.05 (1.01-1.1) Myocardial angina 337 (0%) 3335 (0%) <0.001 1.34 (1.2-1.5) Acute coronary disease 386 (0%) 2340 (0%) <0.001 2.19 (1.97-2.44) Myocardial infarction 961 (0.1%) 7522 (0.1%) <0.001 1.71 (1.6-1.83) Ischemic cardiomyopathy 323 (0%) 3455 (0%) <0.001 1.24 (1.1-1.39) ### Page 20 Arrythmias 5337 (0.7%) 60040 (0.5%) <0.001 1.31 (1.27-1.34) Atrial fibrillation and flutter 1375 (0.1%) 17589 (0.1%) 0.042 1.06 (1-1.12) Paroxysmal tachycardia 825 (0.1%) 7167 (0.1%) <0.001 1.53 (1.43-1.65) Other cardiac arrythmias 1995 (0.2%) 19012 (0.2%) <0.001 1.43 (1.37-1.5) Inflammatory heart disease 632 (0.1%) 4564 (0%) <0.001 1.84 (1.69-2) Pericarditis 418 (0%) 3055 (0%) <0.001 1.81 (1.64-2.01) Myocarditis 46 (0%) 217 (0%) <0.001 2.8 (2.03-3.84) Endocarditis 224 (0%) 1520 (0%) <0.001 1.95 (1.69-2.24) Hypertensive heart disease 5242 (0.8%) 97351 (0.9%) <0.001 0.82 (0.8-0.84) Pulmonary heart diseases 1097 (0.1%) 8846 (0.1%) <0.001 1.67 (1.57-1.77) Heart Failure 1593 (0.2%) 16899 (0.1%) <0.001 1.28 (1.22-1.35) Cardiomyopathy 750 (0.1%) 8490 (0.1%) <0.001 1.18 (1.09-1.27) Cardiomegaly 1329 (0.1%) 10479 (0.1%) <0.001 1.71 (1.61-1.81) Cardiogenic shock 236 (0%) 1529 (0%) <0.001 2.04 (1.78-2.34) Cardiac arrest 557 (0.1%) 3547 (0%) <0.001 2.08 (1.9-2.27) Thrombotic disorders 1121 (0.1%) 10454 (0.1%) <0.001 1.45 (1.36-1.54) Pulmonary embolism 489 (0.1%) 4010 (0%) <0.001 1.63 (1.48-1.79) Deep and superficial thrombosis 891 (0.1%) 8091 (0.1%) <0.001 1.47 (1.38-1.58) Thrombosis with Thrombocytopenia 0 (0%) 10 (0%) 0.384 NA Elevated Troponin I 1134 (0.1%) 7063 (0.1%) <0.001 2.15 (2.02-2.29) Elevated Natriuretic peptide B 1627 (0.2%) 15043 (0.1%) <0.001 1.49 (1.41-1.56) Dyslipidemia 8318 (1.4%) 126938 (1.3%) <0.001 1.1 (1.07-1.12) Triglyceride ≥150 mg/dl 4393 (0.5%) 41471 (0.4%) <0.001 1.54 (1.49-1.58) Total cholesterol ≥200 mg/dl 4080 (0.5%) 37603 (0.3%) <0.001 1.55 (1.5-1.6) LDL-cholesterol ≥130 mg/dl 3591 (0.4%) 31978 (0.3%) <0.001 1.58 (1.53-1.64) HDL-cholesterol <50 mg/dl 7006 (1%) 77765 (0.7%) <0.001 1.4 (1.37-1.44) Cerebrovascular disease 1711 (0.2%) 19007 (0.2%) <0.001 1.22 (1.16-1.28) Transient ischemic attacks 414 (0%) 3294 (0%) <0.001 1.67 (1.51-1.85) Cerebral infarction 732 (0.1%) 7877 (0.1%) <0.001 1.24 (1.15-1.34) Cerebral occlusion without infarction 603 (0.1%) 6604 (0.1%) <0.001 1.22 (1.12-1.32) Intracerebral hemorrhage 177 (0%) 1625 (0%) <0.001 1.44 (1.23-1.68) Subarachnoid hemorrhage 109 (0%) 1045 (0%) 0.001 1.38 (1.13-1.68) Hospital admission 5600 (0.8%) 104777 (1%) <0.001 0.81 (0.78-0.83) Emergency visits 8228 (2.1%) 143424 (1.8%) <0.001 1.15 (1.12-1.17) Outpatient encounters 9303 (2%) 227398 (3.1%) <0.001 0.66 (0.65-0.68) Intensive care unit admission 516 (0.1%) 14079 (0.1%) <0.001 0.49 (0.45-0.54) Mechanical ventilation 1084 (0.1%) 9667 (0.1%) <0.001 1.51 (1.42-1.61) Referral to Cardio services 0 (0%) 10 (0%) 0.384 NA Referral to Neuro services 13 (0%) 154 (0%) 0.713 1.11 (0.63-1.96) ECMO 11 (0%) 121 (0%) 0.566 1.2 (0.65-2.22) ECMO-VV 10 (0%) 42 (0%) 0.001 3.14 (1.57-6.25) ECMO-VA 10 (0%) 88 (0%) 0.224 1.5 (0.78-2.88) Mortality 5285 (0.5%) 37694 (0.3%) <0.001 1.85 (1.79-1.9) 6-9mo Major adverse cardiovascular events 2743 (0.3%) 36661 (0.3%) 0.008 1.05 (1.01-1.1) Cardiovascular disease 3398 (0.4%) 45670 (0.4%) <0.001 1.08 (1.04-1.12) Ischemic heart disease 1863 (0.2%) 24258 (0.2%) 0.016 1.06 (1.01-1.11) Myocardial angina 293 (0%) 2671 (0%) <0.001 1.45 (1.29-1.64) Acute coronary disease 290 (0%) 1981 (0%) <0.001 1.94 (1.72-2.2) Myocardial infarction 678 (0.1%) 6546 (0.1%) <0.001 1.39 (1.28-1.5) Ischemic cardiomyopathy 245 (0%) 2460 (0%) <0.001 1.32 (1.16-1.5) Arrythmias 4539 (0.6%) 48207 (0.4%) <0.001 1.39 (1.35-1.43) Atrial fibrillation and flutter 1063 (0.1%) 13527 (0.1%) 0.051 1.06 (1-1.13) Paroxysmal tachycardia 650 (0.1%) 5395 (0%) <0.001 1.61 (1.48-1.74) Other cardiac arrythmias 1632 (0.2%) 14865 (0.1%) <0.001 1.5 (1.43-1.58) Inflammatory heart disease 416 (0%) 3579 (0%) <0.001 1.55 (1.4-1.71) Pericarditis 271 (0%) 2380 (0%) <0.001 1.51 (1.33-1.71) Myocarditis 33 (0%) 194 (0%) <0.001 2.24 (1.55-3.24) Endocarditis 153 (0%) 1199 (0%) <0.001 1.69 (1.43-2) Hypertensive heart disease 4286 (0.6%) 73291 (0.7%) <0.001 0.89 (0.86-0.92) Pulmonary heart diseases 764 (0.1%) 6783 (0.1%) <0.001 1.51 (1.41-1.63) Heart Failure 1204 (0.1%) 12729 (0.1%) <0.001 1.28 (1.21-1.36) Cardiomyopathy 581 (0.1%) 6285 (0%) <0.001 1.23 (1.13-1.34) ### Page 21 Cardiomegaly 965 (0.1%) 8470 (0.1%) <0.001 1.53 (1.44-1.64) Cardiogenic shock 179 (0%) 1231 (0%) <0.001 1.92 (1.64-2.25) Cardiac arrest 345 (0%) 3007 (0%) <0.001 1.52 (1.36-1.7) Thrombotic disorders 864 (0.1%) 8057 (0.1%) <0.001 1.45 (1.35-1.55) Pulmonary embolism 360 (0%) 3123 (0%) <0.001 1.54 (1.38-1.71) Deep and superficial thrombosis 688 (0.1%) 6306 (0%) <0.001 1.46 (1.35-1.58) Thrombosis with Thrombocytopenia 0 (0%) 0 (0%) NA NA Elevated Troponin I 946 (0.1%) 6284 (0%) <0.001 2.02 (1.88-2.16) Elevated Natriuretic peptide B 1256 (0.1%) 12212 (0.1%) <0.001 1.41 (1.33-1.5) Dyslipidemia 6953 (1.2%) 97409 (1%) <0.001 1.2 (1.17-1.22) Triglyceride ≥150 mg/dl 3803 (0.5%) 35202 (0.3%) <0.001 1.57 (1.52-1.62) Total cholesterol ≥200 mg/dl 3642 (0.4%) 31943 (0.3%) <0.001 1.63 (1.57-1.68) LDL-cholesterol ≥130 mg/dl 3108 (0.4%) 27497 (0.2%) <0.001 1.59 (1.54-1.65) HDL-cholesterol <50 mg/dl 5965 (0.9%) 63027 (0.6%) <0.001 1.48 (1.44-1.52) Cerebrovascular disease 1426 (0.2%) 15183 (0.1%) <0.001 1.27 (1.21-1.34) Transient ischemic attacks 365 (0%) 2799 (0%) <0.001 1.73 (1.55-1.93) Cerebral infarction 625 (0.1%) 6186 (0%) <0.001 1.35 (1.24-1.46) Cerebral occlusion without infarction 537 (0.1%) 5365 (0%) <0.001 1.33 (1.22-1.46) Intracerebral hemorrhage 149 (0%) 1268 (0%) <0.001 1.55 (1.31-1.84) Subarachnoid hemorrhage 101 (0%) 916 (0%) <0.001 1.45 (1.18-1.79) Hospital admission 4858 (0.7%) 71652 (0.7%) 0.202 1.02 (0.99-1.05) Emergency visits 7192 (1.8%) 121312 (1.6%) <0.001 1.19 (1.16-1.22) Outpatient encounters 7169 (1.6%) 146973 (2%) <0.001 0.78 (0.76-0.8) Intensive care unit admission 419 (0%) 10499 (0.1%) <0.001 0.54 (0.49-0.59) Mechanical ventilation 830 (0.1%) 7376 (0.1%) <0.001 1.52 (1.41-1.63) Referral to Cardio services 0 (0%) 10 (0%) 0.384 NA Referral to Neuro services 10 (0%) 141 (0%) 0.835 0.93 (0.49-1.77) ECMO 10 (0%) 98 (0%) 0.371 1.35 (0.7-2.58) ECMO-VV 10 (0%) 36 (0%) <0.001 3.66 (1.82-7.38) ECMO-VA 10 (0%) 66 (0%) 0.038 2 (1.03-3.88) Mortality 3884 (0.4%) 33172 (0.3%) <0.001 1.54 (1.49-1.59) >9mo Major adverse cardiovascular events 14065 (1.7%) 221027 (1.9%) <0.001 0.9 (0.88-0.91) Cardiovascular disease 17599 (2.2%) 277180 (2.4%) <0.001 0.92 (0.91-0.94) Ischemic heart disease 9374 (1.1%) 144237 (1.2%) <0.001 0.9 (0.88-0.92) Myocardial angina 1388 (0.1%) 17045 (0.1%) 0.006 1.08 (1.02-1.14) Acute coronary disease 1205 (0.1%) 11663 (0.1%) <0.001 1.37 (1.29-1.45) Myocardial infarction 3323 (0.4%) 40152 (0.3%) <0.001 1.11 (1.07-1.15) Ischemic cardiomyopathy 983 (0.1%) 13841 (0.1%) 0.062 0.94 (0.88-1) Arrythmias 23914 (3%) 310775 (2.7%) <0.001 1.14 (1.12-1.15) Atrial fibrillation and flutter 4846 (0.5%) 79539 (0.6%) <0.001 0.83 (0.8-0.85) Paroxysmal tachycardia 2823 (0.3%) 33364 (0.3%) <0.001 1.13 (1.09-1.17) Other cardiac arrythmias 7831 (0.9%) 94494 (0.8%) <0.001 1.13 (1.11-1.16) Inflammatory heart disease 1949 (0.2%) 20705 (0.2%) <0.001 1.25 (1.2-1.31) Pericarditis 1275 (0.1%) 13154 (0.1%) <0.001 1.28 (1.21-1.36) Myocarditis 127 (0%) 1015 (0%) <0.001 1.65 (1.37-1.98) Endocarditis 719 (0.1%) 7613 (0.1%) <0.001 1.25 (1.16-1.35) Hypertensive heart disease 27983 (4.1%) 472662 (4.5%) <0.001 0.9 (0.89-0.91) Pulmonary heart diseases 3387 (0.4%) 40376 (0.3%) <0.001 1.13 (1.09-1.17) Heart Failure 5371 (0.6%) 76587 (0.6%) <0.001 0.95 (0.93-0.98) Cardiomyopathy 2448 (0.3%) 35274 (0.3%) <0.001 0.93 (0.89-0.96) Cardiomegaly 4900 (0.5%) 54452 (0.4%) <0.001 1.21 (1.18-1.25) Cardiogenic shock 791 (0.1%) 8051 (0.1%) <0.001 1.3 (1.21-1.4) Cardiac arrest 2173 (0.2%) 20768 (0.2%) <0.001 1.39 (1.33-1.45) Thrombotic disorders 4410 (0.5%) 50647 (0.4%) <0.001 1.17 (1.14-1.21) Pulmonary embolism 1570 (0.2%) 18064 (0.1%) <0.001 1.16 (1.1-1.22) Deep and superficial thrombosis 3672 (0.4%) 40599 (0.3%) <0.001 1.21 (1.17-1.25) Thrombosis with Thrombocytopenia 0 (0%) 13 (0%) 0.32 NA Elevated Troponin I 6176 (0.7%) 54967 (0.4%) <0.001 1.51 (1.47-1.55) Elevated Natriuretic peptide B 6156 (0.7%) 84548 (0.7%) 0.934 1 (0.98-1.03) Dyslipidemia 44346 (7.8%) 690579 (7.2%) <0.001 1.08 (1.07-1.09) Triglyceride ≥150 mg/dl 25611 (3.2%) 287954 (2.5%) <0.001 1.29 (1.28-1.31) Total cholesterol ≥200 mg/dl 24812 (3%) 283101 (2.4%) <0.001 1.25 (1.24-1.27) ### Page 22 LDL-cholesterol ≥130 mg/dl 22463 (2.7%) 247832 (2.1%) <0.001 1.28 (1.26-1.3) HDL-cholesterol <50 mg/dl 37975 (5.5%) 486361 (4.5%) <0.001 1.22 (1.21-1.23) Cerebrovascular disease 6715 (0.7%) 96625 (0.8%) <0.001 0.94 (0.92-0.97) Transient ischemic attacks 1850 (0.2%) 21085 (0.2%) <0.001 1.16 (1.11-1.22) Cerebral infarction 2677 (0.3%) 37571 (0.3%) 0.01 0.95 (0.91-0.99) Cerebral occlusion without infarction 2383 (0.3%) 33350 (0.3%) 0.017 0.95 (0.91-0.99) Intracerebral hemorrhage 608 (0.1%) 8323 (0.1%) 0.383 0.96 (0.89-1.05) Subarachnoid hemorrhage 429 (0%) 5882 (0%) 0.434 0.96 (0.87-1.06) Hospital admission 32255 (4.9%) 457429 (4.6%) <0.001 1.06 (1.05-1.07) Emergency visits 43510 (11.4%) 774690 (10.1%) <0.001 1.13 (1.12-1.14) Outpatient encounters 39487 (8.9%) 722110 (10.2%) <0.001 0.87 (0.86-0.88) Intensive care unit admission 1747 (0.2%) 37950 (0.3%) <0.001 0.62 (0.59-0.65) Mechanical ventilation 4219 (0.4%) 46896 (0.4%) <0.001 1.21 (1.18-1.25) Referral to Cardio services 0 (0%) 56 (0%) 0.039 NA Referral to Neuro services 56 (0%) 1714 (0%) <0.001 0.43 (0.33-0.56) ECMO 44 (0%) 486 (0%) 0.262 1.19 (0.88-1.62) ECMO-VV 14 (0%) 159 (0%) 0.594 1.16 (0.67-2) ECMO-VA 35 (0%) 360 (0%) 0.161 1.28 (0.91-1.81) Mortality 18316 (1.9%) 216878 (1.7%) <0.001 1.11 (1.1-1.13) For outcomes where event counts were fewer than 10, TriNetX platform suppressed exact numbers and reported '10' for de-identification purposes; thus, relative risks may be overestimated or not statistically meaningful in these cases. When zero events were observed, this is indicated as '0'. Caution is warranted in the interpretation of RRs where numerators are at or below this privacy threshold. ECMO: Extracorporeal membrane oxygenation. ### Page 23 Supplementary Table 4. Outcomes in female infected, unvaccinated individuals compared to naive controls (Group 2 vs Group 1) across four post-exposure time windows.Time Outcome Group 2 (n=1,200,737)Group 1 (n=15,366,686) p-value RR (95%CI)Follow-up (months) 24 ± 16 25.1 ± 180-3 mo Major adverse cardiovascular events 8728 (0.7%) 104195 (0.7%) <0.001 1.07 (1.05 -1.1) Cardiovascular disease 13908 (1.2%) 147000 (1%) <0.001 1.25 (1.23 -1.27) Ischemic heart disease 5353 (0.4%) 56961 (0.4%) <0.001 1.18 (1.15 -1.21) Myocardial angina 517 (0%) 7045 (0%) 0.017 0.9 (0.82 -0.98) Acute coronary disease 962 (0.1%) 4007 (0%) <0.001 2.93 (2.73 -3.15) Myocardial infarction 2377 (0.2%) 13799 (0.1%) <0.001 2.12 (2.03 -2.21) Ischemic cardiomyopathy 401 (0%) 3218 (0%) <0.001 1.52 (1.37 -1.69) Arrythmias 18986 (1.7%) 160229 (1.1%) <0.001 1.63 (1.6 -1.65) Atrial fibrillation and flutter 3540 (0.3%) 34738 (0.2%) <0.001 1.26 (1.22 -1.3) Paroxysmal tachycardia 2226 (0.2%) 16640 (0.1%) <0.001 1.64 (1.57 -1.72) Other cardiac arrythmias 6315 (0.5%) 47653 (0.3%) <0.001 1.67 (1.62 -1.71) Inflammatory heart disease 1916 (0.1%) 11089 (0.1%) <0.001 2.12 (2.02 -2.22) Pericarditis 1362 (0.1%) 7775 (0%) <0.001 2.14 (2.02 -2.27) Myocarditis 199 (0%) 434 (0%) <0.001 5.59 (4.72 -6.61) Endocarditis 511 (0%) 3321 (0%) <0.001 1.88 (1.71 -2.06) Hypertensive heart disease 13577 (1.4%) 261625 (1.9%) <0.001 0.73 (0.71 -0.74) Pulmonary heart diseases 4287 (0.3%) 22981 (0.1%) <0.001 2.3 (2.23 -2.38) Heart Failure 4313 (0.3%) 35823 (0.2%) <0.001 1.5 (1.45 -1.54) Cardiomyopathy 1466 (0.1%) 12811 (0.1%) <0.001 1.4 (1.33 -1.48) Cardiomegaly 4713 (0.4%) 24776 (0.2%) <0.001 2.35 (2.28 -2.43) Cardiogenic shock 474 (0%) 2453 (0%) <0.001 2.36 (2.13 -2.6) Cardiac arrest 1270 (0.1%) 5670 (0%) <0.001 2.73 (2.57 -2.9) Thrombotic disorders 5047 (0.4%) 25393 (0.2%) <0.001 2.46 (2.39 -2.53) Pulmonary embolism 2645 (0.2%) 10314 (0.1%) <0.001 3.15 (3.01 -3.28) Deep and superficial thrombosis 3372 (0.3%) 18928 (0.1%) <0.001 2.19 (2.12 -2.28) Thrombosis with Thrombocytopenia 10 (0%) 10 (0%) <0.001 12.18 (5.1 -29.2) Elevated Troponin I 3806 (0.3%) 16355 (0.1%) <0.001 2.86 (2.76 -2.96) Elevated Natriuretic peptide B 9123 (0.7%) 40134 (0.3%) <0.001 2.84 (2.78 -2.9) Dyslipidemia 22612 (2.7%) 386766 (2.9%) <0.001 0.92 (0.91 -0.94) Triglyceride ≥150 mg/dl 11164 (1%) 95561 (0.6%) <0.001 1.54 (1.51 -1.57) Total cholesterol ≥200 mg/dl 10593 (1%) 149307 (1%) 0.019 0.98 (0.96 -1) LDL-cholesterol ≥130 mg/dl 8378 (0.7%) 108323 (0.7%) 0.009 1.03 (1.01 -1.05) HDL-cholesterol <50 mg/dl 15215 (1.4%) 170639 (1.1%) <0.001 1.23 (1.21 -1.25) Cerebrovascular disease 4353 (0.3%) 50891 (0.3%) <0.001 1.07 (1.03 -1.1) Transient ischemic attacks 890 (0.1%) 8973 (0.1%) <0.001 1.22 (1.14 -1.3) Cerebral infarction 2040 (0.2%) 20526 (0.1%) <0.001 1.22 (1.17 -1.28) Cerebral occlusion without infarction 1357 (0.1%) 15583 (0.1%) 0.019 1.07 (1.01 -1.13) Intracerebral hemorrhage 418 (0%) 4499 (0%) 0.015 1.13 (1.02 -1.25) Subarachnoid hemorrhage 269 (0%) 3278 (0%) 0.999 1 (0.88 -1.13) Hospital admission 27691 (3.2%) 448931 (3.5%) <0.001 0.91 (0.9 -0.92) Emergency visits 23033 (4%) 340741 (3.1%) <0.001 1.28 (1.27 -1.3) Outpatient encounters 25651 (4.2%) 992889 (9.6%) <0.001 0.44 (0.43 -0.44) Intensive care unit admission 1948 (0.2%) 39889 (0.2%) <0.001 0.61 (0.58 -0.64) Mechanical ventilation 7376 (0.6%) 26248 (0.2%) <0.001 3.45 (3.36 -3.54) Referral to Cardio services 10 (0%) 41 (0%) 0.001 2.97 (1.49 -5.93) Referral to Neuro services 33 (0%) 276 (0%) 0.04 1.46 (1.02 -2.09) ECMO 151 (0%) 313 (0%) <0.001 5.87 (4.84 -7.13) ECMO-VV 124 (0%) 130 (0%) <0.001 11.61 (9.1 -14.8) ECMO-VA 38 (0%) 210 (0%) <0.001 2.2 (1.56 -3.11) Mortality 20157 (1.5%) 60692 (0.4%) <0.001 4.04 (3.98 -4.11) 3-6mo Major adverse cardiovascular events 3862 (0.3%) 40961 (0.3%) <0.001 1.21 (1.17 -1.25) Cardiovascular disease 5506 (0.5%) 57871 (0.4%) <0.001 1.26 (1.22 -1.29) Ischemic heart disease 2347 (0.2%) 22820 (0.1%) <0.001 1.29 (1.24 -1.35) Myocardial angina 346 (0%) 2863 (0%) <0.001 1.48 (1.32 -1.65) Acute coronary disease 366 (0%) 1965 (0%) <0.001 2.28 (2.04 -2.55) Myocardial infarction 850 (0.1%) 5699 (0%) <0.001 1.83 (1.71 -1.97) Ischemic cardiomyopathy 173 (0%) 1288 (0%) <0.001 1.64 (1.4 -1.92) ### Page 24 Arrythmias 8580 (0.8%) 73028 (0.5%) <0.001 1.63 (1.59 -1.66) Atrial fibrillation and flutter 1321 (0.1%) 13319 (0.1%) <0.001 1.23 (1.16 -1.3) Paroxysmal tachycardia 1064 (0.1%) 7579 (0%) <0.001 1.73 (1.62 -1.84) Other cardiac arrythmias 2678 (0.2%) 20441 (0.1%) <0.001 1.65 (1.59 -1.72) Inflammatory heart disease 693 (0.1%) 4448 (0%) <0.001 1.91 (1.76 -2.07) Pericarditis 489 (0%) 3170 (0%) <0.001 1.89 (1.72 -2.08) Myocarditis 45 (0%) 137 (0%) <0.001 4 (2.86 -5.6) Endocarditis 216 (0%) 1310 (0%) <0.001 2.01 (1.74 -2.32) Hypertensive heart disease 6769 (0.7%) 101774 (0.7%) <0.001 0.93 (0.9 -0.95) Pulmonary heart diseases 1281 (0.1%) 9686 (0.1%) <0.001 1.64 (1.54 -1.73) Heart Failure 1700 (0.1%) 14675 (0.1%) <0.001 1.44 (1.37 -1.51) Cardiomyopathy 604 (0%) 5095 (0%) <0.001 1.45 (1.34 -1.58) Cardiomegaly 1415 (0.1%) 9372 (0.1%) <0.001 1.87 (1.77 -1.98) Cardiogenic shock 151 (0%) 938 (0%) <0.001 1.96 (1.65 -2.33) Cardiac arrest 426 (0%) 2464 (0%) <0.001 2.11 (1.9 -2.34) Thrombotic disorders 1419 (0.1%) 10669 (0.1%) <0.001 1.65 (1.56 -1.74) Pulmonary embolism 569 (0%) 4179 (0%) <0.001 1.67 (1.53 -1.83) Deep and superficial thrombosis 1144 (0.1%) 8140 (0.1%) <0.001 1.73 (1.63 -1.84) Thrombosis with Thrombocytopenia 0 (0%) 0 (0%) NA NA Elevated Troponin I 1212 (0.1%) 6191 (0%) <0.001 2.41 (2.27 -2.57) Elevated Natriuretic peptide B 1869 (0.1%) 15270 (0.1%) <0.001 1.54 (1.46 -1.61) Dyslipidemia 12128 (1.5%) 142899 (1.1%) <0.001 1.34 (1.31 -1.36) Triglyceride ≥150 mg/dl 5276 (0.5%) 39623 (0.3%) <0.001 1.77 (1.72 -1.82) Total cholesterol ≥200 mg/dl 7592 (0.7%) 58523 (0.4%) <0.001 1.79 (1.74 -1.83) LDL-cholesterol ≥130 mg/dl 5889 (0.5%) 42992 (0.3%) <0.001 1.83 (1.78 -1.88) HDL-cholesterol <50 mg/dl 7380 (0.7%) 61714 (0.4%) <0.001 1.65 (1.62 -1.69) Cerebrovascular disease 2165 (0.2%) 20495 (0.1%) <0.001 1.32 (1.26 -1.38) Transient ischemic attacks 552 (0%) 4244 (0%) <0.001 1.59 (1.46 -1.74) Cerebral infarction 884 (0.1%) 8020 (0.1%) <0.001 1.35 (1.26 -1.45) Cerebral occlusion without infarction 737 (0.1%) 6181 (0%) <0.001 1.46 (1.36 -1.58) Intracerebral hemorrhage 202 (0%) 1367 (0%) <0.001 1.8 (1.55 -2.09) Subarachnoid hemorrhage 114 (0%) 1006 (0%) 0.001 1.38 (1.14 -1.68) Hospital admission 11382 (1.3%) 169673 (1.4%) 0.049 0.98 (0.96 -1) Emergency visits 11419 (2.1%) 176828 (1.7%) <0.001 1.24 (1.22 -1.26) Outpatient encounters 12376 (2.1%) 286297 (3.1%) <0.001 0.69 (0.68 -0.71) Intensive care unit admission 790 (0.1%) 20620 (0.1%) <0.001 0.48 (0.44 -0.51) Mechanical ventilation 1090 (0.1%) 8270 (0.1%) <0.001 1.63 (1.53 -1.73) Referral to Cardio services 10 (0%) 16 (0%) <0.001 7.61 (3.45 -16.7) Referral to Neuro services 22 (0%) 199 (0%) 0.184 1.35 (0.87 -2.09) ECMO 10 (0%) 69 (0%) 0.089 1.77 (0.91 -3.43) ECMO-VV 10 (0%) 28 (0%) <0.001 4.35 (2.11 -8.95) ECMO-VA 10 (0%) 46 (0%) 0.004 2.65 (1.34 -5.25) Mortality 4970 (0.4%) 32324 (0.2%) <0.001 1.87 (1.82 -1.93) 6-9mo Major adverse cardiovascular events 3160 (0.3%) 33069 (0.2%) <0.001 1.22 (1.18 -1.27) Cardiovascular disease 4511 (0.4%) 46206 (0.3%) <0.001 1.29 (1.25 -1.33) Ischemic heart disease 1883 (0.2%) 18338 (0.1%) <0.001 1.29 (1.23 -1.35) Myocardial angina 321 (0%) 2403 (0%) <0.001 1.63 (1.45 -1.84) Acute coronary disease 227 (0%) 1643 (0%) <0.001 1.69 (1.47 -1.94) Myocardial infarction 671 (0.1%) 4942 (0%) <0.001 1.67 (1.54 -1.81) Ischemic cardiomyopathy 130 (0%) 1019 (0%) <0.001 1.56 (1.3 -1.87) Arrythmias 6860 (0.6%) 60884 (0.4%) <0.001 1.56 (1.52 -1.6) Atrial fibrillation and flutter 943 (0.1%) 10780 (0.1%) 0.02 1.08 (1.01 -1.16) Paroxysmal tachycardia 820 (0.1%) 5977 (0%) <0.001 1.69 (1.57 -1.82) Other cardiac arrythmias 2128 (0.2%) 16542 (0.1%) <0.001 1.62 (1.55 -1.7) Inflammatory heart disease 495 (0%) 3535 (0%) <0.001 1.72 (1.56 -1.89) Pericarditis 349 (0%) 2478 (0%) <0.001 1.72 (1.54 -1.93) Myocarditis 26 (0%) 147 (0%) <0.001 2.16 (1.42 -3.27) Endocarditis 149 (0%) 1035 (0%) <0.001 1.76 (1.48 -2.09) Hypertensive heart disease 5599 (0.6%) 80125 (0.6%) 0.036 0.97 (0.95 -1) Pulmonary heart diseases 982 (0.1%) 7603 (0%) <0.001 1.6 (1.5 -1.71) Heart Failure 1215 (0.1%) 11589 (0.1%) <0.001 1.3 (1.23 -1.38) Cardiomyopathy 476 (0%) 4052 (0%) <0.001 1.44 (1.31 -1.58) ### Page 25 Cardiomegaly 1196 (0.1%) 7971 (0.1%) <0.001 1.86 (1.75 -1.98) Cardiogenic shock 124 (0%) 768 (0%) <0.001 1.97 (1.63 -2.38) Cardiac arrest 298 (0%) 1920 (0%) <0.001 1.89 (1.68 -2.14) Thrombotic disorders 1139 (0.1%) 8432 (0.1%) <0.001 1.68 (1.58 -1.78) Pulmonary embolism 460 (0%) 3283 (0%) <0.001 1.72 (1.56 -1.9) Deep and superficial thrombosis 873 (0.1%) 6401 (0%) <0.001 1.68 (1.57 -1.81) Thrombosis with Thrombocytopenia 10 (0%) 10 (0%) <0.001 12.18 (5.1 -29.2) Elevated Troponin I 1101 (0.1%) 5637 (0%) <0.001 2.41 (2.26 -2.57) Elevated Natriuretic peptide B 1469 (0.1%) 12779 (0.1%) <0.001 1.44 (1.37 -1.52) Dyslipidemia 10235 (1.3%) 114886 (0.9%) <0.001 1.41 (1.38 -1.44) Triglyceride ≥150 mg/dl 4642 (0.4%) 34882 (0.2%) <0.001 1.77 (1.71 -1.82) Total cholesterol ≥200 mg/dl 6473 (0.6%) 51271 (0.4%) <0.001 1.74 (1.7 -1.79) LDL-cholesterol ≥130 mg/dl 5219 (0.5%) 38191 (0.3%) <0.001 1.83 (1.77 -1.88) HDL-cholesterol <50 mg/dl 6576 (0.6%) 52154 (0.4%) <0.001 1.75 (1.71 -1.79) Cerebrovascular disease 1831 (0.1%) 16855 (0.1%) <0.001 1.36 (1.29 -1.42) Transient ischemic attacks 488 (0%) 3680 (0%) <0.001 1.63 (1.48 -1.79) Cerebral infarction 727 (0.1%) 6503 (0%) <0.001 1.37 (1.27 -1.48) Cerebral occlusion without infarction 591 (0%) 5074 (0%) <0.001 1.43 (1.31 -1.56) Intracerebral hemorrhage 139 (0%) 1118 (0%) <0.001 1.52 (1.27 -1.81) Subarachnoid hemorrhage 105 (0%) 821 (0%) <0.001 1.56 (1.27 -1.91) Hospital admission 8724 (1%) 142580 (1.2%) <0.001 0.9 (0.88 -0.91) Emergency visits 10084 (1.9%) 151187 (1.4%) <0.001 1.28 (1.26 -1.31) Outpatient encounters 9357 (1.6%) 188386 (2.1%) <0.001 0.79 (0.77 -0.8) Intensive care unit admission 674 (0.1%) 15716 (0.1%) <0.001 0.53 (0.49 -0.57) Mechanical ventilation 809 (0.1%) 6368 (0%) <0.001 1.57 (1.46 -1.69) Referral to Cardio services 0 (0%) 10 (0%) 0.365 NA Referral to Neuro services 14 (0%) 207 (0%) 0.481 0.82 (0.48 -1.42) ECMO 10 (0%) 39 (0%) 0.001 3.12 (1.56 -6.26) ECMO-VV 10 (0%) 12 (0%) <0.001 10.15 (4.4 -23.5) ECMO-VA 10 (0%) 25 (0%) <0.001 4.87 (2.34 -10.1) Mortality 3680 (0.3%) 28578 (0.2%) <0.001 1.57 (1.52 -1.62) >9mo Major adverse cardiovascular events 15786 (1.3%) 220036 (1.4%) <0.001 0.92 (0.91 -0.93) Cardiovascular disease 22329 (2%) 301987 (2%) 0.002 0.98 (0.97 -0.99) Ischemic heart disease 9303 (0.7%) 123490 (0.8%) <0.001 0.95 (0.93 -0.97) Myocardial angina 1498 (0.1%) 16055 (0.1%) <0.001 1.14 (1.08 -1.2) Acute coronary disease 1158 (0.1%) 10753 (0.1%) <0.001 1.32 (1.24 -1.4) Myocardial infarction 3195 (0.2%) 34519 (0.2%) <0.001 1.14 (1.1 -1.18) Ischemic cardiomyopathy 475 (0%) 5596 (0%) 0.468 1.04 (0.94 -1.14) Arrythmias 39202 (3.7%) 429856 (2.9%) <0.001 1.27 (1.26 -1.28) Atrial fibrillation and flutter 4228 (0.3%) 65831 (0.4%) <0.001 0.79 (0.77 -0.82) Paroxysmal tachycardia 3777 (0.3%) 40203 (0.3%) <0.001 1.16 (1.12 -1.2) Other cardiac arrythmias 10238 (0.8%) 108121 (0.7%) <0.001 1.19 (1.17 -1.22) Inflammatory heart disease 2397 (0.2%) 23161 (0.1%) <0.001 1.27 (1.22 -1.32) Pericarditis 1624 (0.1%) 15685 (0.1%) <0.001 1.27 (1.2 -1.33) Myocarditis 96 (0%) 754 (0%) <0.001 1.55 (1.25 -1.92) Endocarditis 801 (0.1%) 7578 (0%) <0.001 1.29 (1.2 -1.39) Hypertensive heart disease 35216 (3.6%) 555908 (4.1%) <0.001 0.88 (0.87 -0.89) Pulmonary heart diseases 4176 (0.3%) 48210 (0.3%) <0.001 1.07 (1.04 -1.11) Heart Failure 5316 (0.4%) 73227 (0.5%) <0.001 0.9 (0.88 -0.93) Cardiomyopathy 1868 (0.1%) 23791 (0.1%) 0.107 0.96 (0.92 -1.01) Cardiomegaly 5753 (0.4%) 56505 (0.4%) <0.001 1.26 (1.23 -1.3) Cardiogenic shock 605 (0%) 5435 (0%) <0.001 1.36 (1.25 -1.48) Cardiac arrest 1484 (0.1%) 14206 (0.1%) <0.001 1.28 (1.21 -1.35) Thrombotic disorders 5534 (0.4%) 58189 (0.4%) <0.001 1.18 (1.15 -1.21) Pulmonary embolism 1912 (0.1%) 20681 (0.1%) <0.001 1.14 (1.08 -1.19) Deep and superficial thrombosis 4572 (0.4%) 45781 (0.3%) <0.001 1.23 (1.2 -1.27) Thrombosis with Thrombocytopenia 10 (0%) 12 (0%) <0.001 10.15 (4.4 -23.4) Elevated Troponin I 7036 (0.5%) 55166 (0.3%) <0.001 1.57 (1.53 -1.61) Elevated Natriuretic peptide B 7707 (0.6%) 94741 (0.6%) 0.072 1.02 (1 -1.05) Dyslipidemia 66670 (8.4%) 919473 (7.3%) <0.001 1.15 (1.14 -1.16) Triglyceride ≥150 mg/dl 32118 (2.8%) 306738 (2%) <0.001 1.39 (1.38 -1.41) Total cholesterol ≥200 mg/dl 44690 (4.2%) 475316 (3.3%) <0.001 1.3 (1.29 -1.31) ### Page 26 LDL-cholesterol ≥130 mg/dl 36524 (3.3%) 361503 (2.4%) <0.001 1.35 (1.34 -1.37) HDL-cholesterol <50 mg/dl 43758 (4.2%) 454929 (3.1%) <0.001 1.34 (1.33 -1.35) Cerebrovascular disease 9151 (0.7%) 116412 (0.7%) 0.077 0.98 (0.96 -1) Transient ischemic attacks 2861 (0.2%) 29378 (0.2%) <0.001 1.19 (1.15 -1.24) Cerebral infarction 3409 (0.3%) 42517 (0.3%) 0.414 0.99 (0.95 -1.02) Cerebral occlusion without infarction 2872 (0.2%) 35135 (0.2%) 0.863 1 (0.97 -1.04) Intracerebral hemorrhage 650 (0%) 7934 (0%) 0.973 1 (0.92 -1.08) Subarachnoid hemorrhage 485 (0%) 6129 (0%) 0.44 0.96 (0.88 -1.06) Hospital admission 48472 (5.9%) 650596 (5.4%) <0.001 1.09 (1.08 -1.1) Emergency visits 59536 (11.2%) 998522 (9.7%) <0.001 1.15 (1.14 -1.16) Outpatient encounters 51349 (9.2%) 957650 (10.8%) <0.001 0.85 (0.84 -0.85) Intensive care unit admission 2609 (0.2%) 50492 (0.3%) <0.001 0.64 (0.62 -0.67) Mechanical ventilation 4045 (0.3%) 42625 (0.3%) <0.001 1.17 (1.13 -1.21) Referral to Cardio services 10 (0%) 56 (0%) 0.02 2.17 (1.11 -4.26) Referral to Neuro services 68 (0%) 2534 (0%) <0.001 0.33 (0.26 -0.42) ECMO 28 (0%) 304 (0%) 0.561 1.12 (0.76 -1.65) ECMO-VV 12 (0%) 100 (0%) 0.212 1.46 (0.8 -2.66) ECMO-VA 19 (0%) 218 (0%) 0.804 1.06 (0.66 -1.7) Mortality 18156 (1.4%) 198881 (1.2%) <0.001 1.11 (1.1 -1.13) For outcomes where event counts were fewer than 10, TriNetX platform suppressed exact numbers and reported '10' for de-identification purposes; thus, relative risks may be overestimated or not statistically meaningful in these cases. When zero events were observed, this is indicated as '0'. Caution is warranted in the interpretation of RRs where numerators are at or below this privacy threshold. ECMO: Extracorporeal membrane oxygenation. ### Page 27 Supplementary Table 5. Outcomes in male in vaccinated individuals without prior infection compared to naive controls (Group 3 vs Group 1) across four post-exposure time windows.Time Outcome Group 3 (n=613,395)Group 1 (n=11,250,469) p-value RR (95%CI)Follow-up (months) 22.9 ± 19.3 22.4 ± 17.50-3 mo Major adverse cardiovascular events 1753 (0.3%) 134603 (1.2%) <0.001 0.24 (0.23 -0.25) Cardiovascular disease 2258 (0.4%) 171975 (1.6%) <0.001 0.24 (0.23 -0.25) Ischemic heart disease 1249 (0.2%) 89703 (0.8%) <0.001 0.26 (0.24 -0.27) Myocardial angina 194 (0%) 9660 (0.1%) <0.001 0.37 (0.32 -0.43) Acute coronary disease 127 (0%) 5209 (0%) <0.001 0.45 (0.38 -0.53) Myocardial infarction 337 (0.1%) 20489 (0.2%) <0.001 0.3 (0.27 -0.34) Ischemic cardiomyopathy 166 (0%) 9354 (0.1%) <0.001 0.33 (0.28 -0.38) Arrythmias 2521 (0.4%) 151372 (1.4%) <0.001 0.31 (0.3 -0.32) Atrial fibrillation and flutter 686 (0.1%) 48900 (0.4%) <0.001 0.26 (0.24 -0.28) Paroxysmal tachycardia 415 (0.1%) 17571 (0.1%) <0.001 0.43 (0.39 -0.48) Other cardiac arrythmias 992 (0.2%) 50267 (0.4%) <0.001 0.37 (0.34 -0.39) Inflammatory heart disease 248 (0%) 12113 (0.1%) <0.001 0.38 (0.33 -0.43) Pericarditis 166 (0%) 7811 (0.1%) <0.001 0.39 (0.33 -0.45) Myocarditis 13 (0%) 778 (0%) <0.001 0.31 (0.18 -0.53) Endocarditis 81 (0%) 4208 (0%) <0.001 0.35 (0.28 -0.44) Hypertensive heart disease 3293 (0.6%) 276893 (2.7%) <0.001 0.23 (0.22 -0.24) Pulmonary heart diseases 444 (0.1%) 21963 (0.2%) <0.001 0.37 (0.34 -0.41) Heart Failure 677 (0.1%) 44174 (0.4%) <0.001 0.28 (0.26 -0.3) Cardiomyopathy 371 (0.1%) 23244 (0.2%) <0.001 0.29 (0.26 -0.33) Cardiomegaly 568 (0.1%) 30736 (0.3%) <0.001 0.34 (0.31 -0.37) Cardiogenic shock 72 (0%) 4281 (0%) <0.001 0.31 (0.24 -0.39) Cardiac arrest 165 (0%) 9148 (0.1%) <0.001 0.33 (0.28 -0.39) Thrombotic disorders 409 (0.1%) 26073 (0.2%) <0.001 0.29 (0.26 -0.32) Pulmonary embolism 169 (0%) 10153 (0.1%) <0.001 0.31 (0.26 -0.36) Deep and superficial thrombosis 325 (0%) 20155 (0.2%) <0.001 0.3 (0.27 -0.33) Thrombosis with Thrombocytopenia 0 (0%) 10 (0%) 0.46 NA Elevated Troponin I 266 (0%) 23229 (0.2%) <0.001 0.21 (0.19 -0.24) Elevated Natriuretic peptide B 785 (0.1%) 43562 (0.4%) <0.001 0.33 (0.31 -0.36) Dyslipidemia 6045 (1.3%) 414525 (4.3%) <0.001 0.31 (0.3 -0.31) Triglyceride ≥150 mg/dl 2937 (0.5%) 129324 (1.1%) <0.001 0.44 (0.43 -0.46) Total cholesterol ≥200 mg/dl 2791 (0.5%) 124493 (1.1%) <0.001 0.44 (0.42 -0.45) LDL-cholesterol ≥130 mg/dl 2426 (0.4%) 107147 (0.9%) <0.001 0.44 (0.42 -0.45) HDL-cholesterol <50 mg/dl 4947 (0.9%) 269080 (2.5%) <0.001 0.37 (0.36 -0.38) Cerebrovascular disease 827 (0.1%) 51839 (0.4%) <0.001 0.29 (0.27 -0.31) Transient ischemic attacks 178 (0%) 7631 (0.1%) <0.001 0.43 (0.37 -0.5) Cerebral infarction 331 (0.1%) 20920 (0.2%) <0.001 0.29 (0.26 -0.32) Cerebral occlusion without infarction 298 (0%) 18508 (0.2%) <0.001 0.3 (0.26 -0.33) Intracerebral hemorrhage 85 (0%) 5758 (0%) <0.001 0.27 (0.22 -0.34) Subarachnoid hemorrhage 43 (0%) 3969 (0%) <0.001 0.2 (0.15 -0.27) Hospital admission 2486 (0.4%) 362735 (3.6%) <0.001 0.12 (0.12 -0.13) Emergency visits 5103 (1.1%) 276792 (3.5%) <0.001 0.31 (0.3 -0.32) Outpatient encounters 7662 (2%) 861852 (11.2%) <0.001 0.18 (0.18 -0.18) Intensive care unit admission 142 (0%) 37166 (0.3%) <0.001 0.07 (0.06 -0.08) Mechanical ventilation 356 (0.1%) 36596 (0.3%) <0.001 0.18 (0.16 -0.2) Referral to Cardio services 0 (0%) 22 (0%) 0.273 NA Referral to Neuro services 10 (0%) 247 (0%) 0.353 0.74 (0.39 -1.4) ECMO 10 (0%) 621 (0%) <0.001 0.3 (0.16 -0.55) ECMO-VV 10 (0%) 227 (0%) 0.506 0.81 (0.43 -1.52) ECMO-VA 10 (0%) 435 (0%) 0.005 0.42 (0.23 -0.79) Mortality 1349 (0.2%) 72284 (0.6%) <0.001 0.34 (0.32 -0.36) 3-6mo Major adverse cardiovascular events 1467 (0.2%) 45287 (0.4%) <0.001 0.59 (0.56 -0.62) Cardiovascular disease 1811 (0.3%) 57141 (0.5%) <0.001 0.58 (0.55 -0.6) Ischemic heart disease 1024 (0.2%) 30230 (0.3%) <0.001 0.62 (0.58 -0.66) Myocardial angina 156 (0%) 3280 (0%) 0.097 0.87 (0.74 -1.03) Acute coronary disease 120 (0%) 2173 (0%) 0.9 1.01 (0.84 -1.22) Myocardial infarction 308 (0%) 7077 (0.1%) <0.001 0.8 (0.71 -0.89) Ischemic cardiomyopathy 126 (0%) 3307 (0%) <0.001 0.7 (0.59 -0.83) ### Page 28 Arrythmias 2133 (0.4%) 56594 (0.5%) <0.001 0.69 (0.66 -0.72) Atrial fibrillation and flutter 562 (0.1%) 16987 (0.1%) <0.001 0.6 (0.56 -0.66) Paroxysmal tachycardia 347 (0.1%) 6750 (0.1%) 0.288 0.94 (0.85 -1.05) Other cardiac arrythmias 821 (0.1%) 18096 (0.2%) <0.001 0.84 (0.78 -0.9) Inflammatory heart disease 215 (0%) 4204 (0%) 0.355 0.94 (0.82 -1.08) Pericarditis 137 (0%) 2763 (0%) 0.273 0.91 (0.77 -1.08) Myocarditis 10 (0%) 204 (0%) 0.74 0.9 (0.48 -1.69) Endocarditis 78 (0%) 1453 (0%) 0.889 0.98 (0.78 -1.24) Hypertensive heart disease 2478 (0.5%) 93614 (0.9%) <0.001 0.5 (0.48 -0.52) Pulmonary heart diseases 405 (0.1%) 8295 (0.1%) 0.03 0.9 (0.81 -0.99) Heart Failure 571 (0.1%) 16032 (0.1%) <0.001 0.65 (0.6 -0.71) Cardiomyopathy 305 (0%) 8091 (0.1%) <0.001 0.69 (0.62 -0.78) Cardiomegaly 430 (0.1%) 9442 (0.1%) <0.001 0.84 (0.76 -0.92) Cardiogenic shock 81 (0%) 1434 (0%) 0.766 1.04 (0.83 -1.29) Cardiac arrest 149 (0%) 3372 (0%) 0.011 0.81 (0.69 -0.95) Thrombotic disorders 370 (0.1%) 9739 (0.1%) <0.001 0.7 (0.63 -0.77) Pulmonary embolism 156 (0%) 3756 (0%) 0.001 0.76 (0.65 -0.89) Deep and superficial thrombosis 277 (0%) 7489 (0.1%) <0.001 0.68 (0.6 -0.76) Thrombosis with Thrombocytopenia 0 (0%) 10 (0%) 0.46 NA Elevated Troponin I 274 (0%) 7357 (0.1%) <0.001 0.68 (0.6 -0.77) Elevated Natriuretic peptide B 704 (0.1%) 14607 (0.1%) 0.001 0.88 (0.82 -0.95) Dyslipidemia 4201 (0.9%) 122429 (1.3%) <0.001 0.7 (0.68 -0.72) Triglyceride ≥150 mg/dl 2137 (0.4%) 40756 (0.4%) 0.387 1.02 (0.98 -1.07) Total cholesterol ≥200 mg/dl 1961 (0.3%) 36956 (0.3%) 0.257 1.03 (0.98 -1.07) LDL-cholesterol ≥130 mg/dl 1705 (0.3%) 31328 (0.3%) 0.087 1.04 (0.99 -1.1) HDL-cholesterol <50 mg/dl 3372 (0.6%) 75695 (0.7%) <0.001 0.89 (0.86 -0.92) Cerebrovascular disease 691 (0.1%) 18177 (0.2%) <0.001 0.7 (0.64 -0.75) Transient ischemic attacks 163 (0%) 3062 (0%) 0.77 0.98 (0.83 -1.14) Cerebral infarction 278 (0%) 7472 (0.1%) <0.001 0.68 (0.6 -0.77) Cerebral occlusion without infarction 247 (0%) 6340 (0.1%) <0.001 0.71 (0.63 -0.81) Intracerebral hemorrhage 68 (0%) 1547 (0%) 0.079 0.81 (0.63 -1.03) Subarachnoid hemorrhage 51 (0%) 1005 (0%) 0.609 0.93 (0.7 -1.23) Hospital admission 2051 (0.4%) 99835 (1%) <0.001 0.35 (0.34 -0.37) Emergency visits 4893 (1.1%) 132112 (1.7%) <0.001 0.61 (0.59 -0.63) Outpatient encounters 5810 (1.6%) 210242 (3.1%) <0.001 0.51 (0.49 -0.52) Intensive care unit admission 81 (0%) 14309 (0.1%) <0.001 0.1 (0.08 -0.13) Mechanical ventilation 309 (0%) 9565 (0.1%) <0.001 0.59 (0.53 -0.66) Referral to Cardio services 0 (0%) 10 (0%) 0.46 NA Referral to Neuro services 10 (0%) 155 (0%) 0.608 1.18 (0.62 -2.24) ECMO 10 (0%) 115 (0%) 0.154 1.59 (0.84 -3.04) ECMO-VV 10 (0%) 38 (0%) <0.001 4.82 (2.4 -9.68) ECMO-VA 10 (0%) 86 (0%) 0.02 2.13 (1.11 -4.1) Mortality 1523 (0.2%) 36742 (0.3%) <0.001 0.76 (0.72 -0.8) 6-9mo Major adverse cardiovascular events 1348 (0.2%) 34489 (0.3%) <0.001 0.71 (0.67 -0.75) Cardiovascular disease 1669 (0.3%) 43075 (0.4%) <0.001 0.7 (0.67 -0.74) Ischemic heart disease 948 (0.2%) 22875 (0.2%) <0.001 0.76 (0.71 -0.81) Myocardial angina 160 (0%) 2591 (0%) 0.124 1.13 (0.97 -1.33) Acute coronary disease 115 (0%) 1792 (0%) 0.092 1.18 (0.97 -1.42) Myocardial infarction 313 (0%) 6028 (0.1%) 0.376 0.95 (0.85 -1.06) Ischemic cardiomyopathy 132 (0%) 2275 (0%) 0.492 1.06 (0.89 -1.27) Arrythmias 1947 (0.3%) 44652 (0.4%) <0.001 0.8 (0.76 -0.84) Atrial fibrillation and flutter 576 (0.1%) 12806 (0.1%) <0.001 0.82 (0.76 -0.89) Paroxysmal tachycardia 300 (0%) 5001 (0%) 0.107 1.1 (0.98 -1.24) Other cardiac arrythmias 747 (0.1%) 13892 (0.1%) 0.811 0.99 (0.92 -1.07) Inflammatory heart disease 171 (0%) 3295 (0%) 0.523 0.95 (0.82 -1.11) Pericarditis 124 (0%) 2152 (0%) 0.556 1.06 (0.88 -1.27) Myocarditis 10 (0%) 179 (0%) 0.943 1.02 (0.54 -1.94) Endocarditis 50 (0%) 1139 (0%) 0.132 0.81 (0.61 -1.07) Hypertensive heart disease 2302 (0.4%) 68707 (0.7%) <0.001 0.62 (0.6 -0.65) Pulmonary heart diseases 357 (0.1%) 6207 (0.1%) 0.324 1.06 (0.95 -1.17) Heart Failure 548 (0.1%) 11792 (0.1%) <0.001 0.85 (0.78 -0.93) Cardiomyopathy 303 (0%) 5804 (0%) 0.452 0.96 (0.85 -1.07) ### Page 29 Cardiomegaly 404 (0.1%) 7477 (0.1%) 0.881 0.99 (0.9 -1.1) Cardiogenic shock 94 (0%) 1138 (0%) <0.001 1.51 (1.23 -1.87) Cardiac arrest 176 (0%) 2819 (0%) 0.086 1.14 (0.98 -1.33) Thrombotic disorders 361 (0.1%) 7428 (0.1%) 0.031 0.89 (0.8 -0.99) Pulmonary embolism 135 (0%) 2902 (0%) 0.07 0.85 (0.72 -1.01) Deep and superficial thrombosis 283 (0%) 5765 (0%) 0.082 0.9 (0.8 -1.01) Thrombosis with Thrombocytopenia 0 (0%) 0 (0%) NA NA Elevated Troponin I 260 (0%) 6438 (0.1%) <0.001 0.74 (0.65 -0.84) Elevated Natriuretic peptide B 629 (0.1%) 11549 (0.1%) 0.941 1 (0.92 -1.08) Dyslipidemia 3596 (0.8%) 92080 (1%) <0.001 0.79 (0.76 -0.82) Triglyceride ≥150 mg/dl 1938 (0.3%) 34156 (0.3%) <0.001 1.1 (1.05 -1.16) Total cholesterol ≥200 mg/dl 1860 (0.3%) 30904 (0.3%) <0.001 1.16 (1.11 -1.22) LDL-cholesterol ≥130 mg/dl 1721 (0.3%) 26624 (0.2%) <0.001 1.24 (1.18 -1.3) HDL-cholesterol <50 mg/dl 2922 (0.6%) 60684 (0.6%) 0.042 0.96 (0.93 -1) Cerebrovascular disease 656 (0.1%) 14239 (0.1%) <0.001 0.84 (0.78 -0.91) Transient ischemic attacks 171 (0%) 2603 (0%) 0.018 1.21 (1.03 -1.41) Cerebral infarction 304 (0%) 5745 (0%) 0.582 0.97 (0.86 -1.09) Cerebral occlusion without infarction 252 (0%) 5058 (0%) 0.161 0.91 (0.81 -1.04) Intracerebral hemorrhage 77 (0%) 1181 (0%) 0.132 1.19 (0.95 -1.5) Subarachnoid hemorrhage 39 (0%) 857 (0%) 0.265 0.83 (0.61 -1.15) Hospital admission 1915 (0.3%) 66439 (0.7%) <0.001 0.49 (0.47 -0.51) Emergency visits 4375 (1%) 109837 (1.5%) <0.001 0.65 (0.63 -0.67) Outpatient encounters 4890 (1.3%) 132293 (2%) <0.001 0.67 (0.65 -0.69) Intensive care unit admission 70 (0%) 10503 (0.1%) <0.001 0.12 (0.1 -0.15) Mechanical ventilation 329 (0.1%) 7163 (0.1%) 0.002 0.84 (0.75 -0.94) Referral to Cardio services 0 (0%) 10 (0%) 0.46 NA Referral to Neuro services 10 (0%) 143 (0%) 0.447 1.28 (0.68 -2.43) ECMO 10 (0%) 94 (0%) 0.041 1.95 (1.02 -3.74) ECMO-VV 10 (0%) 34 (0%) <0.001 5.39 (2.66 -10.91) ECMO-VA 10 (0%) 60 (0%) 0.001 3.05 (1.56 -5.96) Mortality 1631 (0.2%) 31950 (0.3%) 0.008 0.94 (0.89 -0.98) >9mo Major adverse cardiovascular events 10387 (1.7%) 202392 (1.8%) <0.001 0.93 (0.91 -0.95) Cardiovascular disease 13706 (2.3%) 253843 (2.4%) 0.014 0.98 (0.96 -1) Ischemic heart disease 7082 (1.1%) 131991 (1.2%) 0.074 0.98 (0.96 -1) Myocardial angina 964 (0.1%) 15932 (0.1%) 0.002 1.11 (1.04 -1.19) Acute coronary disease 787 (0.1%) 10297 (0.1%) <0.001 1.4 (1.3 -1.51) Myocardial infarction 2173 (0.3%) 35788 (0.3%) <0.001 1.11 (1.06 -1.16) Ischemic cardiomyopathy 766 (0.1%) 12340 (0.1%) 0.001 1.14 (1.06 -1.22) Arrythmias 15712 (2.6%) 279594 (2.6%) 0.001 1.03 (1.01 -1.04) Atrial fibrillation and flutter 3952 (0.6%) 73101 (0.6%) 0.397 0.99 (0.96 -1.02) Paroxysmal tachycardia 2249 (0.3%) 29493 (0.2%) <0.001 1.4 (1.34 -1.46) Other cardiac arrythmias 5717 (0.9%) 85656 (0.7%) <0.001 1.23 (1.2 -1.26) Inflammatory heart disease 1244 (0.2%) 18565 (0.2%) <0.001 1.23 (1.16 -1.3) Pericarditis 783 (0.1%) 11604 (0.1%) <0.001 1.24 (1.15 -1.33) Myocarditis 39 (0%) 927 (0%) 0.11 0.77 (0.56 -1.06) Endocarditis 488 (0.1%) 6990 (0.1%) <0.001 1.28 (1.17 -1.4) Hypertensive heart disease 22029 (4.2%) 431149 (4.4%) <0.001 0.95 (0.94 -0.96) Pulmonary heart diseases 2467 (0.4%) 35833 (0.3%) <0.001 1.26 (1.21 -1.32) Heart Failure 3908 (0.6%) 69294 (0.6%) 0.072 1.03 (1 -1.06) Cardiomyopathy 1917 (0.3%) 31567 (0.3%) <0.001 1.11 (1.06 -1.17) Cardiomegaly 2757 (0.4%) 47843 (0.4%) 0.004 1.06 (1.02 -1.1) Cardiogenic shock 570 (0.1%) 7069 (0.1%) <0.001 1.48 (1.36 -1.61) Cardiac arrest 1291 (0.2%) 18904 (0.2%) <0.001 1.25 (1.18 -1.32) Thrombotic disorders 2669 (0.4%) 44998 (0.4%) <0.001 1.09 (1.05 -1.13) Pulmonary embolism 1018 (0.2%) 16069 (0.1%) <0.001 1.16 (1.09 -1.24) Deep and superficial thrombosis 2139 (0.3%) 35893 (0.3%) <0.001 1.09 (1.05 -1.14) Thrombosis with Thrombocytopenia 10 (0%) 11 (0%) <0.001 16.66 (7.07 -39.22) Elevated Troponin I 3128 (0.5%) 54866 (0.5%) 0.028 1.04 (1 -1.08) Elevated Natriuretic peptide B 4574 (0.7%) 76989 (0.7%) <0.001 1.09 (1.06 -1.12) Dyslipidemia 34094 (7.6%) 633544 (7%) <0.001 1.09 (1.07 -1.1) Triglyceride ≥150 mg/dl 18281 (3.2%) 270247 (2.4%) <0.001 1.32 (1.3 -1.34) Total cholesterol ≥200 mg/dl 17805 (3.1%) 264757 (2.4%) <0.001 1.3 (1.28 -1.32) ### Page 30 LDL-cholesterol ≥130 mg/dl 16079 (2.7%) 231973 (2.1%) <0.001 1.33 (1.31 -1.35) HDL-cholesterol <50 mg/dl 26432 (5.2%) 451315 (4.4%) <0.001 1.17 (1.16 -1.18) Cerebrovascular disease 4844 (0.8%) 88233 (0.8%) 0.827 1 (0.98 -1.03) Transient ischemic attacks 1233 (0.2%) 18935 (0.2%) <0.001 1.2 (1.13 -1.27) Cerebral infarction 1884 (0.3%) 33793 (0.3%) 0.402 1.02 (0.97 -1.07) Cerebral occlusion without infarction 1687 (0.3%) 30475 (0.3%) 0.554 1.02 (0.97 -1.07) Intracerebral hemorrhage 472 (0.1%) 7572 (0.1%) 0.005 1.14 (1.04 -1.25) Subarachnoid hemorrhage 360 (0.1%) 5313 (0%) <0.001 1.24 (1.12 -1.38) Hospital admission 16714 (3%) 423689 (4.4%) <0.001 0.66 (0.65 -0.68) Emergency visits 38600 (8.5%) 691031 (9.4%) <0.001 0.91 (0.9 -0.91) Outpatient encounters 35855 (10%) 626610 (9.7%) <0.001 1.03 (1.02 -1.04) Intensive care unit admission 319 (0%) 37811 (0.3%) <0.001 0.15 (0.14 -0.17) Mechanical ventilation 2498 (0.4%) 44042 (0.4%) 0.107 1.03 (0.99 -1.08) Referral to Cardio services 0 (0%) 59 (0%) 0.073 NA Referral to Neuro services 25 (0%) 1685 (0%) <0.001 0.27 (0.18 -0.4) ECMO 19 (0%) 470 (0%) 0.198 0.74 (0.47 -1.17) ECMO-VV 10 (0%) 140 (0%) 0.41 1.31 (0.69 -2.49) ECMO-VA 16 (0%) 346 (0%) 0.516 0.85 (0.51 -1.4) Mortality 13876 (2.1%) 207665 (1.7%) <0.001 1.22 (1.2 -1.25) For outcomes where event counts were fewer than 10, TriNetX platform suppressed exact numbers and reported '10' for de-identification purposes; thus, relative risks may be overestimated or not statistically meaningful in these cases. When zero events were observed, this is indicated as '0'. Caution is warranted in the interpretation of RRs where numerators are at or below this privacy threshold. ECMO: Extracorporeal membrane oxygenation. ### Page 31 Supplementary Table 6. Outcomes in female vaccinated individuals without prior infection compared to naive controls (Group 3 vs Group 1) across four post-exposure time windows.Time Outcome Group 3 (n=742,409)Group 1 (n=15,528,569 ) p-value RR (95%CI)Follow-up (months) 26.5 ± 18.9 25.1 ± 180-3 mo Major adverse cardiovascular events 1775 (0.2%) 106280 (0.7%) <0.001 0.35 (0.33 -0.37) Cardiovascular disease 2452 (0.3%) 149709 (1%) <0.001 0.35 (0.33 -0.36) Ischemic heart disease 1065 (0.1%) 58318 (0.4%) <0.001 0.38 (0.36 -0.4) Myocardial angina 165 (0%) 7134 (0%) <0.001 0.48 (0.41 -0.56) Acute coronary disease 125 (0%) 4036 (0%) <0.001 0.64 (0.54 -0.77) Myocardial infarction 305 (0%) 13959 (0.1%) <0.001 0.45 (0.4 -0.51) Ischemic cardiomyopathy 69 (0%) 3292 (0%) <0.001 0.43 (0.34 -0.55) Arrythmias 3405 (0.5%) 162389 (1.1%) <0.001 0.45 (0.43 -0.46) Atrial fibrillation and flutter 526 (0.1%) 35500 (0.2%) <0.001 0.31 (0.28 -0.34) Paroxysmal tachycardia 477 (0.1%) 16926 (0.1%) <0.001 0.59 (0.53 -0.64) Other cardiac arrythmias 1067 (0.1%) 48228 (0.3%) <0.001 0.46 (0.44 -0.49) Inflammatory heart disease 248 (0%) 11138 (0.1%) <0.001 0.46 (0.41 -0.52) Pericarditis 181 (0%) 7791 (0%) <0.001 0.48 (0.42 -0.56) Myocarditis 10 (0%) 439 (0%) 0.016 0.47 (0.25 -0.88) Endocarditis 74 (0%) 3359 (0%) <0.001 0.46 (0.36 -0.58) Hypertensive heart disease 3422 (0.5%) 267918 (1.9%) <0.001 0.28 (0.27 -0.29) Pulmonary heart diseases 530 (0.1%) 23395 (0.1%) <0.001 0.47 (0.43 -0.51) Heart Failure 654 (0.1%) 36449 (0.2%) <0.001 0.37 (0.35 -0.4) Cardiomyopathy 265 (0%) 13112 (0.1%) <0.001 0.42 (0.37 -0.47) Cardiomegaly 529 (0.1%) 24586 (0.2%) <0.001 0.45 (0.41 -0.49) Cardiogenic shock 57 (0%) 2505 (0%) <0.001 0.47 (0.36 -0.61) Cardiac arrest 105 (0%) 5801 (0%) <0.001 0.38 (0.31 -0.46) Thrombotic disorders 510 (0.1%) 25713 (0.2%) <0.001 0.41 (0.38 -0.45) Pulmonary embolism 216 (0%) 10428 (0.1%) <0.001 0.43 (0.38 -0.49) Deep and superficial thrombosis 391 (0.1%) 19195 (0.1%) <0.001 0.42 (0.38 -0.47) Thrombosis with Thrombocytopenia 0 (0%) 10 (0%) 0.487 NA Elevated Troponin I 265 (0%) 16797 (0.1%) <0.001 0.33 (0.29 -0.37) Elevated Natriuretic peptide B 793 (0.1%) 40498 (0.3%) <0.001 0.41 (0.38 -0.44) Dyslipidemia 6567 (1.2%) 393063 (2.9%) <0.001 0.4 (0.39 -0.41) Triglyceride ≥150 mg/dl 2553 (0.4%) 95999 (0.6%) <0.001 0.58 (0.56 -0.61) Total cholesterol ≥200 mg/dl 3841 (0.6%) 151207 (1%) <0.001 0.57 (0.55 -0.59) LDL-cholesterol ≥130 mg/dl 2966 (0.4%) 109919 (0.7%) <0.001 0.59 (0.57 -0.62) HDL-cholesterol <50 mg/dl 3619 (0.5%) 171734 (1.1%) <0.001 0.47 (0.45 -0.48) Cerebrovascular disease 983 (0.1%) 51751 (0.3%) <0.001 0.4 (0.37 -0.42) Transient ischemic attacks 265 (0%) 9097 (0.1%) <0.001 0.61 (0.54 -0.68) Cerebral infarction 367 (0%) 20763 (0.1%) <0.001 0.37 (0.33 -0.41) Cerebral occlusion without infarction 332 (0%) 15825 (0.1%) <0.001 0.44 (0.39 -0.49) Intracerebral hemorrhage 71 (0%) 4563 (0%) <0.001 0.32 (0.26 -0.41) Subarachnoid hemorrhage 54 (0%) 3332 (0%) <0.001 0.34 (0.26 -0.44) Hospital admission 3766 (0.6%) 438054 (3.4%) <0.001 0.17 (0.17 -0.18) Emergency visits 6456 (1.2%) 345713 (3.1%) <0.001 0.37 (0.37 -0.38) Outpatient encounters 9382 (2.2%) 1003386 (9.7%) <0.001 0.23 (0.22 -0.23) Intensive care unit admission 143 (0%) 39866 (0.2%) <0.001 0.07 (0.06 -0.09) Mechanical ventilation 269 (0%) 26577 (0.2%) <0.001 0.21 (0.19 -0.24) Referral to Cardio services 0 (0%) 41 (0%) 0.159 NA Referral to Neuro services 10 (0%) 276 (0%) 0.371 0.75 (0.4 -1.41) ECMO 10 (0%) 317 (0%) 0.182 0.65 (0.35 -1.23) ECMO-VV 10 (0%) 138 (0%) 0.212 1.5 (0.79 -2.85) ECMO-VA 10 (0%) 213 (0%) 0.931 0.97 (0.52 -1.83) Mortality 1143 (0.1%) 61041 (0.4%) <0.001 0.39 (0.37 -0.41) 3-6mo Major adverse cardiovascular events 1518 (0.2%) 41758 (0.3%) <0.001 0.76 (0.72 -0.8) Cardiovascular disease 2054 (0.3%) 58998 (0.4%) <0.001 0.73 (0.7 -0.76) Ischemic heart disease 899 (0.1%) 23365 (0.1%) <0.001 0.8 (0.75 -0.86) Myocardial angina 146 (0%) 2906 (0%) 0.624 1.04 (0.88 -1.23) Acute coronary disease 115 (0%) 1974 (0%) 0.05 1.21 (1 -1.46) Myocardial infarction 263 (0%) 5763 (0%) 0.373 0.95 (0.84 -1.07) Ischemic cardiomyopathy 57 (0%) 1328 (0%) 0.386 0.89 (0.68 -1.16) ### Page 32 Arrythmias 2877 (0.4%) 73989 (0.5%) <0.001 0.82 (0.79 -0.85) Atrial fibrillation and flutter 508 (0.1%) 13610 (0.1%) <0.001 0.77 (0.71 -0.84) Paroxysmal tachycardia 408 (0.1%) 7721 (0%) 0.069 1.1 (0.99 -1.21) Other cardiac arrythmias 951 (0.1%) 20730 (0.1%) 0.211 0.96 (0.9 -1.02) Inflammatory heart disease 204 (0%) 4479 (0%) 0.425 0.95 (0.82 -1.09) Pericarditis 149 (0%) 3187 (0%) 0.707 0.97 (0.82 -1.14) Myocarditis 10 (0%) 138 (0%) 0.212 1.5 (0.79 -2.85) Endocarditis 58 (0%) 1320 (0%) 0.485 0.91 (0.7 -1.18) Hypertensive heart disease 2767 (0.4%) 105008 (0.8%) <0.001 0.57 (0.55 -0.59) Pulmonary heart diseases 447 (0.1%) 9903 (0.1%) 0.177 0.94 (0.85 -1.03) Heart Failure 585 (0.1%) 14970 (0.1%) <0.001 0.81 (0.75 -0.88) Cardiomyopathy 244 (0%) 5245 (0%) 0.585 0.97 (0.85 -1.1) Cardiomegaly 447 (0.1%) 9317 (0.1%) 0.949 1 (0.91 -1.1) Cardiogenic shock 46 (0%) 956 (0%) 0.982 1 (0.74 -1.34) Cardiac arrest 101 (0%) 2522 (0%) 0.064 0.83 (0.68 -1.01) Thrombotic disorders 421 (0.1%) 10851 (0.1%) <0.001 0.81 (0.73 -0.89) Pulmonary embolism 198 (0%) 4242 (0%) 0.647 0.97 (0.84 -1.12) Deep and superficial thrombosis 315 (0%) 8272 (0.1%) <0.001 0.79 (0.71 -0.88) Thrombosis with Thrombocytopenia 0 (0%) 0 (0%) NA NA Elevated Troponin I 272 (0%) 6348 (0%) 0.052 0.89 (0.79 -1) Elevated Natriuretic peptide B 741 (0.1%) 15480 (0.1%) 0.85 0.99 (0.92 -1.07) Dyslipidemia 4775 (0.9%) 146414 (1.1%) <0.001 0.77 (0.74 -0.79) Triglyceride ≥150 mg/dl 2034 (0.3%) 40284 (0.3%) <0.001 1.1 (1.05 -1.15) Total cholesterol ≥200 mg/dl 2914 (0.4%) 59974 (0.4%) <0.001 1.09 (1.05 -1.13) LDL-cholesterol ≥130 mg/dl 2286 (0.3%) 44052 (0.3%) <0.001 1.14 (1.09 -1.19) HDL-cholesterol <50 mg/dl 2624 (0.4%) 62967 (0.4%) <0.001 0.92 (0.88 -0.95) Cerebrovascular disease 844 (0.1%) 20834 (0.1%) <0.001 0.84 (0.79 -0.9) Transient ischemic attacks 210 (0%) 4312 (0%) 0.877 1.01 (0.88 -1.16) Cerebral infarction 315 (0%) 8119 (0.1%) <0.001 0.8 (0.72 -0.9) Cerebral occlusion without infarction 270 (0%) 6296 (0%) 0.06 0.89 (0.79 -1.01) Intracerebral hemorrhage 65 (0%) 1394 (0%) 0.782 0.97 (0.75 -1.24) Subarachnoid hemorrhage 43 (0%) 1015 (0%) 0.4 0.88 (0.65 -1.19) Hospital admission 3124 (0.5%) 168270 (1.3%) <0.001 0.37 (0.35 -0.38) Emergency visits 5912 (1.1%) 180608 (1.7%) <0.001 0.64 (0.63 -0.66) Outpatient encounters 6738 (1.6%) 293344 (3.1%) <0.001 0.52 (0.51 -0.53) Intensive care unit admission 124 (0%) 20602 (0.1%) <0.001 0.12 (0.1 -0.15) Mechanical ventilation 255 (0%) 8428 (0.1%) <0.001 0.63 (0.55 -0.71) Referral to Cardio services 0 (0%) 16 (0%) 0.379 NA Referral to Neuro services 10 (0%) 198 (0%) 0.889 1.05 (0.55 -1.97) ECMO 10 (0%) 72 (0%) 0.001 2.88 (1.49 -5.57) ECMO-VV 10 (0%) 30 (0%) <0.001 6.9 (3.38 -14.12) ECMO-VA 10 (0%) 49 (0%) <0.001 4.23 (2.14 -8.34) Mortality 1372 (0.2%) 32756 (0.2%) <0.001 0.87 (0.82 -0.92) 6-9mo Major adverse cardiovascular events 1443 (0.2%) 33702 (0.2%) <0.001 0.89 (0.85 -0.94) Cardiovascular disease 1911 (0.3%) 47035 (0.3%) <0.001 0.85 (0.81 -0.89) Ischemic heart disease 831 (0.1%) 18723 (0.1%) 0.023 0.92 (0.86 -0.99) Myocardial angina 110 (0%) 2436 (0%) 0.504 0.94 (0.77 -1.13) Acute coronary disease 95 (0%) 1669 (0%) 0.118 1.18 (0.96 -1.45) Myocardial infarction 257 (0%) 4995 (0%) 0.319 1.07 (0.94 -1.21) Ischemic cardiomyopathy 57 (0%) 1037 (0%) 0.339 1.14 (0.87 -1.49) Arrythmias 2672 (0.4%) 61731 (0.4%) <0.001 0.91 (0.88 -0.95) Atrial fibrillation and flutter 489 (0.1%) 11010 (0.1%) 0.069 0.92 (0.84 -1.01) Paroxysmal tachycardia 353 (0%) 6061 (0%) 0.001 1.21 (1.09 -1.35) Other cardiac arrythmias 844 (0.1%) 16775 (0.1%) 0.149 1.05 (0.98 -1.13) Inflammatory heart disease 178 (0%) 3564 (0%) 0.648 1.04 (0.89 -1.2) Pericarditis 135 (0%) 2501 (0%) 0.204 1.12 (0.94 -1.33) Myocarditis 10 (0%) 145 (0%) 0.273 1.43 (0.75 -2.71) Endocarditis 48 (0%) 1045 (0%) 0.738 0.95 (0.71 -1.27) Hypertensive heart disease 2522 (0.4%) 82432 (0.6%) <0.001 0.66 (0.64 -0.69) Pulmonary heart diseases 387 (0%) 7743 (0%) 0.482 1.04 (0.94 -1.15) Heart Failure 569 (0.1%) 11829 (0.1%) 0.937 1 (0.92 -1.08) Cardiomyopathy 226 (0%) 4151 (0%) 0.075 1.13 (0.99 -1.29) ### Page 33 Cardiomegaly 399 (0.1%) 7935 (0%) 0.392 1.05 (0.95 -1.16) Cardiogenic shock 43 (0%) 784 (0%) 0.416 1.14 (0.84 -1.54) Cardiac arrest 97 (0%) 1955 (0%) 0.797 1.03 (0.84 -1.26) Thrombotic disorders 359 (0%) 8539 (0.1%) 0.011 0.87 (0.79 -0.97) Pulmonary embolism 163 (0%) 3318 (0%) 0.824 1.02 (0.87 -1.19) Deep and superficial thrombosis 259 (0%) 6488 (0%) 0.003 0.83 (0.73 -0.94) Thrombosis with Thrombocytopenia 0 (0%) 10 (0%) 0.487 NA Elevated Troponin I 251 (0%) 5798 (0%) 0.087 0.9 (0.79 -1.02) Elevated Natriuretic peptide B 696 (0.1%) 12976 (0.1%) 0.006 1.11 (1.03 -1.2) Dyslipidemia 4298 (0.8%) 117730 (0.9%) <0.001 0.85 (0.83 -0.88) Triglyceride ≥150 mg/dl 1966 (0.3%) 35634 (0.2%) <0.001 1.2 (1.15 -1.26) Total cholesterol ≥200 mg/dl 2773 (0.4%) 52594 (0.4%) <0.001 1.18 (1.14 -1.23) LDL-cholesterol ≥130 mg/dl 2232 (0.3%) 39269 (0.3%) <0.001 1.25 (1.19 -1.3) HDL-cholesterol <50 mg/dl 2432 (0.4%) 53480 (0.4%) 0.927 1 (0.96 -1.04) Cerebrovascular disease 785 (0.1%) 17166 (0.1%) 0.161 0.95 (0.89 -1.02) Transient ischemic attacks 208 (0%) 3737 (0%) 0.042 1.16 (1.01 -1.33) Cerebral infarction 322 (0%) 6614 (0%) 0.883 1.01 (0.9 -1.13) Cerebral occlusion without infarction 266 (0%) 5185 (0%) 0.32 1.07 (0.94 -1.2) Intracerebral hemorrhage 69 (0%) 1143 (0%) 0.071 1.25 (0.98 -1.59) Subarachnoid hemorrhage 43 (0%) 842 (0%) 0.72 1.06 (0.78 -1.44) Hospital admission 2578 (0.4%) 142052 (1.1%) <0.001 0.35 (0.34 -0.37) Emergency visits 5372 (1%) 154301 (1.5%) <0.001 0.68 (0.66 -0.7) Outpatient encounters 5866 (1.4%) 193404 (2.1%) <0.001 0.67 (0.66 -0.69) Intensive care unit admission 79 (0%) 15706 (0.1%) <0.001 0.1 (0.08 -0.13) Mechanical ventilation 248 (0%) 6477 (0%) <0.001 0.79 (0.7 -0.9) Referral to Cardio services 0 (0%) 10 (0%) 0.487 NA Referral to Neuro services 10 (0%) 206 (0%) 0.987 1.01 (0.53 -1.9) ECMO 0 (0%) 42 (0%) 0.154 NA ECMO-VV 0 (0%) 15 (0%) 0.395 NA ECMO-VA 0 (0%) 27 (0%) 0.254 NA Mortality 1441 (0.2%) 28948 (0.2%) 0.258 1.03 (0.98 -1.09) >9mo Major adverse cardiovascular events 11344 (1.5%) 222559 (1.5%) <0.001 1.06 (1.04 -1.08) Cardiovascular disease 15909 (2.2%) 305195 (2%) <0.001 1.09 (1.07 -1.11) Ischemic heart disease 6671 (0.9%) 125099 (0.8%) <0.001 1.11 (1.08 -1.14) Myocardial angina 957 (0.1%) 16170 (0.1%) <0.001 1.23 (1.15 -1.31) Acute coronary disease 791 (0.1%) 10834 (0.1%) <0.001 1.51 (1.41 -1.63) Myocardial infarction 1888 (0.2%) 34809 (0.2%) <0.001 1.12 (1.07 -1.18) Ischemic cardiomyopathy 304 (0%) 5701 (0%) 0.09 1.11 (0.98 -1.24) Arrythmias 22335 (3.2%) 433163 (2.9%) <0.001 1.09 (1.07 -1.1) Atrial fibrillation and flutter 3432 (0.4%) 66729 (0.4%) <0.001 1.07 (1.03 -1.1) Paroxysmal tachycardia 2751 (0.4%) 40612 (0.3%) <0.001 1.41 (1.35 -1.46) Other cardiac arrythmias 6640 (0.9%) 108798 (0.7%) <0.001 1.28 (1.25 -1.31) Inflammatory heart disease 1534 (0.2%) 23197 (0.1%) <0.001 1.37 (1.3 -1.44) Pericarditis 1009 (0.1%) 15709 (0.1%) <0.001 1.33 (1.25 -1.42) Myocarditis 33 (0%) 760 (0%) 0.55 0.9 (0.64 -1.27) Endocarditis 554 (0.1%) 7586 (0%) <0.001 1.51 (1.39 -1.65) Hypertensive heart disease 25063 (3.9%) 565850 (4.1%) <0.001 0.96 (0.94 -0.97) Pulmonary heart diseases 2820 (0.4%) 48801 (0.3%) <0.001 1.2 (1.16 -1.25) Heart Failure 3942 (0.5%) 74030 (0.5%) <0.001 1.1 (1.07 -1.14) Cardiomyopathy 1412 (0.2%) 24094 (0.1%) <0.001 1.22 (1.15 -1.28) Cardiomegaly 2853 (0.4%) 56299 (0.4%) 0.007 1.05 (1.01 -1.09) Cardiogenic shock 413 (0.1%) 5524 (0%) <0.001 1.55 (1.4 -1.71) Cardiac arrest 861 (0.1%) 14441 (0.1%) <0.001 1.23 (1.15 -1.32) Thrombotic disorders 3158 (0.4%) 58649 (0.4%) <0.001 1.12 (1.08 -1.16) Pulmonary embolism 1140 (0.1%) 20835 (0.1%) <0.001 1.13 (1.07 -1.2) Deep and superficial thrombosis 2540 (0.3%) 46156 (0.3%) <0.001 1.14 (1.1 -1.19) Thrombosis with Thrombocytopenia 0 (0%) 12 (0%) 0.447 NA Elevated Troponin I 3482 (0.4%) 56040 (0.3%) <0.001 1.29 (1.24 -1.33) Elevated Natriuretic peptide B 5212 (0.7%) 95448 (0.6%) <0.001 1.13 (1.1 -1.17) Dyslipidemia 43433 (7.9%) 932017 (7.3%) <0.001 1.09 (1.08 -1.1) Triglyceride ≥150 mg/dl 18594 (2.7%) 309702 (2%) <0.001 1.31 (1.29 -1.33) Total cholesterol ≥200 mg/dl 26429 (4%) 481858 (3.3%) <0.001 1.23 (1.22 -1.25) ### Page 34 LDL-cholesterol ≥130 mg/dl 21914 (3.2%) 367603 (2.4%) <0.001 1.31 (1.29 -1.33) HDL-cholesterol <50 mg/dl 22507 (3.3%) 460654 (3.1%) <0.001 1.07 (1.06 -1.09) Cerebrovascular disease 6356 (0.8%) 117698 (0.7%) <0.001 1.12 (1.09 -1.15) Transient ischemic attacks 1800 (0.2%) 29717 (0.2%) <0.001 1.26 (1.2 -1.32) Cerebral infarction 2273 (0.3%) 42891 (0.3%) <0.001 1.1 (1.05 -1.15) Cerebral occlusion without infarction 1946 (0.3%) 35478 (0.2%) <0.001 1.14 (1.09 -1.19) Intracerebral hemorrhage 501 (0.1%) 8001 (0%) <0.001 1.3 (1.19 -1.42) Subarachnoid hemorrhage 369 (0%) 6152 (0%) <0.001 1.24 (1.12 -1.38) Hospital admission 22730 (3.6%) 650921 (5.3%) <0.001 0.68 (0.67 -0.69) Emergency visits 47540 (8.9%) 1017137 (9.8%) <0.001 0.91 (0.9 -0.92) Outpatient encounters 43557 (10.8%) 977358 (11%) <0.001 0.98 (0.97 -0.99) Intensive care unit admission 381 (0%) 50446 (0.3%) <0.001 0.16 (0.14 -0.17) Mechanical ventilation 1985 (0.3%) 43187 (0.3%) 0.023 0.95 (0.91 -0.99) Referral to Cardio services 0 (0%) 56 (0%) 0.1 NA Referral to Neuro services 34 (0%) 2531 (0%) <0.001 0.28 (0.2 -0.39) ECMO 17 (0%) 310 (0%) 0.609 1.14 (0.7 -1.85) ECMO-VV 10 (0%) 103 (0%) 0.031 2.01 (1.05 -3.85) ECMO-VA 11 (0%) 224 (0%) 0.956 1.02 (0.56 -1.86) Mortality 13581 (1.7%) 201545 (1.2%) <0.001 1.4 (1.37 -1.42) For outcomes where event counts were fewer than 10, TriNetX platform suppressed exact numbers and reported '10' for de-identification purposes; thus, relative risks may be overestimated or not statistically meaningful in these cases. When zero events were observed, this is indicated as '0'. Caution is warranted in the interpretation of RRs where numerators are at or below this privacy threshold. ECMO: Extracorporeal membrane oxygenation. ### Page 35 Supplementary Table 7. Outcomes in male in infected, vaccinated individuals compared to infected, unvaccinated individuals (Group 4 vs Group 2) across four post-exposure time windows.Time Outcome Group 4 (n=61,264)Group 2 (n=858,409) p-value RR (95%CI)Follow-up (months) 22.7 ± 18.8 22 ± 16.20-3 mo Major adverse cardiovascular events 541 (0.8%) 9734 (1.2%) <0.001 0.64 (0.59 -0.7) Cardiovascular disease 659 (1%) 14276 (1.8%) <0.001 0.54 (0.5 -0.58) Ischemic heart disease 432 (0.6%) 6930 (0.8%) <0.001 0.71 (0.65 -0.79) Myocardial angina 63 (0.1%) 657 (0.1%) 0.565 1.08 (0.83 -1.4) Acute coronary disease 136 (0.2%) 1272 (0.1%) 0.046 1.2 (0.99 -1.43) Myocardial infarction 212 (0.3%) 3145 (0.3%) <0.001 0.76 (0.66 -0.87) Ischemic cardiomyopathy 65 (0.1%) 903 (0.1%) 0.093 0.81 (0.63 -1.04) Arrythmias 851 (1.3%) 16595 (2.1%) <0.001 0.6 (0.56 -0.65) Atrial fibrillation and flutter 254 (0.3%) 4718 (0.5%) <0.001 0.6 (0.53 -0.69) Paroxysmal tachycardia 194 (0.2%) 2462 (0.3%) 0.106 0.89 (0.77 -1.03) Other cardiac arrythmias 489 (0.6%) 7309 (0.8%) <0.001 0.77 (0.71 -0.85) Inflammatory heart disease 138 (0.2%) 2224 (0.2%) <0.001 0.7 (0.59 -0.83) Pericarditis 109 (0.1%) 1454 (0.2%) 0.079 0.84 (0.69 -1.02) Myocarditis 11 (0%) 269 (0%) 0.009 0.46 (0.25 -0.83) Endocarditis 29 (0%) 695 (0.1%) <0.001 0.47 (0.32 -0.68) Hypertensive heart disease 539 (1%) 12317 (1.8%) <0.001 0.56 (0.52 -0.61) Pulmonary heart diseases 249 (0.3%) 4598 (0.5%) <0.001 0.61 (0.54 -0.69) Heart Failure 310 (0.4%) 4685 (0.5%) <0.001 0.74 (0.66 -0.83) Cardiomyopathy 151 (0.2%) 2273 (0.2%) <0.001 0.75 (0.63 -0.88) Cardiomegaly 360 (0.4%) 5365 (0.6%) <0.001 0.76 (0.68 -0.85) Cardiogenic shock 65 (0.1%) 745 (0.1%) 0.839 0.97 (0.76 -1.26) Cardiac arrest 109 (0.1%) 1783 (0.2%) <0.001 0.68 (0.56 -0.83) Thrombotic disorders 259 (0.3%) 5658 (0.6%) <0.001 0.52 (0.46 -0.58) Pulmonary embolism 123 (0.1%) 3101 (0.3%) <0.001 0.44 (0.37 -0.53) Deep and superficial thrombosis 192 (0.2%) 3685 (0.4%) <0.001 0.59 (0.51 -0.68) Thrombosis with Thrombocytopenia 0 (0%) 0 (0%) NA NA Elevated Troponin I 221 (0.3%) 4753 (0.5%) <0.001 0.52 (0.45 -0.59) Elevated Natriuretic peptide B 471 (0.6%) 10154 (1.1%) <0.001 0.52 (0.48 -0.57) Dyslipidemia 1108 (3.1%) 21833 (3.7%) <0.001 0.85 (0.8 -0.9) Triglyceride ≥150 mg/dl 756 (1.2%) 12731 (1.6%) <0.001 0.78 (0.73 -0.84) Total cholesterol ≥200 mg/dl 604 (1%) 6539 (0.8%) <0.001 1.19 (1.1 -1.3) LDL-cholesterol ≥130 mg/dl 553 (0.8%) 5817 (0.7%) <0.001 1.2 (1.1 -1.31) HDL-cholesterol <50 mg/dl 1125 (2.4%) 19147 (2.7%) <0.001 0.87 (0.82 -0.92) Cerebrovascular disease 259 (0.3%) 4220 (0.5%) <0.001 0.7 (0.61 -0.79) Transient ischemic attacks 72 (0.1%) 827 (0.1%) 0.865 0.98 (0.77 -1.25) Cerebral infarction 149 (0.2%) 2121 (0.2%) 0.005 0.79 (0.67 -0.93) Cerebral occlusion without infarction 94 (0.1%) 1589 (0.2%) <0.001 0.67 (0.54 -0.82) Intracerebral hemorrhage 24 (0%) 563 (0.1%) <0.001 0.48 (0.32 -0.72) Subarachnoid hemorrhage 22 (0%) 313 (0%) 0.271 0.79 (0.51 -1.21) Hospital admission 719 (1.2%) 19795 (2.9%) <0.001 0.41 (0.38 -0.44) Emergency visits 936 (2.3%) 17873 (4.4%) <0.001 0.53 (0.5 -0.57) Outpatient encounters 694 (2.4%) 22256 (4.8%) <0.001 0.5 (0.47 -0.54) Intensive care unit admission 23 (0%) 1748 (0.2%) <0.001 0.14 (0.1 -0.22) Mechanical ventilation 517 (0.6%) 11014 (1.2%) <0.001 0.52 (0.48 -0.57) Referral to Cardio services 0 (0%) 10 (0%) 0.344 NA Referral to Neuro services 0 (0%) 28 (0%) 0.113 NA ECMO 10 (0%) 298 (0%) 0.001 0.38 (0.2 -0.7) ECMO-VV 10 (0%) 252 (0%) 0.009 0.44 (0.24 -0.83) ECMO-VA 10 (0%) 115 (0%) 0.928 0.97 (0.51 -1.85) Mortality 1375 (1.6%) 25690 (2.7%) <0.001 0.6 (0.57 -0.63) 3-6mo Major adverse cardiovascular events 340 (0.5%) 3359 (0.4%) 0.01 1.16 (1.04 -1.29) Cardiovascular disease 393 (0.6%) 4056 (0.5%) 0.029 1.12 (1.01 -1.24) Ischemic heart disease 233 (0.3%) 2374 (0.3%) 0.096 1.12 (0.98 -1.28) Myocardial angina 46 (0.1%) 353 (0%) 0.014 1.47 (1.08 -1.99) Acute coronary disease 45 (0.1%) 421 (0%) 0.252 1.2 (0.88 -1.63) Myocardial infarction 94 (0.1%) 950 (0.1%) 0.336 1.11 (0.9 -1.37) Ischemic cardiomyopathy 37 (0%) 324 (0%) 0.155 1.28 (0.91 -1.8) ### Page 36 Arrythmias 482 (0.7%) 5145 (0.7%) 0.059 1.09 (0.99 -1.2) Atrial fibrillation and flutter 128 (0.2%) 1349 (0.2%) 0.516 1.06 (0.89 -1.27) Paroxysmal tachycardia 116 (0.1%) 780 (0.1%) <0.001 1.67 (1.38 -2.03) Other cardiac arrythmias 248 (0.3%) 2004 (0.2%) <0.001 1.43 (1.25 -1.63) Inflammatory heart disease 64 (0.1%) 616 (0.1%) 0.244 1.17 (0.9 -1.51) Pericarditis 46 (0.1%) 410 (0%) 0.14 1.26 (0.93 -1.71) Myocarditis 10 (0%) 42 (0%) 0.004 2.66 (1.33 -5.3) Endocarditis 18 (0%) 216 (0%) 0.772 0.93 (0.58 -1.51) Hypertensive heart disease 393 (0.7%) 4962 (0.7%) 0.825 1.01 (0.91 -1.12) Pulmonary heart diseases 99 (0.1%) 1031 (0.1%) 0.468 1.08 (0.88 -1.33) Heart Failure 164 (0.2%) 1531 (0.2%) 0.025 1.2 (1.02 -1.41) Cardiomyopathy 73 (0.1%) 708 (0.1%) 0.232 1.16 (0.91 -1.47) Cardiomegaly 168 (0.2%) 1235 (0.1%) <0.001 1.54 (1.31 -1.81) Cardiogenic shock 34 (0%) 237 (0%) 0.01 1.6 (1.12 -2.29) Cardiac arrest 60 (0.1%) 545 (0.1%) 0.133 1.23 (0.94 -1.6) Thrombotic disorders 104 (0.1%) 1068 (0.1%) 0.39 1.09 (0.89 -1.34) Pulmonary embolism 35 (0%) 453 (0%) 0.4 0.86 (0.61 -1.22) Deep and superficial thrombosis 94 (0.1%) 855 (0.1%) 0.053 1.23 (1 -1.53) Thrombosis with Thrombocytopenia 0 (0%) 0 (0%) NA NA Elevated Troponin I 81 (0.1%) 1161 (0.1%) 0.026 0.77 (0.62 -0.97) Elevated Natriuretic peptide B 183 (0.2%) 1619 (0.2%) 0.002 1.27 (1.09 -1.48) Dyslipidemia 659 (1.9%) 8106 (1.4%) <0.001 1.35 (1.25 -1.46) Triglyceride ≥150 mg/dl 447 (0.7%) 4438 (0.6%) <0.001 1.32 (1.2 -1.45) Total cholesterol ≥200 mg/dl 450 (0.7%) 4041 (0.5%) <0.001 1.44 (1.31 -1.59) LDL-cholesterol ≥130 mg/dl 404 (0.6%) 3583 (0.4%) <0.001 1.42 (1.28 -1.58) HDL-cholesterol <50 mg/dl 663 (1.4%) 6865 (1%) <0.001 1.42 (1.32 -1.54) Cerebrovascular disease 184 (0.2%) 1646 (0.2%) 0.003 1.26 (1.09 -1.47) Transient ischemic attacks 55 (0.1%) 402 (0%) 0.003 1.54 (1.16 -2.04) Cerebral infarction 56 (0.1%) 719 (0.1%) 0.324 0.87 (0.67 -1.15) Cerebral occlusion without infarction 78 (0.1%) 571 (0.1%) <0.001 1.54 (1.22 -1.95) Intracerebral hemorrhage 17 (0%) 179 (0%) 0.819 1.06 (0.65 -1.74) Subarachnoid hemorrhage 22 (0%) 103 (0%) <0.001 2.39 (1.51 -3.78) Hospital admission 418 (0.7%) 5377 (0.8%) 0.003 0.86 (0.78 -0.95) Emergency visits 683 (1.7%) 7898 (2%) <0.001 0.86 (0.8 -0.93) Outpatient encounters 343 (1.2%) 8296 (1.9%) <0.001 0.65 (0.58 -0.72) Intensive care unit admission 12 (0%) 514 (0.1%) <0.001 0.26 (0.14 -0.45) Mechanical ventilation 140 (0.2%) 1100 (0.1%) <0.001 1.41 (1.18 -1.68) Referral to Cardio services 0 (0%) 0 (0%) NA NA Referral to Neuro services 0 (0%) 10 (0%) 0.344 NA ECMO 10 (0%) 10 (0%) <0.001 11.16 (4.65 -26.82) ECMO-VV 10 (0%) 10 (0%) <0.001 11.16 (4.65 -26.82) ECMO-VA 0 (0%) 10 (0%) 0.344 NA Mortality 569 (0.7%) 5145 (0.5%) <0.001 1.24 (1.13 -1.35) 6-9mo Major adverse cardiovascular events 263 (0.4%) 2638 (0.3%) 0.041 1.14 (1.01 -1.29) Cardiovascular disease 315 (0.5%) 3276 (0.4%) 0.066 1.11 (0.99 -1.25) Ischemic heart disease 190 (0.3%) 1812 (0.2%) 0.018 1.2 (1.03 -1.39) Myocardial angina 36 (0%) 287 (0%) 0.05 1.41 (1 -2) Acute coronary disease 50 (0.1%) 313 (0%) <0.001 1.79 (1.33 -2.41) Myocardial infarction 92 (0.1%) 660 (0.1%) <0.001 1.56 (1.26 -1.94) Ischemic cardiomyopathy 32 (0%) 229 (0%) 0.017 1.57 (1.08 -2.27) Arrythmias 414 (0.6%) 4269 (0.6%) 0.015 1.13 (1.03 -1.25) Atrial fibrillation and flutter 105 (0.1%) 1024 (0.1%) 0.179 1.15 (0.94 -1.4) Paroxysmal tachycardia 83 (0.1%) 617 (0.1%) <0.001 1.51 (1.2 -1.9) Other cardiac arrythmias 182 (0.2%) 1601 (0.2%) 0.001 1.31 (1.12 -1.53) Inflammatory heart disease 53 (0.1%) 388 (0%) 0.003 1.53 (1.15 -2.04) Pericarditis 42 (0.1%) 251 (0%) <0.001 1.88 (1.35 -2.6) Myocarditis 10 (0%) 30 (0%) <0.001 3.72 (1.82 -7.61) Endocarditis 14 (0%) 144 (0%) 0.767 1.09 (0.63 -1.88) Hypertensive heart disease 330 (0.6%) 4079 (0.6%) 0.564 1.03 (0.92 -1.16) Pulmonary heart diseases 88 (0.1%) 732 (0.1%) 0.007 1.35 (1.08 -1.69) Heart Failure 123 (0.2%) 1156 (0.1%) 0.061 1.19 (0.99 -1.44) Cardiomyopathy 73 (0.1%) 543 (0.1%) 0.001 1.51 (1.18 -1.93) ### Page 37 Cardiomegaly 124 (0.2%) 905 (0.1%) <0.001 1.55 (1.29 -1.87) Cardiogenic shock 27 (0%) 185 (0%) 0.017 1.63 (1.09 -2.44) Cardiac arrest 55 (0.1%) 341 (0%) <0.001 1.8 (1.35 -2.39) Thrombotic disorders 93 (0.1%) 807 (0.1%) 0.019 1.29 (1.04 -1.6) Pulmonary embolism 33 (0%) 350 (0%) 0.776 1.05 (0.74 -1.51) Deep and superficial thrombosis 82 (0.1%) 638 (0.1%) 0.002 1.44 (1.15 -1.82) Thrombosis with Thrombocytopenia 0 (0%) 0 (0%) NA NA Elevated Troponin I 78 (0.1%) 969 (0.1%) 0.336 0.89 (0.71 -1.13) Elevated Natriuretic peptide B 155 (0.2%) 1245 (0.1%) <0.001 1.4 (1.18 -1.65) Dyslipidemia 602 (1.8%) 6756 (1.2%) <0.001 1.48 (1.37 -1.61) Triglyceride ≥150 mg/dl 458 (0.8%) 3767 (0.5%) <0.001 1.6 (1.45 -1.76) Total cholesterol ≥200 mg/dl 414 (0.7%) 3648 (0.5%) <0.001 1.47 (1.33 -1.63) LDL-cholesterol ≥130 mg/dl 394 (0.6%) 3116 (0.4%) <0.001 1.6 (1.44 -1.77) HDL-cholesterol <50 mg/dl 599 (1.3%) 5852 (0.9%) <0.001 1.52 (1.39 -1.65) Cerebrovascular disease 169 (0.2%) 1372 (0.2%) <0.001 1.39 (1.19 -1.64) Transient ischemic attacks 51 (0.1%) 357 (0%) 0.001 1.61 (1.2 -2.16) Cerebral infarction 79 (0.1%) 610 (0.1%) 0.002 1.45 (1.15 -1.83) Cerebral occlusion without infarction 69 (0.1%) 518 (0.1%) 0.001 1.5 (1.17 -1.93) Intracerebral hemorrhage 21 (0%) 141 (0%) 0.028 1.66 (1.05 -2.63) Subarachnoid hemorrhage 16 (0%) 91 (0%) 0.011 1.96 (1.15 -3.34) Hospital admission 397 (0.7%) 4630 (0.7%) 0.317 0.95 (0.86 -1.05) Emergency visits 663 (1.7%) 6926 (1.8%) 0.229 0.95 (0.88 -1.03) Outpatient encounters 321 (1.2%) 6480 (1.5%) <0.001 0.77 (0.69 -0.86) Intensive care unit admission 18 (0%) 420 (0%) 0.001 0.47 (0.29 -0.75) Mechanical ventilation 117 (0.1%) 827 (0.1%) <0.001 1.57 (1.29 -1.9) Referral to Cardio services 0 (0%) 0 (0%) NA NA Referral to Neuro services 10 (0%) 50 (0%) 0.017 2.23 (1.13 -4.4) ECMO 10 (0%) 45 (0%) 0.007 2.48 (1.25 -4.92) ECMO-VV 10 (0%) 15 (0%) <0.001 7.44 (3.34 -16.57) ECMO-VA 10 (0%) 37 (0%) 0.001 3.02 (1.5 -6.07) Mortality 466 (0.6%) 3737 (0.4%) <0.001 1.39 (1.27 -1.53) >9mo Major adverse cardiovascular events 1292 (1.8%) 13468 (1.7%) 0.001 1.1 (1.04 -1.16) Cardiovascular disease 1632 (2.5%) 16782 (2.2%) <0.001 1.13 (1.07 -1.19) Ischemic heart disease 992 (1.3%) 9031 (1.1%) <0.001 1.26 (1.18 -1.34) Myocardial angina 164 (0.2%) 1374 (0.1%) <0.001 1.34 (1.14 -1.58) Acute coronary disease 188 (0.2%) 1270 (0.1%) <0.001 1.66 (1.42 -1.93) Myocardial infarction 350 (0.4%) 3152 (0.3%) <0.001 1.25 (1.12 -1.39) Ischemic cardiomyopathy 92 (0.1%) 913 (0.1%) 0.268 1.13 (0.91 -1.4) Arrythmias 2163 (3.3%) 22281 (2.9%) <0.001 1.14 (1.09 -1.19) Atrial fibrillation and flutter 460 (0.6%) 4616 (0.5%) 0.025 1.12 (1.01 -1.23) Paroxysmal tachycardia 362 (0.4%) 2589 (0.3%) <0.001 1.57 (1.41 -1.76) Other cardiac arrythmias 929 (1.2%) 7456 (0.8%) <0.001 1.44 (1.34 -1.54) Inflammatory heart disease 270 (0.3%) 1820 (0.2%) <0.001 1.66 (1.47 -1.89) Pericarditis 191 (0.2%) 1189 (0.1%) <0.001 1.8 (1.55 -2.1) Myocarditis 12 (0%) 110 (0%) 0.516 1.22 (0.67 -2.21) Endocarditis 91 (0.1%) 680 (0.1%) <0.001 1.5 (1.2 -1.86) Hypertensive heart disease 2410 (4.6%) 26569 (4%) <0.001 1.16 (1.11 -1.21) Pulmonary heart diseases 389 (0.5%) 3132 (0.3%) <0.001 1.4 (1.26 -1.55) Heart Failure 533 (0.7%) 5113 (0.6%) 0.001 1.17 (1.07 -1.28) Cardiomyopathy 261 (0.3%) 2237 (0.2%) <0.001 1.31 (1.15 -1.49) Cardiomegaly 534 (0.7%) 4562 (0.5%) <0.001 1.33 (1.21 -1.45) Cardiogenic shock 112 (0.1%) 724 (0.1%) <0.001 1.73 (1.42 -2.11) Cardiac arrest 239 (0.3%) 2071 (0.2%) <0.001 1.29 (1.13 -1.47) Thrombotic disorders 478 (0.6%) 4097 (0.5%) <0.001 1.31 (1.19 -1.44) Pulmonary embolism 188 (0.2%) 1444 (0.2%) <0.001 1.45 (1.25 -1.69) Deep and superficial thrombosis 390 (0.5%) 3401 (0.4%) <0.001 1.29 (1.16 -1.43) Thrombosis with Thrombocytopenia 10 (0%) 0 (0%) <0.001 NA Elevated Troponin I 452 (0.5%) 6196 (0.7%) <0.001 0.81 (0.74 -0.89) Elevated Natriuretic peptide B 697 (0.9%) 6022 (0.7%) <0.001 1.3 (1.2 -1.41) Dyslipidemia 3787 (11.4%) 42458 (7.6%) <0.001 1.49 (1.45 -1.54) Triglyceride ≥150 mg/dl 2895 (4.9%) 24890 (3.2%) <0.001 1.53 (1.47 -1.59) Total cholesterol ≥200 mg/dl 2751 (4.5%) 24015 (3%) <0.001 1.49 (1.43 -1.55) ### Page 38 LDL-cholesterol ≥130 mg/dl 2541 (3.9%) 21815 (2.7%) <0.001 1.47 (1.42 -1.54) HDL-cholesterol <50 mg/dl 3679 (8.1%) 36493 (5.4%) <0.001 1.5 (1.45 -1.55) Cerebrovascular disease 728 (0.9%) 6384 (0.7%) <0.001 1.29 (1.2 -1.39) Transient ischemic attacks 240 (0.3%) 1796 (0.2%) <0.001 1.5 (1.32 -1.72) Cerebral infarction 264 (0.3%) 2481 (0.3%) 0.007 1.19 (1.05 -1.35) Cerebral occlusion without infarction 296 (0.4%) 2304 (0.2%) <0.001 1.45 (1.28 -1.63) Intracerebral hemorrhage 68 (0.1%) 547 (0.1%) 0.011 1.39 (1.08 -1.79) Subarachnoid hemorrhage 54 (0.1%) 381 (0%) 0.001 1.58 (1.19 -2.11) Hospital admission 2267 (3.8%) 30805 (4.7%) <0.001 0.81 (0.78 -0.85) Emergency visits 4083 (10.8%) 41491 (11%) 0.161 0.98 (0.95 -1.01) Outpatient encounters 1592 (5.8%) 34896 (8.3%) <0.001 0.71 (0.67 -0.74) Intensive care unit admission 47 (0.1%) 1731 (0.2%) <0.001 0.3 (0.22 -0.4) Mechanical ventilation 505 (0.6%) 4143 (0.5%) <0.001 1.35 (1.23 -1.48) Referral to Cardio services 0 (0%) 0 (0%) NA NA Referral to Neuro services 10 (0%) 50 (0%) 0.017 2.23 (1.13 -4.4) ECMO 10 (0%) 45 (0%) 0.007 2.48 (1.25 -4.92) ECMO-VV 10 (0%) 15 (0%) <0.001 7.44 (3.34 -16.57) ECMO-VA 10 (0%) 37 (0%) 0.001 3.02 (1.5 -6.07) Mortality 2287 (2.7%) 17740 (1.9%) <0.001 1.44 (1.38 -1.5) For outcomes where event counts were fewer than 10, TriNetX platform suppressed exact numbers and reported '10' for de-identification purposes; thus, relative risks may be overestimated or not statistically meaningful in these cases. When zero events were observed, this is indicated as '0'. Caution is warranted in the interpretation of RRs where numerators are at or below this privacy threshold. ECMO: Extracorporeal membrane oxygenation. ### Page 39 Supplementary Table 8. Outcomes in female in infected, vaccinated individuals compared to infected, unvaccinated individuals (Group 4 vs Group 2) across four post-exposure time windows.Time Outcome Group 4 (n=94,451)Group 2 (n=1,190,308) p-value RR (95%CI)Follow-up (months) 25.8 ± 19.1 24 ± 160-3 mo Major adverse cardiovascular events 427 (0.5%) 8731 (0.7%) <0.001 0.62 (0.56 -0.68) Cardiovascular disease 673 (0.8%) 13852 (1.2%) <0.001 0.62 (0.58 -0.67) Ischemic heart disease 308 (0.3%) 5354 (0.4%) <0.001 0.72 (0.64 -0.81) Myocardial angina 52 (0.1%) 507 (0%) 0.087 1.28 (0.96 -1.71) Acute coronary disease 59 (0.1%) 968 (0.1%) 0.039 0.76 (0.58 -0.99) Myocardial infarction 121 (0.1%) 2388 (0.2%) <0.001 0.63 (0.53 -0.76) Ischemic cardiomyopathy 26 (0%) 404 (0%) 0.273 0.8 (0.54 -1.19) Arrythmias 1001 (1.2%) 18875 (1.8%) <0.001 0.7 (0.66 -0.75) Atrial fibrillation and flutter 169 (0.2%) 3540 (0.3%) <0.001 0.59 (0.51 -0.69) Paroxysmal tachycardia 143 (0.1%) 2238 (0.2%) 0.01 0.8 (0.68 -0.95) Other cardiac arrythmias 370 (0.4%) 6297 (0.5%) <0.001 0.75 (0.68 -0.83) Inflammatory heart disease 106 (0.1%) 1900 (0.1%) <0.001 0.7 (0.57 -0.85) Pericarditis 88 (0.1%) 1354 (0.1%) 0.056 0.81 (0.65 -1.01) Myocarditis 10 (0%) 198 (0%) 0.148 0.63 (0.33 -1.19) Endocarditis 21 (0%) 506 (0%) 0.003 0.52 (0.33 -0.8) Hypertensive heart disease 636 (0.9%) 13512 (1.4%) <0.001 0.64 (0.59 -0.69) Pulmonary heart diseases 215 (0.2%) 4313 (0.3%) <0.001 0.62 (0.54 -0.71) Heart Failure 217 (0.2%) 4318 (0.3%) <0.001 0.63 (0.55 -0.72) Cardiomyopathy 99 (0.1%) 1476 (0.1%) 0.088 0.84 (0.68 -1.03) Cardiomegaly 217 (0.2%) 4654 (0.4%) <0.001 0.58 (0.51 -0.67) Cardiogenic shock 32 (0%) 479 (0%) 0.311 0.83 (0.58 -1.19) Cardiac arrest 53 (0.1%) 1291 (0.1%) <0.001 0.51 (0.39 -0.67) Thrombotic disorders 212 (0.2%) 5055 (0.4%) <0.001 0.52 (0.46 -0.6) Pulmonary embolism 113 (0.1%) 2648 (0.2%) <0.001 0.53 (0.44 -0.64) Deep and superficial thrombosis 143 (0.1%) 3388 (0.3%) <0.001 0.53 (0.45 -0.62) Thrombosis with Thrombocytopenia 0 (0%) 10 (0%) 0.37 NA Elevated Troponin I 167 (0.2%) 3893 (0.3%) <0.001 0.53 (0.46 -0.62) Elevated Natriuretic peptide B 324 (0.3%) 9197 (0.7%) <0.001 0.44 (0.39 -0.49) Dyslipidemia 1192 (2.5%) 22560 (2.7%) 0.001 0.91 (0.86 -0.96) Triglyceride ≥150 mg/dl 745 (0.9%) 11173 (1%) 0.079 0.94 (0.87 -1.01) Total cholesterol ≥200 mg/dl 856 (1.2%) 10559 (1%) <0.001 1.22 (1.14 -1.3) LDL-cholesterol ≥130 mg/dl 725 (0.9%) 8392 (0.7%) <0.001 1.22 (1.14 -1.32) HDL-cholesterol <50 mg/dl 890 (1.2%) 15201 (1.4%) <0.001 0.84 (0.79 -0.9) Cerebrovascular disease 240 (0.2%) 4386 (0.4%) <0.001 0.69 (0.6 -0.78) Transient ischemic attacks 63 (0.1%) 895 (0.1%) 0.329 0.88 (0.68 -1.14) Cerebral infarction 93 (0.1%) 2050 (0.2%) <0.001 0.57 (0.46 -0.7) Cerebral occlusion without infarction 77 (0.1%) 1357 (0.1%) 0.003 0.71 (0.56 -0.89) Intracerebral hemorrhage 26 (0%) 421 (0%) 0.191 0.77 (0.52 -1.14) Subarachnoid hemorrhage 22 (0%) 275 (0%) 0.986 1 (0.65 -1.54) Hospital admission 1091 (1.5%) 26397 (3%) <0.001 0.5 (0.47 -0.54) Emergency visits 1332 (2.8%) 22786 (4%) <0.001 0.69 (0.65 -0.73) Outpatient encounters 667 (1.8%) 25681 (4.2%) <0.001 0.42 (0.39 -0.45) Intensive care unit admission 37 (0%) 1946 (0.2%) <0.001 0.23 (0.17 -0.32) Mechanical ventilation 227 (0.2%) 7467 (0.6%) <0.001 0.38 (0.33 -0.43) Referral to Cardio services 0 (0%) 10 (0%) 0.37 NA Referral to Neuro services 10 (0%) 33 (0%) <0.001 3.77 (1.86 -7.65) ECMO 10 (0%) 151 (0%) 0.554 0.82 (0.44 -1.56) ECMO-VV 10 (0%) 124 (0%) 0.991 1 (0.53 -1.91) ECMO-VA 10 (0%) 38 (0%) <0.001 3.28 (1.63 -6.57) Mortality 947 (0.9%) 20302 (1.6%) <0.001 0.58 (0.54 -0.62) 3-6mo Major adverse cardiovascular events 315 (0.3%) 3869 (0.3%) 0.696 1.02 (0.91 -1.15) Cardiovascular disease 488 (0.6%) 5510 (0.5%) 0.008 1.13 (1.03 -1.24) Ischemic heart disease 191 (0.2%) 2355 (0.2%) 0.844 1.02 (0.88 -1.18) Myocardial angina 25 (0%) 353 (0%) 0.556 0.89 (0.59 -1.33) Acute coronary disease 33 (0%) 366 (0%) 0.526 1.12 (0.79 -1.6) Myocardial infarction 56 (0.1%) 855 (0.1%) 0.135 0.81 (0.62 -1.07) Ischemic cardiomyopathy 14 (0%) 173 (0%) 0.978 1.01 (0.59 -1.74) ### Page 40 Arrythmias 663 (0.8%) 8540 (0.8%) 0.65 1.02 (0.94 -1.1) Atrial fibrillation and flutter 81 (0.1%) 1332 (0.1%) 0.013 0.75 (0.6 -0.94) Paroxysmal tachycardia 125 (0.1%) 1071 (0.1%) <0.001 1.46 (1.22 -1.76) Other cardiac arrythmias 254 (0.3%) 2663 (0.2%) 0.003 1.22 (1.07 -1.38) Inflammatory heart disease 64 (0.1%) 689 (0.1%) 0.256 1.16 (0.9 -1.5) Pericarditis 39 (0%) 483 (0%) 0.966 1.01 (0.73 -1.4) Myocarditis 10 (0%) 45 (0%) 0.002 2.77 (1.39 -5.49) Endocarditis 28 (0%) 217 (0%) 0.017 1.61 (1.09 -2.38) Hypertensive heart disease 479 (0.7%) 6748 (0.7%) 0.364 0.96 (0.87 -1.05) Pulmonary heart diseases 92 (0.1%) 1296 (0.1%) 0.261 0.89 (0.72 -1.09) Heart Failure 113 (0.1%) 1710 (0.1%) 0.041 0.82 (0.68 -0.99) Cardiomyopathy 58 (0.1%) 605 (0%) 0.189 1.2 (0.92 -1.57) Cardiomegaly 121 (0.1%) 1399 (0.1%) 0.402 1.08 (0.9 -1.3) Cardiogenic shock 14 (0%) 152 (0%) 0.625 1.15 (0.66 -1.98) Cardiac arrest 31 (0%) 435 (0%) 0.514 0.89 (0.62 -1.28) Thrombotic disorders 111 (0.1%) 1423 (0.1%) 0.782 0.97 (0.8 -1.18) Pulmonary embolism 45 (0%) 571 (0%) 0.9 0.98 (0.72 -1.33) Deep and superficial thrombosis 93 (0.1%) 1147 (0.1%) 0.912 1.01 (0.82 -1.25) Thrombosis with Thrombocytopenia 0 (0%) 0 (0%) NA NA Elevated Troponin I 103 (0.1%) 1226 (0.1%) 0.692 1.04 (0.85 -1.27) Elevated Natriuretic peptide B 141 (0.1%) 1874 (0.1%) 0.428 0.93 (0.79 -1.11) Dyslipidemia 896 (1.9%) 12049 (1.5%) <0.001 1.28 (1.19 -1.37) Triglyceride ≥150 mg/dl 550 (0.7%) 5227 (0.5%) <0.001 1.48 (1.35 -1.61) Total cholesterol ≥200 mg/dl 699 (1%) 7542 (0.7%) <0.001 1.39 (1.29 -1.51) LDL-cholesterol ≥130 mg/dl 610 (0.8%) 5868 (0.5%) <0.001 1.48 (1.36 -1.6) HDL-cholesterol <50 mg/dl 575 (0.8%) 7330 (0.7%) 0.006 1.13 (1.04 -1.23) Cerebrovascular disease 191 (0.2%) 2187 (0.2%) 0.222 1.1 (0.95 -1.27) Transient ischemic attacks 42 (0%) 560 (0%) 0.69 0.94 (0.69 -1.28) Cerebral infarction 87 (0.1%) 890 (0.1%) 0.081 1.22 (0.98 -1.52) Cerebral occlusion without infarction 54 (0.1%) 733 (0.1%) 0.559 0.92 (0.7 -1.21) Intracerebral hemorrhage 23 (0%) 201 (0%) 0.107 1.42 (0.93 -2.19) Subarachnoid hemorrhage 14 (0%) 115 (0%) 0.139 1.52 (0.87 -2.64) Hospital admission 716 (1%) 11099 (1.3%) <0.001 0.77 (0.72 -0.83) Emergency visits 935 (2%) 11309 (2.1%) 0.276 0.96 (0.9 -1.03) Outpatient encounters 384 (1%) 12395 (2.1%) <0.001 0.49 (0.44 -0.54) Intensive care unit admission 26 (0%) 790 (0.1%) <0.001 0.4 (0.27 -0.59) Mechanical ventilation 77 (0.1%) 1099 (0.1%) 0.223 0.87 (0.69 -1.09) Referral to Cardio services 0 (0%) 10 (0%) 0.37 NA Referral to Neuro services 0 (0%) 22 (0%) 0.184 NA ECMO 10 (0%) 10 (0%) <0.001 12.45 (5.18 -29.9) ECMO-VV 0 (0%) 10 (0%) 0.37 NA ECMO-VA 10 (0%) 10 (0%) <0.001 12.45 (5.18 -29.9) Mortality 457 (0.4%) 5023 (0.4%) 0.011 1.13 (1.03 -1.25) 6-9mo Major adverse cardiovascular events 269 (0.3%) 3153 (0.3%) 0.272 1.07 (0.95 -1.21) Cardiovascular disease 394 (0.5%) 4500 (0.4%) 0.03 1.12 (1.01 -1.24) Ischemic heart disease 157 (0.2%) 1886 (0.2%) 0.623 1.04 (0.89 -1.23) Myocardial angina 21 (0%) 316 (0%) 0.41 0.83 (0.53 -1.29) Acute coronary disease 25 (0%) 229 (0%) 0.144 1.36 (0.9 -2.05) Myocardial infarction 60 (0.1%) 677 (0.1%) 0.474 1.1 (0.85 -1.43) Ischemic cardiomyopathy 12 (0%) 128 (0%) 0.608 1.17 (0.65 -2.11) Arrythmias 600 (0.7%) 6851 (0.7%) 0.001 1.15 (1.06 -1.25) Atrial fibrillation and flutter 67 (0.1%) 944 (0.1%) 0.311 0.88 (0.69 -1.13) Paroxysmal tachycardia 81 (0.1%) 825 (0.1%) 0.074 1.23 (0.98 -1.55) Other cardiac arrythmias 194 (0.2%) 2130 (0.2%) 0.044 1.16 (1 -1.35) Inflammatory heart disease 40 (0%) 492 (0%) 0.927 1.02 (0.74 -1.4) Pericarditis 23 (0%) 344 (0%) 0.398 0.83 (0.55 -1.27) Myocarditis 10 (0%) 27 (0%) <0.001 4.61 (2.23 -9.52) Endocarditis 17 (0%) 150 (0%) 0.175 1.41 (0.86 -2.33) Hypertensive heart disease 387 (0.5%) 5585 (0.6%) 0.2 0.94 (0.84 -1.04) Pulmonary heart diseases 79 (0.1%) 983 (0.1%) 0.981 1 (0.8 -1.26) Heart Failure 116 (0.1%) 1223 (0.1%) 0.093 1.18 (0.97 -1.42) Cardiomyopathy 57 (0.1%) 482 (0%) 0.005 1.48 (1.12 -1.94) ### Page 41 Cardiomegaly 79 (0.1%) 1188 (0.1%) 0.114 0.83 (0.66 -1.05) Cardiogenic shock 18 (0%) 128 (0%) 0.024 1.75 (1.07 -2.87) Cardiac arrest 27 (0%) 306 (0%) 0.645 1.1 (0.74 -1.63) Thrombotic disorders 88 (0.1%) 1133 (0.1%) 0.775 0.97 (0.78 -1.2) Pulmonary embolism 29 (0%) 461 (0%) 0.2 0.78 (0.54 -1.14) Deep and superficial thrombosis 80 (0.1%) 870 (0.1%) 0.238 1.15 (0.91 -1.44) Thrombosis with Thrombocytopenia 0 (0%) 10 (0%) 0.37 NA Elevated Troponin I 85 (0.1%) 1124 (0.1%) 0.566 0.94 (0.75 -1.17) Elevated Natriuretic peptide B 131 (0.1%) 1466 (0.1%) 0.26 1.11 (0.93 -1.33) Dyslipidemia 791 (1.7%) 10166 (1.3%) <0.001 1.34 (1.25 -1.44) Triglyceride ≥150 mg/dl 456 (0.6%) 4630 (0.4%) <0.001 1.39 (1.26 -1.52) Total cholesterol ≥200 mg/dl 610 (0.9%) 6451 (0.6%) <0.001 1.43 (1.31 -1.55) LDL-cholesterol ≥130 mg/dl 522 (0.7%) 5200 (0.5%) <0.001 1.43 (1.31 -1.56) HDL-cholesterol <50 mg/dl 549 (0.8%) 6501 (0.6%) <0.001 1.21 (1.11 -1.32) Cerebrovascular disease 163 (0.2%) 1835 (0.1%) 0.181 1.12 (0.95 -1.31) Transient ischemic attacks 42 (0%) 491 (0%) 0.674 1.07 (0.78 -1.47) Cerebral infarction 55 (0.1%) 727 (0.1%) 0.667 0.94 (0.72 -1.24) Cerebral occlusion without infarction 51 (0%) 596 (0%) 0.644 1.07 (0.8 -1.42) Intracerebral hemorrhage 12 (0%) 140 (0%) 0.831 1.07 (0.59 -1.92) Subarachnoid hemorrhage 10 (0%) 103 (0%) 0.566 1.21 (0.63 -2.31) Hospital admission 552 (0.8%) 8473 (1%) <0.001 0.78 (0.72 -0.85) Emergency visits 846 (1.8%) 9968 (1.9%) 0.75 0.99 (0.92 -1.06) Outpatient encounters 298 (0.8%) 9375 (1.6%) <0.001 0.5 (0.44 -0.56) Intensive care unit admission 23 (0%) 674 (0.1%) <0.001 0.42 (0.27 -0.63) Mechanical ventilation 76 (0.1%) 813 (0.1%) 0.226 1.16 (0.91 -1.46) Referral to Cardio services 0 (0%) 0 (0%) NA NA Referral to Neuro services 10 (0%) 14 (0%) <0.001 8.89 (3.95 -20.02) ECMO 0 (0%) 10 (0%) 0.37 NA ECMO-VV 0 (0%) 10 (0%) 0.37 NA ECMO-VA 0 (0%) 10 (0%) 0.37 NA Mortality 385 (0.4%) 3708 (0.3%) <0.001 1.29 (1.16 -1.44) >9mo Major adverse cardiovascular events 1324 (1.4%) 15728 (1.3%) 0.047 1.06 (1 -1.12) Cardiovascular disease 1983 (2.3%) 22230 (2%) <0.001 1.14 (1.09 -1.2) Ischemic heart disease 826 (0.8%) 9294 (0.8%) 0.003 1.11 (1.04 -1.19) Myocardial angina 158 (0.2%) 1484 (0.1%) 0.001 1.33 (1.13 -1.57) Acute coronary disease 90 (0.1%) 1169 (0.1%) 0.696 0.96 (0.77 -1.19) Myocardial infarction 256 (0.2%) 3188 (0.2%) 0.972 1 (0.88 -1.13) Ischemic cardiomyopathy 29 (0%) 480 (0%) 0.135 0.75 (0.52 -1.09) Arrythmias 3410 (4.3%) 38900 (3.7%) <0.001 1.15 (1.11 -1.19) Atrial fibrillation and flutter 362 (0.4%) 4236 (0.3%) 0.292 1.06 (0.95 -1.18) Paroxysmal tachycardia 388 (0.4%) 3761 (0.3%) <0.001 1.29 (1.17 -1.44) Other cardiac arrythmias 1036 (1.1%) 10144 (0.8%) <0.001 1.3 (1.22 -1.39) Inflammatory heart disease 228 (0.2%) 2359 (0.2%) 0.007 1.21 (1.05 -1.38) Pericarditis 134 (0.1%) 1594 (0.1%) 0.599 1.05 (0.88 -1.25) Myocarditis 10 (0%) 94 (0%) 0.397 1.32 (0.69 -2.54) Endocarditis 102 (0.1%) 795 (0.1%) <0.001 1.6 (1.3 -1.97) Hypertensive heart disease 2830 (3.9%) 34979 (3.6%) <0.001 1.09 (1.05 -1.13) Pulmonary heart diseases 378 (0.4%) 4178 (0.3%) 0.024 1.13 (1.02 -1.25) Heart Failure 420 (0.4%) 5316 (0.4%) 0.7 0.98 (0.89 -1.08) Cardiomyopathy 169 (0.2%) 1874 (0.1%) 0.137 1.13 (0.96 -1.32) Cardiomegaly 496 (0.5%) 5669 (0.4%) 0.052 1.1 (1 -1.2) Cardiogenic shock 64 (0.1%) 607 (0%) 0.038 1.31 (1.01 -1.7) Cardiac arrest 142 (0.1%) 1499 (0.1%) 0.062 1.18 (0.99 -1.4) Thrombotic disorders 480 (0.5%) 5529 (0.4%) 0.093 1.08 (0.99 -1.19) Pulmonary embolism 161 (0.2%) 1912 (0.1%) 0.569 1.05 (0.89 -1.23) Deep and superficial thrombosis 406 (0.4%) 4566 (0.4%) 0.044 1.11 (1 -1.23) Thrombosis with Thrombocytopenia 10 (0%) 10 (0%) <0.001 12.45 (5.18 -29.9) Elevated Troponin I 550 (0.5%) 7108 (0.6%) 0.345 0.96 (0.88 -1.05) Elevated Natriuretic peptide B 627 (0.6%) 7654 (0.6%) 0.701 1.02 (0.94 -1.1) Dyslipidemia 5587 (12.3%) 65958 (8.4%) <0.001 1.47 (1.43 -1.5) Triglyceride ≥150 mg/dl 3404 (4.3%) 31727 (2.8%) <0.001 1.51 (1.46 -1.56) Total cholesterol ≥200 mg/dl 4371 (6.3%) 44282 (4.2%) <0.001 1.49 (1.45 -1.54) ### Page 42 LDL-cholesterol ≥130 mg/dl 3683 (4.7%) 36343 (3.3%) <0.001 1.44 (1.4 -1.49) HDL-cholesterol <50 mg/dl 3848 (5.3%) 43297 (4.2%) <0.001 1.28 (1.24 -1.32) Cerebrovascular disease 765 (0.8%) 9146 (0.7%) 0.19 1.05 (0.98 -1.13) Transient ischemic attacks 273 (0.3%) 2852 (0.2%) 0.004 1.2 (1.06 -1.36) Cerebral infarction 252 (0.2%) 3420 (0.3%) 0.184 0.92 (0.81 -1.04) Cerebral occlusion without infarction 269 (0.3%) 2860 (0.2%) 0.011 1.18 (1.04 -1.33) Intracerebral hemorrhage 51 (0%) 651 (0%) 0.86 0.98 (0.73 -1.3) Subarachnoid hemorrhage 49 (0%) 482 (0%) 0.115 1.27 (0.94 -1.7) Hospital admission 3310 (4.8%) 47086 (5.7%) <0.001 0.84 (0.81 -0.87) Emergency visits 5123 (11.4%) 58839 (11.2%) 0.306 1.01 (0.99 -1.04) Outpatient encounters 1462 (4%) 51230 (9.1%) <0.001 0.44 (0.42 -0.47) Intensive care unit admission 67 (0.1%) 2605 (0.2%) <0.001 0.31 (0.25 -0.4) Mechanical ventilation 326 (0.3%) 4069 (0.3%) 0.872 0.99 (0.89 -1.11) Referral to Cardio services 0 (0%) 10 (0%) 0.37 NA Referral to Neuro services 10 (0%) 68 (0%) 0.07 1.83 (0.94 -3.56) ECMO 10 (0%) 28 (0%) <0.001 4.45 (2.16 -9.15) ECMO-VV 10 (0%) 12 (0%) <0.001 10.37 (4.48 -24.01) ECMO-VA 10 (0%) 19 (0%) <0.001 6.55 (3.05 -14.09) Mortality 1900 (1.8%) 18241 (1.4%) <0.001 1.3 (1.24 -1.36) For outcomes where event counts were fewer than 10, TriNetX platform suppressed exact numbers and reported '10' for de-identification purposes; thus, relative risks may be overestimated or not statistically meaningful in these cases. When zero events were observed, this is indicated as '0'. Caution is warranted in the interpretation of RRs where numerators are at or below this privacy threshold. ECMO: Extracorporeal membrane oxygenation. ### Page 43 Supplementary Table 9. Outcomes in male vaccinated individuals without infection compared to infected, unvaccinated individuals (Group 3 vs Group 2) across four post-exposure time windows.Time Outcome Group 3 (n=625,068)Group 2 (n=848,176) p-value RR (95%CI)Follow-up (months) 22.7 ± 18.8 22 ± 16.20-3 mo Major adverse cardiovascular events 1693 (0.3%) 9663 (1.1%) <0.001 0.24 (0.23 -0.25) Cardiovascular disease 2209 (0.4%) 14202 (1.8%) <0.001 0.21 (0.2 -0.22) Ischemic heart disease 1200 (0.2%) 6710 (0.8%) <0.001 0.25 (0.23 -0.26) Myocardial angina 184 (0%) 610 (0.1%) <0.001 0.44 (0.37 -0.51) Acute coronary disease 129 (0%) 1222 (0.1%) <0.001 0.15 (0.13 -0.18) Myocardial infarction 346 (0.1%) 3121 (0.3%) <0.001 0.16 (0.14 -0.18) Ischemic cardiomyopathy 163 (0%) 926 (0.1%) <0.001 0.25 (0.22 -0.3) Arrythmias 2507 (0.4%) 15915 (2%) <0.001 0.21 (0.2 -0.22) Atrial fibrillation and flutter 654 (0.1%) 4822 (0.5%) <0.001 0.19 (0.18 -0.21) Paroxysmal tachycardia 410 (0.1%) 2557 (0.3%) <0.001 0.23 (0.21 -0.26) Other cardiac arrythmias 1001 (0.2%) 6379 (0.7%) <0.001 0.22 (0.21 -0.24) Inflammatory heart disease 256 (0%) 2327 (0.2%) <0.001 0.16 (0.14 -0.18) Pericarditis 171 (0%) 1495 (0.2%) <0.001 0.17 (0.14 -0.19) Myocarditis 14 (0%) 279 (0%) <0.001 0.07 (0.04 -0.12) Endocarditis 85 (0%) 752 (0.1%) <0.001 0.16 (0.13 -0.21) Hypertensive heart disease 3148 (0.6%) 12479 (1.8%) <0.001 0.33 (0.31 -0.34) Pulmonary heart diseases 453 (0.1%) 5033 (0.5%) <0.001 0.13 (0.12 -0.14) Heart Failure 656 (0.1%) 4924 (0.5%) <0.001 0.19 (0.17 -0.2) Cardiomyopathy 365 (0.1%) 2362 (0.2%) <0.001 0.22 (0.2 -0.25) Cardiomegaly 584 (0.1%) 5574 (0.6%) <0.001 0.15 (0.14 -0.16) Cardiogenic shock 73 (0%) 752 (0.1%) <0.001 0.14 (0.11 -0.18) Cardiac arrest 159 (0%) 1832 (0.2%) <0.001 0.13 (0.11 -0.15) Thrombotic disorders 416 (0.1%) 6092 (0.6%) <0.001 0.1 (0.09 -0.11) Pulmonary embolism 176 (0%) 3384 (0.4%) <0.001 0.08 (0.06 -0.09) Deep and superficial thrombosis 328 (0%) 3921 (0.4%) <0.001 0.12 (0.11 -0.13) Thrombosis with Thrombocytopenia 0 (0%) 0 (0%) NA NA Elevated Troponin I 258 (0%) 4359 (0.5%) <0.001 0.09 (0.08 -0.1) Elevated Natriuretic peptide B 757 (0.1%) 10193 (1.1%) <0.001 0.1 (0.1 -0.11) Dyslipidemia 5897 (1.2%) 21348 (3.5%) <0.001 0.35 (0.34 -0.36) Triglyceride ≥150 mg/dl 2815 (0.5%) 12159 (1.5%) <0.001 0.33 (0.31 -0.34) Total cholesterol ≥200 mg/dl 2640 (0.4%) 6476 (0.8%) <0.001 0.58 (0.55 -0.6) LDL-cholesterol ≥130 mg/dl 2325 (0.4%) 5758 (0.7%) <0.001 0.57 (0.55 -0.6) HDL-cholesterol <50 mg/dl 4787 (0.9%) 18373 (2.5%) <0.001 0.35 (0.34 -0.36) Cerebrovascular disease 825 (0.1%) 4289 (0.5%) <0.001 0.27 (0.25 -0.29) Transient ischemic attacks 176 (0%) 771 (0.1%) <0.001 0.33 (0.28 -0.39) Cerebral infarction 316 (0%) 2146 (0.2%) <0.001 0.21 (0.19 -0.24) Cerebral occlusion without infarction 305 (0%) 1543 (0.2%) <0.001 0.29 (0.25 -0.32) Intracerebral hemorrhage 81 (0%) 585 (0.1%) <0.001 0.2 (0.16 -0.25) Subarachnoid hemorrhage 46 (0%) 329 (0%) <0.001 0.2 (0.15 -0.28) Hospital admission 2427 (0.4%) 19728 (2.9%) <0.001 0.15 (0.14 -0.15) Emergency visits 5000 (1%) 18523 (4.5%) <0.001 0.24 (0.23 -0.24) Outpatient encounters 7499 (1.9%) 23366 (4.8%) <0.001 0.4 (0.39 -0.41) Intensive care unit admission 142 (0%) 1744 (0.2%) <0.001 0.12 (0.1 -0.14) Mechanical ventilation 339 (0.1%) 10711 (1.1%) <0.001 0.05 (0.04 -0.05) Referral to Cardio services 0 (0%) 10 (0%) 0.009 NA Referral to Neuro services 10 (0%) 26 (0%) 0.112 0.56 (0.27 -1.16) ECMO 10 (0%) 289 (0%) <0.001 0.05 (0.03 -0.09) ECMO-VV 10 (0%) 240 (0%) <0.001 0.06 (0.03 -0.11) ECMO-VA 10 (0%) 98 (0%) <0.001 0.15 (0.08 -0.28) Mortality 1380 (0.2%) 25841 (2.7%) <0.001 0.08 (0.07 -0.08) 3-6mo Major adverse cardiovascular events 1418 (0.2%) 3424 (0.4%) <0.001 0.56 (0.52 -0.59) Cardiovascular disease 1752 (0.3%) 4189 (0.5%) <0.001 0.55 (0.52 -0.58) Ischemic heart disease 996 (0.2%) 2392 (0.3%) <0.001 0.58 (0.53 -0.62) Myocardial angina 153 (0%) 337 (0%) <0.001 0.66 (0.54 -0.79) Acute coronary disease 121 (0%) 386 (0%) <0.001 0.45 (0.37 -0.55) Myocardial infarction 300 (0%) 961 (0.1%) <0.001 0.45 (0.39 -0.51) Ischemic cardiomyopathy 116 (0%) 323 (0%) <0.001 0.52 (0.42 -0.64) ### Page 44 Arrythmias 2097 (0.3%) 5337 (0.7%) <0.001 0.51 (0.49 -0.54) Atrial fibrillation and flutter 538 (0.1%) 1375 (0.1%) <0.001 0.55 (0.5 -0.61) Paroxysmal tachycardia 346 (0.1%) 825 (0.1%) <0.001 0.6 (0.53 -0.68) Other cardiac arrythmias 810 (0.1%) 1995 (0.2%) <0.001 0.57 (0.53 -0.62) Inflammatory heart disease 215 (0%) 632 (0.1%) <0.001 0.49 (0.42 -0.57) Pericarditis 142 (0%) 418 (0%) <0.001 0.49 (0.41 -0.59) Myocarditis 10 (0%) 46 (0%) <0.001 0.32 (0.16 -0.62) Endocarditis 73 (0%) 224 (0%) <0.001 0.47 (0.36 -0.61) Hypertensive heart disease 2354 (0.4%) 5242 (0.8%) <0.001 0.57 (0.55 -0.6) Pulmonary heart diseases 402 (0.1%) 1097 (0.1%) <0.001 0.52 (0.47 -0.59) Heart Failure 558 (0.1%) 1593 (0.2%) <0.001 0.49 (0.45 -0.54) Cardiomyopathy 290 (0%) 750 (0.1%) <0.001 0.56 (0.48 -0.64) Cardiomegaly 449 (0.1%) 1329 (0.1%) <0.001 0.48 (0.43 -0.54) Cardiogenic shock 79 (0%) 236 (0%) <0.001 0.48 (0.38 -0.63) Cardiac arrest 136 (0%) 557 (0.1%) <0.001 0.35 (0.29 -0.43) Thrombotic disorders 369 (0.1%) 1121 (0.1%) <0.001 0.47 (0.42 -0.53) Pulmonary embolism 156 (0%) 489 (0.1%) <0.001 0.46 (0.38 -0.55) Deep and superficial thrombosis 279 (0%) 891 (0.1%) <0.001 0.45 (0.39 -0.51) Thrombosis with Thrombocytopenia 0 (0%) 0 (0%) NA NA Elevated Troponin I 249 (0%) 1134 (0.1%) <0.001 0.31 (0.27 -0.36) Elevated Natriuretic peptide B 670 (0.1%) 1627 (0.2%) <0.001 0.57 (0.52 -0.63) Dyslipidemia 4036 (0.9%) 8318 (1.4%) <0.001 0.61 (0.59 -0.63) Triglyceride ≥150 mg/dl 2004 (0.3%) 4393 (0.5%) <0.001 0.64 (0.6 -0.67) Total cholesterol ≥200 mg/dl 1847 (0.3%) 4080 (0.5%) <0.001 0.64 (0.6 -0.67) LDL-cholesterol ≥130 mg/dl 1603 (0.3%) 3591 (0.4%) <0.001 0.63 (0.6 -0.67) HDL-cholesterol <50 mg/dl 3199 (0.6%) 7006 (1%) <0.001 0.61 (0.58 -0.63) Cerebrovascular disease 681 (0.1%) 1711 (0.2%) <0.001 0.56 (0.51 -0.61) Transient ischemic attacks 158 (0%) 414 (0%) <0.001 0.55 (0.46 -0.66) Cerebral infarction 275 (0%) 732 (0.1%) <0.001 0.54 (0.47 -0.62) Cerebral occlusion without infarction 247 (0%) 603 (0.1%) <0.001 0.59 (0.51 -0.68) Intracerebral hemorrhage 65 (0%) 177 (0%) <0.001 0.53 (0.4 -0.71) Subarachnoid hemorrhage 47 (0%) 109 (0%) 0.007 0.63 (0.44 -0.88) Hospital admission 1974 (0.3%) 5600 (0.8%) <0.001 0.41 (0.39 -0.43) Emergency visits 4724 (1%) 8228 (2.1%) <0.001 0.48 (0.47 -0.5) Outpatient encounters 5624 (1.5%) 9303 (2%) <0.001 0.73 (0.71 -0.75) Intensive care unit admission 80 (0%) 516 (0.1%) <0.001 0.22 (0.17 -0.28) Mechanical ventilation 296 (0%) 1084 (0.1%) <0.001 0.39 (0.34 -0.44) Referral to Cardio services 0 (0%) 0 (0%) NA NA Referral to Neuro services 10 (0%) 13 (0%) 0.794 1.12 (0.49 -2.55) ECMO 10 (0%) 11 (0%) 0.526 1.32 (0.56 -3.11) ECMO-VV 10 (0%) 10 (0%) 0.403 1.45 (0.6 -3.49) ECMO-VA 10 (0%) 10 (0%) 0.403 1.45 (0.6 -3.49) Mortality 1531 (0.2%) 5285 (0.5%) <0.001 0.42 (0.4 -0.45) 6-9mo Major adverse cardiovascular events 1319 (0.2%) 2768 (0.3%) <0.001 0.64 (0.6 -0.68) Cardiovascular disease 1638 (0.3%) 3432 (0.4%) <0.001 0.62 (0.59 -0.66) Ischemic heart disease 924 (0.1%) 1875 (0.2%) <0.001 0.68 (0.63 -0.74) Myocardial angina 157 (0%) 295 (0%) 0.008 0.77 (0.63 -0.93) Acute coronary disease 115 (0%) 291 (0%) <0.001 0.57 (0.46 -0.71) Myocardial infarction 309 (0%) 687 (0.1%) <0.001 0.64 (0.56 -0.73) Ischemic cardiomyopathy 132 (0%) 249 (0%) 0.013 0.77 (0.62 -0.95) Arrythmias 1959 (0.3%) 4593 (0.6%) <0.001 0.55 (0.52 -0.58) Atrial fibrillation and flutter 561 (0.1%) 1074 (0.1%) <0.001 0.73 (0.66 -0.81) Paroxysmal tachycardia 304 (0%) 659 (0.1%) <0.001 0.66 (0.58 -0.76) Other cardiac arrythmias 739 (0.1%) 1649 (0.2%) <0.001 0.63 (0.58 -0.69) Inflammatory heart disease 185 (0%) 420 (0%) <0.001 0.63 (0.53 -0.75) Pericarditis 131 (0%) 273 (0%) 0.001 0.69 (0.56 -0.85) Myocarditis 10 (0%) 33 (0%) 0.019 0.44 (0.22 -0.89) Endocarditis 56 (0%) 155 (0%) <0.001 0.52 (0.39 -0.71) Hypertensive heart disease 2270 (0.4%) 4322 (0.6%) <0.001 0.67 (0.64 -0.7) Pulmonary heart diseases 367 (0.1%) 777 (0.1%) <0.001 0.67 (0.59 -0.76) Heart Failure 547 (0.1%) 1223 (0.1%) <0.001 0.63 (0.57 -0.69) Cardiomyopathy 301 (0%) 588 (0.1%) <0.001 0.73 (0.64 -0.84) ### Page 45 Cardiomegaly 418 (0.1%) 974 (0.1%) <0.001 0.61 (0.54 -0.68) Cardiogenic shock 97 (0%) 181 (0%) 0.043 0.78 (0.61 -0.99) Cardiac arrest 175 (0%) 346 (0%) 0.001 0.73 (0.61 -0.88) Thrombotic disorders 363 (0.1%) 872 (0.1%) <0.001 0.59 (0.52 -0.67) Pulmonary embolism 141 (0%) 366 (0%) <0.001 0.55 (0.46 -0.67) Deep and superficial thrombosis 284 (0%) 692 (0.1%) <0.001 0.59 (0.51 -0.67) Thrombosis with Thrombocytopenia 0 (0%) 0 (0%) NA NA Elevated Troponin I 241 (0%) 952 (0.1%) <0.001 0.36 (0.31 -0.42) Elevated Natriuretic peptide B 608 (0.1%) 1272 (0.1%) <0.001 0.66 (0.6 -0.73) Dyslipidemia 3559 (0.8%) 7003 (1.2%) <0.001 0.63 (0.61 -0.66) Triglyceride ≥150 mg/dl 1894 (0.3%) 3841 (0.5%) <0.001 0.69 (0.65 -0.72) Total cholesterol ≥200 mg/dl 1821 (0.3%) 3670 (0.4%) <0.001 0.7 (0.66 -0.74) LDL-cholesterol ≥130 mg/dl 1663 (0.3%) 3135 (0.4%) <0.001 0.75 (0.71 -0.8) HDL-cholesterol <50 mg/dl 2852 (0.5%) 6017 (0.9%) <0.001 0.63 (0.6 -0.66) Cerebrovascular disease 653 (0.1%) 1440 (0.2%) <0.001 0.64 (0.58 -0.7) Transient ischemic attacks 172 (0%) 373 (0%) <0.001 0.67 (0.56 -0.8) Cerebral infarction 312 (0%) 629 (0.1%) <0.001 0.71 (0.62 -0.81) Cerebral occlusion without infarction 252 (0%) 546 (0.1%) <0.001 0.66 (0.57 -0.77) Intracerebral hemorrhage 77 (0%) 152 (0%) 0.026 0.73 (0.56 -0.96) Subarachnoid hemorrhage 40 (0%) 101 (0%) 0.003 0.57 (0.4 -0.83) Hospital admission 1867 (0.3%) 4900 (0.7%) <0.001 0.44 (0.42 -0.46) Emergency visits 4311 (0.9%) 7267 (1.9%) <0.001 0.49 (0.48 -0.51) Outpatient encounters 4810 (1.3%) 7234 (1.6%) <0.001 0.8 (0.77 -0.83) Intensive care unit admission 71 (0%) 430 (0%) <0.001 0.23 (0.18 -0.3) Mechanical ventilation 328 (0%) 835 (0.1%) <0.001 0.55 (0.49 -0.63) Referral to Cardio services 0 (0%) 0 (0%) NA NA Referral to Neuro services 10 (0%) 10 (0%) 0.402 1.45 (0.6 -3.49) ECMO 10 (0%) 10 (0%) 0.403 1.45 (0.6 -3.48) ECMO-VV 10 (0%) 10 (0%) 0.403 1.45 (0.6 -3.49) ECMO-VA 10 (0%) 10 (0%) 0.403 1.45 (0.6 -3.49) Mortality 1689 (0.3%) 3926 (0.4%) <0.001 0.62 (0.59 -0.66) >9mo Major adverse cardiovascular events 10036 (1.6%) 14065 (1.7%) 0.001 0.96 (0.93 -0.98) Cardiovascular disease 13397 (2.2%) 17599 (2.2%) 0.501 0.99 (0.97 -1.02) Ischemic heart disease 6787 (1.1%) 9374 (1.1%) 0.905 1 (0.97 -1.03) Myocardial angina 944 (0.1%) 1388 (0.1%) 0.676 0.98 (0.91 -1.07) Acute coronary disease 784 (0.1%) 1205 (0.1%) 0.158 0.94 (0.86 -1.03) Myocardial infarction 2133 (0.3%) 3323 (0.4%) 0.001 0.92 (0.87 -0.97) Ischemic cardiomyopathy 749 (0.1%) 983 (0.1%) 0.048 1.1 (1 -1.21) Arrythmias 15734 (2.6%) 23914 (3%) <0.001 0.85 (0.83 -0.87) Atrial fibrillation and flutter 3746 (0.6%) 4846 (0.5%) <0.001 1.09 (1.04 -1.13) Paroxysmal tachycardia 2194 (0.3%) 2823 (0.3%) <0.001 1.12 (1.06 -1.18) Other cardiac arrythmias 5736 (0.9%) 7831 (0.9%) 0.082 1.03 (1 -1.07) Inflammatory heart disease 1276 (0.2%) 1949 (0.2%) 0.095 0.94 (0.88 -1.01) Pericarditis 815 (0.1%) 1275 (0.1%) 0.071 0.92 (0.85 -1.01) Myocarditis 40 (0%) 127 (0%) <0.001 0.46 (0.32 -0.65) Endocarditis 491 (0.1%) 719 (0.1%) 0.841 0.99 (0.88 -1.11) Hypertensive heart disease 21618 (4%) 27983 (4.1%) 0.04 0.98 (0.97 -1) Pulmonary heart diseases 2430 (0.4%) 3387 (0.4%) 0.435 1.02 (0.97 -1.08) Heart Failure 3848 (0.6%) 5371 (0.6%) 0.805 1.01 (0.97 -1.05) Cardiomyopathy 1888 (0.3%) 2448 (0.3%) 0.001 1.11 (1.04 -1.17) Cardiomegaly 2859 (0.4%) 4900 (0.5%) <0.001 0.83 (0.79 -0.87) Cardiogenic shock 557 (0.1%) 791 (0.1%) 0.734 1.02 (0.91 -1.14) Cardiac arrest 1285 (0.2%) 2173 (0.2%) <0.001 0.85 (0.8 -0.91) Thrombotic disorders 2714 (0.4%) 4410 (0.5%) <0.001 0.87 (0.83 -0.92) Pulmonary embolism 1033 (0.2%) 1570 (0.2%) 0.147 0.94 (0.87 -1.02) Deep and superficial thrombosis 2180 (0.3%) 3672 (0.4%) <0.001 0.85 (0.8 -0.89) Thrombosis with Thrombocytopenia 10 (0%) 0 (0%) <0.001 NA Elevated Troponin I 2953 (0.4%) 6176 (0.7%) <0.001 0.68 (0.65 -0.71) Elevated Natriuretic peptide B 4366 (0.7%) 6156 (0.7%) 0.427 0.98 (0.95 -1.02) Dyslipidemia 33446 (7.3%) 44346 (7.8%) <0.001 0.94 (0.92 -0.95) Triglyceride ≥150 mg/dl 17810 (3.1%) 25611 (3.2%) <0.001 0.97 (0.95 -0.98) Total cholesterol ≥200 mg/dl 17202 (2.9%) 24812 (3%) 0.008 0.98 (0.96 -0.99) ### Page 46 LDL-cholesterol ≥130 mg/dl 15393 (2.6%) 22463 (2.7%) 0.001 0.97 (0.95 -0.99) HDL-cholesterol <50 mg/dl 25289 (4.8%) 37975 (5.5%) <0.001 0.88 (0.87 -0.89) Cerebrovascular disease 4759 (0.7%) 6715 (0.7%) 0.874 1 (0.96 -1.04) Transient ischemic attacks 1206 (0.2%) 1850 (0.2%) 0.096 0.94 (0.88 -1.01) Cerebral infarction 1884 (0.3%) 2677 (0.3%) 0.817 1.01 (0.95 -1.07) Cerebral occlusion without infarction 1642 (0.2%) 2383 (0.3%) 0.763 0.99 (0.93 -1.06) Intracerebral hemorrhage 489 (0.1%) 608 (0.1%) 0.012 1.16 (1.03 -1.31) Subarachnoid hemorrhage 368 (0.1%) 429 (0%) 0.002 1.24 (1.08 -1.43) Hospital admission 16173 (2.8%) 32255 (4.9%) <0.001 0.58 (0.56 -0.59) Emergency visits 37742 (8.1%) 43510 (11.4%) <0.001 0.71 (0.7 -0.72) Outpatient encounters 34724 (9.4%) 39487 (8.9%) <0.001 1.05 (1.04 -1.07) Intensive care unit admission 321 (0%) 1747 (0.2%) <0.001 0.26 (0.23 -0.29) Mechanical ventilation 2433 (0.4%) 4219 (0.4%) <0.001 0.81 (0.77 -0.86) Referral to Cardio services 0 (0%) 0 (0%) NA NA Referral to Neuro services 27 (0%) 56 (0%) 0.125 0.7 (0.44 -1.11) ECMO 21 (0%) 44 (0%) 0.163 0.69 (0.41 -1.16) ECMO-VV 10 (0%) 14 (0%) 0.932 1.04 (0.46 -2.33) ECMO-VA 16 (0%) 35 (0%) 0.171 0.66 (0.37 -1.2) Mortality 14030 (2.1%) 18316 (1.9%) <0.001 1.11 (1.09 -1.14) For outcomes where event counts were fewer than 10, TriNetX platform suppressed exact numbers and reported '10' for de-identification purposes; thus, relative risks may be overestimated or not statistically meaningful in these cases. When zero events were observed, this is indicated as '0'. Caution is warranted in the interpretation of RRs where numerators are at or below this privacy threshold. ECMO: Extracorporeal membrane oxygenation. ### Page 47 Supplementary Table 10. Outcomes in female vaccinated individuals without infection compared to infected, unvaccinated individuals (Group 3 vs Group 2) across four post-exposure time windows.Time Outcome Group 3 (n=751,081)Group 2 (n=1,184,987) p-value RR (95%CI)Follow-up (months) 25.8 ± 19.1 24 ± 160-3 mo Major adverse cardiovascular events 1760 (0.2%) 8728 (0.7%) <0.001 0.32 (0.3 -0.34) Cardiovascular disease 2451 (0.3%) 13908 (1.2%) <0.001 0.27 (0.26 -0.29) Ischemic heart disease 1064 (0.1%) 5353 (0.4%) <0.001 0.32 (0.3 -0.34) Myocardial angina 164 (0%) 517 (0%) <0.001 0.52 (0.44 -0.63) Acute coronary disease 132 (0%) 962 (0.1%) <0.001 0.23 (0.19 -0.27) Myocardial infarction 313 (0%) 2377 (0.2%) <0.001 0.22 (0.19 -0.24) Ischemic cardiomyopathy 72 (0%) 401 (0%) <0.001 0.3 (0.23 -0.38) Arrythmias 3438 (0.5%) 18986 (1.7%) <0.001 0.27 (0.26 -0.28) Atrial fibrillation and flutter 521 (0.1%) 3540 (0.3%) <0.001 0.24 (0.22 -0.26) Paroxysmal tachycardia 477 (0.1%) 2226 (0.2%) <0.001 0.35 (0.32 -0.39) Other cardiac arrythmias 1079 (0.1%) 6315 (0.5%) <0.001 0.28 (0.26 -0.3) Inflammatory heart disease 256 (0%) 1916 (0.1%) <0.001 0.22 (0.19 -0.25) Pericarditis 184 (0%) 1362 (0.1%) <0.001 0.22 (0.19 -0.26) Myocarditis 10 (0%) 199 (0%) <0.001 0.08 (0.04 -0.16) Endocarditis 79 (0%) 511 (0%) <0.001 0.26 (0.2 -0.32) Hypertensive heart disease 3337 (0.5%) 13577 (1.4%) <0.001 0.37 (0.36 -0.39) Pulmonary heart diseases 534 (0.1%) 4287 (0.3%) <0.001 0.2 (0.19 -0.22) Heart Failure 660 (0.1%) 4313 (0.3%) <0.001 0.25 (0.23 -0.27) Cardiomyopathy 272 (0%) 1466 (0.1%) <0.001 0.31 (0.27 -0.35) Cardiomegaly 570 (0.1%) 4713 (0.4%) <0.001 0.2 (0.18 -0.22) Cardiogenic shock 56 (0%) 474 (0%) <0.001 0.2 (0.15 -0.26) Cardiac arrest 107 (0%) 1270 (0.1%) <0.001 0.14 (0.11 -0.17) Thrombotic disorders 501 (0.1%) 5047 (0.4%) <0.001 0.16 (0.15 -0.18) Pulmonary embolism 211 (0%) 2645 (0.2%) <0.001 0.13 (0.11 -0.15) Deep and superficial thrombosis 384 (0%) 3372 (0.3%) <0.001 0.19 (0.17 -0.21) Thrombosis with Thrombocytopenia 0 (0%) 10 (0%) 0.014 NA Elevated Troponin I 262 (0%) 3806 (0.3%) <0.001 0.11 (0.1 -0.13) Elevated Natriuretic peptide B 797 (0.1%) 9123 (0.7%) <0.001 0.14 (0.13 -0.15) Dyslipidemia 6548 (1.1%) 22612 (2.7%) <0.001 0.42 (0.41 -0.43) Triglyceride ≥150 mg/dl 2604 (0.4%) 11164 (1%) <0.001 0.38 (0.36 -0.39) Total cholesterol ≥200 mg/dl 3831 (0.6%) 10593 (1%) <0.001 0.57 (0.55 -0.59) LDL-cholesterol ≥130 mg/dl 2933 (0.4%) 8378 (0.7%) <0.001 0.56 (0.54 -0.59) HDL-cholesterol <50 mg/dl 3682 (0.5%) 15215 (1.4%) <0.001 0.38 (0.36 -0.39) Cerebrovascular disease 964 (0.1%) 4353 (0.3%) <0.001 0.36 (0.34 -0.39) Transient ischemic attacks 257 (0%) 890 (0.1%) <0.001 0.48 (0.41 -0.55) Cerebral infarction 356 (0%) 2040 (0.2%) <0.001 0.29 (0.26 -0.32) Cerebral occlusion without infarction 331 (0%) 1357 (0.1%) <0.001 0.4 (0.36 -0.45) Intracerebral hemorrhage 71 (0%) 418 (0%) <0.001 0.28 (0.22 -0.36) Subarachnoid hemorrhage 57 (0%) 269 (0%) <0.001 0.35 (0.26 -0.47) Hospital admission 4168 (0.6%) 27691 (3.2%) <0.001 0.2 (0.2 -0.21) Emergency visits 6483 (1.1%) 23033 (4%) <0.001 0.29 (0.28 -0.3) Outpatient encounters 9139 (2.1%) 25651 (4.2%) <0.001 0.49 (0.48 -0.5) Intensive care unit admission 143 (0%) 1948 (0.2%) <0.001 0.12 (0.1 -0.14) Mechanical ventilation 271 (0%) 7376 (0.6%) <0.001 0.06 (0.05 -0.07) Referral to Cardio services 0 (0%) 10 (0%) 0.014 NA Referral to Neuro services 10 (0%) 33 (0%) 0.051 0.5 (0.25 -1.02) ECMO 10 (0%) 151 (0%) <0.001 0.11 (0.06 -0.21) ECMO-VV 0 (0%) 124 (0%) <0.001 NA ECMO-VA 10 (0%) 38 (0%) 0.016 0.44 (0.22 -0.88) Mortality 1157 (0.1%) 20157 (1.5%) <0.001 0.1 (0.09 -0.1) 3-6mo Major adverse cardiovascular events 1507 (0.2%) 3862 (0.3%) <0.001 0.62 (0.58 -0.66) Cardiovascular disease 2046 (0.3%) 5506 (0.5%) <0.001 0.57 (0.54 -0.6) Ischemic heart disease 902 (0.1%) 2347 (0.2%) <0.001 0.62 (0.57 -0.67) Myocardial angina 153 (0%) 346 (0%) 0.001 0.73 (0.6 -0.88) Acute coronary disease 121 (0%) 366 (0%) <0.001 0.55 (0.44 -0.67) Myocardial infarction 276 (0%) 850 (0.1%) <0.001 0.53 (0.47 -0.61) Ischemic cardiomyopathy 57 (0%) 173 (0%) <0.001 0.55 (0.4 -0.74) ### Page 48 Arrythmias 2861 (0.4%) 8580 (0.8%) <0.001 0.5 (0.47 -0.52) Atrial fibrillation and flutter 497 (0.1%) 1321 (0.1%) <0.001 0.61 (0.55 -0.68) Paroxysmal tachycardia 415 (0.1%) 1064 (0.1%) <0.001 0.64 (0.57 -0.72) Other cardiac arrythmias 952 (0.1%) 2678 (0.2%) <0.001 0.58 (0.53 -0.62) Inflammatory heart disease 205 (0%) 693 (0.1%) <0.001 0.49 (0.42 -0.57) Pericarditis 150 (0%) 489 (0%) <0.001 0.51 (0.42 -0.61) Myocarditis 10 (0%) 45 (0%) 0.003 0.37 (0.19 -0.73) Endocarditis 60 (0%) 216 (0%) <0.001 0.46 (0.35 -0.61) Hypertensive heart disease 2695 (0.4%) 6769 (0.7%) <0.001 0.6 (0.58 -0.63) Pulmonary heart diseases 439 (0.1%) 1281 (0.1%) <0.001 0.56 (0.5 -0.62) Heart Failure 587 (0.1%) 1700 (0.1%) <0.001 0.56 (0.51 -0.62) Cardiomyopathy 243 (0%) 604 (0%) <0.001 0.66 (0.57 -0.77) Cardiomegaly 476 (0.1%) 1415 (0.1%) <0.001 0.55 (0.5 -0.61) Cardiogenic shock 45 (0%) 151 (0%) <0.001 0.49 (0.35 -0.69) Cardiac arrest 104 (0%) 426 (0%) <0.001 0.4 (0.33 -0.5) Thrombotic disorders 411 (0.1%) 1419 (0.1%) <0.001 0.47 (0.42 -0.53) Pulmonary embolism 194 (0%) 569 (0%) <0.001 0.56 (0.48 -0.66) Deep and superficial thrombosis 309 (0%) 1144 (0.1%) <0.001 0.44 (0.39 -0.5) Thrombosis with Thrombocytopenia 0 (0%) 0 (0%) NA NA Elevated Troponin I 261 (0%) 1212 (0.1%) <0.001 0.35 (0.31 -0.4) Elevated Natriuretic peptide B 744 (0.1%) 1869 (0.1%) <0.001 0.64 (0.59 -0.7) Dyslipidemia 4780 (0.8%) 12128 (1.5%) <0.001 0.57 (0.55 -0.59) Triglyceride ≥150 mg/dl 2059 (0.3%) 5276 (0.5%) <0.001 0.62 (0.59 -0.66) Total cholesterol ≥200 mg/dl 2935 (0.4%) 7592 (0.7%) <0.001 0.61 (0.58 -0.64) LDL-cholesterol ≥130 mg/dl 2278 (0.3%) 5889 (0.5%) <0.001 0.62 (0.59 -0.65) HDL-cholesterol <50 mg/dl 2665 (0.4%) 7380 (0.7%) <0.001 0.56 (0.53 -0.58) Cerebrovascular disease 832 (0.1%) 2165 (0.2%) <0.001 0.62 (0.58 -0.68) Transient ischemic attacks 209 (0%) 552 (0%) <0.001 0.62 (0.53 -0.73) Cerebral infarction 321 (0%) 884 (0.1%) <0.001 0.6 (0.52 -0.68) Cerebral occlusion without infarction 268 (0%) 737 (0.1%) <0.001 0.6 (0.52 -0.69) Intracerebral hemorrhage 62 (0%) 202 (0%) <0.001 0.51 (0.38 -0.68) Subarachnoid hemorrhage 41 (0%) 114 (0%) 0.004 0.6 (0.42 -0.85) Hospital admission 3376 (0.5%) 11382 (1.3%) <0.001 0.39 (0.38 -0.41) Emergency visits 5940 (1.1%) 11419 (2.1%) <0.001 0.52 (0.5 -0.53) Outpatient encounters 6618 (1.5%) 12376 (2.1%) <0.001 0.72 (0.7 -0.74) Intensive care unit admission 124 (0%) 790 (0.1%) <0.001 0.25 (0.21 -0.31) Mechanical ventilation 252 (0%) 1090 (0.1%) <0.001 0.38 (0.33 -0.43) Referral to Cardio services 0 (0%) 10 (0%) 0.014 NA Referral to Neuro services 10 (0%) 22 (0%) 0.455 0.75 (0.36 -1.59) ECMO 10 (0%) 10 (0%) 0.255 1.66 (0.69 -3.98) ECMO-VV 10 (0%) 10 (0%) 0.254 1.66 (0.69 -3.98) ECMO-VA 10 (0%) 10 (0%) 0.254 1.66 (0.69 -3.98) Mortality 1376 (0.2%) 4970 (0.4%) <0.001 0.46 (0.43 -0.49) 6-9mo Major adverse cardiovascular events 1424 (0.2%) 3160 (0.3%) <0.001 0.71 (0.67 -0.76) Cardiovascular disease 1897 (0.3%) 4511 (0.4%) <0.001 0.65 (0.61 -0.68) Ischemic heart disease 823 (0.1%) 1883 (0.2%) <0.001 0.7 (0.65 -0.76) Myocardial angina 118 (0%) 321 (0%) <0.001 0.61 (0.49 -0.75) Acute coronary disease 97 (0%) 227 (0%) 0.004 0.71 (0.56 -0.89) Myocardial infarction 260 (0%) 671 (0.1%) <0.001 0.64 (0.55 -0.73) Ischemic cardiomyopathy 56 (0%) 130 (0%) 0.033 0.71 (0.52 -0.97) Arrythmias 2665 (0.4%) 6860 (0.6%) <0.001 0.57 (0.55 -0.6) Atrial fibrillation and flutter 467 (0.1%) 943 (0.1%) <0.001 0.81 (0.72 -0.9) Paroxysmal tachycardia 343 (0%) 820 (0.1%) <0.001 0.69 (0.61 -0.78) Other cardiac arrythmias 852 (0.1%) 2128 (0.2%) <0.001 0.65 (0.6 -0.7) Inflammatory heart disease 183 (0%) 495 (0%) <0.001 0.61 (0.51 -0.72) Pericarditis 139 (0%) 349 (0%) <0.001 0.66 (0.54 -0.8) Myocarditis 10 (0%) 26 (0%) 0.221 0.64 (0.31 -1.32) Endocarditis 50 (0%) 149 (0%) <0.001 0.56 (0.4 -0.77) Hypertensive heart disease 2507 (0.4%) 5599 (0.6%) <0.001 0.67 (0.64 -0.71) Pulmonary heart diseases 374 (0%) 982 (0.1%) <0.001 0.62 (0.55 -0.7) Heart Failure 564 (0.1%) 1215 (0.1%) <0.001 0.75 (0.68 -0.83) Cardiomyopathy 213 (0%) 476 (0%) <0.001 0.74 (0.63 -0.87) ### Page 49 Cardiomegaly 431 (0.1%) 1196 (0.1%) <0.001 0.59 (0.53 -0.66) Cardiogenic shock 37 (0%) 124 (0%) <0.001 0.49 (0.34 -0.71) Cardiac arrest 99 (0%) 298 (0%) <0.001 0.55 (0.44 -0.69) Thrombotic disorders 361 (0%) 1139 (0.1%) <0.001 0.52 (0.46 -0.58) Pulmonary embolism 165 (0%) 460 (0%) <0.001 0.59 (0.49 -0.7) Deep and superficial thrombosis 260 (0%) 873 (0.1%) <0.001 0.49 (0.42 -0.56) Thrombosis with Thrombocytopenia 0 (0%) 10 (0%) 0.014 NA Elevated Troponin I 236 (0%) 1101 (0.1%) <0.001 0.35 (0.3 -0.4) Elevated Natriuretic peptide B 702 (0.1%) 1469 (0.1%) <0.001 0.77 (0.7 -0.84) Dyslipidemia 4264 (0.8%) 10235 (1.3%) <0.001 0.59 (0.57 -0.62) Triglyceride ≥150 mg/dl 1980 (0.3%) 4642 (0.4%) <0.001 0.68 (0.65 -0.72) Total cholesterol ≥200 mg/dl 2771 (0.4%) 6473 (0.6%) <0.001 0.67 (0.64 -0.7) LDL-cholesterol ≥130 mg/dl 2191 (0.3%) 5219 (0.5%) <0.001 0.67 (0.64 -0.7) HDL-cholesterol <50 mg/dl 2436 (0.4%) 6576 (0.6%) <0.001 0.57 (0.54 -0.6) Cerebrovascular disease 777 (0.1%) 1831 (0.1%) <0.001 0.69 (0.63 -0.75) Transient ischemic attacks 208 (0%) 488 (0%) <0.001 0.7 (0.6 -0.83) Cerebral infarction 310 (0%) 727 (0.1%) <0.001 0.7 (0.61 -0.8) Cerebral occlusion without infarction 261 (0%) 591 (0%) <0.001 0.73 (0.63 -0.84) Intracerebral hemorrhage 65 (0%) 139 (0%) 0.086 0.77 (0.58 -1.04) Subarachnoid hemorrhage 44 (0%) 105 (0%) 0.04 0.69 (0.49 -0.99) Hospital admission 2771 (0.4%) 8724 (1%) <0.001 0.42 (0.4 -0.43) Emergency visits 5343 (1%) 10084 (1.9%) <0.001 0.52 (0.5 -0.54) Outpatient encounters 5726 (1.3%) 9357 (1.6%) <0.001 0.82 (0.8 -0.85) Intensive care unit admission 79 (0%) 674 (0.1%) <0.001 0.19 (0.15 -0.24) Mechanical ventilation 252 (0%) 809 (0.1%) <0.001 0.51 (0.44 -0.59) Referral to Cardio services 0 (0%) 0 (0%) NA NA Referral to Neuro services 10 (0%) 14 (0%) 0.685 1.18 (0.53 -2.66) ECMO 0 (0%) 10 (0%) 0.014 NA ECMO-VV 0 (0%) 10 (0%) 0.014 NA ECMO-VA 0 (0%) 10 (0%) 0.014 NA Mortality 1442 (0.2%) 3680 (0.3%) <0.001 0.65 (0.61 -0.69) >9mo Major adverse cardiovascular events 1424 (0.2%) 3160 (0.3%) <0.001 0.71 (0.67 -0.76) Cardiovascular disease 1897 (0.3%) 4511 (0.4%) <0.001 0.65 (0.61 -0.68) Ischemic heart disease 823 (0.1%) 1883 (0.2%) <0.001 0.7 (0.65 -0.76) Myocardial angina 118 (0%) 321 (0%) <0.001 0.61 (0.49 -0.75) Acute coronary disease 97 (0%) 227 (0%) 0.004 0.71 (0.56 -0.89) Myocardial infarction 260 (0%) 671 (0.1%) <0.001 0.64 (0.55 -0.73) Ischemic cardiomyopathy 56 (0%) 130 (0%) 0.033 0.71 (0.52 -0.97) Arrythmias 2665 (0.4%) 6860 (0.6%) <0.001 0.57 (0.55 -0.6) Atrial fibrillation and flutter 467 (0.1%) 943 (0.1%) <0.001 0.81 (0.72 -0.9) Paroxysmal tachycardia 343 (0%) 820 (0.1%) <0.001 0.69 (0.61 -0.78) Other cardiac arrythmias 852 (0.1%) 2128 (0.2%) <0.001 0.65 (0.6 -0.7) Inflammatory heart disease 183 (0%) 495 (0%) <0.001 0.61 (0.51 -0.72) Pericarditis 139 (0%) 349 (0%) <0.001 0.66 (0.54 -0.8) Myocarditis 10 (0%) 26 (0%) 0.221 0.64 (0.31 -1.32) Endocarditis 50 (0%) 149 (0%) <0.001 0.56 (0.4 -0.77) Hypertensive heart disease 2507 (0.4%) 5599 (0.6%) <0.001 0.67 (0.64 -0.71) Pulmonary heart diseases 374 (0%) 982 (0.1%) <0.001 0.62 (0.55 -0.7) Heart Failure 564 (0.1%) 1215 (0.1%) <0.001 0.75 (0.68 -0.83) Cardiomyopathy 213 (0%) 476 (0%) <0.001 0.74 (0.63 -0.87) Cardiomegaly 431 (0.1%) 1196 (0.1%) <0.001 0.59 (0.53 -0.66) Cardiogenic shock 37 (0%) 124 (0%) <0.001 0.49 (0.34 -0.71) Cardiac arrest 99 (0%) 298 (0%) <0.001 0.55 (0.44 -0.69) Thrombotic disorders 361 (0%) 1139 (0.1%) <0.001 0.52 (0.46 -0.58) Pulmonary embolism 165 (0%) 460 (0%) <0.001 0.59 (0.49 -0.7) Deep and superficial thrombosis 260 (0%) 873 (0.1%) <0.001 0.49 (0.42 -0.56) Thrombosis with Thrombocytopenia 0 (0%) 10 (0%) 0.014 NA Elevated Troponin I 236 (0%) 1101 (0.1%) <0.001 0.35 (0.3 -0.4) Elevated Natriuretic peptide B 702 (0.1%) 1469 (0.1%) <0.001 0.77 (0.7 -0.84) Dyslipidemia 4264 (0.8%) 10235 (1.3%) <0.001 0.59 (0.57 -0.62) Triglyceride ≥150 mg/dl 1980 (0.3%) 4642 (0.4%) <0.001 0.68 (0.65 -0.72) Total cholesterol ≥200 mg/dl 2771 (0.4%) 6473 (0.6%) <0.001 0.67 (0.64 -0.7) ### Page 50 LDL-cholesterol ≥130 mg/dl 2191 (0.3%) 5219 (0.5%) <0.001 0.67 (0.64 -0.7) HDL-cholesterol <50 mg/dl 2436 (0.4%) 6576 (0.6%) <0.001 0.57 (0.54 -0.6) Cerebrovascular disease 777 (0.1%) 1831 (0.1%) <0.001 0.69 (0.63 -0.75) Transient ischemic attacks 208 (0%) 488 (0%) <0.001 0.7 (0.6 -0.83) Cerebral infarction 310 (0%) 727 (0.1%) <0.001 0.7 (0.61 -0.8) Cerebral occlusion without infarction 261 (0%) 591 (0%) <0.001 0.73 (0.63 -0.84) Intracerebral hemorrhage 65 (0%) 139 (0%) 0.086 0.77 (0.58 -1.04) Subarachnoid hemorrhage 44 (0%) 105 (0%) 0.04 0.69 (0.49 -0.99) Hospital admission 2771 (0.4%) 8724 (1%) <0.001 0.42 (0.4 -0.43) Emergency visits 5343 (1%) 10084 (1.9%) <0.001 0.52 (0.5 -0.54) Outpatient encounters 5726 (1.3%) 9357 (1.6%) <0.001 0.82 (0.8 -0.85) Intensive care unit admission 79 (0%) 674 (0.1%) <0.001 0.19 (0.15 -0.24) Mechanical ventilation 252 (0%) 809 (0.1%) <0.001 0.51 (0.44 -0.59) Referral to Cardio services 0 (0%) 0 (0%) NA NA Referral to Neuro services 10 (0%) 14 (0%) 0.685 1.18 (0.53 -2.66) ECMO 0 (0%) 10 (0%) 0.014 NA ECMO-VV 0 (0%) 10 (0%) 0.014 NA ECMO-VA 0 (0%) 10 (0%) 0.014 NA Mortality 1442 (0.2%) 3680 (0.3%) <0.001 0.65 (0.61 -0.69) For outcomes where event counts were fewer than 10, TriNetX platform suppressed exact numbers and reported '10' for de-identification purposes; thus, relative risks may be overestimated or not statistically meaningful in these cases. When zero events were observed, this is indicated as '0'. Caution is warranted in the interpretation of RRs where numerators are at or below this privacy threshold. ECMO: Extracorporeal membrane oxygenation. ### Page 51 Supplementary Table 11. Dose-dependent protection against cardiovascular events during the acute phase following Pfizer-BioNTech vaccination.Outcome Group A Group B p-value RR (95%CI)Comparison groups Monovalent Second dose (n=785,847)Monovalent One dose (n=301,327)Major adverse cardiovascular events 397 (0.05%) 236 (0.08%) <0.001 0.65 (0.55-0.76) Cardiovascular disease 520 (0.07%) 301 (0.1%) <0.001 0.66 (0.57-0.76) Ischemic heart disease 264 (0.03%) 152 (0.05%) <0.001 0.67 (0.55-0.81) Myocardial angina 58 (0.01%) 16 (0.01%) 0.244 1.39 (0.8-2.41) Acute coronary disease 34 (0%) 28 (0.01%) 0.002 0.47 (0.28-0.77) Myocardial infarction 69 (0.01%) 56 (0.02%) <0.001 0.47 (0.33-0.67) Ischemic cardiomyopathy 29 (0%) 20 (0.01%) 0.04 0.56 (0.31-0.98) Arrythmias 670 (0.09%) 410 (0.14%) <0.001 0.62 (0.54-0.7) Atrial fibrillation and flutter 142 (0.02%) 84 (0.03%) 0.002 0.65 (0.5-0.85) Paroxysmal tachycardia 88 (0.01%) 75 (0.02%) <0.001 0.45 (0.33-0.61) Other cardiac arrythmias 218 (0.03%) 157 (0.05%) <0.001 0.53 (0.43-0.65) Inflammatory heart disease 56 (0.01%) 44 (0.01%) <0.001 0.49 (0.33-0.72) Pericarditis 37 (0%) 34 (0.01%) <0.001 0.42 (0.26-0.66) Myocarditis 10 (0%) 10 (0%) 0.026 0.38 (0.16-0.92) Endocarditis 17 (0%) 14 (0%) 0.03 0.47 (0.23-0.94) Hypertensive heart disease 750 (0.11%) 391 (0.15%) <0.001 0.73 (0.64-0.82) Pulmonary heart diseases 89 (0.01%) 74 (0.02%) <0.001 0.46 (0.34-0.63) Heart Failure 165 (0.02%) 95 (0.03%) 0.001 0.66 (0.52-0.86) Cardiomyopathy 77 (0.01%) 58 (0.02%) <0.001 0.51 (0.36-0.72) Cardiomegaly 99 (0.01%) 87 (0.03%) <0.001 0.43 (0.33-0.58) Cardiogenic shock 14 (0%) 21 (0.01%) <0.001 0.26 (0.13-0.5) Cardiac arrest 31 (0%) 38 (0.01%) <0.001 0.31 (0.19-0.5) Thrombotic disorders 85 (0.01%) 60 (0.02%) <0.001 0.54 (0.39-0.75) Pulmonary embolism 30 (0%) 28 (0.01%) <0.001 0.41 (0.25-0.69) Deep and superficial thrombosis 67 (0.01%) 41 (0.01%) 0.017 0.63 (0.42-0.92) Thrombosis with Thrombocytopenia 51 (0.01%) 55 (0.02%) <0.001 0.36 (0.24-0.52) Elevated Troponin I 200 (0.02%) 137 (0.04%) <0.001 0.56 (0.45-0.69) Elevated Natriuretic peptide B 1186 (0.19%) 1225 (0.53%) <0.001 0.35 (0.32-0.38) Dyslipidemia 469 (0.06%) 533 (0.19%) <0.001 0.33 (0.29-0.37) Triglyceride ≥150 mg/dl 543 (0.07%) 627 (0.23%) <0.001 0.32 (0.29-0.36) Total cholesterol ≥200 mg/dl 430 (0.06%) 520 (0.18%) <0.001 0.31 (0.27-0.35) LDL-cholesterol ≥130 mg/dl 780 (0.11%) 978 (0.37%) <0.001 0.29 (0.27-0.32) HDL-cholesterol <50 mg/dl 190 (0.02%) 118 (0.04%) <0.001 0.62 (0.49-0.78) Cerebrovascular disease 51 (0.01%) 27 (0.01%) 0.173 0.72 (0.45-1.15) Transient ischemic attacks 79 (0.01%) 53 (0.02%) 0.001 0.57 (0.4-0.81) Cerebral infarction 64 (0.01%) 45 (0.01%) 0.002 0.55 (0.37-0.8) Cerebral occlusion without infarction 14 (0%) 11 (0%) 0.068 0.49 (0.22-1.07) Intracerebral hemorrhage 546 (0.08%) 653 (0.26%) <0.001 0.3 (0.27-0.34) Subarachnoid hemorrhage 1241 (0.21%) 806 (0.36%) <0.001 0.57 (0.52-0.63) Hospital admission 2151 (0.45%) 1465 (1%) <0.001 0.45 (0.42-0.48) Emergency visits 18 (0%) 35 (0.01%) <0.001 0.2 (0.11-0.35) Outpatient encounters 67 (0.01%) 75 (0.02%) <0.001 0.34 (0.25-0.48) Intensive care unit admission 187 (0.02%) 306 (0.1%) <0.001 0.23 (0.2-0.28) Mechanical ventilation 397 (0.05%) 236 (0.08%) <0.001 0.65 (0.55-0.76) Referral to Cardio services 520 (0.07%) 301 (0.1%) <0.001 0.66 (0.57-0.76) Referral to Neuro services 264 (0.03%) 152 (0.05%) <0.001 0.67 (0.55-0.81) ECMO 58 (0.01%) 16 (0.01%) 0.244 1.39 (0.8-2.41) ECMO-VV 34 (0%) 28 (0.01%) 0.002 0.47 (0.28-0.77) ECMO-VA 69 (0.01%) 56 (0.02%) <0.001 0.47 (0.33-0.67) Mortality 29 (0%) 20 (0.01%) 0.04 0.56 (0.31-0.98)Comparison groupsMonovalent Booster dose (n=252,933)Monovalent One dose (n=306,413)Major adverse cardiovascular events 215 (0.09%) 248 (0.08%) 0.599 1.05 (0.88-1.26) Cardiovascular disease 278 (0.11%) 316 (0.11%) 0.366 1.08 (0.92-1.27) Ischemic heart disease 137 (0.05%) 159 (0.05%) 0.774 1.03 (0.82-1.3) ### Page 52 Myocardial angina 13 (0%) 18 (0.01%) 0.668 0.86 (0.42-1.75) Acute coronary disease 22 (0.01%) 30 (0.01%) 0.611 0.87 (0.5-1.5) Myocardial infarction 40 (0.01%) 58 (0.02%) 0.324 0.82 (0.55-1.22) Ischemic cardiomyopathy 13 (0%) 21 (0.01%) 0.376 0.73 (0.37-1.46) Arrythmias 327 (0.14%) 431 (0.15%) 0.32 0.93 (0.81-1.07) Atrial fibrillation and flutter 80 (0.03%) 89 (0.03%) 0.661 1.07 (0.79-1.45) Paroxysmal tachycardia 71 (0.03%) 80 (0.02%) 0.751 1.05 (0.77-1.45) Other cardiac arrythmias 129 (0.05%) 165 (0.05%) 0.576 0.94 (0.74-1.18) Inflammatory heart disease 25 (0.01%) 47 (0.01%) 0.059 0.63 (0.39-1.02) Pericarditis 22 (0.01%) 36 (0.01%) 0.228 0.72 (0.43-1.23) Myocarditis 0 (0%) 10 (0%) 0.004 NA Endocarditis 10 (0%) 15 (0%) 0.559 0.79 (0.35-1.76) Hypertensive heart disease 335 (0.16%) 407 (0.15%) 0.41 1.06 (0.92-1.23) Pulmonary heart diseases 68 (0.03%) 79 (0.02%) 0.896 1.02 (0.74-1.41) Heart Failure 90 (0.03%) 101 (0.03%) 0.693 1.06 (0.8-1.41) Cardiomyopathy 38 (0.01%) 63 (0.02%) 0.102 0.72 (0.48-1.07) Cardiomegaly 62 (0.02%) 97 (0.03%) 0.087 0.76 (0.55-1.04) Cardiogenic shock 12 (0%) 24 (0.01%) 0.132 0.59 (0.3-1.18) Cardiac arrest 24 (0.01%) 41 (0.01%) 0.149 0.69 (0.42-1.15) Thrombotic disorders 48 (0.02%) 64 (0.02%) 0.547 0.89 (0.61-1.3) Pulmonary embolism 24 (0.01%) 31 (0.01%) 0.749 0.92 (0.54-1.56) Deep and superficial thrombosis 33 (0.01%) 43 (0.01%) 0.687 0.91 (0.58-1.43) Thrombosis with Thrombocytopenia 34 (0.01%) 56 (0.02%) 0.127 0.72 (0.47-1.1) Elevated Troponin I 96 (0.04%) 148 (0.05%) 0.046 0.77 (0.6-1) Elevated Natriuretic peptide B 1012 (0.61%) 1255 (0.54%) 0.001 1.15 (1.06-1.24) Dyslipidemia 430 (0.19%) 541 (0.19%) 0.948 1 (0.88-1.13) Triglyceride ≥150 mg/dl 558 (0.25%) 638 (0.23%) 0.059 1.12 (1-1.25) Total cholesterol ≥200 mg/dl 471 (0.2%) 534 (0.18%) 0.138 1.1 (0.97-1.24) LDL-cholesterol ≥130 mg/dl 783 (0.37%) 1004 (0.37%) 0.92 1.01 (0.92-1.1) HDL-cholesterol <50 mg/dl 116 (0.04%) 127 (0.04%) 0.489 1.09 (0.85-1.41) Cerebrovascular disease 32 (0.01%) 28 (0.01%) 0.238 1.36 (0.82-2.25) Transient ischemic attacks 51 (0.02%) 56 (0.02%) 0.69 1.08 (0.74-1.58) Cerebral infarction 45 (0.02%) 47 (0.01%) 0.539 1.14 (0.76-1.71) Cerebral occlusion without infarction 16 (0.01%) 14 (0%) 0.409 1.35 (0.66-2.77) Intracerebral hemorrhage 337 (0.15%) 683 (0.26%) <0.001 0.58 (0.51-0.66) Subarachnoid hemorrhage 615 (0.35%) 842 (0.37%) 0.232 0.94 (0.85-1.04) Hospital admission 872 (0.66%) 1482 (0.98%) <0.001 0.68 (0.62-0.74) Emergency visits 28 (0.01%) 35 (0.01%) 0.826 0.95 (0.58-1.56) Outpatient encounters 52 (0.02%) 80 (0.02%) 0.138 0.77 (0.54-1.09) Intensive care unit admission 208 (0.08%) 335 (0.1%) <0.001 0.73 (0.62-0.87) Mechanical ventilation 215 (0.09%) 248 (0.08%) 0.599 1.05 (0.88-1.26) Referral to Cardio services 278 (0.11%) 316 (0.11%) 0.366 1.08 (0.92-1.27) Referral to Neuro services 137 (0.05%) 159 (0.05%) 0.774 1.03 (0.82-1.3) ECMO 13 (0%) 18 (0.01%) 0.668 0.86 (0.42-1.75) ECMO-VV 22 (0.01%) 30 (0.01%) 0.611 0.87 (0.5-1.5) ECMO-VA 40 (0.01%) 58 (0.02%) 0.324 0.82 (0.55-1.22) Mortality 13 (0%) 21 (0.01%) 0.376 0.73 (0.37-1.46)Comparison groupsBivalent vaccines Booster dose (n=62,794)Bivalent vaccines One dose (n=47,377)Major adverse cardiovascular events 70 (0.11%) 36 (0.07%) 0.063 1.46 (0.98-2.18) Cardiovascular disease 125 (0.2%) 71 (0.15%) 0.055 1.33 (0.99-1.78) Ischemic heart disease 50 (0.07%) 25 (0.05%) 0.096 1.5 (0.93-2.42) Myocardial angina 10 (0.01%) 10 (0.02%) 0.514 0.75 (0.31-1.8) Acute coronary disease 10 (0.01%) 10 (0.02%) 0.512 0.75 (0.31-1.79) Myocardial infarction 16 (0.02%) 12 (0.02%) 0.993 1 (0.47-2.11) Ischemic cardiomyopathy 10 (0.01%) 0 (0%) 0.006 NA Arrythmias 138 (0.23%) 84 (0.18%) 0.12 1.24 (0.95-1.63) Atrial fibrillation and flutter 29 (0.04%) 20 (0.04%) 0.78 1.08 (0.61-1.92) Paroxysmal tachycardia 17 (0.02%) 10 (0.02%) 0.548 1.27 (0.58-2.77) Other cardiac arrythmias 65 (0.1%) 39 (0.08%) 0.267 1.25 (0.84-1.86) Inflammatory heart disease 10 (0.01%) 10 (0.02%) 0.513 0.75 (0.31-1.8) ### Page 53 Pericarditis 10 (0.01%) 10 (0.02%) 0.512 0.75 (0.31-1.79) Myocarditis 10 (0.01%) 10 (0.02%) 0.511 0.75 (0.31-1.79) Endocarditis 10 (0.01%) 10 (0.02%) 0.512 0.75 (0.31-1.79) Hypertensive heart disease 143 (0.28%) 81 (0.21%) 0.036 1.34 (1.02-1.76) Pulmonary heart diseases 23 (0.03%) 14 (0.03%) 0.543 1.23 (0.63-2.39) Heart Failure 27 (0.04%) 18 (0.03%) 0.707 1.12 (0.62-2.04) Cardiomyopathy 11 (0.02%) 10 (0.02%) 0.651 0.82 (0.35-1.93) Cardiomegaly 34 (0.05%) 20 (0.04%) 0.393 1.27 (0.73-2.21) Cardiogenic shock 10 (0.01%) 10 (0.02%) 0.511 0.75 (0.31-1.79) Cardiac arrest 10 (0.01%) 10 (0.02%) 0.511 0.75 (0.31-1.79) Thrombotic disorders 16 (0.02%) 10 (0.02%) 0.656 1.2 (0.54-2.64) Pulmonary embolism 10 (0.01%) 10 (0.02%) 0.513 0.75 (0.31-1.79) Deep and superficial thrombosis 12 (0.02%) 10 (0.02%) 0.799 0.9 (0.39-2.08) Thrombosis with Thrombocytopenia 11 (0.02%) 10 (0.02%) 0.653 0.82 (0.35-1.94) Elevated Troponin I 26 (0.04%) 12 (0.02%) 0.163 1.62 (0.82-3.21) Elevated Natriuretic peptide B 722 (2.14%) 541 (2.07%) 0.578 1.03 (0.92-1.15) Dyslipidemia 285 (0.52%) 211 (0.51%) 0.818 1.02 (0.86-1.22) Triglyceride ≥150 mg/dl 434 (0.86%) 326 (0.86%) 0.985 1 (0.87-1.15) Total cholesterol ≥200 mg/dl 374 (0.68%) 285 (0.69%) 0.839 0.98 (0.84-1.15) LDL-cholesterol ≥130 mg/dl 587 (1.26%) 453 (1.27%) 0.834 0.99 (0.87-1.12) HDL-cholesterol <50 mg/dl 31 (0.05%) 22 (0.04%) 0.846 1.06 (0.61-1.82) Cerebrovascular disease 10 (0.01%) 10 (0.02%) 0.513 0.75 (0.31-1.79) Transient ischemic attacks 10 (0.01%) 10 (0.02%) 0.513 0.75 (0.31-1.8) Cerebral infarction 10 (0.01%) 10 (0.02%) 0.514 0.75 (0.31-1.8) Cerebral occlusion without infarction 10 (0.01%) 10 (0.02%) 0.512 0.75 (0.31-1.79) Intracerebral hemorrhage 213 (0.38%) 205 (0.49%) 0.008 0.77 (0.64-0.93) Subarachnoid hemorrhage 223 (0.5%) 157 (0.46%) 0.419 1.09 (0.89-1.33) Hospital admission 247 (1.19%) 236 (3.48%) <0.001 0.34 (0.29-0.41) Emergency visits 10 (0.01%) 10 (0.02%) 0.515 0.75 (0.31-1.8) Outpatient encounters 14 (0.02%) 10 (0.02%) 0.915 1.05 (0.46-2.35) Intensive care unit admission 59 (0.08%) 35 (0.07%) 0.281 1.26 (0.83-1.91) Mechanical ventilation 70 (0.11%) 36 (0.07%) 0.063 1.46 (0.98-2.18) Referral to Cardio services 125 (0.2%) 71 (0.15%) 0.055 1.33 (0.99-1.78) Referral to Neuro services 50 (0.07%) 25 (0.05%) 0.096 1.5 (0.93-2.42) ECMO 10 (0.01%) 10 (0.02%) 0.514 0.75 (0.31-1.8) ECMO-VV 10 (0.01%) 10 (0.02%) 0.512 0.75 (0.31-1.79) ECMO-VA 16 (0.02%) 12 (0.02%) 0.993 1 (0.47-2.11) Mortality 10 (0.01%) 0 (0%) 0.006 NA For outcomes where event counts were fewer than 10, TriNetX platform suppressed exact numbers and reported '10' for de-identification purposes; thus, relative risks may be overestimated or not statistically meaningful in these cases. When zero events were observed, this is indicated as '0'. Caution is warranted in the interpretation of RRs where numerators are at or below this privacy threshold. ECMO: Extracorporeal membrane oxygenation. ### Page 54 Supplementary Table 12. Risk differences (RDs) with 95% confidence intervals and temporal trend p-values for six primary outcomes across four pairwise cohort comparisons, stratified by sex and four post-exposure time windows (0–3, 3–6, 6–9, and >9 months).Outcome/ Time windowExposed n(%) Comparator n(%) p-value RR (95%CI) RD (95%CI) p-value (trend) Infection effect — COVID-only vs Control Myocardial infarctionMale 0-3m 3121 (0.3%) 21770 (0.2%) <0.001* 1.92 (1.85 -1.99) +0.157% (+0.145% to +0.170%) 0.0022* 3-6m 961 (0.1%) 7522 (0.1%) <0.001* 1.71 (1.6 -1.83) +0.041% (+0.034% to +0.048%) 6-9m 678 (0.1%) 6546 (0.1%) <0.001* 1.39 (1.28 -1.5) +0.018% (+0.012% to +0.024%) >9m 3323 (0.4%) 40152 (0.3%) <0.001* 1.11 (1.07 -1.15) +0.017% (+0.004% to +0.030%) Female 0-3m 2377 (0.2%) 13799 (0.1%) <0.001* 2.12 (2.03 -2.21) +0.103% (+0.095% to +0.111%) 0.0019* 3-6m 850 (0.1%) 5699 (0%) <0.001* 1.83 (1.71 -1.97) +0.032% (+0.027% to +0.037%) 6-9m 671 (0.1%) 4942 (0%) <0.001* 1.67 (1.54 -1.81) +0.022% (+0.018% to +0.027%) >9m 3195 (0.2%) 34519 (0.2%) <0.001* 1.14 (1.1 -1.18) +0.035% (+0.026% to +0.044%)PericarditisMale 0-3m 1495 (0.2%) 8668 (0.1%) <0.001* 2.28 (2.16 -2.41) +0.091% (+0.082% to +0.099%) 0.0049* 3-6m 418 (0%) 3055 (0%) <0.001* 1.81 (1.64 -2.01) +0.020% (+0.015% to +0.024%) 6-9m 271 (0%) 2380 (0%) <0.001* 1.51 (1.33 -1.71) +0.009% (+0.006% to +0.013%) >9m 1275 (0.1%) 13154 (0.1%) <0.001* 1.28 (1.21 -1.36) +0.026% (+0.018% to +0.035%) Female 0-3m 1362 (0.1%) 7775 (0%) <0.001* 2.14 (2.02 -2.27) +0.060% (+0.054% to +0.066%) 0.0054* 3-6m 489 (0%) 3170 (0%) <0.001* 1.89 (1.72 -2.08) +0.019% (+0.015% to +0.023%) 6-9m 349 (0%) 2478 (0%) <0.001* 1.72 (1.54 -1.93) +0.012% (+0.009% to +0.015%) >9m 1624 (0.1%) 15685 (0.1%) <0.001* 1.27 (1.2 -1.33) +0.030% (+0.023% to +0.036%)MyocarditisMale 0-3m 279 (0%) 829 (0%) <0.001* 4.44 (3.87 -5.08) +0.024% (+0.020% to +0.028%) 0.0133* 3-6m 46 (0%) 217 (0%) <0.001* 2.8 (2.03 -3.84) +0.003% (+0.002% to +0.005%) 6-9m 33 (0%) 194 (0%) <0.001* 2.24 (1.55 -3.24) +0.002% (+0.001% to +0.003%) >9m 127 (0%) 1015 (0%) <0.001* 1.65 (1.37 -1.98) +0.005% (+0.003% to +0.008%) Female 0-3m 199 (0%) 434 (0%) <0.001* 5.59 (4.72 -6.61) +0.013% (+0.011% to +0.016%) 0.0110* 3-6m 45 (0%) 137 (0%) <0.001* 4 (2.86 -5.6) +0.003% (+0.002% to +0.004%) 6-9m 26 (0%) 147 (0%) <0.001* 2.16 (1.42 -3.27) +0.001% (+0.000% to +0.002%) >9m 96 (0%) 754 (0%) <0.001* 1.55 (1.25 -1.92) +0.003% (+0.001% to +0.004%)Pulmonary embolismMale 0-3m 3384 (0.4%) 10927 (0.1%) <0.001* 4.12 (3.96 -4.28) +0.283% (+0.270% to +0.295%) 0.0007* 3-6m 489 (0.1%) 4010 (0%) <0.001* 1.63 (1.48 -1.79) +0.019% (+0.014% to +0.024%) 6-9m 360 (0%) 3123 (0%) <0.001* 1.54 (1.38 -1.71) +0.013% (+0.008% to +0.017%) >9m 1570 (0.2%) 18064 (0.1%) <0.001* 1.16 (1.1 -1.22) +0.016% (+0.007% to +0.025%) Female 0-3m 2645 (0.2%) 10314 (0.1%) <0.001* 3.15 (3.01 -3.28) +0.147% (+0.139% to +0.156%) 0.0011* 3-6m 569 (0%) 4179 (0%) <0.001* 1.67 (1.53 -1.83) +0.019% (+0.015% to +0.023%) 6-9m 460 (0%) 3283 (0%) <0.001* 1.72 (1.56 -1.9) +0.016% (+0.013% to +0.019%) >9m 1912 (0.1%) 20681 (0.1%) <0.001* 1.14 (1.08 -1.19) +0.021% (+0.014% to +0.028%)StrokeMale 0-3m 2146 (0.2%) 22595 (0.2%) <0.001* 1.27 (1.21 -1.32) +0.040% (+0.030% to +0.051%) 0.0109* 3-6m 732 (0.1%) 7877 (0.1%) <0.001* 1.24 (1.15 -1.34) +0.012% (+0.006% to +0.018%) 6-9m 625 (0.1%) 6186 (0%) <0.001* 1.35 (1.24 -1.46) +0.015% (+0.010% to +0.021%) >9m 2677 (0.3%) 37571 (0.3%) 0.010* 0.95 (0.91 -0.99) -0.033% (-0.044% to -0.021%) Female 0-3m 2040 (0.2%) 20526 (0.1%) <0.001* 1.22 (1.17 -1.28) +0.032% (+0.025% to +0.040%) 0.0140* 3-6m 884 (0.1%) 8020 (0.1%) <0.001* 1.35 (1.26 -1.45) +0.020% (+0.015% to +0.024%) ### Page 55 6-9m 727 (0.1%) 6503 (0%) <0.001* 1.37 (1.27 -1.48) +0.017% (+0.012% to +0.021%) >9m 3409 (0.3%) 42517 (0.3%) 0.414 0.99 (0.95 -1.02) +0.001% (-0.009% to +0.010%)MortalityMale 0-3m 25841 (2.7%) 75197 (0.6%) <0.001* 4.53 (4.46 -4.59) +2.230% (+2.195% to +2.265%) 0.0001* 3-6m 5285 (0.5%) 37694 (0.3%) <0.001* 1.85 (1.79 -1.9) +0.259% (+0.242% to +0.275%) 6-9m 3884 (0.4%) 33172 (0.3%) <0.001* 1.54 (1.49 -1.59) +0.142% (+0.128% to +0.156%) >9m 18316 (1.9%) 216878 (1.7%) <0.001* 1.11 (1.1 -1.13) +0.133% (+0.102% to +0.163%) Female 0-3m 20157 (1.5%) 60692 (0.4%) <0.001* 4.04 (3.98 -4.11) +1.239% (+1.217% to +1.262%) 0.0001* 3-6m 4970 (0.4%) 32324 (0.2%) <0.001* 1.87 (1.82 -1.93) +0.193% (+0.182% to +0.204%) 6-9m 3680 (0.3%) 28578 (0.2%) <0.001* 1.57 (1.52 -1.62) +0.113% (+0.103% to +0.123%) >9m 18156 (1.4%) 198881 (1.2%) <0.001* 1.11 (1.1 -1.13) +0.182% (+0.160% to +0.204%)Vaccine effect — Vaccine-only vs ControlMyocardial infarctionMale0-3m 337 (0.1%) 20489 (0.2%) <0.001* 0.3 (0.27 -0.34) -0.142% (-0.148% to -0.136%) 0.0029* 3-6m 308 (0%) 7077 (0.1%) <0.001* 0.8 (0.71 -0.89) -0.020% (-0.026% to -0.015%) 6-9m 313 (0%) 6028 (0.1%) 0.376 0.95 (0.85 -1.06) -0.010% (-0.015% to -0.004%) >9m 2173 (0.3%) 35788 (0.3%) <0.001* 1.11 (1.06 -1.16) -0.011% (-0.025% to +0.004%) Female 0-3m 305 (0%) 13959 (0.1%) <0.001* 0.45 (0.4 -0.51) -0.055% (-0.059% to -0.051%) 0.0073* 3-6m 263 (0%) 5763 (0%) 0.373 0.95 (0.84 -1.07) -0.007% (-0.011% to -0.003%) 6-9m 257 (0%) 4995 (0%) 0.319 1.07 (0.94 -1.21) -0.003% (-0.006% to +0.001%) >9m 1888 (0.2%) 34809 (0.2%) <0.001* 1.12 (1.07 -1.18) -0.008% (-0.018% to +0.002%)PericarditisMale0-3m 166 (0%) 7811 (0.1%) <0.001* 0.39 (0.33 -0.45) -0.048% (-0.053% to -0.044%) 0.0068* 3-6m 137 (0%) 2763 (0%) 0.273 0.91 (0.77 -1.08) -0.005% (-0.009% to -0.002%) 6-9m 124 (0%) 2152 (0%) 0.556 1.06 (0.88 -1.27) -0.002% (-0.005% to +0.002%) >9m 783 (0.1%) 11604 (0.1%) <0.001* 1.24 (1.15 -1.33) +0.008% (-0.000% to +0.017%) Female 0-3m 181 (0%) 7791 (0%) <0.001* 0.48 (0.42 -0.56) -0.030% (-0.033% to -0.026%) 0.0069 3-6m 149 (0%) 3187 (0%) 0.707 0.97 (0.82 -1.14) -0.003% (-0.006% to -0.001%) 6-9m 135 (0%) 2501 (0%) 0.204 1.12 (0.94 -1.33) -0.001% (-0.003% to +0.002%) >9m 1009 (0.1%) 15709 (0.1%) <0.001* 1.33 (1.25 -1.42) +0.014% (+0.007% to +0.022%)MyocarditisMale0-3m 13 (0%) 778 (0%) <0.001* 0.31 (0.18 -0.53) -0.005% (-0.007% to -0.004%) 0.1726 3-6m 10 (0%) 204 (0%) 0.740 0.9 (0.48 -1.69) -0.000% (-0.001% to +0.001%) 6-9m 10 (0%) 179 (0%) 0.940 1.02 (0.54 -1.94) -0.000% (-0.001% to +0.001%) >9m 39 (0%) 927 (0%) 0.1109 0.77 (0.56 -1.06) -0.003% (-0.005% to -0.001%) Female0-3m 10 (0%) 439 (0%) 0.016* 0.47 (0.25 -0.88) -0.002% (-0.002% to -0.001%) 0.5852 3-6m 10 (0%) 138 (0%) 0.212 1.5 (0.79 -2.85) +0.000% (-0.000% to +0.001%) 6-9m 10 (0%) 145 (0%) 0.273 1.43 (0.75 -2.71) +0.000% (-0.001% to +0.001%) >9m 33 (0%) 760 (0%) 0.550 0.9 (0.64 -1.27) -0.001% (-0.002% to +0.000%)Pulmonary embolismMale0-3m 169 (0%) 10153 (0.1%) <0.001* 0.31 (0.26 -0.36) -0.070% (-0.074% to -0.066%) 0.0050* 3-6m 156 (0%) 3756 (0%) 0.001* 0.76 (0.65 -0.89) -0.012% (-0.016% to -0.008%) 6-9m 135 (0%) 2902 (0%) 0.070 0.85 (0.72 -1.01) -0.007% (-0.011% to -0.003%) >9m 1018 (0.2%) 16069 (0.1%) <0.001* 1.16 (1.09 -1.24) +0.002% (-0.008% to +0.011%) Female0-3m 216 (0%) 10428 (0.1%) <0.001* 0.43 (0.38 -0.49) -0.043% (-0.046% to -0.039%) 0.0070* 3-6m 198 (0%) 4242 (0%) 0.647 0.97 (0.84 -1.12) -0.005% (-0.008% to -0.001%) 6-9m 163 (0%) 3318 (0%) 0.824 1.02 (0.87 -1.19) -0.003% (-0.006% to +0.000%) >9m 1140 (0.1%) 20835 (0.1%) <0.001* 1.13 (1.07 -1.2) -0.004% (-0.012% to +0.004%)Stroke ### Page 56 Male0-3m 331 (0.1%) 20920 (0.2%) <0.001* 0.29 (0.26 -0.32) -0.147% (-0.153% to -0.141%) 0.0025* 3-6m 278 (0%) 7472 (0.1%) <0.001* 0.68 (0.6 -0.77) -0.029% (-0.034% to -0.023%) 6-9m 304 (0%) 5745 (0%) 0.582 0.97 (0.86 -1.09) -0.008% (-0.014% to -0.003%) >9m 1884 (0.3%) 33793 (0.3%) 0.402 1.02 (0.97 -1.07) -0.035% (-0.048% to -0.022%) Female 0-3m 367 (0%) 20763 (0.1%) <0.001* 0.37 (0.33 -0.41) -0.092% (-0.097% to -0.087%) 0.0036* 3-6m 315 (0%) 8119 (0.1%) <0.001* 0.8 (0.72 -0.9) -0.016% (-0.020% to -0.012%) 6-9m 322 (0%) 6614 (0%) 0.883 1.01 (0.9 -1.13) -0.006% (-0.010% to -0.002%) >9m 2273 (0.3%) 42891 (0.3%) <0.001* 1.1 (1.05 -1.15) -0.016% (-0.027% to -0.005%)MortalityMale0-3m 1349 (0.2%) 72284 (0.6%) <0.001* 0.34 (0.32 -0.36) -0.477% (-0.489% to -0.465%) 0.0006* 3-6m 1523 (0.2%) 36742 (0.3%) <0.001* 0.76 (0.72 -0.8) -0.117% (-0.129% to -0.105%) 6-9m 1631 (0.2%) 31950 (0.3%) 0.008* 0.94 (0.89 -0.98) -0.056% (-0.068% to -0.043%) >9m 13876 (2.1%) 207665 (1.7%) <0.001* 1.22 (1.2 -1.25) +0.128% (+0.093% to +0.164%) Female 0-3m 1143 (0.1%) 61041 (0.4%) <0.001* 0.39 (0.37 -0.41) -0.263% (-0.271% to -0.255%) 0.0005* 3-6m 1372 (0.2%) 32756 (0.2%) <0.001* 0.87 (0.82 -0.92) -0.054% (-0.063% to -0.045%) 6-9m 1441 (0.2%) 28948 (0.2%) 0.258 1.03 (0.98 -1.09) -0.022% (-0.030% to -0.013%) >9m 13581 (1.7%) 201545 (1.2%) <0.001* 1.4 (1.37 -1.42) +0.257% (+0.230% to +0.283%)Vaccine post infection — Hybrid vs COVID-only Myocardial infarctionMale 212 (0.3%) 3145 (0.3%) <0.001* 0.76 (0.66 -0.87) -0.085% (-0.121% to -0.050%) 0.0347* 0-3m 94 (0.1%) 950 (0.1%) 0.336 1.11 (0.9 -1.37) +0.009% (-0.014% to +0.033%) 3-6m 92 (0.1%) 660 (0.1%) <0.001* 1.56 (1.26 -1.94) +0.038% (+0.015% to +0.060%) 6-9m 350 (0.4%) 3152 (0.3%) <0.001* 1.25 (1.12 -1.39) +0.076% (+0.031% to +0.120%) >9m Female 0-3m 121 (0.1%) 2388 (0.2%) <0.001* 0.63 (0.53 -0.76) -0.072% (-0.094% to -0.049%) 0.0572 3-6m 56 (0.1%) 855 (0.1%) 0.135 0.81 (0.62 -1.07) -0.013% (-0.028% to +0.002%) 6-9m 60 (0.1%) 677 (0.1%) 0.474 1.1 (0.85 -1.43) +0.005% (-0.010% to +0.021%) >9m 256 (0.2%) 3188 (0.2%) 0.972 1 (0.88 -1.13) -0.002% (-0.034% to +0.031%)PericarditisMale0-3m 109 (0.1%) 1454 (0.2%) 0.079 0.84 (0.69 -1.02) -0.027% (-0.052% to -0.001%) 0.0272* 3-6m 46 (0.1%) 410 (0%) 0.14 1.26 (0.93 -1.71) +0.010% (-0.006% to +0.027%) 6-9m 42 (0.1%) 251 (0%) <0.001* 1.88 (1.35 -2.6) +0.023% (+0.007% to +0.038%) >9m 191 (0.2%) 1189 (0.1%) <0.001* 1.8 (1.55 -2.1) +0.098% (+0.065% to +0.130%) Female 0-3m 88 (0.1%) 1354 (0.1%) 0.056 0.81 (0.65 -1.01) -0.021% (-0.040% to -0.002%) 0.2393 3-6m 39 (0%) 483 (0%) 0.966 1.01 (0.73 -1.4) -0.000% (-0.013% to +0.013%) 6-9m 23 (0%) 344 (0%) 0.398 0.83 (0.55 -1.27) -0.005% (-0.015% to +0.005%) >9m 134 (0.1%) 1594 (0.1%) 0.599 1.05 (0.88 -1.25) +0.005% (-0.018% to +0.028%)MyocarditisMale0-3m 11 (0%) 269 (0%) 0.009* 0.46 (0.25 -0.83) -0.016% (-0.024% to -0.007%) 0.1955 3-6m 10 (0%) 42 (0%) 0.004* 2.66 (1.33 -5.3) +0.007% (-0.000% to +0.015%) 6-9m 10 (0%) 30 (0%) <0.001* 3.72 (1.82 -7.61) +0.009% (+0.001% to +0.016%) >9m 12 (0%) 110 (0%) 0.516 1.22 (0.67 -2.21) +0.002% (-0.006% to +0.011%) Female 0-3m 10 (0%) 198 (0%) 0.148 0.63 (0.33 -1.19) -0.006% (-0.013% to +0.001%) 0.2929 3-6m 10 (0%) 45 (0%) 0.002* 2.77 (1.39 -5.49) +0.006% (+0.000% to +0.013%) 6-9m 10 (0%) 27 (0%) <0.001* 4.61 (2.23 -9.52) +0.008% (+0.002% to +0.014%) >9m 10 (0%) 94 (0%) 0.397 1.32 (0.69 -2.54) +0.002% (-0.004% to +0.009%)Pulmonary embolismMale0-3m 123 (0.1%) 3101 (0.3%) <0.001* 0.44 (0.37 -0.53) -0.185% (-0.213% to -0.157%) 0.0102* 3-6m 35 (0%) 453 (0%) 0.400 0.86 (0.61 -1.22) -0.007% (-0.021% to +0.007%) ### Page 57 6-9m 33 (0%) 350 (0%) 0.776 1.05 (0.74 -1.51) +0.002% (-0.012% to +0.015%) >9m 188 (0.2%) 1444 (0.2%) <0.001* 1.45 (1.25 -1.69) +0.067% (+0.035% to +0.100%) Female 0-3m 113 (0.1%) 2648 (0.2%) <0.001* 0.53 (0.44 -0.64) -0.100% (-0.123% to -0.078%) 0.0376* 3-6m 45 (0%) 571 (0%) 0.900 0.98 (0.72 -1.33) -0.001% (-0.015% to +0.012%) 6-9m 29 (0%) 461 (0%) 0.200 0.78 (0.54 -1.14) -0.008% (-0.019% to +0.003%) >9m 161 (0.2%) 1912 (0.1%) 0.569 1.05 (0.89 -1.23) +0.006% (-0.019% to +0.032%)StrokeMale0-3m 149 (0.2%) 2121 (0.2%) 0.005* 0.79 (0.67 -0.93) -0.050% (-0.080% to -0.021%) 0.0573 3-6m 56 (0.1%) 719 (0.1%) 0.324 0.87 (0.67 -1.15) -0.011% (-0.029% to +0.007%) 6-9m 79 (0.1%) 610 (0.1%) 0.002* 1.45 (1.15 -1.83) +0.028% (+0.007% to +0.049%) >9m 264 (0.3%) 2481 (0.3%) 0.007* 1.19 (1.05 -1.35) +0.046% (+0.007% to +0.085%) Female 0-3m 93 (0.1%) 2050 (0.2%) <0.001* 0.57 (0.46 -0.7) -0.072% (-0.092% to -0.052%) 0.1683 3-6m 87 (0.1%) 890 (0.1%) 0.081 1.22 (0.98 -1.52) +0.015% (-0.004% to +0.034%) 6-9m 55 (0.1%) 727 (0.1%) 0.667 0.94 (0.72 -1.24) -0.004% (-0.019% to +0.011%) >9m 252 (0.2%) 3420 (0.3%) 0.184 0.92 (0.81 -1.04) -0.024% (-0.057% to +0.008%)MortalityMale0-3m 1375 (1.6%) 25690 (2.7%) <0.001* 0.6 (0.57 -0.63) -1.115% (-1.206% to -1.025%) 0.0016* 3-6m 569 (0.7%) 5145 (0.5%) <0.001* 1.24 (1.13 -1.35) +0.121% (+0.064% to +0.177%) 6-9m 466 (0.6%) 3737 (0.4%) <0.001* 1.39 (1.27 -1.53) +0.150% (+0.098% to +0.201%) >9m 2287 (2.7%) 17740 (1.9%) <0.001* 1.44 (1.38 -1.5) +0.797% (+0.686% to +0.909%) Female 0-3m 947 (0.9%) 20302 (1.6%) <0.001* 0.58 (0.54 -0.62) -0.689% (-0.753% to -0.626%) 0.0033* 3-6m 457 (0.4%) 5023 (0.4%) 0.011* 1.13 (1.03 -1.25) +0.050% (+0.008% to +0.093%) 6-9m 385 (0.4%) 3708 (0.3%) <0.001* 1.29 (1.16 -1.44) +0.085% (+0.045% to +0.124%) >9m 1900 (1.8%) 18241 (1.4%) <0.001* 1.3 (1.24 -1.36) +0.422% (+0.335% to +0.509%)Vaccine x infection — Vaccine-only vs COVID-only Myocardial infarctionMale0-3m 346 (0.1%) 3121 (0.3%) <0.001* 0.16 (0.14 -0.18) -0.298% (-0.311% to -0.285%) 0.0016* 3-6m 300 (0%) 961 (0.1%) <0.001* 0.45 (0.39 -0.51) -0.063% (-0.071% to -0.054%) 6-9m 309 (0%) 687 (0.1%) <0.001* 0.64 (0.56 -0.73) -0.031% (-0.038% to -0.023%) >9m 2133 (0.3%) 3323 (0.4%) 0.001* 0.92 (0.87 -0.97) -0.053% (-0.072% to -0.035%) Female 0-3m 313 (0%) 2377 (0.2%) <0.001* 0.22 (0.19 -0.24) -0.172% (-0.182% to -0.162%) 0.0073* 3-6m 276 (0%) 850 (0.1%) <0.001* 0.53 (0.47 -0.61) -0.039% (-0.046% to -0.032%) 6-9m 260 (0%) 671 (0.1%) <0.001* 0.64 (0.55 -0.73) -0.025% (-0.031% to -0.018%) >9m 260 (0%) 671 (0.1%) <0.001* 0.64 (0.55 -0.73) -0.025% (-0.031% to -0.018%)PericarditisMale0-3m 171 (0%) 1495 (0.2%) <0.001* 0.17 (0.14 -0.19) -0.142% (-0.151% to -0.133%) 0.0031* 3-6m 142 (0%) 418 (0%) <0.001* 0.49 (0.41 -0.59) -0.026% (-0.031% to -0.020%) 6-9m 131 (0%) 273 (0%) 0.001* 0.69 (0.56 -0.85) -0.011% (-0.016% to -0.006%) >9m 815 (0.1%) 1275 (0.1%) 0.071 0.92 (0.85 -1.01) -0.021% (-0.032% to -0.009%) Female 0-3m 184 (0%) 1362 (0.1%) <0.001* 0.22 (0.19 -0.26) -0.098% (-0.105% to -0.090%) 0.0121* 3-6m 150 (0%) 489 (0%) <0.001* 0.51 (0.42 -0.61) -0.023% (-0.029% to -0.018%) 6-9m 139 (0%) 349 (0%) <0.001* 0.66 (0.54 -0.8) -0.012% (-0.017% to -0.008%) >9m 139 (0%) 349 (0%) <0.001* 0.66 (0.54 -0.8) -0.012% (-0.017% to -0.008%)MyocarditisMale0-3m 14 (0%) 279 (0%) <0.001* 0.07 (0.04 -0.12) -0.029% (-0.033% to -0.025%) 0.0372* 3-6m 10 (0%) 46 (0%) <0.001* 0.32 (0.16 -0.62) -0.004% (-0.005% to -0.002%) 6-9m 10 (0%) 33 (0%) 0.019* 0.44 (0.22 -0.89) -0.002% (-0.004% to -0.001%) >9m 40 (0%) 127 (0%) <0.001* 0.46 (0.32 -0.65) -0.008% (-0.011% to -0.005%) Female 0-3m 10 (0%) 199 (0%) <0.001* 0.08 (0.04 -0.16) -0.017% (-0.019% to -0.014%) 0.0569 ### Page 58 3-6m 10 (0%) 45 (0%) 0.003* 0.37 (0.19 -0.73) -0.003% (-0.004% to -0.001%) 6-9m 10 (0%) 26 (0%) 0.221 0.64 (0.31 -1.32) -0.001% (-0.002% to +0.000%) >9m 10 (0%) 26 (0%) 0.221 0.64 (0.31 -1.32) -0.001% (-0.002% to +0.000%)Pulmonary embolismMale0-3m 176 (0%) 3384 (0.4%) <0.001* 0.08 (0.06 -0.09) -0.353% (-0.366% to -0.340%) 0.0023* 3-6m 156 (0%) 489 (0.1%) <0.001* 0.46 (0.38 -0.55) -0.031% (-0.038% to -0.025%) 6-9m 141 (0%) 366 (0%) <0.001* 0.55 (0.46 -0.67) -0.020% (-0.025% to -0.014%) >9m 1033 (0.2%) 1570 (0.2%) 0.147 0.94 (0.87 -1.02) -0.021% (-0.034% to -0.009%) Female 0-3m 211 (0%) 2645 (0.2%) <0.001* 0.13 (0.11 -0.15) -0.210% (-0.220% to -0.200%) 0.0069* 3-6m 194 (0%) 569 (0%) <0.001* 0.56 (0.48 -0.66) -0.025% (-0.030% to -0.019%) 6-9m 165 (0%) 460 (0%) <0.001* 0.59 (0.49 -0.7) -0.019% (-0.024% to -0.014%) >9m 165 (0%) 460 (0%) <0.001* 0.59 (0.49 -0.7) -0.019% (-0.024% to -0.014%)StrokeMale0-3m 316 (0%) 2146 (0.2%) <0.001* 0.21 (0.19 -0.24) -0.193% (-0.205% to -0.182%) 0.0019* 3-6m 275 (0%) 732 (0.1%) <0.001* 0.54 (0.47 -0.62) -0.041% (-0.049% to -0.033%) 6-9m 312 (0%) 629 (0.1%) <0.001* 0.71 (0.62 -0.81) -0.024% (-0.031% to -0.016%) >9m 1884 (0.3%) 2677 (0.3%) 0.817 1.01 (0.95 -1.07) -0.018% (-0.035% to -0.001%) Female 0-3m 356 (0%) 2040 (0.2%) <0.001* 0.29 (0.26 -0.32) -0.135% (-0.145% to -0.126%) 0.0086* 3-6m 321 (0%) 884 (0.1%) <0.001* 0.6 (0.52 -0.68) -0.036% (-0.043% to -0.028%) 6-9m 310 (0%) 727 (0.1%) <0.001* 0.7 (0.61 -0.8) -0.023% (-0.030% to -0.016%) >9m 310 (0%) 727 (0.1%) <0.001* 0.7 (0.61 -0.8) -0.023% (-0.030% to -0.016%)MortalityMale0-3m 1380 (0.2%) 25841 (2.7%) <0.001* 0.08 (0.07 -0.08) -2.689% (-2.726% to -2.653%) 0.0002* 3-6m 1531 (0.2%) 5285 (0.5%) <0.001* 0.42 (0.4 -0.45) -0.363% (-0.383% to -0.343%) 6-9m 1689 (0.3%) 3926 (0.4%) <0.001* 0.62 (0.59 -0.66) -0.187% (-0.205% to -0.169%) >9m 14030 (2.1%) 18316 (1.9%) <0.001* 1.11 (1.09 -1.14) +0.047% (+0.002% to +0.093%) Female 0-3m 1157 (0.1%) 20157 (1.5%) <0.001* 0.1 (0.09 -0.1) -1.665% (-1.692% to -1.638%) 0.0005* 3-6m 1376 (0.2%) 4970 (0.4%) <0.001* 0.46 (0.43 -0.49) -0.259% (-0.275% to -0.243%) 6-9m 1442 (0.2%) 3680 (0.3%) <0.001* 0.65 (0.61 -0.69) -0.133% (-0.148% to -0.118%) >9m 1442 (0.2%) 3680 (0.3%) <0.001* 0.65 (0.61 -0.69) -0.133% (-0.148% to -0.118%) Outcomes across four pairwise cohort comparisons (COVID-only vs Control, Vaccine-only vs Control, Hybrid vs COVID-only, and Vaccine-only vs COVID-only), stratified by sex and four post-exposure time windows (0–3, 3–6, 6–9, and >9 months). RD = p_Exposed − p_Comparator, where p = events/n. 95% CI = RD ± 1.96 × √[p_A(1−p_A)/n_A + p_B(1−p_B)/n_B] (Wald method; valid for large independent samples). Cohort sizes (n) estimated from event counts and reported percentages. Positive RD = increased absolute risk in exposed; Negative RD = reduced risk (protective effect). Temporal trend of relative risks derived from weighted meta-regression of log(RR) on time interval midpoints (1.5, 4.5, 7.5, 12.0 months) using inverse-variance weights (1/SE²). Weight = 1/SE² where SE = [ln(upper CI) − ln(lower CI)]/(2×1.96). Slope p-value = trend p-value. * p<0.05 significant temporal trend.