Open Access Original
Article

DOI: 10.7759/cureus.52108

A Study on the Self-Reported PhysicianDiagnosed Cardiac Complications Post mRNA
Vaccination in Saudi Arabia

Review began 12/12/2023
Review ended 01/09/2024
Published 01/11/2024© Copyright 2024
Sheriff et al. This is an open access article

Muazzam M. Sheriff 1, Renad Ahmed A. Marghalani 2 , Ohoud Mohammed M. Almana 3,
Wardah Mohammed Yousef A. Almaimani 2 , Yasmin Fahad A. Saidi 2, Sahar Fawzi S. Arbaeen 2 ,Atheer K. Almutairi 2, Atheer G. Alharbi 2 , Ranya M. Aljehani 2, Hesham Mortadh M. Alhasan 4

distributed under the terms of the Creative
Commons Attribution License CC-BY 4.0.,
which permits unrestricted use, distribution,and reproduction in any medium, provided
the original author and source are credited.

1. Microbiology and Immunology, Ibn Sina National College for Medical Studies, Jeddah, SAU 2. Medicine and Surgery,Ibn Sina National College for Medical Studies, Jeddah, SAU 3. Medicine and Surgery, Ibn Sina National College For
Medical Studies, Jeddah, SAU 4. Critical Care, King Faisal General Hospital, Makkah, SAU
Corresponding author: Muazzam M. Sheriff, muazzamsheriffm@gmail.com

Abstract
Introduction
The advent of mRNA-based vaccines has been a pivotal milestone in the global response to the pandemic,
prompting widespread vaccination campaigns, including in Saudi Arabia. This study investigates selfreported physician-diagnosed cardiac complications post mRNA vaccination in Saudi Arabia, recognizing
the need to monitor these rare events. The research aimed to study the self-reported physician-diagnosed
incidence, nature, and associated factors of cardiac complications in this distinctive demographic group of
post-mRNA vaccinations. Due to the scarcity of specific vaccine safety data, the study sought to provide data
supporting public awareness and recommendations for global public health practices. Emphasizing ethicalconsiderations, the study focuses on local factors, contributing valuable insights into the safety profile ofmRNA vaccines, and aiding informed decision-making for public health strategies in Saudi Arabia andglobally.

Material and methods
In a cross-sectional design, the study employs a culturally adapted questionnaire covering demographic
details, vaccination history, health conditions, and perceptions. A rigorous development and validation
process ensured the reliability of the questionnaire. A sample size of 804 participants was collected throughan online survey link distributed via social media through the groups. Statistical analyses exploredassociations between demographic variables, vaccination behaviors, health diagnoses, and perceptions
using IBM SPSS version 23 and Microsoft Excel.

Results
Significant associations were found among demographic variables, vaccination behaviors, health diagnoses,
and perceptions of self-reported physician-diagnosed cardiac complications post mRNA vaccination in
Saudi Arabia. Key findings included a high mRNA vaccine uptake with a frequency of 747 (92.79%) and amere frequency of 218 (27.11%) reporting cardiac complications post vaccination. The study highlighted
diverse influences on vaccine decisions, with a frequency of 384 (47.76%) expressing neutral confidence invaccine safety. The study contributes to the global understanding of mRNA vaccine safety, emphasizing theunique Saudi demographic context. Methodological rigor, ethical considerations, and acknowledgment oflimitations enhance credibility. Collaborative efforts and tailored recommendations for public healthpolicies and communication strategies are underscored.

Conclusion
This study on self-reported physician-diagnosed cardiac complications post mRNA vaccination in Saudi
Arabia is a crucial addition to global vaccine safety research. Providing insights shaped by local factors, thestudy aids in informed decision-making for public health strategies in Saudi Arabia and globally. It addresses
the scarcity of specific vaccine safety data, fostering a nuanced understanding of mRNA vaccine-related
cardiac complications worldwide.

Categories: Other, Preventive Medicine, Public Health
Keywords: post-vaccination, diagnosed, complications, cross-section study, mrna

Introduction
The advent of mRNA-based vaccines stands as a pivotal achievement in the global battle against the
pandemic. As numerous nations embarked on extensive vaccination campaigns to curb virus transmission,
the imperative to monitor and comprehend potential side effects, especially those impacting the

How to cite this article
Sheriff M M, Marghalani R A, Almana O M, et al. (January 11, 2024) A Study on the Self-Reported Physician-Diagnosed Cardiac Complications
Post mRNA Vaccination in Saudi Arabia. Cureus 16(1): e52108. DOI 10.7759/cureus.52108

cardiovascular system, became apparent [1]. Though cardiac complications following vaccination are rare,global reports have necessitated a thorough investigation into the occurrence and characteristics of selfreported physician-diagnosed cardiac complications among those who have received mRNA vaccines in
Saudi Arabia, as it boasts a distinctive demographic and epidemiological profile, necessitating an
understanding of how mRNA vaccination affects cardiac health within this context [2]. Due to the scarcity ofdata on vaccine safety specific to the Saudi population, a dedicated study becomes imperative to uncover theincidence, nature, and associated factors of self-reported physician-diagnosed cardiac complications post
mRNA vaccination [3].
Cardiac complications, albeit infrequent, carry significant implications for public health. Grasping andcomprehending these complications after mRNA vaccination is vital for a comprehensive assessment ofvaccine safety and for guiding public health measures [4]. Continuous monitoring of vaccine safety isparamount, and investigating self-reported physician-diagnosed cardiac complications post mRNA
vaccination provides real-world data to complement clinical trial findings, enhancing our understanding of
the long-term safety profile of these vaccines [5]. By scrutinizing self-reported cases, the study aims to raiseawareness of potential cardiac complications among the general population and healthcare providers,fostering early detection, prompt reporting, and appropriate management [6]. Identifying specific risk
factors or patterns of cardiac complications post mRNA vaccination can optimize healthcare resources,
including targeted monitoring, efficient facility utilization, and streamlined healthcare responses, ultimately
benefiting both patients and healthcare systems [7]. Addressing concerns related to cardiac complications
following mRNA vaccination contributes to bolstering public confidence in vaccination programs, whereaccurate information about risks and benefits is essential for maintaining high vaccination rates andachieving population immunity [8].
The unique genetic, cultural, and lifestyle factors in the Saudi population may influence responses to mRNA
vaccines [9]. Investigating cardiac complications within this specific context will provide insights directly
applicable to the local population, enabling tailored public health interventions [10]. As vaccine hesitancy
remains a global concern, especially with emerging vaccine technologies, transparently communicating andinvestigating cardiac complications post mRNA vaccination is crucial for maintaining and building publictrust [11]. Providing accurate information can alleviate concerns and enhance confidence in the vaccination
program [12].
The study findings can inform public health policies and guidelines related to mRNA vaccination. If specificrisk factors or patterns emerge, targeted recommendations can be developed to maximize vaccination
benefits while minimizing potential risks [13]. The clinical trials provide valuable insights, and real-world
evidence is equally important for understanding how vaccines perform in diverse populations and under
everyday conditions [14]. This study contributes real-world data, complementing clinical trial findings andproviding a more comprehensive understanding of vaccine safety in this context.
The ethical imperative ensures the well-being of vaccine recipients; investigating self-reported cardiac
complications is not only scientifically justified but also ethically responsible. The study contributes to theongoing commitment to prioritize safety in vaccine administration. Adding to the growing body of global
knowledge on the safety profile of mRNA vaccines, cross-referencing findings from different regions
enhances our understanding of potential cardiac complications, contributing to a more comprehensive andnuanced assessment of the safety of mRNA vaccines worldwide [15].
This cross-sectional study included determining the frequency, characterizing the nature and severity,
investigating the temporal relationship between vaccination and cardiac complications, identifying
associated risk factors, and evaluating healthcare-seeking behavior for cardiac complications [16]. To achievethese aims, the study outlined specific objectives. It aims to conduct a comprehensive cross-sectional
survey, developed and administered to individuals who have received mRNA vaccines in Saudi Arabia.
Additionally, the study intends to review medical information and obtain consent to validate andcorroborate self-reported cardiac complications. Incidence rates will be calculated, stratifying data bydemographic and clinical variables, and cardiac complications will be characterized in terms of nature andseverity, considering symptomatology, diagnostic procedures, and clinical outcomes [17]. The temporal
relationship between mRNA vaccination and the onset of cardiac complications will be analyzed to explore
patterns or clusters of cases [18]. Statistical analyses will be employed to identify potential risk factors
associated with the occurrence of self-reported physician-diagnosed cardiac complications post mRNA
vaccination, considering variables such as age, gender, comorbidities, and vaccination specifics [19]. The
study also explored healthcare-seeking behavior and examined patterns among individuals reporting cardiac
complications, including the types of healthcare facilities visited and the timeliness of seeking medical
attention. Furthermore, the findings are summarized to provide recommendations for public healthpractices, vaccination guidelines, and communication strategies [20]. Finally, the study aimed to contributeto the global understanding of mRNA vaccine safety by disseminating research findings, facilitatingcomparisons with international data, and enriching the collective knowledge base on vaccine-related cardiac
complications. By accomplishing these aims and objectives, the study endeavors to offer valuable insights
into the safety profile of mRNA vaccines in the population. The timely and critical nature of this research
was vital for ensuring the ongoing success and safety of the vaccination campaign and providing value to the
population in a global context.

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The primary aims of this study are to assess the incidence of self-reported physician-diagnosed cardiac
complications among individuals who have received mRNA vaccines in Saudi Arabia. A study on selfreported physician-diagnosed cardiac complications post mRNA vaccination in Saudi Arabia was not only
timely but also critical for ensuring the success and safety of future vaccination campaigns. This research
will contribute valuable data to the global understanding of mRNA vaccine safety and provide insights
specific to the unique characteristics of the studied population.

Materials And Methods
Study design
This investigation employed a cross-sectional research design to explore the dynamics of evaluating selfreported physician-diagnosed cardiac complications following mRNA vaccination in Saudi Arabia. The
research methodology involved developing and validating a comprehensive questionnaire, collecting data,and subsequently analyzing it [21].

Questionnaire development
A detailed questionnaire was created to assess self-reported physician-diagnosed cardiac complications post
mRNA vaccination in Saudi Arabia. The questionnaire encompassed sections on demographic details,
knowledge and awareness-based inquiries, psychosocial aspects, frequency of cases, hesitancy, vaccination
history, self-reported cardiac symptoms, healthcare-seeking behavior, relevant medical history, andvalidated assessment scales of patient health [22].

Translation and cultural adaptation
To ensure cultural relevance and linguistic accuracy, a meticulous translation and adaptation process wasundertaken for the questionnaire. Certified licensed bilingual experts translated the English version into
Arabic, followed by a separate back-translation by a different set of certified licensed bilingual experts. The
consensus resolution addressed any discrepancies, preserving the original intent while aligning with thelocal cultural context [23].

Questionnaire validation
The translated questionnaire underwent validation to ensure its reliability and validity. The Cronbach’s
alpha was 0.77344 for the questionnaires. Content validation involved a panel of experts, including a criticalcare expert. A pilot study on a small sample size of 10 participants assessed the clarity andcomprehensibility of questionnaire items, with participant feedback used to refine them [24]. The pilot
study participants were also included in the actual study, and the confidentiality of their data, including
demographic information, was preserved as part of ethical consideration.

Sample size
The study's sample size was determined using the Raosoft online sample calculator (Raosoft Inc., Seattle,
WA), targeting a 95% confidence level with a margin of error within ±5%. The decision to select a sample sizeof 804 participants for the cross-sectional study on self-reported physician-diagnosed cardiac complications
post mRNA vaccination in Saudi Arabia was influenced by several crucial factors, including the anticipatedvariability in the population regarding cardiac complications, the desired confidence level and margin oferror for accurate estimates, and the statistical power needed to detect significant effects. Additionally, thestudy's design, the complexity of the variables involved, and the planned analyses played a role indetermining the optimal sample size. Practical considerations, including available resources and potential
constraints, have also influenced this decision. The chosen sample size reflected a careful balance between
statistical precision and feasibility, aiming to provide meaningful insights into the incidence and nature ofcardiac complications in the specific demographic context of Saudi Arabia. The confidence level represents
the certainty with which conclusions about the population are based on the sample, as the common choices
are 95% or 99%. A higher confidence level provided a larger sample size. The calculated sample size required
was 804, based on inclusion criteria set by a specialist critical care professional [25].

Inclusion and exclusion criteria
The inclusion criteria for the study encompass individuals aged 18 and above, residents of Saudi Arabia, andthose who have received at least one dose of an mRNA vaccine (Pfizer-BioNTech, Moderna, or both).
Voluntary participation with informed consent was mandatory to uphold ethical standards. The consent was
mentioned on the first page of the survey form and will proceed to the questionnaires only upon acceptance.
The exclusion criteria include individuals below the age of 18, those who have not received any mRNA
vaccine dose, individuals unable to provide informed consent by acceptance on the first page of the survey
form, non-residents of Saudi Arabia, as the study was only intended for the residents of urban areas tojustify the study population mentioned in the title, and those providing inconsistent or unreliable survey
responses. Maintaining data accuracy and ensuring the study's focus on the local population were key
considerations in determining eligibility. These criteria collectively aimed to yield meaningful insights into
the incidence and nature of cardiac complications post mRNA vaccination within the specific demographic

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context of Saudi Arabia.

Ethical approval
The research adhered rigorously to ethical protocols, prioritizing participant anonymity and privacy andobtaining informed consent. Approval was granted by the Ibn Sina National College (ISNC) Institutional
Research Review Board (IRRB), Jeddah, Saudi Arabia, under the ethical approval reference number IRRB-0315102023.

Data collection
Informed consent was obtained, emphasizing confidentiality and voluntary participation. The study was
conducted from September 17, 2023, to November 16, 2023, with 804 participating volunteers aged 18 andabove from diverse geographic regions to ensure a representative sample. The study was conducted on
individuals who had previously experienced the onset and duration of cardiac complications diagnosed by aphysician post-vaccination, which varied from less than a month to 12 months. The online survey createdwith a Google Form (Google Inc., Mountainview, CA) in English was used for the cross-sectional study [26]. A
non-probability-purposed sampling technique was employed for participant selection. The distribution
strategy involved sharing the survey with the intended population through group posts and direct messages,
ensuring broad accessibility for potential participants [27]. Before participation, individuals were provided
with informed consent, highlighting their commitment to maintaining confidentiality and emphasizing thevoluntary nature of their involvement.

Data analysis
A thorough statistical analysis was conducted on the collected data. Descriptive statistics presented
demographic and intricacy-related variables describing the complications. Validated assessment scales wereanalyzed to quantify intricacy prevalence and severity [25]. Inferential statistics, including chi-square tests
and regression analysis, explored relationships between intricacy and various factors. IBM SPSS software
version 23 (IBM Corp., Armonk, NY) and Microsoft Excel (Microsoft Corp., Redmond, WA) were employed fordata analysis, maintaining a statistical power of 80% at a cutoff value of 0.05 [24].

Results
A study on self-reported physician-diagnosed cardiac complications following mRNA vaccination in Saudi
Arabia revealed significant associations between demographic variables, vaccination behaviors, healthdiagnoses, and perceptions of participants who reported physician-diagnosed cardiac complications after
the administration of mRNA vaccination in Saudi Arabia. The findings provide a nuanced understanding of
the diverse factors influencing vaccine outcomes and perceptions within the surveyed population. These
results can guide public health interventions, communication strategies, and targeted healthcare
approaches to consider the specific concerns and health outcomes associated with mRNA vaccination.
Further research and monitoring are essential for the continuous assessment and adaptation of strategies in
response to evolving patterns and concerns.

Demographic variables
The survey included 804 participants from various regions, with the Western region exhibiting the highest
response rate at 26.12%. The gender distribution was nearly balanced, and participants spanned diverse agegroups, nationalities, marital statuses, and educational backgrounds. Statistically significant differences (p≤0.05) were achieved using Pearson's chi-square test from the responses based on province, gender, agegroup, nationality, marital status, and education. The details of the demographic variables are mentioned inTable 1.

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Survey questionnaires

Response rate: absolute number (total=804)

Response rate: percentage

Northern

127

15.80%Southern

166

20.65%

Eastern174

21.64%

Western210

26.12%

Central

127

15.8%

Male

379

47.14%

Female42552.86%

18-24

194

24.13%

25-34

221

27.49%

35-44

175

21.77%

45-54

167

20.77%

55 and above

47

5.85%

Saudi

543

67.41%

Non-Saudi

261

32.49%

Single179

22.26%

Married625

77.74%

Undergraduate

254

31.59%

Graduate371

46.14%

Postgraduate

79

9.83%

Doctorate

17

2.11%

Others83

10.32%

p-value (p ≤0.05)

Province

0.042

Gender0.051

Age group (in years)

0.043

Nationality
0.037

Marital status
0.029

Education

0.039

TABLE 1: Demographic characteristics of the study group

Vaccination information
A majority of participants (92.79%) reported receiving mRNA vaccines, with Pfizer-BioNTech (43.18%) andModerna (27.49%) being the predominant choices. The number of vaccine doses received varied, with one
dose being the most common (39.43%). Statistically significant differences (p ≤0.05) were observed in
responses related to vaccine uptake and types. The details of the vaccination information are mentioned inTable 2.

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Survey questionnaires

Response rate: absolute number (total=804)

Response rate: percentage

p-value (≤0.05)

Yes

747

92.79%

0.011

No

57

7.21%

Have you received an mRNA vaccine?

Specify which mRNA vaccine(s) you have received.
Pfizer-BioNTech

347

43.18%

Moderna221

27.49%

Both Pfizer-BioNTech and Moderna178

22.14%

None

0

0%

Other

58

7.21%

0.045

How many doses of the mRNA vaccine have you received?
One

317

39.43%

Two297

36.95%

Three120

14.93%

Four

70

8.71%

0.042

TABLE 2: Information about vaccination received by the study group

Health conditions before vaccination
Pre-existing health conditions were reported by participants, with diabetes (48.26%) and hypertension(56.72%) being the most prevalent. Statistically significant differences (p ≤0.05) were noted in theprevalence of various health conditions, reflecting the diversity of the sample. The details of the healthconditions before vaccination are mentioned in Table 3.

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Survey questionnaires

Response rate: absolute number (total=804)

Response rate: percentage

p-value (p ≤0.05)

0.049

Have you been diagnosed with diabetes mellitus?
Yes

387

48.26%

No

417

51.74%Have you been diagnosed with hypertension?
Yes

456

56.72%

No

348

43.28%

0.046

Have you been diagnosed with dyslipidemia?
Yes

173

21.52%

No

631

78.48%

0.027

Have you been diagnosed with obesity?
Yes

315

39.15%

No

489

60.85%

0.039

Have you been diagnosed with any health issues that may be related to your sedentary lifestyle?
Yes

178

22.14%

No

626

77.86%

0.028

Have you been diagnosed with any smoking-related health issues?
Yes

221

27.49%

No

583

72.51%

0.027

TABLE 3: The details of the study group's health conditions before vaccination

Health outcomes following mRNA vaccination
Approximately 27.11% of participants reported being diagnosed with cardiac complications post mRNA
vaccination. Duration, hospitalization, and treatment methods varied significantly, with medical treatment
being the most common. The onset of cardiac complications was reported within different timeframes.
Statistically significant differences (p ≤0.05) were observed in responses related to cardiac complications,
hospitalization, and treatment. The details of the health outcomes after vaccination are mentioned in Table
4.

Survey questionnaires

Response rate: absolute number (Total=804)

Response rate: percentage

p-value (p ≤0.05)

0.024

Have you been diagnosed with cardiac complications by a physician?
Yes

218

27.11%

No

586

72.89%

What is the onset duration of cardiac complications diagnosed by a physician post vaccination?
Less than 1 month117

14.55%

1-3 months

53

6.97%

3-6 months

31

3.86%

6-12 months

11

1.37%

More than 12 months

6

0.75%

Not applicable586

45.77%

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0.032

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Did you get admitted to the hospital?
Yes

218

27.11%

No

586

72.89%

0.023

Have you been admitted to the critical care unit or ward?
Critical care unit

127

15.80%

Ward

91

11.44%

No

586

72.89%

0.025

What was the duration of hospitalization?
Less than 1 day

56

6.97%

1-3 days

89

11.07%

4-7 days

67

8.33%

1-2 weeks

4

0.50%

2-4 weeks

2

0.25%

More than 4 weeks

00%

Not applicable586

72.89%

0.024

What is the duration of treatment?
Less than 1 month

7

0.87%

1-3 months

13

1.62%

3-6 months

11

1.37%

6-12 months

53

6.59%

More than 12 months

76

9.45%

Continuous

57

7.11%

No current treatment

1

0.12%

Not applicable586

72.89%

0.023

What is the treatment method?
Medical197

24.50%

Procedure

21

2.61%

Not applicable586

72.89%

0.022

TABLE 4: The study group's health outcomes post vaccination

Perceptions and concerns
Participants expressed varying levels of confidence in the safety of mRNA vaccines, with 47.76% being
neutral. A notable proportion believed that their cardiac complications were related to the vaccine.
Influences on vaccine decisions included healthcare professionals (22.89%) and government health agencies(34.45%). Statistically significant differences (p ≤0.05) were observed in responses related to vaccine
confidence, perceived vaccine-cardiac complications relationship, and sources of information. The details of
the perceptions and concerns are mentioned in Table 5.

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Survey questionnaires

Response rate: absolute number (total=804)

Response rate: percentage

p-value (p ≤0.05)

How confident are you in the safety of the mRNA vaccine?
Very confident

127

15.80%

Somewhat confident

156

19.40%

Neutral384

47.76%

Somewhat not confident

67

8.33%

Not confident at all

70

8.71%

0.044

To what extent do you believe that the cardiac complications you experienced were related to the mRNA vaccine?
Strongly related

73

9.08%

Somewhat related

84

10.45%

Neutral366

45.52%

Not very related

137

17.01%

Not related at all

144

17.91%

0.042

What sources of information influenced your decision to receive the mRNA vaccine?
Healthcare professionals

184

22.89%

Government health agencies

277

34.45%

Scientific studies and research

16

1.99%

Family and friends

79

9.85%

News media

103

12.81%

Social media

139

17.27%

Other

6

0.75%

0.040

TABLE 5: The participants' perceptions and concerns regarding the mRNA vaccine

The analysis conducted on the survey questionnaires unveiled significant relationships between various
demographic variables and participants' responses, as denoted by p-values (p ≤0.05). In Table 1,
demographic data indicates noteworthy findings, such as the Western region exhibiting the highest response
rate at 26.12%, a balanced gender distribution, and diverse educational levels. Table 2 delves into
vaccination information, revealing a high uptake of mRNA vaccines (92.79%) and significant preferences for
Pfizer-BioNTech and Moderna. Table 3 explores health conditions before vaccination, highlighting prevalentdiagnoses such as diabetes mellitus (48.26%) and hypertension (56.72%). Table 4 examines health outcomes
post-vaccination, with 27.11% reporting cardiac complications and diverse treatment durations. Table 5
focuses on perceptions and concerns, revealing varied confidence levels in vaccine safety and influencesfrom healthcare professionals and government health agencies. These regression findings provide
comprehensive insights into the intricate relationships between demographic factors, vaccination behaviors,
health diagnoses, and perceptions, offering valuable data for targeted public health strategies. These
regression findings provide valuable insights into the relationships between demographic variables,
vaccination behaviors, health diagnoses, and perceptions. The statistical significance of these associations
contributes to a nuanced understanding of the survey responses. Future research may delve deeper into
specific demographic factors or health outcomes to inform targeted interventions and public healthstrategies.

Discussion
The study on self-reported physician-diagnosed cardiac complications post mRNA vaccination in Saudi
Arabia represents a pivotal contribution to the ongoing global efforts to understand the safety profile ofmRNA-based vaccines. This research emerges against the backdrop of the unprecedented development anddeployment of mRNA vaccines in response to the pandemic [28]. As Saudi Arabia, like many nations,vigorously rolls out vaccination campaigns to curb virus transmission, the imperative to closely monitor andcomprehend potential side effects, particularly those affecting the cardiovascular system, becomes

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This study acutely recognizes the rarity of cardiac complications post-vaccination, as reported globally [3].
However, the recognition of these rare events necessitates a thorough investigation into the incidence,nature, and associated factors of self-reported physician-diagnosed cardiac complications among those whohave received mRNA vaccines within the unique demographic and epidemiological landscape of Saudi Arabia[29].
This study acknowledges the unique genetic, cultural, and lifestyle factors inherent in the Saudi population.
These factors may play a crucial role in influencing how individuals respond to mRNA vaccines [7]. By
delving into cardiac complications within this specific context, the study not only provides localized insights
but also lays the foundation for tailoring public health interventions that resonate with the Saudi population[10].
The meticulous approach to questionnaire development, translation, and cultural adaptation ensures therelevance and accuracy of the data collected [23]. The emphasis on ethical considerations underscores thecommitment to the well-being of vaccine recipients, aligning with the broader ethical imperatives ofscientific research [22]. The study’s comprehensive objectives, ranging from assessing incidence toevaluating healthcare-seeking behavior, highlight a dedication to generating a nuanced understanding of
the impact of mRNA vaccination on cardiac health.
By providing valuable insights, future longitudinal studies could offer a deeper understanding of theevolution of cardiac complications over time. The transparent acknowledgment of limitations, coupled withthe robust validation process of the questionnaire, contributes to the study's credibility.
In comparing this study with similar research endeavors globally, common concerns surrounding cardiac
complications post mRNA vaccination are evident [30]. The emphasis on collaborative efforts, global
knowledge enrichment, and the dissemination of findings for international comparisons aligns with thecollective endeavor to enhance the understanding of vaccine-related complications on a global scale [30].
The study's findings carry substantial implications for public health policies globally. The tailored
recommendations informed by the study could prove instrumental in maximizing the benefits of vaccination
programs while minimizing potential risks [9]. The communication strategies outlined in the study
contribute to the broader global challenge of building and maintaining public trust in vaccination, especiallywith emerging vaccine technologies [20].
The study on self-reported physician-diagnosed cardiac complications post mRNA vaccination in Saudi
Arabia stands as a comprehensive and timely contribution to the evolving landscape of vaccine safety
research [22]. Its methodological rigor, cultural sensitivity, and commitment to ethical considerations
position it as a valuable piece in the global mosaic of understanding mRNA vaccine safety [15]. As the world
navigates through ongoing vaccination campaigns, the insights generated by this study carry weight for thebroader global community facing challenges and concerns.

Strengths and weaknesses of the study
The study on self-reported physician-diagnosed cardiac complications post mRNA vaccination in Saudi
Arabia exhibits several notable strengths. Its timely investigation into the rare but crucial aspect of cardiac
complications aligns with global mRNA vaccination efforts. A comprehensive questionnaire, covering
demographic details, health conditions, vaccination history, and perceptions, demonstrates methodologicalrigor. Ethical considerations, such as informed consent and confidentiality, underscore the commitment toparticipant well-being. However, the study faces limitations, including potential self-reporting bias and theuse of convenience sampling, affecting generalizability. The cross-sectional design captures a single
snapshot in time, and the accuracy of participants' vaccination history recall may vary. Despite theseweaknesses, the study's strengths in methodology, relevance, and ethical considerations contribute valuable
insights into the safety profile of mRNA vaccines in the specific context, fostering informed public healthstrategies in Saudi Arabia.

Conclusions
The study on self-reported physician-diagnosed cardiac complications post mRNA vaccination in Saudi
Arabia emerges as a crucial and timely contribution to the global discourse on vaccine safety. The advent ofmRNA vaccines has marked a significant milestone in public health. This study, conducted in the distinctive
demographic and epidemiological landscape of Saudi Arabia, not only recognizes the rarity of cardiac
complications following vaccination but diligently investigates their incidence, nature, and associatedfactors. The study contributes to the global understanding of mRNA vaccine safety by providing real-world
data that complements clinical trial findings. The insights generated by this research not only benefit the
Saudi population but also contribute to the collective knowledge base on vaccine-related cardiac
complications worldwide. As nations strive to build and maintain public trust in vaccination programs,
especially with emerging vaccine technologies, studies of this nature play a pivotal role in fostering2024 Sheriff et al. Cureus 16(1): e52108. DOI 10.7759/cureus.52108

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informed decision-making and ensuring the ongoing success and safety of vaccination campaigns.

Additional Information
Author Contributions
All authors have reviewed the final version to be published and agreed to be accountable for all aspects of thework.
Concept and design: Muazzam M. Sheriff, Hesham Mortadh M. Alhasan, Renad Ahmed A. Marghalani,
Ohoud Mohammed M. Almana, Wardah Mohammed Yousef A. Almaimani, Yasmin Fahad A. Saidi, Sahar
Fawzi S. Arbaeen
Critical review of the manuscript for important intellectual content: Muazzam M. Sheriff, Hesham
Mortadh M. Alhasan, Wardah Mohammed Yousef A. AlmaimaniSupervision: Muazzam M. Sheriff, Hesham Mortadh M. Alhasan
Drafting of the manuscript: Renad Ahmed A. Marghalani, Ohoud Mohammed M. Almana, Yasmin Fahad
A. Saidi, Sahar Fawzi S. Arbaeen, Atheer K. Almutairi, Atheer G. Alharbi , Ranya M. Aljehani
Acquisition, analysis, or interpretation of data: Atheer K. Almutairi, Atheer G. Alharbi , Ranya M.
Aljehani

Disclosures
Human subjects: Consent was obtained or waived by all participants in this study. Ibn Sina National
College (ISNC) Institutional Research Review Board (IRRB) issued approval IRRB-03-15102023. Animal
subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts ofinterest: In compliance with the ICMJE uniform disclosure form, all authors declare the following:
Payment/services info: All authors have declared that no financial support was received from anyorganization for the submitted work. Financial relationships: All authors have declared that they have nofinancial relationships at present or within the previous three years with any organizations that might havean interest in the submitted work. Other relationships: All authors have declared that there are no otherrelationships or activities that could appear to have influenced the submitted work.

Acknowledgements
The authors are very thankful to the administration of Ibn Sina National College for Medical Studies, Jeddah,
Saudi Arabia, for giving us constant encouragement, support, and guidance. All authors have made equal
contributions to the work and approved it for publication. Authors affirm that all people assigned to beauthors who qualify for origin have checked the article and endorsed the ultimate draft and are capable ofthe substance and closeness file of the composition.

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