This study explores the development and testing of a social resilience psychometric scale, through physical and social unrest during the COVID-19 pandemic. Qualitative interviews (N = 40) were aggregated to define social resilience measured statements. When tested in quantitative analysis respondents (N = 901) “see myself as a monster” when evaluating others and are “scared to let people know the real me” fearing loss of relationships. Anxiety is heightened through a perception through the measure “could have done better.” When testing for “want to be liked even when disagree on issues” Black respondents are significantly different than White, Asian and those expressing other races. Liberals and moderate conservatives are significantly different in perception of social resilience, as are those exemplifying feminine versus masculine traits. Logistic regression testing for “comfortable with who I am in society” indicates narcissism (65% more likely) and negative social resilience (56% more likely) are key adapters. Human wellbeing, the act of perceiving self as a healthy or unhealthy actor in society, has been influenced through groupthink and polarization of the “other.” This study suggests the construct of self-esteem has been pushed into reactive mode. Research that explicates the psychological dimensions of modern resilience, is warranted.

Objectives: To evaluate cellular immune responses induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines immunization in population based on HLA-E-restricted CD8 + T cell epitopes identification. Methods: HLA-E-restricted SARS-CoV-2 CD8 + T cell nonamer peptides were predicted with software. HLA-E-transfected K562 cells binding assay was used to screen for high-affinity peptides. IFN-γ enzyme-linked immunospot assay were used to identify HLA-E-restricted epitopes. HLA-E/epitope tetramer was employed to detect the frequencies of epitope-specific CD8 + T cells. Results: Four CD8 + T cell epitopes on spike protein of SARS-CoV-2 restricted by both HLA-E*0101 and E*0103 were identified. HLA-E-restricted epitope specific IFN-γ-secreting CD8 + T cell responses could be detected in individuals vaccinated with SARS-CoV-2 vaccines. Importantly, the frequencies of epitope-specific CD8 + T cell in Ad5-nCoV vaccinated individual were higher than that in individuals vaccinated with recombinant protein or inactivated vaccines. Moreover, frequencies of epitope-specific CD8 + T cells could maintain for at least 120 days after only one dose Ad5-nCoV vaccination. While frequencies of epitope-specific CD8 + T cells decreased in individuals after two doses of Ad5-nCoV vaccination. Conclusions: These findings may contribute to more comprehensive evaluating protective effects of vaccines for SARS-CoV-2, meanwhile may provide information to characterize HLA-E-restricted CD8 + T cell immunity against SARS-CoV-2 infection.

Title pageTitle: Rust-colored patches of the lower extremity in a COVID-19 patientAuthrors: Jacem Rouatbi1, Mouna Korbi1*, Nouha Ben Abdeljalil2, Hichem Belhadjali1*, Jameleddine Zili1*

A Case of TAFRO syndrome after COVID-19 vaccinationHitomi Hirosea, Hitoshi Suzukia,c*, Yukako Umezawaa, Masako Iwasakia, Hiromitsu Fukudaa, Hisatsugu Takaharaa, Shigeki Tomitab, Yusuke Suzukica. Department of Nephrology, b. Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan. c. Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan.Correspondence to:Hitoshi Suzuki, M.D., Ph.DDepartment of Nephrology, Juntendo University Urayasu Hospital2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, JapanEmail: shitoshi@juntendo.ac.jpKey words: COVID-19, mRNA vaccine, TAFRO syndrome, renal dysfunction

In this paper, we propose a blockchain-based cold chain technology for vaccine cooling track. The COVID-19 pandemic has caused the death of millions of people. An important step towards ending the pandemic is vaccination. Vaccines must be kept under control temperature during the whole process, from fabrication to the hands of the health professionals who will immunize the population. However, there are numerous reports of vaccine loss due to temperature variations, and, currently, people getting vaccinated have no control if their vaccine was kept safe. Blockchain is a technology solution that can provide public and verifiable records. We review the World Health Organization (WHO) cool chain and Blockchain technology. Moreover, we describe current IoT temperature monitoring devices and propose Blockcoldchain to track vaccine cold chain using blockchain, thus proving an unalterable vaccine temperature history. Our experimental results using smart contracts demonstrate the system’s feasibility.

Numerous different complications have been reported following Covid-19 disease.Although the disease often improves after going through various clinical phases,some people have Various complications, including coagulation disorders. The patient is a 59-year-old man who developed extensive heart thrombosis following covid19 involvement a month ago and was hospitalized with extensive cardiac dysrhythmias

New-onset pemphigus after COVID-19Yihang Xie1 Mei Yang1 Peimei Zhou1* Jiaming Fan1 Sijie Zhou11.Department of Dermatovenereology, Chengdu Second People’s Hospital, Chengdu, China* Corresponding Author: 46551704@qq.comrunning head: pemphigus after COVID‐19The category of the article: LetterKeywords: COVID‐19, pemphigusManuscript word count: 690 wordsThe number of figures: 2The number of tables: 0The number of references: 8Correspondence to: Peimei Zhou, M.D, Ph.D., Department of Dermatovenereology, Chengdu Second People’s Hospital, Qingyun Street, Chengdu, 610041, China.Tel: +86 18908176315; E-mail:46551704@qq.comFull conflict of interest statement: Y. Xie, and my co-authors have no conflict of interest to declare.Ethics statement: The patient has consented to publish this information.Data availability statement: Data sharing does not apply to this article as no new data were created or analyzed in this study.Funding sources: noneDear Editor,Cutaneous manifestations of coronavirus disease (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; family Coronaviridae, genus Betacoronavirus, subgenusSarbecovirus ), have been increasingly reported. SARS-CoV-2 infection is multisystemic and leads to potentially detrimental effects on various organs. Maculopapular, urticarial, vesicular, livedoid, and Chilblain-like lesions (CBLL) have been commonly reported to be associated with COVID-191. Here, we encountered an intriguing case of pemphigus that developed after COVID-19 infection.A 73-year-old male presented with a 42-day history of pruritic flaccid blisters that arose on the trunk and both upper limbs on normal and erythematous skin. Cutaneous lesions started 3 days after the positive reverse transcription polymerase chain reaction (RT-PCR) test diagnostic for SARS-CoV-2. He denied any history of systemic diseases, medication, and medicine or food allergies, and had not used any medication before symptom onset. The patient had first been diagnosed with allergic dermatitis caused by COVID-19 at another hospital and was prescribed oral prednisone (8 mg once daily for 4 days). The patient reported no new blisters, but the erythema did not fade; therefore, he visited our hospital. Physical examination revealed cutaneous lesions on the trunk and both upper limbs without mucosal involvement and scattered superficial blisters that developed into crusted erosions on an erythematous base(Figure1 A-D). Laboratory examination revealed normal white cell count (8.63 Ö109/L; normal 3.5-9.5 Ö109/L) with eosinophilia (6%; normal 0.5%-5.0%). Desmoglein (Dsg) 1 antibody levels were > 150 U/mL (positive: > 20), while Dsg3, BP(bullous pemphigoid)180, and BP230 antibody levels were within normal ranges. Other laboratory tests including RT-PCR targeting SARS-CoV-2, immunoglobulin, erythrocyte sedimentation rate, the spectrum of antinuclear antibodies, and T-spot were negative or normal. Chest and abdominal computed tomography revealed chronic inflammatory changes but no obvious tumors. Histological analysis of an incisional cutaneous biopsy taken from the patient’s abdomen showed subcorneal blister formation, acantholytic cells within the blister, and marked spongiotic edema in the spongiosa layer that had mixed inflammatory infiltrate with eosinophils, leukomonocytes, and neutrophils(Figure2A). Direct immunofluorescence (DIF) showed deposition of intracellular IgG and C3 in subepidermal 2/3 interspinous cells, though was negative for IgA and IgM, confirming pemphigus(Figure2B,C). Considering the good response to hormone treatment, the patient continued oral prednisone at 8 mg once daily along with the use of topical corticosteroids. Symptoms were completely absent after 3 weeks(Figure1 E-F).An increasing number of studies on cutaneous manifestations of COVID-19 have been reported; however, knowledge is still lacking on the common skin manifestations of this disease. Nonspecific cutaneous manifestations due to SARS-CoV-2 infection have also been reported, such as immune thrombocytopenic purpura (ITP), dengue-like exanthem, pityriasis rosea-like eruptions, acral ischemia, mucositis, dusky lesions, and bullae2.3.4. We searched all relevant articles and found only two cases of pemphigus vulgaris induced by COVID-19. In the case presented here, we realized that COVID-19 may be responsible for the rash eruption, possibly due to an inflammatory reaction5. The onset time of the rash was similar to that in the cases of pemphigus previously reported by De Medeiros5 and Mohaghegh F6 (within 1.5 months). In our case, although direct immunofluorescence showed subepidermal 2/3 deposition, we still diagnosed pemphigus foliaceus in combination with the pathological presentation, indirect immunofluorescence, and good treatment outcome. We speculate that the reason why direct immunofluorescence showed subepidermal 2/3 deposition may be the marked sponge edema of the epidermis, which may lead to a discontinuity of acantholysis, resulting in leakage of Dsg1 into the deeper epidermis.Pemphigus is defined as a group of rare mucocutaneous autoimmune diseases. Its etiology is unknown, though there are studies on autoimmune etiology which is believed to be related to stimulation by certain drugs, ultraviolet radiation, and malignant tumors; these induce autoimmune reactions by making the adhesive substances between the spiny cell layers become autoantigens7. It is rarely considered, however, that viral infections might cause pemphigus. The ability of SARS-CoV-2 to induce a hyper-stimulated immune state was discovered at the beginning of the pandemic8. As an instrumental trigger of autoimmunity, SARS-CoV-2 infection could be a trigger for autoimmune reactions, possibly through more than one mechanism. Because of this, all factors should be considered in any patient presenting with new-onset or exacerbating cutaneous reactions.

Over three years, humans have experienced multiple rounds of global transmission of SARS-CoV-2 and its variants. In addition, the widely used vaccines against SARS-CoV-2 involve multiple strategies of development and inoculation. Thus, the acquired immunity established among humans is complicated, and there is a lack of understanding within a panoramic vision. Here, we provide the special characteristics of the cellular and humoral responses in 2-year convalescents after inactivated vaccines, in parallel to vaccinated COVID-19 naïve persons and unvaccinated controls. The decreasing trends of the IgG, IgA, and NAb, but not IgM of the convalescents were reversed by the vaccination. Both cellular and humoral immunity in convalescents after vaccination were higher than the vaccinated COVID-19 naïve persons. Notably, inoculation with inactivated vaccine fueled the NAb to BA.1, BA.2, BA.4, and BA.5 in 2-year convalescents, much higher than the NAb during 6 months and 1 year after symptoms onset. And no obvious T cell escaping to the S protein was observed in 2-year convalescents after inoculation. The study provides insight into the complicated features of human acquired immunity to SARS-CoV-2 and variants in the real world, indicating that promoting vaccine inoculation is essential for achieving herd immunity against emerging variants, especially in convalescents.

We examined associations between mild or asymptomatic prenatal SARS-CoV-2 infection and preterm live birth in a prospective cohort study. During August 2020–October 2021, pregnant persons were followed with systematic surveillance for RT-PCR or serologically-confirmed SARS-CoV-2 infection until pregnancy end. The association between prenatal SARS-CoV-2 infection and preterm birth was assessed using Cox proportional-hazards regression. Among 954 pregnant persons with a live birth, 185 (19%) had prenatal SARS-CoV-2 infection and 123 (13%) had preterm birth. The adjusted hazard ratio for the association between SARS-CoV-2 infection and preterm birth was 1.28 (95% confidence interval 0.82-1.99, p=0.28), although results did not reach statistical significance.

The emergence of SARS-CoV-2 Omicron variant has led to a complete reconfiguration of the therapeutic landscape, with most monoclonal antibodies having lost any neutralization activity. We report here a case series of 75 immunocompromised patients infected by the Omicron variant who benefited of convalescent plasma. At baseline, 49 (68%) of the participants had a WHO score of 5 and 23 (32%) a WHO score of 6. At day 28 the case fatality was 24%. We observed no significant difference in the clinical outcome between patients with hematological malignancies, solid organ transplantation or auto-immune diseases. These promising results require controlled studies.

Changes in Conception Rates, Not in Pregnancy-Related Behavior, Likely Caused Decline in Pre-Term Births in Developed Countries During the First Year of the COVID-19 Pandemic 11* Corresponding author: Peter Fallesen, peter.fallesen@sofi.su.se, Swedish Institute for Social Research, Stockholm University, Stockholm 106 91, Sweden.Peter Fallesen, PhDSwedish Institute for Social Research, Stockholm University, Stockholm 106 91, Sweden ROCKWOOL Foundation, Ny Kongensgade 6, 1472 Copenhagen C, DenmarkMoritz Oberndorfer, MSc

Cutaneous vasculitis after COVID-19 vaccination in a 41-year-old maleMehran Pournazari1, Shirin Assar1, Faraneh Farsad2, Dena Mohamadzadeh11Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran2 Research Centre of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Saliva specimens offer practical advantages over serum specimens for studying SARS-CoV-2 immunity following natural infections or vaccination. Salivary anti-spike (S)-protein immunoglobulin G (IgG) antibody titers are quantifiable by ELISA with high sensitivity and specificity and robustly correlated with serum titers. Our longitudinal prospective study enrolled participants who received two-dose regimen vaccination with either mRNA-1273 or BNT162b2 vaccines, and salivary anti-S-protein IgG titers were measured at intervals for its duration. Subsequently, participants received homologous mRNA-1273 (n=28) and BNT162b2 (n=29) booster vaccines and enrolled in the booster study. Participants performed self-collection of saliva specimens with the OraSure ® device at predetermined time intervals for each cohort. Salivary anti-S-protein IgG titers varied between participants following the second dose; titers waned from their peak 9 to 150-fold in the mRNA-1273 cohort and 7 to 105-fold in the BNT162b2 cohort. The booster dose elicited a 2 to 238-fold increase in the mRNA-1273 cohort and a 20 to 255-fold increase in the BNT162b2 cohort from the lowest titer. These results replicate the antibody waning and recall trends following second and third doses reported in larger studies using serum specimens, supporting the use of non-invasive saliva specimens to monitor antibody titers during future epidemics or vaccination campaigns.

As the Coronavirus Disease 2019 (COVID-19) outbreak spread, evidence has emerged that gender and race would bear a disproportionate impact on the morbimortality of COVID-19. Here, we conducted a retrospective observational study using the TabNet/DATASUS platform of the city of São Paulo. COVID-19 records from March 2020 thru December 2021 were included, and we evaluated the temporal trends of confirmed cases and case fatality rate by gender and ethnicity. Statistical analysis was performed using the R-software and the BioEstat-software, considering p<0.05 significant. From March/2020 to December/2021, 1,315,160 COVID-19 confirmed cases were recorded (57.1% females), and 2,973 deaths were due to COVID-19. Males presented higher median mortality (0.44% vs 0.23%; p<0.05) and ICU admission rates (0.34% vs 0.20%; p<0.05). Men were also associated with a higher risk of death (RR=1.28; p<0.05) and a higher chance of requiring ICU care (RR=1.29; p<0.05). The black ethnicity was associated with a higher risk of death (RR=1.19; p<0.05). White patients were more likely to require ICU admission (RR=1.13; p<0.05), whereas browns were associated with a protective effect (RR=0.86; p<0.05). Further, men presented a higher chance of death than women across the three major ethnic groups: whites (RR=1.33; p<0.05), blacks (RR=1.24; p<0.05), and browns (RR=1.35; p<0.05). In this study of COVID-19 in São Paulo, men were associated with worse outcomes, including in the three major ethnicities in the population. Blacks exhibited a higher risk of death, whites were more likely to require intensive care, and browns were at protection from ICU hospitalization.

We reported the first case of Guillain-Barré syndrome that is associated with COVID-19 and malaria coinfection. The current report demonstrates diagnostic challenge to identify GBS case in a country like Sudan that is endemic with several infectious diseases associated with developing GBS.

Background Based on previous reports of disparities in financial burden following cancer, this study aims to characterize mechanisms of disparities experienced by caregivers of children with cancer, including the impact of work flexibility and social support. Methods Cross-sectional survey (in English or Spanish) of caregivers of children with cancer that assessed household material hardship (HMH), financial toxicity and income change. Results Of 156 caregivers surveyed, 32% were Hispanic and 32% were low income. Hispanic caregivers were more likely to report HMH and financial toxicity compared to non-Hispanic White and Asian (HMH 57% v. 21% v. 19%, p<0.001; financial toxicity 73% v. 52% v. 53%, p=0.07). Low and middle income caregivers were more likely to experience HMH and financial toxicity compared to high income (HMH: 68% low v. 38% middle v 8.7% high, p<0.001; financial toxicity: 81% v. 68% v. 44%, p<0.001). All income categories demonstrated significant increases in HMH one year after diagnosis. Seventeen percent reported >40% income loss, more of whom were low income than high income (27% v. 12%, p=0.20). Work flexibility and social support were associated with income and financial toxicity. Conclusion HMH, financial toxicity, and income loss are prevalent after a child’s cancer diagnosis, suggesting that screening should be incorporated into routine care. This financial burden disproportionately affects low income and Hispanic caregivers. Further research is underway to understand how safety net services are utilized by families, how best to support families with HMH, and how the financial burden of cancer has been impacted by COVID-19.

Evaluating the IgG titers targeting the S protein of SARS-CoV-2 by ELISA assays have been used in the development of several anti-SARS-CoV-2 vaccines in China. It is unclear whether the IgG levels against S protein tested by ELISA can monitor immune evasion against different Omicron variants. In the study, 88 recipients immunized with three doses of a COVID-19-inactivated vaccine were enrolled, whose serum samples were collected within 2 months after the third immunization. The IgG antibody levels were detected by using three commercial ELISA kits, which coated the S protein of the prototype, Omicron BA.1 and BA.5 variants respectively. The neutralizing activities of sera against the pseudotyped Omicron variant, prototype was determined. We also analyzed the correlation between the IgG titers with the neutralizing antibodies. The results showed that, after the third dose of the homologous inactivated vaccine, the neutralizing activity against the Omicron variant BA.1(GMT, 60) and BA. 5(GMT, 42) were decreased significantly compared with the prototype (GMT, 331) respectively ( P<0.05). However, the IgG titers against the S of Omicron BA.1(GMT, 2334) and BA.5(GMT, 2447) variants showed no significant difference with the prototype (GMT, 2797). Our results showed different correlation levels between anti-Spike protein of SARS-CoV-2 IgG titers and neutralizing antibodies, against SARS-CoV-2 prototype, Omicron variant BA.1 and BA.5 In summary, our result highlight that the Omicron variant BA.1 and BA.5 escape vaccine-induced immunity by neutralization activity test, and IgG titers against the SARS-CoV-2 Spike protein can not predict the viral immune evasion against different Omicron variants.

Mechanical forces play a crucial role in biological processes at the molecular and cellular levels. Recent advancements in dynamic force spectroscopies (DFS) have enabled the application and measurement of forces and displacements with high resolutions, providing insights into the mechanical pathways involved in various diseases, including cancer, cardiovascular disease, and COVID-19. Among the various DFS techniques, biomembrane force probe (BFP) advancements have improved our ability to measure bond kinetics and cellular mechanosensing with pico-newton and nano-meter resolutions. In this review, we provide a comprehensive overview of the classical BFP-DFS setup and highlight key advancements, including the development of dual biomembrane force probe (dBFP) and fluorescence biomembrane force probe (fBFP). BFP-DFS not only enables the investigation of dynamic bond behaviors on living cells, but also contributed significantly to our understanding of the specific ligand–receptor axes mediated cell mechanosensing. Besides, we explore the contribution of discoveries made possible by BFP-DFS in cancer biology, thrombosis, and inflammation, as well as predict future BFP upgrades to improve output and feasibility. Although BFP-DFS is still a niche research modality, its contribution to the growing field of cell mechanobiology is unparalleled, and its potential to elucidate novel therapeutic discoveries is significant.

SARS-CoV-2 causes COVID-19 pandemic and continues to pose a threat to global public health through genetic mutation. In this study, we have found that an ACE2-specific monoclonal antibody at low concentration was able to greatly enhance SARS-CoV-2 infection and growth in cell culture. Strikingly, it promotes SARS-CoV-2 plaque formation, resulting in accurate titration of different SARS-CoV-2 variants, particularly the newly emerged Omicron variants, which otherwise cannot be determined by standard plaque assays. Quantification of infectious titers of the newly emerged variants will facilitate the development and evaluation of vaccines and antiviral drugs against SARS-CoV-2.

In response to the COVID-19 pandemic shut-down of in-person research laboratories, remote data collection became mainstream in developmental psychology research. The aim of this study was to test the feasibility of two remote data collection methods for studying sleep and motor development in infancy and the relationship between the two. We asked 1,371 parents of infants aged 4 to 17 months who used the Nanit baby monitor to take the on-line Survey of Well-being of Young Children (SWYC) about their infants’ motor experience. Nanit uses auto-videosomnography and computer vision algorithms to calculate and report summary statistics of infants’ sleep. Nanit replicated all expected developmental trends in sleep, while the SWYC only replicated some, appearing to underestimate infants at the transition between motor milestones. However, we replicated some well-established findings regarding the relationship between sleep and motor development using both measures, suggesting that both Nanit and the SWYC can feasibly be used for remote data collection, especially if some modifications were made to how researchers explained using the SWYC to caregivers. Researchers should consider alternatives to traditional research methods not only when in-person participation is difficult or impossible, but also when large samples are needed and/or simple measurement tools are sufficient.

Effective vaccines have reduced SARS-CoV-2 morbidity and mortality; however, the elderly remain the most at risk. Understanding how vaccines generate protective immunity, and how these mechanisms change with age is key for informing future vaccine design. Cytotoxic CD8+ T cells are important for killing virally infected cells, and vaccines that induce antigen specific CD8+ T cells in addition to humoral immunity provide an extra layer of immune protection. This is particularly important in cases where antibody titres are sub-optimal, as can occur in older individuals. Here, we show that in aged mice, spike-epitope specific CD8+ T cells are generated in comparable numbers to younger animals after ChAdOx1 nCoV-19 vaccination, although phenotypic differences exist. This demonstrates that ChAdOx1 nCoV-19 elicits a good CD8+ T cell response in older bodies, but that typical age-associated features are evident on these vaccine reactive T cells.

Azvudine was included into the Guidelines for the Diagnosis and Treatment of Coronavirus Disease 2019 (version ninth) issued by the National Health Commission and National Administration of Traditional Chinese Medicine announced on August 9, 2022. Numerous domestic public hospitals introduced Azvudine to copy with the current omicron wave of the COVID-19 pandemic by the end of 2022. In the study, we comprehensively evaluated the efficacy and safety of Azvudine using the clinical data from four phase Ⅲ clinical trials.

Considering the efficacy of monoclonal antibodies (mAbs) directed against the Spike (S) protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in reducing disease severity, the aim of this study was to investigate the innate immune response before and after mAbs treatment in 72 vaccinated and 31 unvaccinated SARS-CoV-2 patients. Type I interferon (IFN-I) signature and cytokines genes were evaluated by real time RT-PCR. The vaccinated patients had increased negative rate of SARS-CoV-2 RT/real-time PCR tests as compared to unvaccinated ones after mAbs treatment. Unvaccinated patients but also those that resulted negative for serum anti-S antibodies despite vaccination had lower IFN-I and higher IFN-I related genes and cytokines mRNAs levels as compared to vaccinated individuals before mAbs. In addition, patients with low anti-S antibody titer showed immune genes expression levels between those found in negative and patients with high titer of anti-S antibodies. Changes in IFN-I pathway and cytokines levels were observed in unvaccinated patients after mAbs treatment, while the expression of most of the type I IFN genes and cytokines analysed, except for ISGs and IL-10 mRNAs, remained unchanged vaccinated patients. These data suggest that mAbs treatment is associated to a different virological and immunological response in SARS-CoV-2 infected patients according to their vaccination status and related anti-S antibodies titers.

Aim: Nirmatrelvir as a new 3CL protease inhibitor for treating COVID-19 drug of antiviral drug, the potential side effects have not yet been fully studied yet. The aim of this study was to identify potential risk of Nirmatrelvir by analyzing post-marketing safety data based on the largest publicly available worldwide pharmacovigilance database. Methods: We analyzed Nirmatrelvir adverse events to detect and characterize relevant safety signals based on the FDA Adverse Event Reporting System database in 2022. Case/non-case approach were used to estimate the reporting odds ratio (ROR) and information component (IC) with relevant confidence intervals (95% CI) for AEs with ≥4 counts. Results: Total of 26846 cases were included. Disease recurrence [ROR(95%CI)=413.2(395.6-431.59)], dysgeusia [ROR(95%CI)=110.84(106.04-115.85)], anosmia [ROR(95%CI)=15.21(12.76-18.11)], ageusia [ROR(95%CI)=9.80(8.50-11.3)] and urticaria [ROR(95%CI)=1.91(1.69-2.17)] were the main safety signals. In addition, abdominal pain upper and skin toxicity were two specific safety signals of Nirmatrelvir. In pregnant population, a significant increased ROR was found in life-threatening [ROR(95%CI)=5.12(1.38-19.00)]. Conclusion: We identified that disease recurrence, dysgeusia, abdominal pain upper and skin toxicity were the main and specific safety signals of Nirmatrelvir. Clinician and pharmacist should pay attention on these AEs. Notably, a potential risk of Nirmatrelvir in pregnant population should be alerted.