Deaths are attributed to COVID-19 according to clinical symptoms and diagnosis; deaths that occur after vaccination are systematically reported and investigated

“If you die within 20 days of testing positive for [COVID-19][...], you’ll be counted as a COVID death.”; vaccines are systematically dismissed as a possible cause of death.
Inadequate support: The post claimed that deaths can be attributed to COVID-19 within 20 days of testing positive for the disease. However, no such rule can be found in the CDC’s guidelines.
Inaccurate: Vaccines aren’t automatically dismissed as a possible cause of death. Instead, deaths occurring following vaccination are reported and investigated to determine whether the medical history and clinical symptoms of the deceased indicate a causal link between vaccination and death.
A death can only be attributed to COVID-19 if the clinical condition of the patient was consistent with the disease’s symptoms. Health agencies continuously monitor the safety of COVID-19 vaccines and any severe adverse event that occurs after vaccination, including death, is reported and investigated. No causal link has been formally established between COVID-19 vaccines and death.

FULL CLAIM: “If you die within 20 days of testing positive for [COVID-19] (no matter what other factors were involved) you’ll be counted as a COVID death. However, if you drop dead within 24 hours of taking the vaccine it has nothing to do with it.”


The COVID-19 pandemic and the large-scale COVID-19 vaccination campaign led to the rollout of an important epidemiological and clinical surveillance. As of 7 May 2021, almost 600,000 persons died from COVID-19 in the U.S. and almost 100 million inhabitants were fully vaccinated.

Since the onset of the pandemic, the death toll of COVID-19 and the safety of vaccines have been the target of misinformation. One example of such misinformation is the claim that any person who died within 20 days testing positive for COVID-19 would automatically be attributed to the disease, while suspicious deaths following COVID-19 vaccination are allegedly ignored. But thus far, investigations from health agencies haven’t found a causal link between COVID-19 vaccination and subsequent death, as we explain below.

Deaths are attributed to COVID-19 only if the clinical signs are consistent with what is known of the disease

The U.S. Centers for Disease Control and Prevention (CDC) published guidelines on how and when to attribute a death to COVID-19. As the CDC explains:

“ Similar to many other diagnoses, a cause-of-death statement is an informed medical opinion that should be based on sound medical judgment drawn from clinical training and experience, as well as knowledge of current disease states and local trends.”

In other words, the health practitioners filling out death certificates must determine the underlying cause of death based on the consistency of symptoms and the chain of medical events leading to the patient’s demise. Whether the patient tested positive for COVID-19 alone wouldn’t be sufficient for COVID-19 to be considered as the cause of death, if the clinical condition of the patient wasn’t consistent with the signs and symptoms known to be associated with the disease.

Importantly, the CDC’s guideline contains no mention of such a 20-day rule and thus this claim is unsupported by available data. In a fact-check by Lead Stories, the Connecticut chief medical examiner explained that the determination of the cause of death is a local process with different state laws, which would preclude a nationwide rule enforcing the attribution of a death within 20 days of a positive COVID-19 test.

Furthermore, this claim is at odds with the overall mortality in the U.S. in 2020. Indeed, the CDC monitors the number of deaths from all causes in the U.S. each year and compares it to the mortality in the previous years. The CDC registered an abnormally high number of deaths in 2020 regardless of the cause of death. If the number of deaths from COVID-19 were inflated simply due to an intentional or accidental mislabelling of the cause of death, as the claim alleges, the total number of deaths in the country wouldn’t have changed. However, there were an additional 500,000 deaths in 2020 compared to previous years. There is no plausible explanation for such a sudden and drastic increase in the number of deaths in the country apart from the COVID-19 pandemic, suggesting that COVID-19 deaths were not mislabelled.

The safety of authorized vaccines is closely monitored

The claim further suggests that deaths occurring after COVID-19 vaccination are ignored. This is in fact contradicted by the ongoing monitoring measures of health agencies. The U.S. Food and Drug Administration (FDA) constantly monitors the outcome of the COVID-19 vaccination campaigns through a series of active and passive systems.

The active surveillance consists of a proactive gathering of data from health providers in order to uncover early signs of possible vaccine-related adverse events. Adverse events are any type of undesirable medical event that occurs after vaccination and may or may not be caused by the vaccine. By contrast, side effects are undesirable effects for which the causal link with vaccination is established.

Passive surveillance relies on self-reporting systems such as the Vaccine Adverse Event Reporting System (VAERS). The VAERS database allows anyone to report adverse events following vaccination. It is important to remember that the VAERS database is not designed to demonstrate that vaccines are the cause of a given adverse event, as Health Feedback explained on several occasions. Rather, VAERS works as an early warning system: it serves as a warning sign for health agencies to look deeper in the matter when adverse events begin to be reported.

As explained on the VAERS website: “Healthcare providers are required to report to VAERS” serious adverse events such as death when using vaccines under Emergency Use Authorization, as is currently the case for COVID-19 vaccines. Serious adverse events submitted to VAERS, such as death, are then reviewed and additional information collected to determine whether the vaccine may have caused this event.

In summary, COVID-19 is listed as a cause of death only if the patient’s symptoms and the physician’s diagnosis are compatible with what we know of the disease. There is no nationwide rule to systematically attribute the death of a person who tested positive for COVID-19 to the disease. Furthermore, deaths occurring after COVID-19 vaccination are closely monitored and healthcare providers are obligated to report such events to the relevant authorities.


Published on: 10 May 2021 | Editor:

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