Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine
New England Journal of Medicine, 2021 · paper · Clinical trials
A placebo-controlled trial of two doses of the BNT162b2 mRNA vaccine in 43,548 people aged 16 and older. The vaccine was 95% effective in preventing Covid-19, with mild-to-moderate short-term side effects and similar serious adverse event rates to placebo.
Checked: PDF from europepmc.org, fetched 4 Oct 2026. Page numbers are those of that PDF.
3 findings
Reference or label Results text labels the primary-end-point interval "95.0% vaccine efficacy (95% confidence interval [CI], 90.3 to 97.6; Table 2)", but Table 2 and the abstract label 90.3–97.6 a 95% credible interval; Table 3 gives the confidence interval for the same estimate as 90.0–97.9.
- p. 8 Results, Efficacy, last lines
(95% confidence interval [CI], 90.3 to 97.6; Ta-
- p. 9 Table 2, first row
95.0 (90.3–97.6)
- p. 10 Table 3, Overall row (Clopper–Pearson CI)
95.0 (90.0–97.9)
- p. 8 Results, Efficacy
95% confidence interval [CI], 90.3 to 97.6; Ta-
Judge's note: Crop C004-a shows 'confidence interval [CI], 90.3 to 97.6'. Crop C004-h shows the Table 2 column header '95% Credible Interval' over 95.0 (90.3–97.6). Crop C004-c shows the Table 3 Overall row (95% CI, Clopper–Pearson) as 95.0 (90.0–97.9) for the same 8 vs 162 cases. The interval type is mislabelled in the text.
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Reference or label "also reported by many placebo recipients (23% and 24%, respectively, after the second dose, among younger vaccine recipients; 17% and 14% among older recipients)" — placebo rates attributed to 'vaccine recipients'.
- p. 8 Systemic Reactogenicity paragraph
also reported by many placebo recipients (23% and 24%, respectively, after the second dose, among younger vaccine recipients
Judge's note: Crop C005-a confirms the wording. Within the same sentence, the 23%/24% figures are presented as placebo-recipient rates, while the younger vaccine-recipient rates were given just before as 59% and 52%. The population label should read 'younger placebo recipients' (or 'younger recipients').
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Reference or label "corresponding to 94.6% vaccine efficacy (95% CI, 89.9 to 97.3)" — Table 2 gives 94.6 (89.9–97.3) under the header '95% Credible Interval'.
- p. 9 Results, first paragraph
vaccine efficacy (95% CI, 89.9 to 97.3)
- p. 9 Table 2, second row
94.6 (89.9–97.3)
Judge's note: Crop C006-a shows '95% CI, 89.9 to 97.3'. The Table 2 header (crop C004-h) labels this column a credible interval from the beta-binomial model. The paper uses 'CI' for Clopper–Pearson intervals in Table 3. This is the same labelling problem as C004 but in a separate place and for a different end point.
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15 minor (typos and the like; most checked by the judge only)
Wording supp-02 Table S1 labels the Figure 1 population "All enrolled population N=37,706 'main safety subset'", but Table S3 and the main text use 'all enrolled' for the 43,252 participants who received at least 1 dose.
- p. 8 Table S1, Figure 1 row
All enrolled population N=37,706
- p. 10 Table S3 title/caption
(All Enrolled Participants)
- p. 8 Adverse Events
all en-rolled 43,252 participants
Only the authors can say what is right here.
Judge's note: Supp-02 p8 Table S1 Figure 1 row: "All enrolled population N=37,706 'main safety subset'". Supp-02 p10 Table S3 caption defines 'all enrolled' as all participants who received at least 1 dose. Table S1 also lists N=43,252 for Table S3, and main p8 says "all enrolled 43,252 participants". The explanation column of the same Table S1 row makes clear that 37,706 is the main safety subset, so the problem is the label, and only the authors can say which wording they intend.
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Wording "vaccine efficacy, 94.6%; 95% CI, 68.7 to 99.9; case split: BNT162b2, 2 cases; placebo, 44 cases" — estimate, interval and case split do not correspond under the declared Clopper–Pearson method.
- p. 9 Results, Efficacy paragraph
efficacy, 94.6%; 95% CI, 68.7 to 99.9; case split: BNT162b2, 2 cases; placebo, 44 cases
Only the authors can say what is right here.
Judge's note: With equal surveillance time, 2 vs 44 gives VE 95.5%. Reaching 94.6% needs a placebo:vaccine time ratio of about 1.19. With the Clopper–Pearson exact method for 2 of 46, upper p≈0.147, so the VE lower bound is ≈82.8% at ratio 1; a lower bound of 68.7% would need a ratio of ≈1.8, and an upper bound of 99.9% would need a ratio of ≈0.2. No single ratio fits all three numbers. Every other subgroup in Table 3 has a ratio near 1. Surveillance time for the hypertension subgroup is not reported, so query the authors on which case split, analysis population and method produced each number.
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Wording "...which is higher than that observed in recipients of some vaccines recommended for older adults. This rate of severe fatigue is also lower than that observed in recipients of another approved viral vaccine" — 'also' links two comparisons in opposite directions.
- p. 10 Discussion, right column
This rate of severe fatigue is also lower than that
- p. 10 Discussion, preceding sentence
which is higher than that observed in recipients of some vaccines recommended for older adults.
Only the authors can say what is right here.
Judge's note: Crop C010-a confirms the wording. Both statements can be true because they concern different comparator vaccines, but the connective 'also' makes the passage read as contradictory. The files cannot show whether 'higher' is itself in error, as one reviewer claimed. Treated as a wording ambiguity.
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Wording supp-02 Table S4: the age-by-risk n2 values (7671, 5878, 1701, 2147; placebo 7701, 5917, 1771, 2109) do not sum to the Overall n2 (17411; 17511) or to the At-risk Yes/No rows (8030/9381), and no footnote explains this.
- p. 11 Table S4, age group and at risk rows vs At risk / Overall rows
16–64 and not at risk
Only the authors can say what is right here.
Judge's note: Checked on the page image of supp-02 p11. At risk Yes + No = 17411, which matches Overall, but the age-by-risk subgroups add up to 14 fewer (vaccine) and 13 fewer (placebo). The age-by-obesity subgroups also fall short (8811+4734+2582+1265=17392). Surveillance times add up (0.962+0.744+0.227+0.281=2.214). The footnotes do not mention missing age or BMI data. Probably missing data, but only the authors can confirm.
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Typo Investigator list (supp-02): Zerbini, CEPIC, "Sao Paolo, Brazil" — the main article appendix spells the city 'São Paulo'.
- p. 6 List of Investigators, Zerbini
Sao Paolo, Brazil
Judge's note: Crop C015-a shows 'Sao Paolo'. The main article appendix (crop C013-a) gives the same institution (Centro Paulista de Investigação Clinica) in 'São Paulo'.
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Typo supp-02 p7: "Testing for SARS-CoV-2 antibodies was conducting using the Roche Elecsys®" should read "was conducted using".
- p. 7 SARS-CoV-2 Testing Information
was conducting using the Roche Elecsys
- p. 7 SARS-CoV-2 Testing Information
Testing for SARS-CoV-2 antibodies was conducting using the Roche Elecsys
- p. 7
Testing for SARS-CoV-2 antibodies was conducting using the Roche Elecsys®
Judge's note: The page image shows "was conducting using". The sentence just before it correctly says "was conducted using". Cosmetic verb-form error.
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Typo "prior SARS CoV-2 infection" is missing the hyphen (SARS-CoV-2 elsewhere).
- p. 9 Results, Efficacy, first paragraph
prior SARS CoV-2 infection
Judge's note: Crop C006-a shows 'SARS CoV-2' mid-line. The same page also prints 'SARS-CoV-2' elsewhere.
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Typo Table 2 title "Vaccine Efficacy against Covid-19 at Least 7 days after the Second Dose" — lowercase 'days' in a title-case title.
- p. 9 Table 2 title
Vaccine Efficacy against Covid-19 at Least 7 days after the Second Dose
Judge's note: Crop C004-h shows lowercase 'days'. The Table 3 title uses 'Days' ('before 7 Days after Dose 2').
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Typo Table 3, Male, placebo: "1.108 (8762)" lacks the thousands separator used elsewhere (e.g., 8,875; 8,749).
- p. 10 Table 3, Sex, Male, placebo
1.108 (8762)
Judge's note: Crop C011-a shows '8762' without a comma, while the neighbouring cells use commas.
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Typo Reference 13: "Shringrix (zoster vaccine recombinant, adjuvanted) product information" — product name misspelled; URL in same entry reads '.../vaccines/shingrix'.
- p. 13 Reference 13
Shringrix (zoster vaccine recombinant,
- p. 13 References, entry 13
Shringrix (zoster vaccine recombinant, adjuvanted) product information
- p. 13
Shringrix (zoster vaccine recombinant, adjuvanted)
Judge's note: Crop C012-a shows 'Shringrix' printed. The URL in the same reference spells it 'shingrix'.
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Typo Appendix: "BioNTech, Mainz (ÖT., U.Ş.)" — initials missing a period (Ö.T.).
- p. 13 Appendix, affiliations
Mainz (ÖT., U.Ş.)
Judge's note: Crop C013-a shows 'ÖT.'. All other initials in the appendix carry a period after each letter.
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Typo supp-04 protocol p21, SoA footnote c: "The first 5 participants in in each sentinel group" has a duplicated "in".
- p. 21
The first 5 participants in in each sentinel group will be observed
Judge's note: The page image shows "in in" on a single line of footnote c.
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Typo supp-04 p32: "and Stage 3; a final candidate/dose large-scale stage" uses a semicolon where the parallel "Stage 1:" and "Stage 2:" use colons.
- p. 32
and Stage 3; a final candidate/dose large-scale stage
Judge's note: Confirmed on the crop image. Punctuation only.
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Typo supp-04 p43 Section 6.1 table: the BNT162a1 column header reads "(BNT 162 RNA-LNP vaccine utilizing uRNA)" with a stray space; the other columns read "BNT162 RNA-".
- p. 43
(BNT 162 RNA-
Judge's note: Confirmed on the full page image. Cosmetic.
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Typo supp-04 p51: "positive nonvaccine antigen SARS-CoV-2 antibody result in a participant with a prior nonvaccine antigen SARS-CoV-2 antibody result was negative" is ungrammatical; the bullet just before it uses "whose most recent prior ... result was negative".
- p. 51
positive nonvaccine antigen SARS-CoV-2 antibody result in a participant with a prior
Judge's note: Confirmed on the crop image. The sentence is grammatical only if it reads 'whose prior' (or 'with a prior ... result that was negative'). Cosmetic wording.
Second check: none (judge only)