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Background: The administration of the COVID-19 vaccine has been linked to the development of herpes zoster (HZ). However, studies examining the clinical outcomes in COVID-19 vaccination-associated and non-COVID-19 vaccination-associated HZ are lacking., Objective: To investigate the risk of postherpetic neuralgia (PHN) in COVID-19 vaccination associated HZ., Methods: A total of 7200 patients with COVID-19 vaccination-associated HZ and 7200 matched controls were enrolled from the US Collaborative Network in the TriNetX database. The main outcome of this study was the development of PHN. Patients were followed-up from 3 months after HZ until PHN diagnoses, withdrawal from the database, or October 8, 2024., Results: We observed that patients with COVID-19 vaccination-associated HZ had a significantly higher risk of developing PHN as compared to the control group, with hazard ratio of 1.69 (> 3 months), 1.80 (> 6 months), 1.86 (> 1 year), and 1.93 (>2 years), respectively. Additionally, the association remained significant in the stratified analysis, which included sex, age, malignancy status, and initial use of antiviral agents., Conclusion: This study showed that COVID-19 vaccination-associated HZ demonstrated a significantly higher risk of developing PHN., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Chen-Yi Wu has made payments to Ministry of Science and Technology, Taiwan and Taipei Veterans General Hospital., (Copyright © 2024. Published by Elsevier Ltd.)