Findings: In this cohort study including 22.7 million vaccinated individuals and 5.9 million unvaccinated individuals, vaccinated individuals had a 74% lower risk of death from severe COVID-19 and no increased risk of all-cause mortality over a median follow-up of 45 months. Findings In this cohort study including 22.7 million vaccinated individuals and 5.9 million unvaccinated individuals, vaccinated individuals had a 74% lower risk of death from severe COVID-19 and no increased risk of all-cause mortality over a median follow-up of 45 months