Medical Case Reports

A 14-year-old Japanese girl died unexpectedly 2 days after receiving the third dose of the BNT1262b2 mRNA COVID-19 vaccine. Autopsy findings showed congestive edema of the lungs, T-cell lymphocytic and macrophage infiltration in the lungs, pericardium, and myocardium of the left atria and left ventricle, liver, kidneys, stomach, duodenum, bladder, and diaphragm. Since there was no preceding infection, allergy, or drug toxicity exposure, the patient was diagnosed with post-vaccination pneumonia, myopericarditis, hepatitis, nephritis, gastroenteritis, cystitis, and myositis. Arrhythmia of atrial origin was assumed as the cause of cardiac failure and death.  Histopathology of the heart (left atrium), lung, liver, kidney, diaphragm, stomach, duodenum, and bladder of the child (Figure) show severe infiltration.  Multisystem inflammatory syndrome is a life-threatening condition associated with elevated inflammatory markers and multiple organ injury. A diagnosis of exclusion, it has...

Healthy 21-year-old male experienced mild pain/tenderness in the arm after receiving the first dose of BNT162b2 vaccine. It resolved in ~3 days. Later he received the second dose of the same vaccine in the deltoid area of his left arm. He gradually noticed a severe burning sensation and weakness in that arm. Half a day later his hand began to hang down at the wrist ("wrist drop").  On neurological examination two days after vaccination, his wrist and finger drop on the left side were near paralysis (MRC grade 1-2 on the scale of 1-5 of muscle power).  In addition, there was weakness in arm extension and flexion (MRC grade 3-4/5). On sensory examination, there was dysesthesia and numbness over the lateral dorsum of the left hand. Reflexes were hypoactive. Left radial neuropathy with demyelination and axonal injury were suspected. Laboratory findings for vasculitis, autoimmune disorders, malignancy and infectious disease were unremarkable . The patient was diagnosed with ipsil...

  A 60-year-old woman with medical history notable for type II diabetes, hypertension, atrial fibrillation and systemic lupus erythrematosis  presented on May 2, 2021 with a one-week history of fever (T max  104 F) and productive cough. Notably, the patient had been vaccinated with an mRNA vaccine (Pfizer, New York, NY) receiving the second dose on February 18, 2021. She underwent routine COVID testing in anticipation of screening colonoscopy procedure and tested positive on April 1, 2021.  The patient was negative for SARS-CoV-2 antibodies upon hospital admission on May 3, 2021.   The patient was admitted to the ICU due to acute hypoxic respiratory failure on May 9, 2021. She had a complex course which included treatment with broad spectrum antibiotics given her immunocompromised state, high dose steroids for concern for lupus flair, and remdesivir .  Hypoxic respiratory failure, complicated by disseminated intravascular coagulopathy (dissem...