Medical Case Reports

Vaccines and Related Biological Products Advisory Committee met yesterday  (1/26/2023), to continue investigating preliminary data indicating a possible stroke risk following simultaneous administration of the Pfizer Covid booster and the flu vaccine. FDA is launching a study to look into this possibility. Two weeks ago , we reviewed some of the VAERS reports in the 65+ age group. Multiple case reports describing stroke after COVID-19 vaccination have been published in medical literature. Some had unusual presentations.  A 43‐year‐old male patient with uneventful medical history was admitted 23 days after receiving a first dose of ChAdOx1 nCoV‐19 vaccine. Symptoms of headache, falls, and unsteadiness began 7 days after vaccination. At admission, he presented with reduced vigilance, multiple blue, or purple bruises in all extremities and left‐sided hemiparesis. The bruises had the typical clinical characteristics of hematomas after subcutaneous bleeding and were painful, ...

A 24-year-old South-Asian female received  er first dose of the Pfizer vaccine  at 30 weeks of gestation. One week later she presented with severe epigastric pain radiating to the back and worsening on lying supine, associated with nausea and vomiting. She was diagnosed with acute pancreatitis with a serum lipase level of 4376 U/L and an ultrasound showing features of pancreatitis. The patient had a spontaneous vaginal delivery, and the baby was shifted to the neonatal intensive care unit in a stable condition. A computed tomography scan postpartum (day 2) demonstrated acute interstitial edematous pancreatitis. The patient was managed conservatively in the intensive care unit and discharged home in a stable condition. A 28-year old previously healthy woman   experienced  abdominal pain three days after the injection of the second dose of the Sinopharm COVID-19 vaccine. She presented at the emergency department but all the tests and imaging were normal and she was di...

Besides vaccine-induced myocarditis, there could be other cardiovascular complications, such as post-vaccinal Kounis syndrome (also referred to as allergic angina) or Vasospastic Angina (VSA). The latter form of angina pectoris is characterized by severe pain in the chest (caused by coronary artery spasm, which consists of a sudden occlusive vasoconstriction of a segment of an epicardial artery, resulting in a dramatic reduction of coronary blood flow). It can occur at rest, with transient electrocardiogram modifications and preserved exercise capacity. COVID-19 vaccination may increase coronary artery spasticity.  A 41-year-old male patient was referred for chest pain at rest following mRNA vaccination; he had never experienced chest pain prior to vaccination. He was diagnosed by an acetylcholine (Ach) provocation test that showed multivessel vasospasm. After the initiation of treatment with a calcium channel blocker and nitrate, no further exacerbation of chest pain was observed....

A 38‐year‐old Thai woman developed painful oral lesions lasting over 8 weeks. The lesions appeared 1 week following the administration of the first dose of AZD1222 vaccine. Her extraoral examination was unremarkable. The intraoral examination revealed generalized desquamative epithelium, erythematous areas along the marginal gingivae and alveolar mucosa. Pseudomembranes, and erosions and ulceration on the buccal gingiva subjacent to the maxillary and mandibular teeth, and the right lingual dorsum could be seen. Furthermore, generalized desquamative epithelium of the alveolar mucosa of the anterior mandibular teeth as well as the right mandibular and left maxillary posterior molars extending to the mucobuccal folds were present. Erythematous areas also extended from the lingual gingiva of anterior mandibular teeth onto the floor of mouth. The histopathologic and direct immunofluorescence examination confirmed a diagnosis of pemphigus. After treatment with a potent topical steroid, fluo...

A 35-year-old woman with history of cardiovascular disease presented with shortness of breath, lightheadedness, fatigue, chest pain, and premature ventricular contractions (pericarditis) 3 weeks after her second COVID-19 vaccine.  Some long-COVID–like symptoms  subsided following treatment except for chest pain and fatigue .  3 weeks later, the patient tested positive for SARS-CoV-2 .  Shortly after infection, the patient presented again with chest pain when moving or breathing, joint pain, and dermatitis, symptoms that persisted for 6 months.   Antinuclear antibody (ANA) Immunofluorescence assay screening was positive for autoimmune antibodies. This is in line with our findings about higher probability of breakthrough infections among those with long-COVID-like reactions to COVID-19 vaccines and genetic origins of some adverse reactions.  The patient has a family history of diabetes, high blood pressure, and cardiac cirrhosis. Genetic anal...

  An 85-year-old Japanese woman with chronic renal failure and hypertension  developed malaise, vomiting, and persistent high fever (up to 39.7°C) on the 12 th  day after receiving the second dose of the  BNT162b2  vaccine. Initial evaluation revealed neutropenia.  Further tests showed hyperferritinemia (serum ferritin 2284.4 μg/L). Bone marrow examination revealed haemophagocytosis. A provisional diagnosis of HLH associated with the Comirnaty ®  vaccination was made based on the HLH-2004 diagnostic criteria.  The patient was treated with granulocyte colony-stimulating factor and 500 mg methylprednisolone. A significant improvement was observed; the abnormal laboratory results resolved gradually, and the patient was discharged. READ MORE REFERENCE Shimada Y, Nagaba Y, Okawa H, Ehara K, Okada S, Yokomori H. A case of hemophagocytic lymphohistiocytosis after BNT162b2 COVID-19 (Comirnaty®) vaccination. Medicine (Baltimore). 2022 Oct 28;101(43):e3130...

Thousands of case reports of myocarditis after COVID-19 vaccination have been published in medical literature. Some of them were fatal.  A 27-year-old athletic man was transferred to the emergency room due to cardiopulmonary arrest 8 days after  the first dose of the mRNA-1273 SARS-CoV-2 vaccine (Moderna, Cambridge, MA, USA). His  teammates called for an ambulance   when he was found sitting unconscious during practice. A chest radiograph obtained in an emergency room showed an enlarged heart and  pulmonary congestion (Panel  E). The patient had undergone orthopedic surgery 3 months before the recent hospitalization. An electrocardiogram (ECG)  abnormality and mild cardiac shadow enlargement in chest radiograph had been also noted preoperatively ( Panels  B, D); however, since he was asymptomatic, no further examination was performed. E ndomyocardial biopsy performed before death showed no evidence of myocarditis; therefo...

A 75-year-old African American woman presented to the Emergency Department (ED) complaining of shortness of breath, cough and a drop in her oxygen saturation (SpO2) from her baseline of 95%–88%.  She received a Pfizer COVID 19 booster vaccine one day before her symptoms began. The patient had received the Johnson & Johnson COVID-19 vaccine 11 months prior without a notable reaction.    She had a history of  chronic obstructive pulmonary disease (COPD)  but was  not on any home oxygen.  Upon admission the patient had an SpO2 of 82% and a heart rate of 101 beats per minute. Notably, she was afebrile, with a temperature of 36.6 °C. On physical exam the patient was noted to be wheezing and breathing with difficulty. She t ested negative for a variety of respiratory viruses including COVID-19.  A chest radiograph (x-ray) demonstrated subtle patchy opacifications consistent  with a COPD exacerbation, and no consolidations or pleural effusions....

A previously hypertensive 56-year-old male presented with the subacute onset of severe constipation, urinary retention, erectile dysfunction, sudomotor failure, sicca symptoms, non-reactive pupils and severe orthostatic hypotension shortly after receiving the second dose of the Comirnaty mRNA vaccine against COVID19.  Autonomic testing revealed severe cardiovagal, adrenergic and sudomotor impairment, and tonic 'half-mast' pupils with evidence of sympathetic and parasympathetic denervation (see Figure). T ilt-table testing demonstrated a drop in blood pressure from 140/90 mmHg supine to 54/35 mmHg after two minutes at 60 degrees, with no heart rate response.  There was no heart rate response to Valsalva maneuver  and sympathetic skin responses in the hands and feet were absent. Sweat testing demonstrated complete anhidrosis. Pathological α3-ganglionic ACHR antibodies were positive in serum as detected by a new flow cytometric immunomodulation assay. Malignancy wa...

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...

38-year-old woman  without systemic disease presented with acute-onset amnesia, language disturbance, and seizure two weeks after the first dose of ChAdOx1 nCov-19 vaccine. Brain magnetic resonance imaging revealed a subacute infarction at the right internal capsule and irregular vascular contour, which indicated a vasculopathy. Cerebrospinal fluid analysis revealed inflammation without pleocytosis, and electroencephalography detected diffuse background slowing with sharp transients at the right temporal region.   Although autoantibody tests were negative, steroid pulse therapy was initiated. The patient's symptoms improved rapidly. The patient was discharged without neurological deficit or sequelae. One week after discharge, the patient received repeat EEG, which revealed resolved slow waves without epileptiform discharges. Three months later, repeated brain MRI revealed regressive change of previous irregularity of vascular contour. (Fig. C)  Cases of post-vaccinal...

  A 48-year-old woman complained of a tickle sensation in the throat and dyspnea 30 minutes after being administered the first dose of the Moderna coronavirus disease 2019 (COVID-19) vaccine. The patient had no history of hypertension, anxiety, or panic disorder. Forty-five minutes after the vaccination, stridor was noted, and the patient developed severe hypertension with a blood pressure of 197/153 mmHg. The patient also had tachycardia, cervical angioedema, and nausea, which occurred in a short period of time, indicating type I hypersensitivity reaction, that is, an anaphylactic reaction.  The patient had persistent nausea, conjunctival hyperemia, facial swelling, and nonpruritic angioedema in the neck.  The patient was diagnosed with Brighton classification Level 1 anaphylaxis caused by COVID-19 vaccination. For managing the patient, two intramuscular adrenaline injections, famotidine, chlorpheniramine, metoclopramide, and methylprednisolone were administered via int...

Using a unique dataset from Israel National Emergency Medical Services (EMS) from 2019 to 2021, a n increase of over 25% was detected in both  cardiac arrest (CA) and acute coronary syndrome (ACS) EMS calls  during January–May 2021, compared with the years 2019–2020.  This study leveraged the Israel National EMS (IEMS) data system and analyzed all calls related to CA and ACS events over two and a half years, from January 1st, 2019, throughout June 20th, 2021. U sing Negative Binomial regression models, the weekly emergency call counts were significantly associated with the rates of 1st and 2nd vaccine doses administered to this age group but were not with COVID-19 infection rates.  These findings are emphasized by Figures  that present the graphs described in the “ Methods ” section for both CA and ACS, CA only, and ACS only, respectively. Both the CA and ACS call counts (red curve) start increasing early January 2021 and seem to track closely the 2nd dose curv...

A 43-year-old man who had malignant melanoma (pT3bN1bM0 stage IIIC) received nivolumab treatment (480 mg 1× every 4 wks) 12 months before admission. Fasting plasma glucose level was 94 mg/dL and glycated hemoglobin (HbA1c) 5.6% at treatment initiation. Plasma glucose and HbA1c were tested every 4 weeks. His range of plasma glucose was 90–123 mg/dL and that of HbA1c was 5.4%–5.7% ( Figure ). Positron emission tomography–computed tomography showed no metastasis or recurrence of the tumor 1 month before admission. The man received his first SARS-CoV-2 vaccination 35 days before admission. No apparent adverse reactions occurred, except for local pain. The last nivolumab dose was administered 21 days before admission and the second SARS-CoV-2 vaccination 14 days before admission. The next day, he had a slight fever (temperature 37°C), which soon subsided. Thirst, polydipsia, and polyuria appeared 2 days after the second vaccination. He started drinking 3 L of water/day, and his weight decre...

To examine the possible non-specific effects of the novel COVID-19 vaccines, the authors of this study  (to be published in Lancet) reviewed the randomized control trials (RCTs) of mRNA and adenovirus-vector COVID-19 vaccines reporting overall mortality, including COVID-19 deaths, accident deaths, cardiovascular deaths and other non-COVID-19 deaths. For overall mortality, with 74,193 participants and 61 deaths (mRNA:31; placebo:30), the relative risk (RR) for the two mRNA vaccines compared with placebo was 1.03 (95% CI=0.63-1.71).  There is now ample evidence that vaccines can not only add protection but also increase susceptibility to unrelated infections or even other non-infectious immune mediated diseases.  Analysis of the final study reports from vaccine clinical trials found the vaccines had no effect on overall mortality. Among 74,000 trial participants, at 6 months follow-up, there were 31 all-cause deaths among the vaccinated (n=37,110) and 30 among the pl...

The Accident Compensation Corporation ( ACC ) of New Zealand has accepted 987 claims for injuries relating to the Covid-19 vaccine, and 68% of those are women. Between the beginning of New Zealand’s vaccine program in February 2021 and April 2, 2022, ACC received 2522 claims, with 987 being accepted, and 297 are still pending. During this period, ACC paid out $1.12 million in compensation.  ACC had accepted 186 claims related to allergic reactions, 103 claims for sprains, 102 claims for contusions. There were 77 accepted claims for cardiac injury, such as myocarditis or pericarditis. In terms of age, the group that lodged the greatest number of claims were those in the 45-49 age bracket. Ethnicity data showed 71% of claims lodged with ACC were from Pākehā, and 9% Māori. Of the 1238 rejected claims, 973 were turned down because ACC deemed there was no injury, and in 119 cases there was no causal link to the vaccine. Three claims have been made for fatal injury – all due to myocardit...