A 59-Year-Old Woman with Extensive Deep Vein Thrombosis and Pulmonary Thromboembolism 7 Days Following a First Dose of the Pfizer-BioNTech BNT162b2 mRNA COVID-19 Vaccine

Abstract

Patient: Female, 59-year-old Final Diagnosis: Deep vein thrombosis • pulmonary embolism • thrombosis Symptoms: Chest pain • shortness of breath Medication: — Clinical Procedure: — Specialty: Hematology • Infectious Diseases • General and Internal Medicine Objective: Unusual clinical course Background: The COVID-19 pandemic is an ongoing cause of the current global healthcare crisis. Several vaccines were approved for use by emergency vaccination campaigns worldwide. At present, there are very few reports of COVID-19 vaccine-induced immune-thrombotic thrombocytopenia, a variant of heparin-induced thrombocytopenia (HIT), in comparison to the massive number of vaccinated people worldwide. Case Report: A 59-year-old woman presented to the Emergency Department with a 3-day history of sudden-onset left leg pain 7 days after receiving her first dose of BNT162b2 mRNA COVID-19 (Pfizer-BioNTech). She was diagnosed with deep vein thrombosis (DVT) and pulmonary embolism (PE) and found to have a positive HIT screen with optical density (OD) of 0.6 via ELISA test. She was hospitalized for 4 days and discharged home with an oral anticoagulant (rivaroxaban). Conclusions: This case report describes a possible link between BNT162b2 mRNA COVID-19 (Pfizer-BioNTech) vaccination and thromboembolism. However, further data are needed to support such an association.

Cerebral venous thrombosis after COVID-19 vaccination: is the risk of thrombosis increased by intravascular application of the vaccine?

“…For other SARS-CoV-2 vaccines, which do not use adenovirus vectors, similar observations were only reported until now in two women [ 6 , 7 ].…”

A Case of Acute Pulmonary Embolus after mRNA SARS-CoV-2 Immunization

“…Our patient’s D-dimer level was 3840 ng/mL fibrinogen equivalent units (FEU), whereas the median D-dimer level in the VITT patients was 31,301 FEU, or approximately ten times that of our patient [ 4 , 13 ]. This, combined with the fact that our patient had a normal platelet count, significantly reduces the likelihood that VITT/TTS was the mechanism of thrombosis in our patient, though we cannot rule out a mechanism similar to that of the Al-Maqbali et al report with normal platelets and a positive HIT ELISA [ 7 ]. We look forward to the publication of more reports of VTE after SARS-CoV-2 immunizations so that a better assessment of potential mechanisms and comparison of patient characteristics and laboratory data can be performed.…”

“…Carli et al described a case of a 66-year-old woman who developed a right calf DVT two days after the second dose of the Pfizer-BioNTech BNT162b2 vaccine [ 6 ]. Al-Maqbali et al described the case of a 59-year-old woman who developed DVT and PE seven days following the first dose of the Pfizer-BioNTech BNT162b2 vaccine [ 7 ]. That patient’s laboratory testing was notable for normal platelets (182 × 10 9 /L) but a positive HIT ELISA test with an optical density assay of 0.617 (normal <0.4).…”

“…Recently, reports of rare venous thromboembolism (VTE) and thrombocytopenia events were described for two adenovirus-based vaccines, the AstraZeneca ChAdOx1 nCoV-19 vaccine and the Janssen Ad.26.COV2.S vaccine, leading to further regulatory and safety review [ 3 , 4 , 5 ]. Furthermore, two cases of VTE were recently described shortly after patients received the Pfizer-BioNTech BNT162b2 mRNA vaccine [ 6 , 7 ]. While these events are fortunately rare, VTE is a potentially life-threatening adverse event whose prompt recognition is critical.…”

Immune Thrombocytopenic Purpura Following Pfizer-BioNTech COVID-19 Vaccine in an Elderly Female

“…Cases of immune thrombocytopenia following the Pfizer Bio-NTech Covid-19 vaccine have not been as widely reported. There are reports of 35 possible cases of central nervous system thrombosis following vaccination [12] and two cases of deep vein thrombosis [13,14]. In addition, there have been some cases of thrombocytopenia following vaccination reported in the Vaccine Adverse Events Reporting System (VAERS).…”