Compilation of 195 Case Reports Documenting 386 Vaccine Associated Hematological Injuries

Or in FDA-Speak: 386 Reports of Mild Safe & Effective Immune Reactions

Compilation of 143 Case Reports of Vaccine Related Myo/Pericarditis & Other Cardiac Injuries

27 Noteworthy Myocarditis Case Studies

---

I attempted to collect every hematological case report (mostly dealing with thromb* events) published as of 5/16.

I had to remove 1 accidental duplicate which messed up the number scheme, but it would take way too much time to go through them all manually, so there’s no #102.

They are organized by date published online, oldest to newest.

A brief primer for laypeople: A case report or case series is a report written by the attending physicians - sometimes with help or input from others - describing the clinical details of a patient they treated. They are exceedingly rare, as doctors don’t have the time to write up lengthy academic papers on a level that is acceptable to submit to a legit medical journal. Also, with the covid vaccines, there is the additional pressure to not make the vaccines look bad in any way or promote “vaccine hesitancy”.

One more thing, I included the primary hematological diagnoses for each study. It is not comprehensive however, so there are going to be missing diagnostic conditions. A list of abbreviations is in this footnote¹.

1: Immune thrombocytopenia in a 22-year-old post Covid-19 vaccine - PubMed

Author Tarawneh & Tarawneh

Country: US

Date Published Online: 2/11/21

Vaccine: Pfizer

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/33476455/

Case: “A 22‐year‐old healthy male with no medication use received the Pfizer‐BioNTech BNT16B2b2 mRNA vaccine through his work as an emergency department employee. On day three, post‐vaccination, he experienced widespread petechiae (Figure ​(Figure1)1) and gum bleeding, which prompted his presentation.”

“To our knowledge, outside of a report in the press, 5 , 6 this is the first case published in the medical literature of an individual, with no other cause identified and no associated illness, experiencing ITP after receiving the Pfizer‐BioNTech vaccine.”

2: Idiopathic Thrombocytopenic Purpura and the Moderna Covid-19 Vaccine - Annals of Emergency Medicine

Author Julian et al

Country: US

Date Published Online: 2/12/21

Vaccine: Moderna

Diagnoses: IdTPu

Link: https://www.annemergmed.com/article/S0196-0644(21)00122-0/fulltext

Case: “Here, we report a case of idiopathic thrombocytopenic purpura in a 72-year-old woman 1 day after receiving the first dose of the Moderna COVID-19 vaccine.

The day after receiving her vaccination, the patient woke up with a rash, spontaneous oral bleeding, and headache.”

3: Immune Thrombocytopenic Purpura Cases Following COVID-19 Vaccination

Author Condorell et al

Country: Italy

Date Published Online: 3/1/21

Vaccine: Pfizer, AtraZeneca

Diagnoses: ITPP

Link: https://pubmed.ncbi.nlm.nih.gov/34276916/

Case: “Here we report three clinical cases of Immune thrombocytopenic purpura (ITP) following COVID-19 vaccination, including AstraZeneca and Pfizer-BioNTech COVID-19 vaccinations.”

“Case #1: A 52-year-old male patient with no past medical history presented to the emergency room with gum bleeding and diffuse cutaneous purpura three weeks after administering the first dose of the AstraZeneca COVID-19 vaccine. He experienced gum bleeding as soon as three days after vaccination. On admission, complete blood count (CBC) showed isolated severe thrombocytopenia (platelet count, PLT=1.000/mm3), with normal white blood cell count and hemoglobin value.”

“Case 2: A 24-year-old male came to our attention for thrombocytopenia following the Pfizer-BioNTech COVID-19 vaccination. […] Four days after receiving the second dose of vaccine, he performed routine analyses, and CBC showed severe thrombocytopenia (PLT=15.000/mm3), with normal hemoglobin value and white blood cell count.”

“Case 3: A 73-year-old male patient with a medical history of hypertension, diabetes mellitus on insulin therapy, hyperlipidemia, coronary artery bypass grafting, and iron deficiency anemia received the first dose of Pfizer-BioNTech COVID-19 vaccination on 21st, 2021. Eighteen days after vaccination, ecchymosis appeared on the injection site of insulin. He received the second dose of the SARS-CoV-2 vaccine on April 12th, 2021. Two days after administering the second dose, he presented to the emergency department with tongue and oral mucosa petechiae along with subcutaneous ecchymosis on forearms and abdomen. Complete blood count showed an extremely low platelet count of 2.000/mm3, with normal hemoglobin and white blood cell count. A previous CBC report performed a few days before the second dose administration revealed a platelet count of 8.000/mm3.

4: Familial thrombocytopenia flare‐up following the first dose of mRNA‐1273 Covid‐19 vaccine

Author Toom et al

Country: US

Date Published Online: 3/1/21

Vaccine: Moderna

Diagnoses: ITP

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014325/

Case: “A 36‐year‐old female with a past medical history of thrombocytopenia, previously classified as immune thrombocytopenic purpura (ITP), presented to the hospital with diffuse petechiae, easy bruising, bleeding gums and a mild headache.”

“Patient received the first dose of SARS‐CoV‐2 mRNA‐1273 Moderna Covid‐19 vaccine 2 weeks prior to presentation.”

“The temporal sequence of the events suggests an exacerbation of our patient's chronic thrombocytopenia related to the receipt of the mRNA‐1273 Covid‐19 vaccine. It is possible, but based on reviews of reported side effects unlikely, that the patient's headache medications or her contraception were triggers for this event. Also, improvement of platelet counts despite continuation of combination contraceptive medication, argues against it being causative agent.”

5: Untimely Myocardial Infarction or COVID-19 Vaccine Side Effect - PubMed

Author Boivin & Martin

Country: US

Date Published Online: 3/2/21

Vaccine: Moderna

Diagnoses: MI

Link: https://pubmed.ncbi.nlm.nih.gov/33824804/

Case: “We present the case of a 96-year-old female, with no known cardiac history, who suffered a myocardial infarction (MI) one hour after her first Moderna coronavirus disease 2019 (COVID-19) vaccination. The patient was medically managed and discharged three days later.”

“Repeat EKG in the ED (Figure ​(Figure1)1) showed ST segment elevation in the anterior leads of V2, V3, and avL, with no reciprocal ST segment depression. A point-of-care ultrasound performed by ED providers showed an anterior wall motion abnormality (Figure 2).”

“The formal EKG performed in the ED showed an ejection fraction of 35%, and an anterior and apical wall motion abnormality consistent with an anterior myocardial infarction (MI).”

6: Deep vein thrombosis (DVT) occurring shortly after the second dose of mRNA SARS-CoV-2 vaccine

Author Carli et al

Country: Italy

Date Published Online: 3/9/21

Vaccine: Pfizer

Diagnoses: DVT

Link: https://pubmed.ncbi.nlm.nih.gov/33687691/

Case: “Here we describe a case of distal deep vein thrombosis occurring immediately days after the second dose of mRNA vaccine.

A 66-year-old woman received the first dose of mRNA Covid-19 vaccine (BNT162b2, Comirnaty, Pfizer/BioNTech) subcutaneously on January 4th, 2021, without any reported clinical problem; she was scheduled for the second dose on January 25th. […] On January 26th, 24 h after the second vaccine dose, she received acetaminophen for persistent fever with chills, fatigue, malaise, and muscle pain. On January 27th, 48 h after the second vaccine dose, persistent fever was still present, and acute right calf pain appeared in the absence of trauma. On January 28th, she was admitted for evaluation at the emergency room because of persistent pain and inability to walk. […] A Color-Doppler ultrasound scan revealed the presence of deep vein thrombosis involving the right peroneal vein and extending up to the popliteal vein, without signs of venous insufficiency.”

7: Acute entire colitis and vein thrombosis after COVID-19 mRNA-1273 vaccination

Author Unno et al

Country: Japan

Date Published Online: 3/21/21

Vaccine: Moderna

Diagnoses: VT, VIT

Link: https://pubmed.ncbi.nlm.nih.gov/35313019/

Case: “Herein, we describe a case of acute colitis with venous thrombosis after COVID‐19 vaccination.”

“A 40‐year‐old man was admitted with a 1‐week history of fever, abdominal pain and bloodless diarrhea (>20 stools/day), which appeared 2 weeks after his first mRNA‐1273 SARS‐CoV‐2 (Moderna, Cambridge, MA, USA) dose. His second dose was administered the day before hospital admission. Contrast‐enhanced computed tomography showed edematous thickening of the entire colonic wall and thrombosis in the hepatic (Fig. 1a) and splenic veins. Colonoscopy revealed redness, edema, and multiple deep ulcers (including longitudinal ulcers) in the entire colon, but rectal findings were minor (Fig. 1b,c). Histopathology revealed cryptitis, crypt abscesses, and infiltration of various inflammatory cells (Fig. 1d). Based on the atypical endoscopic findings and the clinical course, we excluded ulcerative colitis. 2 We also excluded infectious and drug‐induced colitis because of the lack of recent medication history, negative stool culture, and non remarkable immunostaining findings on biopsy. Furthermore, protein C and S levels were within normal limits, and the patient was considered to have no thrombogenic predisposition. Finally, vaccine‐induced colitis and vein thrombosis were diagnosed.”

“The vaccine‐induced thrombocytopenia is attributed to immune‐mediated mechanisms. 3 Patients with ulcerative colitis are at a high risk of developing venous thrombosis, which is thought to be an immune response to inflammatory cytokines, 4 similar to this case.”

8: Vaccine-induced immune thrombocytopenia and thrombosis after mRNA-1273 booster vaccination

Author Langerak et al

Country: Netherlands

Date Published Online: 4/4/22 (*out of chronological order)

Vaccine: Moderna

Diagnoses: VI- ITT, PE, AO

Link: https://www.thrombosisresearch.com/article/S0049-3848(22)00121-9/fulltext

Case: “We report an 83-year-old woman previously known with hypertension and a transient ischemic attack for which she used a platelet aggregation inhibitor (clopidogrel) who presented to our hospital with dyspnea and retrosternal pain since one day. She received an mRNA-1273 SARS-CoV-2 booster vaccination (Moderna) 20 days prior to symptom onset. Eight months prior to the mRNA-1273 booster, this patient had been vaccinated twice with a BNT162b2 SARS-CoV-2 vaccine (Pfizer/BioNTech) without complications. Blood tests showed a thrombocytopenia (48*109/mL, 339*109/mL five months earlier) and high D-dimers (>6.8 mg/l). Chest computed tomography angiography revealed large pulmonary emboli, almost completely occluding the right pulmonary artery branches.”

“Based on these results, the diagnosis VITT was made and intravenous immunoglobulins (IVIg, Nanogam, 1 g/kg for two days) were given.”

9: Severe, Refractory Immune Thrombocytopenia Occurring After SARS-CoV-2 Vaccine

Author Helms et al

Country: US

Date Published Online: 4/6/21

Vaccine: Moderna

Diagnoses: ITP, RTCP

Link: https://pubmed.ncbi.nlm.nih.gov/33854395/

Case: “We report a 74-year-old man who developed refractory thrombocytopenia within one day of receiving the Moderna SARS-CoV-2 vaccine. Several hours after vaccination, he developed significant epistaxis and cutaneous purpura. Severe thrombocytopenia was documented the following day, and he developed extremity weakness and encephalopathy with facial muscle weakness. Over a 14-day period, thrombocytopenia was treated first with high dose dexamethasone, intravenous immunoglobulin, platelet transfusions, rituximab, plasma exchange (for presumed acute inflammatory demyelinating polyneuropathy (AIDP)), and four daily doses of the thrombopoietin receptor agonist (TPO-RA) eltrombopag (Promacta™), without a platelet response. Three days later, he received the TPO-RA romiplostim (Nplate™). Five days later, his platelet count began to rise and by post-vaccination day 25, his platelet count was in the normal range. Thrombocytopenia was refractory to frontline and second-line treatment. The eventual rise in his platelet count suggests that one or both TPO-RAs may have impacted platelet recovery. Possibly, but less likely given the temporality, the drug-induced thrombocytopenia was subsiding. The aggressive use of immunosuppressive treatment may jeopardize the intended purpose of the SARS-CoV-2 vaccine, and earlier use of non-immunosuppressive second-line treatment for vaccine-related severe thrombocytopenia, such as with TPO-RAs, should be considered. While it is imperative to continue the global vaccination program, vigilance to the occurrence of post-vaccination severe thrombocytopenia is warranted.”

10: Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination

Author Greinacher et al

Country: Germany, Austria

Date Published Online: 4/9/21

Vaccine: AstraZeneca

Diagnoses: TTCP, PE, SVT, ICH

Link: https://pubmed.ncbi.nlm.nih.gov/33835769/

Case: “We assessed the clinical and laboratory features of 11 patients in Germany and Austria in whom thrombosis or thrombocytopenia had developed after vaccination with ChAdOx1 nCov-19. We used a standard enzyme-linked immunosorbent assay to detect platelet factor 4 (PF4)-heparin antibodies and a modified (PF4-enhanced) platelet-activation test to detect platelet-activating antibodies under various reaction conditions. Included in this testing were samples from patients who had blood samples referred for investigation of vaccine-associated thrombotic events, with 28 testing positive on a screening PF4-heparin immunoassay.”

“Of the 11 original patients, 9 were women, with a median age of 36 years (range, 22 to 49). Beginning 5 to 16 days after vaccination, the patients presented with one or more thrombotic events, with the exception of 1 patient, who presented with fatal intracranial hemorrhage. Of the patients with one or more thrombotic events, 9 had cerebral venous thrombosis, 3 had splanchnic-vein thrombosis, 3 had pulmonary embolism, and 4 had other thromboses; of these patients, 6 died. Five patients had disseminated intravascular coagulation. None of the patients had received heparin before symptom onset. All 28 patients who tested positive for antibodies against PF4-heparin tested positive on the platelet-activation assay in the presence of PF4 independent of heparin. Platelet activation was inhibited by high levels of heparin, Fc receptor-blocking monoclonal antibody, and immune globulin (10 mg per milliliter). Additional studies with PF4 or PF4-heparin affinity purified antibodies in 2 patients confirmed PF4-dependent platelet activation.”

“Vaccination with ChAdOx1 nCov-19 can result in the rare development of immune thrombotic thrombocytopenia mediated by platelet-activating antibodies against PF4, which clinically mimics autoimmune heparin-induced thrombocytopenia.”

11: Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination

Author Schultz et al

Country: Norway

Date Published Online: 4/9/21

Vaccine: AstraZeneca

Diagnoses: VT, TCP, VTE

Link: https://pubmed.ncbi.nlm.nih.gov/33835768/

Case: “We report findings in five patients who presented with venous thrombosis and thrombocytopenia 7 to 10 days after receiving the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccine against coronavirus disease 2019 (Covid-19). The patients were health care workers who were 32 to 54 years of age. All the patients had high levels of antibodies to platelet factor 4–polyanion complexes; however, they had had no previous exposure to heparin.”

“Levels of d-dimer were elevated at the time of admission in all patients. The international normalized ratio (INR) and activated partial thromboplastin time were within the normal range. The fibrinogen level was lower than normal in Patient 2 and was slightly lower than normal in Patients 4 and 5 (Table 1). The C-reactive protein level was moderately elevated in Patients 1, 3, and 5.”

12: Thrombocytopenia and Intracranial Venous Sinus Thrombosis after "COVID-19 Vaccine AstraZeneca" Exposure

Author Wolf et al

Country: Germany

Date Published Online: 4/9/21

Vaccine: AstraZeneca

Diagnoses: ICVST, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/33918932/

Case: “Three women with intracranial venous sinus thrombosis after their first vaccination with "COVID-19 vaccine AstraZeneca" were encountered. Patient #1 was 22 years old and developed headaches four days after the vaccination. On day 7, she experienced a generalized epileptic seizure. Patient #2 was 46 years old. She presented with severe headaches, hemianopia to the right, and mild aphasia 13 days after the vaccination. MRI showed a left occipital intracerebral hemorrhage. Patient #3 was 36 years old and presented 17 days after the vaccination with acute somnolence and right-hand hemiparesis. The three patients were diagnosed with extensive venous sinus thrombosis. They were managed by heparinization and endovascular recanalization of their venous sinuses. They shared similar findings: elevated levels of D-dimers, platelet factor 4 antiplatelet antibodies, corona spike protein antibodies, combined with thrombocytopenia. Under treatment with low-molecular-weight heparin, platelet counts normalized within several days.”

13: A Rare Case of Cerebral Venous Thrombosis and Disseminated Intravascular Coagulation Temporally Associated to the COVID-19 Vaccine Administration - PubMed

Author D'Agostino et al

Country: Italy

Date Published Online: 4/11/21

Vaccine: AstraZeneca

Diagnoses: CVT, DIC

Link: https://pubmed.ncbi.nlm.nih.gov/33917902/

Case: “We report the case of a 54-year-old woman who developed disseminated intravascular coagulation (DIC) with multi-district thrombosis 12 days after the AstraZeneca COVID-19 vaccine administration. A brain computed tomography (CT) scan showed multiple subacute intra-axial hemorrhages in atypical locations, including the right frontal and the temporal lobes. A plain old balloon angioplasty (POBA) of the right coronary artery was performed, without stent implantation, with restoration of distal flow, but with persistence of extensive thrombosis of the vessel. A successive thorax angio-CT added the findings of multiple contrast filling defects with multi-vessel involvement: at the level of the left upper lobe segmental branches, of left interlobar artery, of the right middle lobe segmental branches and of the right interlobar artery. A brain magnetic resonance imaging (MRI) in the same day showed the presence of an acute basilar thrombosis associated with the superior sagittal sinus thrombosis. An abdomen angio-CT showed filling defects at the level of left portal branch and at the level of right suprahepatic vein. Bilaterally, it was adrenal hemorrhage and blood in the pelvis. An evaluation of coagulation factors did not show genetic alterations so as the nasopharyngeal swab ruled out a COVID-19 infection. The patient died after 5 days of hospitalization in intensive care.”

14: A Three-Case Series of Thrombotic Deaths in Patients over 50 with Comorbidities Temporally after modRNA COVID-19 Vaccination - PubMed

Author Roncati et al

Country: Italy

Date Published Online: 4/11/21

Vaccine: Pfizer

Diagnoses: VITT, PE, MT (Heart)

Link: https://pubmed.ncbi.nlm.nih.gov/35456110/

Case: “Case 1: An 81-year-old woman, hypertensive and dyslipidemic in therapy with calcium channel blocker, beta-blocker and statin, allergic to corticosteroids, was admitted to the emergency room for exertional dyspnea with progressive worsening; of note, the patient had received the first dose of Comirnaty® 16 days earlier. [..] Two days later—that is, 18 days after Comirnaty® administration—the patient was found on the floor in the bathroom of the hospital room in asystole; the subsequent resuscitation maneuvers failed, and an autopsy was required.”

“Surprisingly, post-mortem examination of formalin-fixed paraffin-embedded specimens revealed, by means of hematoxylin and eosin (H&E) and phosphotungstic acid hematoxylin (PTAH) stains, widespread thrombotic phenomena in the micro-/macrocirculation of both the lungs (Figure 2A,B).”

“Case 2: An 84-year-old woman, affected by autoimmune hemolytic anemia (AIHA) and hypertension in sartan therapy, with a history of vertebral collapses, was admitted to the emergency room for malaise and dyspnea accompanied by desaturation in room air. The patient had received the first and second dose of Comirnaty® 143 and 122 days before, respectively. The chest X-ray taken at the entrance to the hospital showed parenchymal thickening at the suprabasal area of the left paracardiac with ipsilateral pleurogenic haze; the molecular nasopharyngeal swab for SARS-CoV-2 was negative. However, the chest X-ray taken on the next day, when the patient was already in cardiac arrest, pointed out bilateral apico-lateral pneumothorax, pneumomediastinum and massive subcutaneous thoraco-abdominal emphysema extended to the upper limbs and neck (Figure 3).”

“By means of H&E, PTAH, anti-CD61 and anti-PF4 staining method, performed as for case #1, on post-mortem lung examination, the cause of pneumothorax was traced back to multiple thromboembolic phenomena inside the pulmonary microcirculation even in this circumstance (Figure 4).”

“Case 3: A 52-year-old man, thyroidectomized for papillary microcarcinoma and a kidney transplant recipient for polycystic disease undergoing peritoneal dialysis plus tacrolimus in therapeutic range at the last check (7.37 ηg/mL), was found gasping by a relative in his car. Immediately alerted the rescue, the patient died in asystole at the emergency room after 62 min of resuscitation maneuvers. He had received only a single dose of Comirnaty® two weeks and a half before, since four months earlier he had suffered from COVID-19. Before autopsy, a molecular nasopharyngeal swab for SARS-CoV-2 was carried out that was negative; post-mortem histopathology and immunohistochemistry, performed following the same methodological procedure as for case #1 and case #2, revealed mural thrombosis of the right heart ventricle and of a subendocardial vessel with images of organization (Figure 5).”

15: Thrombotic Thrombocytopenia after Ad26.COV2.S Vaccination

Author Muir et al

Country: US

Date Published Online: 4/14/21

Vaccine: J&J

Diagnoses: TTCP

Link: https://pubmed.ncbi.nlm.nih.gov/33852795/

Case: “We describe a case of extensive thrombosis associated with severe thrombocytopenia and disseminated intravascular coagulation that resembled autoimmune heparin-induced thrombocytopenia3 in a patient who had received the Ad26.COV2.S vaccine (Johnson & Johnson/Janssen), a recombinant adenovirus serotype 26 vector encoding the SARS-CoV-2 spike glycoprotein.

A 48-year-old White woman with an unremarkable medical history presented to the emergency department with a 3-day history of malaise and abdominal pain. The initial evaluation at another hospital showed mild anemia and severe thrombocytopenia (platelet count, 13,000 per cubic millimeter [reference range, 150,000 to 400,000]). A peripheral-blood smear confirmed a marked reduction in the platelet count with occasional schistocytes. Additional studies showed a low fibrinogen level (89 mg per deciliter [reference range, 220 to 397]), a prolonged activated partial thromboplastin time (41 seconds [reference range, 25 to 37]), and a marked elevation in the d-dimer level (117.5 mg per liter [reference value, <0.5]), indicating a disseminated intravascular coagulation–like state. Computed tomographic (CT) imaging of the abdomen and pelvis showed extensive splanchnic-vein thrombosis.”

“On further inquiry, it was noted that the patient had received the Ad26.COV2.S vaccine 14 days before symptom onset.”

16: Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination

Author Scully et al

Country: UK

Date Published Online: 4/16/21

Vaccine: AstraZeneca

Diagnoses: CVT, PE, PVT, AT, JVT, MCA infarc, Hemo

Link: https://www.nejm.org/doi/full/10.1056/NEJMoa2105385

Case: “We report findings in 23 patients who presented with thrombosis and thrombocytopenia 6 to 24 days after receiving the first dose of the ChAdOx1 nCoV-19 vaccine (AstraZeneca). “

“In the absence of previous prothrombotic medical conditions, 22 patients presented with acute thrombocytopenia and thrombosis, primarily cerebral venous thrombosis, and 1 patient presented with isolated thrombocytopenia and a hemorrhagic phenotype. All the patients had low or normal fibrinogen levels and elevated d-dimer levels at presentation. No evidence of thrombophilia or causative precipitants was identified. Testing for antibodies to platelet factor 4 (PF4) was positive in 22 patients (with 1 equivocal result) and negative in 1 patient. On the basis of the pathophysiological features observed in these patients, we recommend that treatment with platelet transfusions be avoided because of the risk of progression in thrombotic symptoms and that the administration of a nonheparin anticoagulant agent and intravenous immune globulin be considered for the first occurrence of these symptoms.”

17: Relapse of thrombotic thrombocytopenic purpura after COVID-19 vaccine

Author Sissa et al

Country: Italy

Date Published Online: 4/16/21

Vaccine: Pfizer

Diagnoses: TTP

Link: https://www.sciencedirect.com/science/article/pii/S1473050221001117

Case: “We report a case of a 48-year-old white female patient with a history of relapsing thrombotic thrombocytopenic purpura (TTP). [..] Six days before the TTP relapse (March 6, 2021), the patient had received the second dose of the anti-COVID-19 vaccine produced by Pfizer-BioNTech (the first dose had been administered on February 11, 2021).”

18: Cerebral venous sinus thrombosis and thrombocytopenia after COVID-19 vaccination - A report of two UK cases - PubMed

Author Mehta et al

Country: UK

Date Published Online: 4/20/21

Vaccine: AstraZeneca

Diagnoses: CVST, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/33857630/

Case: “We describe the cases of two young males, who developed severe thrombocytopenia and fatal CVST following the first dose of Vaxzevria. Both presented with a headache, with subsequent rapid neurological deterioration. One patient underwent PF4 antibody testing, which was positive. A rapid vaccination programme is essential in helping to control the COVID-19 pandemic. Hence, it is vital that such COVID-19 vaccine-associated events, which at this stage appear to be very rare, are viewed through this lens. However, some cases have proved fatal. It is critical that clinicians are alerted to the emergence of such events to facilitate appropriate management. Patients presenting with CVST features and thrombocytopenia post-vaccination should undergo PF4 antibody testing and be managed in a similar fashion to HIT, in particular avoiding heparin and platelet transfusions.”

19: US Case Reports of Cerebral Venous Sinus Thrombosis With Thrombocytopenia After Ad26.COV2.S Vaccination, March 2 to April 21, 2021 - PubMed

Author See et al

Country: US

Date Published Online: 4/30/21

Vaccine: J&J

Diagnoses: CVST, ICH, JVT, PVT, VT, DVT, PE

Link: https://pubmed.ncbi.nlm.nih.gov/33929487/

Case: “Patients' ages ranged from 18 to younger than 60 years; all were White women, reported from 11 states. Seven patients had at least 1 CVST risk factor, including obesity (n = 6), hypothyroidism (n = 1), and oral contraceptive use (n = 1); none had documented prior heparin exposure. Time from Ad26.COV2.S vaccination to symptom onset ranged from 6 to 15 days. Eleven patients initially presented with headache; 1 patient initially presented with back pain and later developed headache. Of the 12 patients with CVST, 7 also had intracerebral hemorrhage; 8 had non-CVST thromboses. After diagnosis of CVST, 6 patients initially received heparin treatment. Platelet nadir ranged from 9 ×103/µL to 127 ×103/µL. All 11 patients tested for the heparin-platelet factor 4 HIT antibody by enzyme-linked immunosorbent assay (ELISA) screening had positive results. All patients were hospitalized (10 in an intensive care unit [ICU]). As of April 21, 2021, outcomes were death (n = 3), continued ICU care (n = 3), continued non-ICU hospitalization (n = 2), and discharged home (n = 4).”

“The initial 12 US cases of CVST with thrombocytopenia after Ad26.COV2.S vaccination represent serious events.”

20: Case Report: Thrombotic Thrombocytopenia after COVID-19 Janssen Vaccination

Author Costello et al

Country: US

Date Published Online: 4/30/21

Vaccine: J&J

Diagnoses: TTCP, PE, VST

Link: https://pubmed.ncbi.nlm.nih.gov/34060795/

Case: “We present a case of a patient with a cerebral venous sinus thrombosis, pulmonary embolism, and thrombocytopenia after receiving the Janssen Ad26.COV2.S vaccine.

A 40-year-old woman with a history of migraines, obesity, and no other known thrombotic risk factors developed a sudden headache, body aches, fever, and chills six days after receiving the Janssen vaccine. The patient presented to an urgent care facility on day 8 because of worsening pain with sinus pressure and was prescribed amoxicillin/clavulanate (Augmentin), methocarbamol (Robaxin), and methylprednisolone for presumed acute sinusitis. On day 9, her headache improved, but she developed swollen red cheeks and bilateral lower-extremity pain without edema. On day 10, her lower-extremity pain resolved, but her headache worsened, and she experienced intermittent vertigo. As the redness and swelling resolved, she noticed petechiae on her right cheek and bilateral breasts and spontaneous bruising in her extremities. On day 12, she presented to the emergency department for an intolerable headache. Laboratory and imaging studies demonstrated thrombocytopenia (platelets of 20,000), a d-dimer of 45,570 ng per mL (normal is less than 500 ng per mL), pulmonary emboli, and dural venous sinus thrombosis (Figure 1). [..] Although this patient had no previous exposure to heparin, the clinical presentation and laboratory results were similar to heparin-induced thrombotic thrombocytopenia. This patient's presentation is consistent with the reported cases of suspected vaccine-induced thrombotic thrombocytopenia recently described in the literature.”

21: Immune thrombocytopenic purpura after SARS‐CoV‐2 vaccine

Author Candelli et al

Country: Italy

Date Published Online: 5/2/21

Vaccine: AstraZeneca

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/33934330/

Case: “A 28‐years‐old male presented to our Emergency Department (ED) on 8 March, 2021, because of oral bleeding and the appearance of petechiae over the trunk, arms, and legs for three days (Fig 1). He underwent a complete blood count showing 4 × 109/l platelets. Being a healthcare worker, he received the first dose of the AstraZeneca vaccine for Sars‐CoV‐2 on 14 February, 2021. Starting the next day, he experienced fatigue and headache for 10 days and fever for two days. [..] Physical examination showed purpura over the trunk, all four limbs, and bleeding lesions within the oral cavity.”

22: Acute Coronary Tree Thrombosis After Vaccination for COVID-19

Author Tajstra et al

Country: Poland

Date Published Online: 5/3/21

Vaccine: Pfizer

Diagnoses: CTT

Link: https://www.sciencedirect.com/science/article/pii/S1936879821003988

Case: “On January 27, 2021, the patient received the first dose of Pfizer–BioNTech vaccine (Pfizer, New York, New York). Approximately 30 min after the injection, the patient collapsed. Based on electrocardiogram findings, acute ST-segment elevation myocardial infarction of the inferior wall was diagnosed (Figure 1A) and was referred to our center. On admission, the patient was unconscious, with clinical and hemodynamic signs of cardiogenic shock and recurrent bradyarrhythmias. Coronary angiography revealed occlusions/distal embolization in the distal part of the left anterior descending coronary artery, in the first diagonal branch, and in the distal part of the dominant right coronary artery, with large thrombus (Figures 1B and 1C). [..] Unfortunately, on January 30, 2021, the patient died.”

23: Thrombotic Thrombocytopenic Purpura after Ad26.COV2-S Vaccination

Author Yocum & Simon

Country: US

Date Published Online: 5/4/21

Vaccine: J&J

Diagnoses: TTCPP

Link: https://pubmed.ncbi.nlm.nih.gov/33980419/

Case: “We report a 62-year-old female who presented to the emergency department (ED) with acute onset of altered mental status. She had received the Ad26.COV2-S vaccine 37 days prior to ED presentation. She developed thrombotic thrombocytopenic purpura (TTP) and no other cause was found.”

“A 62-year-old-female presented to the emergency department (ED) for altered mental status. Thirty-seven days prior she had received the Ad26.COV2-S COVID-19 vaccine. Emergency medical services reported the patient was found altered in her bathroom combative and covered in feces. Patient was unable to converse or provide any history. Family reported she was last seen normal around 9 pm and around midnight they heard a loud sound upstairs and went up to find the patients room covered in emesis, feces on the floor and she had torn her room apart and ripped things off the walls. Prior to going upstairs for bed she was in her normal state of good health and had eaten dinner with family.”

“On the basis of these reports, the diagnosis of VITT should be confirmed with an approved P4 ELISA. Our patient was PF4 negative.

This patient's TTP was likely caused by her recent vaccination with Ad26.COV2-S, as no other cause could be definitively determined.”

24: Thrombocytopenia with acute ischemic stroke and bleeding in a patient newly vaccinated with an adenoviral vector-based COVID-19 vaccine - PubMed

Author Blauenfeldt et al

Country: Denmark

Date Published Online: 5/5/21

Vaccine: AstraZeneca

Diagnoses: TCP, IS

Link: https://pubmed.ncbi.nlm.nih.gov/33877737/

Case: “We describe the first Danish case of presumed inflammatory and thrombotic response to vaccination with an adenoviral (ChAdOx1) vector-based COVID-19 vaccine (AZD1222). The case describes a 60-year-old woman who was admitted with intractable abdominal pain 7 days after receiving the vaccine. Computed tomography of the abdomen revealed bilateral adrenal hemorrhages. On the following day, she developed a massive right-sided ischemic stroke and magnetic resonance imaging angiography showed occlusion of the right internal carotid artery. The ischemic area was deemed too large to offer reperfusion therapy. During admission, blood tests showed a remarkable drop in platelet counts from 118,000 to 5000 per μl and a substantial increase in D-dimer. The patient died on the sixth day of hospitalization. Blood tests revealed platelet factor 4 reactive antibodies, imitating what is seen in heparin-induced thrombocytopenia. This may be a novel immune-mediated response to the vaccine.”

25: Fatal cerebral venous sinus thrombosis after COVID-19 vaccination - PMC

Author Jamme et al

Country: France

Date Published Online: 5/13/21

Vaccine: AstraZeneca

Diagnoses: CVST

Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8117129/

Case: “A 69-year-old woman with arterial hypertension treated daily by hydrochlorothiazide and angiotensin receptor antagonist received a first dose of Oxford–AstraZeneca vaccine.

Eleven days after the vaccination, the patient developed headache associated with behavioral symptoms. At day 13, her daughter found her unconscious. Physical examination revealed a coma Glasgow 4/15, right mydriasis, bilateral Babinski reflex without hemodynamic instability or respiratory failure. She was intubated and transferred in our intensive care unit.

Immediate CT scan followed by MRI highlighted a severe bilateral frontal hemorrhage with brain herniation complicating a cerebral venous thrombosis of the left internal jugular vein, sigmoid sinus and superior sagittal sinus (Fig. ​(Fig.1).1). Moreover, thoracic CT scan showed concomitant segmentary pulmonary embolism. Blood analysis at admission revealed an isolated thrombopenia measured at 18G/L with positive anti-PF4 antibodies.

Evolution was dramatically poor in the next few hours with brain death, leading to an organ donation procedure.”

26: Limb ischemia and pulmonary artery thrombosis after the ChAdOx1 nCoV-19 (Oxford–AstraZeneca) Vaccine: a case of vaccine-induced immune thrombotic thrombocytopenia - PMC

Author Jones et al

Country: Canada

Date Published Online: 5/14/21

Vaccine: AstraZeneca

Diagnoses: LI, PAT

Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8248449/

Case: “A 63-year-old man presented to the emergency department with a 5-day history of a cool, painful left leg, new onset of paresthesia of the left leg and foot, and severe shortness of breath. [..] The patient had received his first dose of the ChAdOx1 nCoV-19 vaccine 20 days before the onset of his symptoms.”

“A computed tomography angiogram showed left popliteal artery occlusion with no visible tibial vessels, even on delayed imaging. It also showed bilateral segmental pulmonary artery thrombi and thrombus adherent to the wall of the infrarenal aorta (Figure 1).”

27: A Case of Autoimmune Hemolytic Anemia Following COVID-19 Messenger Ribonucleic Acid Vaccination

Author Brito et al

Country: Portugal

Date Published Online: 5/15/21

Vaccine: mRNA

Diagnoses: AIHA

Link: https://pubmed.ncbi.nlm.nih.gov/34150386/

Case: “An 88-year-old Caucasian woman was admitted to the emergency room (ER) with a sudden onset of asthenia and jaundice two days after receiving the second dose of the COVID-19 messenger ribonucleic acid (mRNA) vaccine (nucleoside-modified).”

“In light of the above findings, a diagnosis of AIHA was assumed. [..] Her acute kidney injury showed improvement without any need for renal function replacement therapy after eight days.”

28: Antibody-mediated procoagulant platelets in SARS-CoV-2-vaccination associated immune thrombotic thrombocytopenia

Author Althaus et al

Country: Germany

Date Published Online: 5/20/21

Vaccine: AstraZeneca

Diagnoses: CVST, DVT, PE

Link: https://pubmed.ncbi.nlm.nih.gov/34011137/

Case: “We report pathological and immunological findings in 8 patients who developed vaccine-induced immune thrombotic thrombocytopenia (VITT) after administration of SARS-CoV-2 vaccine ChAdOx1 nCoV-19. We analyzed patient material using enzyme immune assays, flow cytometry and heparin-induced platelet aggregation assay and performed autopsies on two fatal cases. Eight patients (5 female, 3 male) with a median age of 41.5 years (range, 24 to 53) were referred to us with suspected thrombotic complications 6 to 20 days after ChAdOx1 nCoV-19 vaccination. All patients had thrombocytopenia at admission. Patients had a median platelet count of 46.5 x109/L (range, 8 to 92). Three had a fatal outcome and 5 were successfully treated. Autopsies showed arterial and venous thromboses in various organs and the occlusion of glomerular capillaries by hyaline thrombi. Sera from VITT patients contain high titer antibodies against platelet factor 4 (PF4) (OD 2.59±0.64). PF4 antibodies in VITT patients induced significant increase in procoagulant markers (P-selectin and phosphatidylserine externalization) compared to healthy volunteers and healthy vaccinated volunteers. The generation of procoagulant platelets was PF4 and heparin dependent. We demonstrate the contribution of antibody-mediated platelet activation in the pathogenesis of VITT.”

29: Post-mortem findings in vaccine-induced thrombotic thombocytopenia | Haematologica

Author Pomara et al

Country: Spain

Date Published Online: 5/21/21

Vaccine: AstraZeneca

Diagnoses: VITT, ICH

Link: https://haematologica.org/article/view/haematol.2021.279075

Case: “Patient 1 was a 50-year-old man (body weight 90 kg) with abdominal pain that developed 10 days after vaccination with ChAdOx1 nCoV-19. He had neither a history for thrombosis risk factors nor had he any intake of drugs increasing this risk. At the emergency room he presented with severe thrombocytopenia, low plasma fibrinogen and very high D-dimer (Table 1). The results of other blood tests were normal except for moderately elevated white blood cells and inflammatory serum markers. Computed tomography (CT) showed portal vein thrombosis with smaller thrombi in the splenic and upper mesenteric veins. During the next 4 days after admission platelets and fibrinogen remained low and D-dimer very high with no substantial changes. An initial dose of the low molecular weight heparin nadroparin was given subcutaneously at a dosage of 5,700 IU followed by a second dose after 8 hours. Clinical conditions deteriorated and a new CT scan showed massive intracerebral hemorrhage. Treated with multiple transfusions of platelet concentrates that failed to control bleeding the patient died 4 days after the onset of symptoms and 16 days after vaccination.”

“Patient 2, a 37-year old previously healthy woman (61 kg) with a negative history for significant disease and drug intake developed 10 days after the administration of the same vaccine first low back pain and then a strong headache. She became progressively drowsy and ultimately unconscious, and was, therefore, admitted to the emergency room of her local hospital. With laboratory tests similar of those of patient 1 (Table 1), a CT scan showed an occlusive thrombus in the superior sagittal venous sinus and a very large hemorrhage in the frontal cerebral lobe. Transported comatose by helicopter to a larger hub hospital she underwent craniotomy in order to control intracranial hypertension and remove the frontal lobe hemorrhage. She survived the operation but remained comatose and died 10 days after the first hospital admission and 23 days after vaccination.”

30: Immediate high-dose intravenous immunoglobulins followed by direct thrombin-inhibitor treatment is crucial for survival in Sars-Covid-19-adenoviral vector vaccine-induced immune thrombotic thrombocytopenia VITT with cerebral sinus venous and portal vein thrombosis

Author Graf et al

Country: Germany

Date Published Online: 5/22/21

Vaccine: AstraZeneca

Diagnoses: VITT, CSVT, PVT

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8140563/

Case: “Here, we report a case of a 29-year-old male public health care professional, vaccinated with the recombinant adenoviral vector encoding the spike protein antigen of SARS-CoV-2 (ChAdOx1 nCov-19, AstraZeneca) on the 29th of March (day 1). Nine days later, he developed headache and abdominal pain, on day 12 emesis and abdominal cramps. On day 14, he was urgently admitted to a hospital due to severe headache and hematemesis. Upon admission, thrombocytopenia of 32/nL was detected. Gastroscopy showed diffuse mucosal bleeding. On MR imaging of the brain, a complete thrombosis of the left transverse and sigmoid sinus down to the left proximal jugular vein was demonstrated (Fig. 1a). [..] An abdominal CT angiography revealed extensive thrombosis of the mesenteric and portal vein, explaining the profuse bleeding of the stomach. [..] During the first night in our hospital, after application of 90 g IVIG, with a platelet count of 40/nl and a PTT of 50 s, the patient suffered two subsequent epileptic seizures as a consequence of a new left temporo-parietal intracranial hemorrhage found on CCT scan (Fig. 1c).”

31: Oxford-AstraZeneca COVID-19 vaccine-induced cerebral venous thrombosis and thrombocytopaenia: A missed opportunity for a rapid return of experience - ScienceDirect

Author Geeraerts et al

Country: France

Date Published Online: 5/24/21

Vaccine: AstraZeneca

Diagnoses: VI- CVT, CVTCP

Link: https://www.sciencedirect.com/science/article/pii/S235255682100093X

Case: “The 21st and 23rd of March 2021, we had to manage in the ICU two patients with severe cerebral venous thrombosis associated with thrombocytopaenia in the context of recent vaccination. Progressive severe disorders of consciousness developed and decompressive craniectomy was performed in both patients.”

“Unfortunately, both patients had unfavourable outcome with refractory intracranial hypertension leading to death.”

“We were aware of the possibility of cerebral venous thrombosis after COVID-19 vaccination, and the declaration to our regional pharmacovigilance centre was made on the 23rd of March 2021. We would like, however, to share the difficulties we had to find reliable clinical information in this context.

Our knowledge of the pathophysiology and therapeutic possibilities was very limited. Several major issues were questioned as the performances of detection methods for antibodies against platelet factor 4 (PF4)/heparin complex, possible efficacy of steroids, intravenous immunoglobulins, plasma exchange, or choice of anticoagulants.”

32: Ischaemic stroke as a presenting feature of ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopenia | Journal of Neurology, Neurosurgery & Psychiatry

Author Al-Mayhani et al

Country: UK

Date Published Online: 5/25/21

Vaccine: AstraZeneca

Diagnoses: IS, VITT, PE, VT

Link: https://jnnp.bmj.com/content/92/11/1247.long

Case: “Here, we report three patients with VITT who presented with ischaemic stroke.”

“Patient 1, a 35-year-old Asian woman, developed episodic right temporal and periorbital headache 6 days after receiving the ChAdOx1 nCoV-19 vaccine. Five days later, she awoke with left face, arm and leg weakness, right gaze preference and drowsiness. Non-contrast CT and CT angiography (CTA) revealed occlusion of the right middle cerebral artery (MCA) distal M1 segment with extensive ischaemia and haemorrhagic transformation (figure 1A-C)). Subsequent imaging revealed right portal vein thrombosis. [..] Fourteen days after presentation, her conscious level suddenly dropped; CT head showed extensive haemorrhagic transformation of the left MCA infarct with mass effect and herniation of the brain through the decompressive hemicraniectomy. Brainstem death was subsequently confirmed.”

“Patient 2, a 37-year-old White female, presented 12 days after receiving the ChAdOx1 nCoV-19 vaccine with diffuse headache, left visual field loss, confusion and left arm weakness. CTA showed occlusion of both internal carotid arteries (figure 1E) and left transverse sinus thrombosis (figure 1F); diffusion-weighted MRI showed bilateral acute infarcts in a borderzone distribution (figure 1G,H). Subsequent imaging confirmed pulmonary embolism and thromboses of the left transverse and sigmoid sinuses, left jugular, right hepatic and both iliac veins.”

“Patient 3, a 43-year-old Asian male, presented 21 days after the ChAdOx1 nCoV-19 vaccine with dysphasia. CT and magnetic resonance (MR) showed an acute left frontal and insular infarct corresponding to the anterior cortical territory of the left MCA, with a small volume of haemorrhagic transformation within the infarct.”

33: Cerebral Venous Thrombosis after BNT162b2 mRNA SARS-CoV-2 vaccine

Author Dias et al

Country: Portugal

Date Published Online: 5/25/21

Vaccine: Pfizer

Diagnoses: CVT, MT

Link: https://pubmed.ncbi.nlm.nih.gov/34111775/

Case: “Case 1: A 47-year-old female, who had iron-deficiency anemia due to adenomyosis and used combined oral contraceptives, developed persistent headache, nausea and photophobia six days after the first vaccine dose. Three days later, she presented a sudden left motor deficit. Papilledema, left visual extinction, right gaze deviation, and left hemiparesis were documented. Brain MRI with venography revealed thrombosis of superior sagittal, right lateral, transverse, sigmoid sinuses and jugular vein and left sigmoid sinus, together with right frontal subarachnoid hemorrhage and a cortical venous infarct.”

“Case 2: A 67-year-old female had a history of multiple cerebral cavernous malformations, hypertension, diabetes, dyslipidemia, viral myocarditis, and depression. Three days after the second vaccine dose, she presented with sudden right lower limb clonic movements, followed by motor deficit, loss of consciousness and headache. Tongue bite was evident. Brain MRI showed thrombosis of high convexity cortical veins, superior sagittal, right transverse, and sigmoid sinus and jugular vein. [..] A chest-abdomen-pelvis CT showed a probable renal cell carcinoma.”

34: AZD1222 vaccine-related coagulopathy and thrombocytopenia without thrombosis in a young female

Author Ryan et al

Country: UK

Date Published Online: 5/25/21

Vaccine: AstraZeneca

Diagnoses: VIT, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34036570/

Case: “We describe the first reported Irish case of VITT. A 35‐year‐old Caucasian woman presented 14 days after vaccination with AZD1222. She presented with a medical history of migraine, with no known risk factors for thrombosis.

Following vaccination, she described general myalgia and extreme fatigue, and noticed the onset of bruising and petechiae 10 days later. She attended the Emergency Department 14 days following vaccination. Her petechiae had resolved but she had persistent bruising. She described a headache which was slightly different to her known migraine headaches. She had no recent exposure to heparin.

Laboratory investigation revealed thrombocytopenia with a platelet count of 50 × 109/l, with a normal haemoglobin and white cell count.”

35: Cytokine release syndrome in a patient with colorectal cancer after vaccination with BNT162b2

Author Au et al

Country: UK

Date Published Online: 5/26/21

Vaccine: Pfizer

Diagnoses: TCP, CRS

Link: https://pubmed.ncbi.nlm.nih.gov/34040262/

Case: “He received the first dose of BNT162b2 vaccine on 29 December 2020 (Fig. ​(Fig.1a)1a) without immediate adverse events, except for grade 1 inflammation at the vaccination site. Five days later (32 d after the last anti-PD-1 dose), he presented with myalgia, 2-d history of diarrhea (grade 1) and 1-d history of fever (38.4 °C) despite anti-pyretics (ibuprofen) use. [..] Laboratory investigations revealed elevated inflammatory markers (C-reactive protein (CRP)), 125 mg L−1 (normal, <6 mg L−1); serum lactate dehydrogenase (LDH), 184 U L−1 (normal range, 120–246 U L−1); and thrombocytopenia (68 × 109 cells per liter (normal range, 150–410 cells per liter)), confirmed on microscopy (Fig. ​(Fig.1b).1b).”

36: Secondary immune thrombocytopenia supposedly attributable to COVID-19 vaccination | BMJ Case Reports

Author Fueyo-Rodriguez et al

Country: Mexico

Date Published Online: 5/31/21

Vaccine: Pfizer

Diagnoses: ITP

Link: https://casereports.bmj.com/content/14/5/e242220.abstract

Case: “A 41-year-old woman, with history of multiple allergies (quinolones, cephalosporins, strawberries and iodinated contrast), presented to the emergency department with a 12-hour history of fever, tachycardia and nausea. She had a history of hypothyroidism, hypertension and pre-diabetes and was under treatment with enalapril and levothyroxine. She had received the mRNA COVID-19 vaccine BNT162b2 (Pfizer–BioNTech) 12 hours before the symptoms developed.

At her initial evaluation, the patient reported malaise, headache and loose stools on multiple occasions.”

“After 12 hours in the emergency department, a new blood test revealed a decrease in platelets (38×109 ). At that point, she developed headache, bleeding gums and petechiae, so we administered 1gm of methylprednisolone. [..] Haematology was consulted for suspicion of secondary ITP due to the COVID-19 vaccine.”

37: First report of a de novo iTTP episode associated with an mRNA-based anti-COVID-19 vaccination

Author de Bruijn et al

Country: Belgium

Date Published Online: 6/8/21

Vaccine: Pfizer

Diagnoses: iTTP

Link: https://pubmed.ncbi.nlm.nih.gov/34105244/

Case: “We report a case of a 38-year-old woman with a de novo iTTP after exposure to the mRNA-based anti-coronavirus disease 2019 (COVID-19) vaccine produced by Pfizer-BioNTech. She presented with increased bruising and petechiae starting 2 weeks after receiving the first dose of the anti-COVID-19 vaccine. Laboratory data revealed a severe ADAMTS13-deficiency in combination with a very high autoantibody titer against ADAMTS13. She was successfully treated with plasma exchange, corticosteroids, rituximab, and caplacizumab.”

38: Cerebral venous sinus thrombosis 2 weeks after the first dose of mRNA SARS-CoV-2 vaccine - PubMed

Author Zakaria et al

Country: Malaysia

Date Published Online: 6/8/21

Vaccine: Pfizer

Diagnoses: CVST

Link: https://pubmed.ncbi.nlm.nih.gov/34101024/

Case: “The patient received the first dose of subcutaneous mRNA COVID-19 vaccine (EP2163, Pfizer/BioNTech) on March 1, 2021 and reported mild symptoms of soreness at the injection site and myalgia that lasted for 24 h. Sixteen days later (March 17), the patient complained of a new-onset of mild to moderate headache and giddiness, which initially was thought from the exertion of working. The symptom persisted, requiring a hospital visit 5 days later (March 21).”

“A noncontrast computed tomography (CT) of the brain showed cordlike hyperattenuation within the left transverse and sigmoid sinus suggestive of cord or dense clot sign (Fig. 1a,b). The patient elected to ignore the radiological finding and persevere with the symptoms. On March 22, he received the second dose of the vaccine (EP9605, Pfizer/BioNTech). Due to unresolved and somewhat worsening symptoms, the patient agreed to CT cerebral venography 2 days later. The finding confirmed a long segment-filling defect and empty delta sign within the superior sagittal sinus (SSS), extending into the torcula Herophili, left transverse sinus, and sigmoid sinus to proximal internal jugular vein (Fig. 1c,d).”

39: 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 - PubMed

Author Al-Maqbali et al

Country: Oman

Date Published Online: 6/12/21

Vaccine: Pfizer

Diagnoses: DVT, PE

Link: https://pubmed.ncbi.nlm.nih.gov/34117206/

Case: “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).”

40: Intracerebral hemorrhage associated with vaccine-induced thrombotic thrombocytopenia following ChAdOx1 nCOVID-19 vaccine in a pregnant woman - PMC

Author Mendes-de-Almeida et al

Country: Brazil

Date Published Online: 6/15/21

Vaccine: AstraZeneca

Diagnoses: VITT, ICH

Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8561298/

Case: “Herein we present a fatal case of a 35-year-old pregnant woman who developed intracerebral hemorrhage in the left temporal lobe associated with VITT 12 days after the off-label ChAdOx1 nCOVID-19 vaccination and we show the characterization of the hemostatic profile. A 35-years-old white pregnant woman at 23 weeks gestation was in prenatal follow- up with normal platelet counts and controlled hypothyroidism due to Hashimoto's disease. She received the first dose of the ChAdOx1 nCov-19 vaccine in late April 2021 (day 0). The next day, she reported having minor symptoms (malaise, chills, tremors, and "cold feeling"). On day 2, she presented a generalized skin rash on her legs, abdomen, and back with spontaneous resolution (see Figure 1A). Prenatal exams on day 3 identified urinary tract infection caused by Morganella morganii treated with trimethoprim-sulfamethoxazole and 148,000/mm3 platelets at the routine complete blood count. On day 7, she presented headache, nausea, nonspecific malaise, polaciuria, pain in the lower limbs and hips. Despite having 121,000/mm3 platelets, she received analgesics and was discharged from the obstetric emergency room. On the following days, she maintained headache and bilateral leg pain, partially responsive to dipyrone. On day 11, she reported a severe headache located in the left maxillary region, and on day 12, she was admitted with 33,000/mm3 platelets and an excruciating headache. During the computed tomography (CT) exam, she became comatose and underwent endotracheal intubation, which precluded the realization of CT cerebral venography, confirming the suspicion of central venous sinus thrombosis. Brain CT showed a large acute intraparenchymal hematoma in the temporal lobe, insula, and temporoparietal transition of the left cerebral hemisphere measuring approximately 10.1x5.4x5.5 cm. The hematoma was surrounded by vasogenic edema with midline shift to the right, herniation of the uncus, marked compressive effect on the midbrain, and subtotal collapse of the supratentorial ventricular system (Figure 1B). The patient received platelet concentrate transfusion and underwent urgent neurosurgery for hematoma drainage and decompressive craniectomy. After receiving critical care procedures, obstetric ultrasound detected fetal death. There were no platelet clumps, signs of erythrocyte fragmentation, or blast cells on blood film. She received 80 g (1 g/Kg) immunoglobulin (Ig) and 2 g fibrinogen without success. The patient died on day 17 (after vaccination) with refractory intracranial hypertension despite all pressure control measures.”

“Besides that, thrombosis was observed in placental vessels. The constellation of signs and symptoms suggests VITT diagnosis complicated by intracranial hemorrhage with a fatal outcome both to fetus and mother.”

41: Cerebral venous thrombosis post BNT162b2 mRNA SARS‐CoV‐2 vaccination: A black swan event - Fan - 2021 - American Journal of Hematology - Wiley Online Library

Author Fan et al

Country: Singapore

Date Published Online: 6/16/21

Vaccine: Pfizer

Diagnoses: CVT, VI, MT

Link: https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.26272

Case: “Patient 1: A healthy 54-year-old Chinese male with well controlled hyperlipidaemia, developed severe headache and vomiting 24 h after his second dose of BNT162b2 mRNA vaccine, and acute left hemiparesis 2 days later. A CT Brain revealed a large right temporo-parietal lobe intraparenchymal hemorrhage with associated midline shift and uncal herniation, necessitating a decompressive craniectomy. A CT angiogram excluded underlying vascular malformations, and CT venogram confirmed dural venous sinus thrombosis (transverse and sigmoid sinus).”

“Patient 2: A healthy 62-year-old Chinese female with a history of well-controlled hypertension presented with headache and vomiting 9 days after her second dose of BNT162b2 mRNA Covid-19 vaccine. [..] Both CT Brain and CT venogram on admission confirmed acute right cerebral bleed involving occipital and temporal lobes associated with subarachnoid hemorrhage due to thrombosed right transverse and sigmoid sinus veins. Unfractionated heparin was started with close therapeutic monitoring. On day 4 of admission there was a drop in her Glasgow Coma Scale from 14 to 9, with repeat CT showed increasing size of haemorrhagic right cerebral venous infarcts with worsening of mass effect and development of early hydrocephalus, requiring decompressive craniectomy. This was later complicated by intracranial empyema requiring drainage. Post operatively, UFH infusion was resumed and later converted to LMWH. Thrombophilia workup was negative. Bilateral lower limb deep vein thrombosis scan was negative for thrombosis. Whole body CT performed 3 weeks into admission was negative for malignancy, however, right upper lobe segmental artery pulmonary embolism, left internal iliac artery and right common iliac vein thrombi were detected, likely from immobility in ICU and perioperative discontinuation of anticoagulation. Incidentally, a left iliopsoas haematoma was detected. Despite her haematoma, UFH was resumed due the increased thrombotic burden and later converted to LMWH, with bridging to warfarin a week later.”

“Patient 3: A 60-year-old Chinese female with family history of thrombosis (her son had unprovoked pulmonary embolism) and medical history of diabetes mellitus, hypertension and hyperlipidaemia, presented 8 days after her second dose of BNT162b2 mRNA Covid-19 vaccine for right ataxic hemiparesis. Both CT brain and venogram confirmed extensive dural venous thrombosis and venous infarct in bilateral perirolandic gyri. This was complicated by acute right occipital lobe intraparenchymal hematoma and bilateral subarachnoid hemorrhage.”

42: Immune thrombocytopenic purpura associated with COVID‐19 Pfizer‐BioNTech BNT16B2b2 mRNA vaccine - PMC

Author Krajewski & Szepietowski

Country: Poland

Date Published Online: 6/16/21

Vaccine: Pfizer

Diagnoses: ITPP

Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8242419/

Case: “A 74‐year‐old Caucasian male patient presented to Dermatology Department with multiple haemorrhagic blisters on oral and nasal mucosa and purpuric rash on lower extremities. The cutaneous lesions appeared for the first time a day before admission, firstly on patient's thighs and then spread to lower legs and forearms. Moreover, that morning patient woke up with blood on his pillow. According to the anamnesis, on the day preceding the appearance of the symptoms, the patient received first dose of Pfizer (New York, NY, USA) – BioNTech (Mainz, Germany) BNT16B2b2 mRNA vaccine. On admission, physical examination revealed multiple haemorrhagic blisters on oral and nasal mucous membranes of various size (Fig. 1a). Moreover, purpuric rash localized on lower legs, thigs and forearms was visible (Fig. 1b). At the injection site, an ecchymosis of 2 cm in diameter was observed (Fig. 1c). [..] Based on clinical manifestation and laboratory tests, immune thrombocytopenic purpura associated with SARS‐CoV‐2 vaccine was diagnosed.”

43: A case of vaccine-induced immune thrombotic thrombocytopenia with massive artero-venous thrombosis - PMC

Author Turi et al

Country: Italy

Date Published Online: 6/19/21

Vaccine: AstraZeneca

Diagnoses: TTCP, AVT, PE, MT, AT, PVT

Link: https://pubmed.ncbi.nlm.nih.gov/34059191/

Case: “A previously healthy 57-year-old female received her first dose of the ChAdOx1 nCoV-19 Astra Zeneca vaccine on March 11th, 2021. The following day she developed fever, arthromyalgia and headache.”

“On the 11th day she returned to the Emergency Unit because of persisting flu-like symptoms and the onset of purpuric lesions on both legs. [..] Five days later she was readmitted, because of severe chest and abdominal pain. [..] Contrast CT of chest and abdomen revealed pulmonary embolism, thrombosis of the portal vein and splenic artery, with splenic infarction, parietal thrombus in the thoracic aorta and increased size of the thrombus in the abdominal aorta. [..] In the following days her condition worsened due to liver failure, although platelet counts progressively increased up to 145×109/L (Figure 1) and liver failure resolved after 3 days.”

“In our case IVIG were administered immediately after the detection of thrombocytopenia; despite the early start of therapy, our patient developed multiple district thrombosis. This would suggest that IVIG administration did not arrest the early coagulation process. During the second hospital admission, IVIG were given for 3 days, which is longer than usual, and associated with steroids and direct oral anticoagulants. Since the patient’s condition improved quickly and progressively, this type of combined treatment should be preferred.”

44: A Case of Immune Thrombocytopenia After BNT162b2 mRNA COVID-19 Vaccination

Author King & Towner

Country: US

Date Published Online: 6/21/21

Vaccine: Pfizer

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34285180/

Case: “Here, we present a case of ITP as a complication of the BNT162b2 mRNA COVID-19 vaccine. CASE REPORT Three days after receiving a second dose of the BNT162b2 mRNA COVID-19 vaccine, a 39-year-old woman presented with a petechial rash on her trunk, legs, and arms, and fatigue and muscle aches. At the time of her hospital admission, her platelet count was 1000/µL. A peripheral smear showed profound thrombocytopenia.”

45: Immune Thrombocytopenia Following the Pfizer-BioNTech BNT162b2 mRNA COVID-19 Vaccine

Author Ganzel & Ben-Chetrit

Country: Israel

Date Published Online: 6/22/21

Vaccine: Pfizer

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34155844/

Case: “A 53-year-old male was admitted to the Shaare Zedek Medical Center in Jerusalem due to epistaxis and low platelet count 2 weeks after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine.”

“Physical examination revealed wet purpura on his palate and petechial and purpuric rash on the trunk and limbs. [..] Immune thrombocytopenic purpura (ITP) was diagnosed.”

46: A case of thrombocytopenia and multiple thromboses after vaccination with ChAdOx1 nCoV-19 against SARS-CoV-2 - PubMed

Author Tølbøll Sørensen et al

Country: Denmark

Date Published Online: 6/22/21

Vaccine: AstraZeneca

Diagnoses: MT, TCP, PVT, CVST

Link: https://pubmed.ncbi.nlm.nih.gov/34137813/

Case: “We describe an otherwise healthy 30-year-old woman who developed thrombocytopenia, ecchymosis, portal vein thrombosis, and cerebral venous sinus thrombosis the second week after she received the ChAdOx1 nCoV-19 vaccine. Extensive diagnostic workup for thrombosis predispositions showed heterozygosity for the prothrombin mutation, but no evidence of myeloproliferative neoplasia or infectious or autoimmune diseases. Her only temporary risk factor was long-term use of oral contraceptive pills (OCPs). Although both the prothrombin mutation and use of OCPs predispose to portal and cerebral vein thrombosis, the occurrence of multiple thromboses within a short time and the associated pattern of thrombocytopenia and consumption coagulopathy are highly unusual.”

47: Acute Ischemic Stroke Revealing ChAdOx1 nCov-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia: Impact on Recanalization Strategy - PubMed

Author Costentin et al

Country: France

Date Published Online: 6/24/21

Vaccine: AstraZeneca

Diagnoses: VITT, IS, CVT, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34175640/

Case: “We describe a case of a young healthy women suffering from acute ischemic stroke due to large vessel occlusion without cerebral venous thrombosis 8 days after vaccination and its consequences on recanalization strategy. Considering the thrombocytopenia, intravenous thrombolysis was contraindicated. She underwent mechanical thrombectomy with complete recanalization and dramatically improved clinically. Positive detection of anti-PF4-heparin-antibodies confirmed vaccine-induced immune thrombotic thrombocytopenia diagnosis. In case of acute ischemic stroke after recent ChAdOx1 nCov-19 or Ad26.COV2.S vaccine, platelet count should be systematically checked before giving thrombolysis, and direct mechanical thrombectomy should be proposed in patients with large vessel occlusion.”

48: Anti-PF4 antibody negative cerebral venous sinus thrombosis without thrombocytopenia following immunization with COVID-19 vaccine in an elderly non-comorbid Indian male, managed with conventional heparin-warfarin based anticoagulation - ScienceDirect

Author Dutta et al

Country: India

Date Published Online: 6/24/21

Vaccine: AstraZeneca

Diagnoses: CVT

Link: https://www.sciencedirect.com/science/article/pii/S1871402121002046

Case: “51-year-old non-comorbid male, was admitted with subacute onset progressive persistent holocranial headache, for last 14 days, which was associated with vomiting on a couple of occasions without any definite aggravating or relieving factors. Headache had developed 6 days following immunization against COVID-19 with first-dose of COVISHIELD. [..] For last 2 days, alongside headache, he started complaining of double vision which appeared in horizontal gaze (double vision in right gaze was more than that of left gaze). His daughter also noticed loss of parallelism of her father's eyeballs in neutral position. [..] Neurological examination was marked by presence of bilateral, asymmetric lateral rectus palsy (right more than left). [..] Presence of holocranial headache, vomiting, bilateral lateral rectus palsy and papilloedema pointed towards raised ICP and possibility of CVT. Magnetic resonance imaging (MRI) of brain with contrast revealed no intraparenchymal lesion but MR venography revealed thrombosis in superior sagittal sinus and transverse sinus with presence of extensive venous collaterals (Fig. 1).

49: Acute immune thrombocytopenia (ITP) following COVID-19 vaccination in a patient with previously stable ITP

Author Jawed et al

Country: US

Date Published Online: 6/24/21

Vaccine: Pfizer

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34307734/

Case: “A 47-year-old female with a medical history of hypothyroidism (secondary to Hashimoto’s thyroiditis), iron deficiency anemia, lymphadenopathy, and ITP received her first dose of the Pfizer-BioNTech mRNA vaccine and experienced mild arm soreness for 2 days postvaccination but did not experience any other adverse effects.”

“Eighteen days postadministration, the patient presented to the emergency room with complaints of easy bruising, gum bleeding, and an episode of epistaxis. [..] Physical exam was remarkable for ecchymosis and petechiae on her bilateral upper and lower extremities and dried blood within her oropharynx. No splenomegaly or hepatomegaly was noted. [..] Peripheral smear confirmed the thrombocytopenia and showed normal red blood cell (RBC) morphology (Figures 1 & 2).

50: Case Report of Clot from mRNA Vaccine: Thrombosis With Thrombocytopenia After the Messenger RNA–1273 Vaccine | Annals of Internal Medicine

Author Sangli et al

Country: US

Date Published Online: 6/29/21

Vaccine: Moderna

Diagnoses: VITT, TTS, DVT, PE, MT, CVST, TCP

Link: https://www.acpjournals.org/doi/10.7326/L21-0244

Case: “A 65-year-old man with chronic hypertension and hyperlipidemia presented to our hospital with 1 week of bilateral lower-extremity discomfort, intermittent headaches, and 2 days of dyspnea. He had received a second dose of the mRNA-1273 vaccine 10 days before the onset of symptoms. He had no known prior heparin exposure.

A computed tomography angiogram of the chest showed large, bilateral, acute pulmonary emboli with right ventricular strain. Doppler studies of the lower extremities revealed acute deep venous thromboses in both lower extremities. The patient had severe thrombocytopenia (14 × 109 cells/L) (Table and Figure) (171 × 109 cells/L had been documented 18 months earlier).

“Three days later, the patient developed an acute gluteal hematoma requiring withdrawal of heparin. The thrombocytopenia persisted, and we evaluated him for HIT. [..] Twelve hours later, he developed acute encephalopathy. A computed tomography angiogram of the head and neck showed cerebral venous sinus thrombosis, which was confirmed with a computed tomography venogram. [..] He continued to deteriorate, his family elected to pursue comfort measures, and he died after compassionate extubation.”

51: Secondary Immune Thrombocytopenia (ITP) Associated with ChAdOx1 Covid-19 Vaccination - A Case Report - PubMed

Author Koch et al

Country: Germany

Date Published Online: 6/30/21

Vaccine: AstraZeneca

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34377889/

Case: “A 41-year-old caucasian male presented to the emergency department in March 2021 with petechial and mucosal bleeding. Blood tests revealed a severe thrombocytopenia with platelet count of <1GPt/L and normal hemoglobin and leucocyte levels with no further laboratory abnormalities in routine tests.”

“Closer review of the patient's medical history revealed that he had received the first dose of ChAdOx1 Covid-19 vaccination (AstraZeneca) 14 days prior to hospital admission. [..] The patient reported an episode of severe headache combined with blurry vision ∼8 days post vaccination, leading to a head MRI showing no pathologic findings. First petechial bleedings occurred 10 days, mucosal bleeding 11 days after vaccination.”

“After exclusion of these causes for isolated severe thrombocytopenia, clinical manifestation (acute onset of severe thrombocytopenia, typical bleeding pattern) was suggestive for immune thrombocytopenia (ITP). Due to the suggestive temporal connection, we concluded that ChAdOx1 Covid-19 vaccination was the most likely trigger for this case of secondary ITP.”

52: Antibody epitopes in vaccine-induced immune thrombotic thrombocytopaenia | Nature

Author Huynh et al

Country: Canada

Date Published Online: 7/7/21

Vaccine: AstraZeneca

Diagnoses: VITT

Link: https://www.nature.com/articles/s41586-021-03744-4

Case: “Samples from patients with VITT (n = 5) were referred to the McMaster Platelet Immunology Laboratory for diagnosis. All patients with VITT had received a single dose of the ChAdOx1 nCoV-19 vaccine (AstraZeneca COVID-19 vaccine, AstraZeneca; COVISHIELD, Verity Pharmaceuticals and Serum Institute of India) and subsequently developed thrombocytopaenia and thrombosis; the mean age of patients was 44 years (range, 35–72 years) and 2 out of 5 (40%) were female. The time from first dose of the ChAdOx1 nCoV-19 vaccine to sample collection was 14–40 days (mean, 28 days). All samples from patients with VITT (hereafter, VITT samples) had antibodies against PF4 (mean optical density (OD), 2.71; range, 0.763–3.347).”

53: Middle-age Asian male with cerebral venous thrombosis after COVID-19 AstraZeneca vaccination - ScienceDirect

Author Guan et al

Country: Taiwan

Date Published Online: 7/8/21

Vaccine: AstraZeneca

Diagnoses: CVT, TTCP, VT

Link: https://www.sciencedirect.com/science/article/pii/S0735675721005714

Case: ‘A 52-year-old man with no underlying disease presented to the ED with nausea and thunderclap headache for 5 days. He also claimed pain on the left side of his neck, but he had no other symptoms. He received the ChAdOx1 vaccine 10 days prior, and headache developed gradually 5 days after vaccination. [..] Laboratory work up revealed thrombocytopenia (Platelet 99*109/L) and elevated d-dimer (>20.0 mg/L) but was otherwise normal. Hyperdensity of the sinus, including Cord sign and dense vein sign at the left transverse and sigmoid sinuses, was discovered via non-enhanced computer tomography (CT) (Fig. 1). CT venogram revealed CVST at the left transverse sinus and sigmoid sinuses and thrombosis of the left internal jugular vein (Fig. 2). A diagnosis of VACVST with thrombotic thrombocytopenia was made.”

54: Acquired Thrombotic Thrombocytopenic Purpura: a rare disease associated Acquired with BNT162b2 vaccine - PMC

Author Maayan et al

Country: Israel

Date Published Online: 7/8/21

Vaccine: Pfizer

Diagnoses: aTTP

Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8237075/

Case: “Here we describe a case series of patients who developed acquired Thrombotic Thrombocytopenic Purpura, a rare autoimmune disease, within several days of receiving the BNT162b2 vaccine.”

‘Four patients from two academic medical centers were identified from mid-February to mid-March 2021.”

“Patient demographic and laboratory data are summarized in Table 1. Mean age at presentation was 33 years, with first aTTP episode in two and relapse following long periods of remission in two cases. Patients presented at a mean of 14 days following BNT162b2 vaccination.”

55: Management of a patient with a rare congenital limb malformation syndrome after SARS-CoV-2 vaccine-induced thrombosis and thrombocytopenia (VITT) - PubMed

Author Lang et al

Country: UK

Date Published Online: 7/9/21

Vaccine: AstraZeneca

Diagnoses: VITT, CVST, PVT, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34097311/

Case: “A 54-year-old man with a rare congenital limb malformation (left image) presented to the Accident and Emergency department with a 7-day history of worsening headache, bruising and unilateral right calf swelling. [..] Computed tomography (CT) showed extensive cerebral venous sinus thrombosis and ultrasonography confirmed concurrent venous thrombosis in the portal vein (right image, filling defect indicated by arrow). There was also thrombophlebitis of the right leg. On presentation, his platelet count was 34 × 109/l and D-Dimer was 60 000 ng/ml. His blood film confirmed a true thrombocytopenia, with the absence of polychromasia, spherocytes and fragments making the diagnosis of thrombotic thrombocytopenic purpura unlikely. The patient had received the AstraZeneca SARS-CoV-2 vaccine 3 weeks before presentation, making the likely diagnosis vaccine-induced thrombosis and thrombocytopenia (VITT). An anti-platelet factor 4 (anti-PF4) antibody assay was 2·509 (normal range 0–0·4), thus confirming the diagnosis.”

56: Autoimmune Hematologic Disorders in Two Patients After mRNA COVID-19 Vaccine

Author Gaignard et al

Country: Switzerland

Date Published Online: 7/13/21

Vaccine: Moderna

Diagnoses: ITP, AIHA

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8274740/

Case: “Here, we report two different cases of autoimmune hematologic disorders, ITP and AIHA, respectively, occurring with a clear timely correlation after administration of Moderna mRNA-1273 COVID-19 vaccine.”

“Patient 1: A 56-year-old male was admitted to the emergency department with unprovoked multiple painless petechia located on the oral mucous membranes of the lower lip and to a smaller extent on the skin of his left upper arm where he reported receiving his first injection of the Moderna COVID-19 vaccine 3 days ago (Figure ​(Figure1).1).”

“Patient 2: A healthy 77-year-old man without known comorbidities and with no medication use received his first Moderna mRNA-1273 vaccine in the context of the regional vaccination campaign. On day 5 postvaccination, he experienced weakness, fatigue and shortness of breath which led him to consult his general practitioner. Due to a newly diagnosed anemia the patient was referred to our clinic. Well-being until vaccination and no history of a recent infection were reported. [..] Warm AIHA was diagnosed.”

57: Autoimmune- and complement-mediated hematologic condition recrudescence following SARS-CoV-2 vaccination

Author Portuguese et al

Country: US

Date Published Online: 7/13/21

Vaccine: Moderna

Diagnoses: HAIDR, TCP, ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34255033/

Case: “We describe the recrudescence of 2 autoimmune conditions (ITP and acquired von Willebrand Disease [AvWD]/acquired hemophilia A) and 1 complementopathy (paroxysmal nocturnal hemoglobinuria [PNH]). We report the first known case of AvWD/acquired hemophilia A, and describe the first PNH exacerbation in the absence of complement inhibition after SARS-CoV-2 vaccination. Although SARS-CoV-2 vaccine-induced ITP is a known concern, our case clearly depicts how thrombocytopenia in the setting of preexisting ITP can sequentially worsen with each vaccine dose.”

“Patient 1 was a 72-year-old woman with chronic ITP on maintenance eltrombopag 25 mg daily. Recent SARS-CoV-2 semiquantitative total antibody testing was negative. Before dose 1 of the Moderna SARS-CoV-2 vaccine, her platelet baseline was 65 × 109/L to 80 × 109/L (Figure ​(Figure1A).1A). Approximately 13 hours after receiving dose 1 of the Moderna SARS-CoV-2 vaccine, her platelet count fell to 45 × 109/L (42% decrease).”

“Patient 2 was an 81-year-old woman with a long-standing history of steroid-responsive, classic PNH (granulocyte clone size, 98%), with a flare 2 years earlier, triggered by her second Shingrix vaccine. She had never been treated with terminal complement inhibition. Approximately 8 hours after receiving dose 2 of the Moderna SARS-CoV-2 vaccine, she developed flu-like symptoms (Figure ​(Figure1B).1B). One day after dose 2, she developed dark urine, generalized weakness, abdominal pain, and odynophagia. She presented to hematology clinic, where laboratory results demonstrated severe hemolysis: lactate dehydrogenase (LDH), 1272 U/L; total bilirubin, 1.8 mg/dL; hemoglobin (Hb), 10.0 g/dL; hematocrit (Hct), 30%; creatinine (Cr), 0.91 mg/dL; and a negative direct antibody test. She received a transfusion of 2 U red blood cells (RBCs), was sent to the emergency department and then was admitted for further management of a PNH flare.”

“Patient 3 was a 76-year-old woman with a history of asthma; Raynaud’s phenomenon; multiple episodes of large, upper extremity ecchymoses; and a paraesophageal hernia status post recent uncomplicated Nissen fundoplication. She tolerated dose 1 of the Moderna SARS-CoV-2 vaccine. After dose 2, on day 4 she developed large ecchymoses covering most of her upper extremities (Figure ​(Figure2A).2A). The lesions were similar to those that had spontaneously developed about 1 year earlier (Figure ​(Figure2B),2B), at which time laboratory testing demonstrated abnormal ristocetin-induced platelet aggregation consistent with vWD and mildly prolonged activated partial thromboplastin time (aPTT), although no definitive diagnosis was made. On day 7, she developed persistently melanotic stool. On day 15 she presented to the emergency department with presyncope and was admitted for blood loss anemia. Initial laboratory results were notable for international normalized ratio, 1.5; aPTT, 122 s; von Willebrand factor (vWF) antigen, 5%; vWF activity, <3%; and factor VIII activity, <3% (Figure ​(Figure1C).1C). Admission SARS-CoV-2 reverse transcription polymerase chain reaction was negative. Monoclonal protein was not detected by serum protein electrophoresis. A vWF multimer analysis showed a normal pattern and distribution of bands, consistent with a quantitative vWF deficiency. A factor VIII inhibitor was detected and quantified as 11.2 Bethesda units (BUs). The patient was diagnosed with recurrent AvWD and acquired hemophilia A, presumed to be due to an antibody directed against the FVIII/vWF complex.”

58: Acute Myocardial Infarction Within 24 Hours After COVID-19 Vaccination - American Journal of Cardiology

Author Sung et al

Country: US

Date Published Online: 7/13/21

Vaccine: Moderna

Diagnoses: MI, AO

Link: https://www.ajconline.org/article/S0002-9149(21)00631-7/fulltext

Case: “In the first case, the patient experienced gradual onset of left shoulder pain within 1 day after her first dose of COVID-19 vaccine (mRNA-1273) that later progressed to left-sided chest pain. She initially attributed her symptoms to the vaccine. She presented to the emergency department (ED) approximately two hours after chest pain (Table 1). Bedside cardiac ultrasound showed left ventricular ejection fraction of 50% and hypokinesis of the anterolateral and inferolateral walls. The patient tested negative for SARS-CoV-2 by PCR on 2 separate nasopharyngeal aspirates. Emergency coronary angiography revealed an occluded proximal segment of the left circumflex (LC) artery with a globular thrombus and TIMI 0 flow (Figure 1 & Video 1).”

“The patient in the second case presented with 4 days of chest and shoulder pain. Symptoms started the night after he had his first dose of COVID-19 vaccine (mRNA-1273). He woke up from sleep with sharp, intense chest pain that radiated to the jaw. Symptoms slightly improved but remained for 4 more days, and he finally presented to an outside hospital. He also reported injection site pain from the vaccination but was otherwise asymptomatic. At the emergency department, he was found to have elevated troponin with no significant ECG changes. He was then transferred to our center, and a CT coronary angiogram revealed complete occlusion of the LC artery. In view of this finding, he was transferred to the catheterization laboratory (Table 1). [..] CT coronary angiography showed a large amount of noncalcified plaque in the proximal LC artery, resulting in complete focal occlusion just proximal to the origin of first obtuse marginal artery. Coronary angiography in the catheterization laboratory revealed a 90% stenosis in the proximal LC artery with TIMI 1 flow (Figure 2 & Video 3).”

59: Pulmonary embolism, transient ischaemic attack and thrombocytopenia after the Johnson & Johnson COVID-19 vaccine - PubMed

Author Malik et al

Country: US

Date Published Online: 7/14/21

Vaccine: J&J

Diagnoses: PE, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34261635/

Case: “Our patient is a 43-year-old Caucasian woman with a history of hyperlipidaemia, anxiety, depression, obesity, obstructive sleep apnoea and gastro-oesophageal reflux disease who presented to the emergency department with a 3-day history of generalised headache, fever, body aches, chills, mild dyspnoea and lightheadedness. Approximately 10 days before her presentation, she received the J&J COVID-19 vaccine.”

60: A case of severe autoimmune hemolytic anemia after a receipt of a first dose of SARS-CoV-2 vaccine

Author Murdych

Country: US

Date Published Online: 7/14/21

Vaccine: Pfizer

Diagnoses: AIHA

Link: https://pubmed.ncbi.nlm.nih.gov/34258873/

Case: “He received the first dose of Pfizer‐BioNTech BNT16B2b2 mRNA vaccine through the Veterans Administration system in early 2021.

On day 19 post‐vaccine, the patient presented to his primary clinic with increased urinary frequency and dizziness.”

“The patient was referred to outpatient hematology, but his symptoms worsened before his scheduled appointment.

These symptoms included dizziness/vertigo, nausea, anorexia, shortness of breath, chest pain, palpitations, "ashen" appearance, and dark urine, ultimately causing an emergency presentation to our hospital and inpatient admission 5 days after his initial visit to the outpatient clinic. The patient appeared pale, but his vital signs including oxygenation were normal.”

“Inpatient hematology consultation was obtained, concluding that autoimmune hemolytic anemia indeed is present.”

“A second COVID‐19 vaccination was not advised at this point due to the occurrence of autoimmune hemolytic anemia in the weeks following the first dose.”

61: A COVID-Positive 52-Year-Old Man Presented With Venous Thromboembolism and Disseminated Intravascular Coagulation Following Johnson & Johnson Vaccination: A Case-Study - PubMed

Author Shazley & Alshazley

Country: St Vincent Grenadines

Date Published Online: 7/14/21

Vaccine: J&J

Diagnoses: DVT, DIC, PE, VTE

Link: https://pubmed.ncbi.nlm.nih.gov/34408937/

Case: “A 52-year-old man presented to the intensive care unit (ICU) with severe dyspnea. [..] A computed tomography angiogram (CTA) revealed a mildly enlarged right ventricle and interventricular septum consistent for right heart strain due to a saddle pulmonary embolism (PE) that extended into the main pulmonary lobar segmental arteries bilaterally. The patient was transferred to a higher-level (tertiary) care for radiology intervention to remove the pulmonary embolism found on his lungs. This patient presented with severe dyspnea secondary to massive PE and deep venous thrombosis (DVT) due to SARS-CoV2 infection following the administration of the J&J vaccine.”

62: Thrombotic thrombocytopenic purpura: a new menace after COVID bnt162b2 vaccine

Author Waqar et al

Country: US

Date Published Online: 7/15/21

Vaccine: Pfizer

Diagnoses: TTCPP

Link: https://pubmed.ncbi.nlm.nih.gov/34264514/

Case: “Thrombotic thrombocytopenic purpura (TTP) is a known menace in hematology and is quite rare in practice with known triggers.”

“A 69-year-old male with a known medical history of hypertension, chronic kidney disease, HIV on anti-retroviral therapy (ART), chronic hepatitis B, two prior episodes of deep vein thrombosis managed with daily oral warfarin, presented to the emergency department with primary complaints of severe fatigue and new onset of shortness of breath for past three days. The shortness of breath was progressive, limiting his ability to walk and even talk in complete sentences without stopping to catch his breath. He denied any inciting event. There was no association with fever, chills, night sweats, weight loss, headaches, vision changes, cough, sputum chest pain, abdominal pain, rash, bleeding, bruising, edema, focal weakness, or changes in bowel or urinary habits. The patient received a second dose of BNT162b2 mRNA vaccine one week before the onset of concerning symptoms.”

“All these findings were consistent with the hemolytic phenomenon. Henceforth, a tentative diagnosis of Thrombotic Thrombocytopenic Purpura (TTP) was made. [..] Since the patient’s HIV status is stable with a CD4 count above 200, the trigger of TTP was presumed to be recent vaccination.”

63: COVID-19 vaccination associated severe immune thrombocytopenia

Author Shah et al

Country: US

Date Published Online: 7/16/21

Vaccine: Pfizer, J&J

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34266487/

Case: “Case #1: 53 year old male with past medical history of Crohn's disease was admitted for myalgias and diffuse petechial rash 8 days after receiving second dose of Pfizer-BioNTech COVID-19 vaccine. A complete blood test showed a platelet count of 2 × 109/L. Patient did not have a prior history of thrombocytopenia and other causes of thrombocytopenia were ruled out by history and pertinent lab data.”

“Case #2: 67 year male with past medical history of chronic ITP in remission was admitted for melena 2 days after receiving his first dose of Pfizer-BioNTech COVID-19 vaccine. A complete blood test showed a platelet count of 2 × 109/L. Physical exam showed generalized petechiae. There was no history of recent flares of ITP and patient had normal platelet counts following his splenectomy 4 years ago.”

“Case #3: 59 year old female with past medical history of chronic ITP secondary to SLE was admitted for bloody diarrhea 2 days after receiving her first dose of Johnson and Johnson COVID-19 vaccine. Physical exam was unremarkable. A complete blood test showed platelet count of 64 × 109/L which dropped to 27 × 109/L during hospital course.”

64: Immune thrombocytopenic purpura after vaccination with COVID-19 vaccine (ChAdOx1 nCov-19)

Author Paulsen et al

Country: Germany

Date Published Online: 7/23/21

Vaccine: AstraZeneca

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34297792/

Case: “We conducted retrospective and prospective analyses of patients who received treatment in our institution for ITP associated with ChAdOx1 nCoV19 vaccination within a 19-day period in May 2021. We evaluated patients' records and confirmed the diagnosis of ITP.”

“The patients were White women and men between 64 and 72 years of age from Germany. They presented 2 to 15 days after receiving the first dose of ChAdOx1 nCov-19 with severe symptomatic thrombocytopenia of ≤6 × 109/L cells.”

65: Secondary thrombocytopenia after SARS-CoV-2 Vaccine: Report of a case of hemorrhage and hematoma after minor oral surgery - PubMed

Author Vaira et al

Country: Italy

Date Published Online: 7/24/21

Vaccine: Pfizer

Diagnoses: TCP, Hema, Hemo

Link: https://pubmed.ncbi.nlm.nih.gov/34314875/

Case: “An 81-year-old man reported the sudden appearance of a bluish cheek lesion. This lesion grew in a few days until it reached the size of 22 × 9 mm. On the advice of the dentist, the patient referred to the Maxillofacial Surgery Unit of the University Hospital of Sassari.”

“The patient had completed the anti-SARS-CoV-2 vaccination protocol with Pfizer vaccine: first dose on 03/20/2021 (COMIRNATY mRNA, lot No. ET3620) and second dose on 04/12/2021 (COMIRNATY mRNA, lot No. EW2246). The second dose was given 3 days before the lesion appeared and 18 days before surgery.”

“Approximately 8 h after surgery, the patient referred to the emergency department due to copious bleeding through the surgical wound and massive hematoma and ecchymosis of the right cheek (Figs. 2 and ​and3 ).3 ). Blood tests revealed severe thrombocytopenia (platelet count: 4 × 103/μL), normal white blood cells (8.81 × 103/μL), mild anemia (hemoglobin: 11.6 g/dL, red blood cell count: 3.85 × 103/μL), and normal coagulation profile (PT: 11.4 s, aPTT 21.0 s, INR 1.07).”

66: Acquired thrombotic thrombocytopenic purpura after first vaccination dose of BNT162b2 mRNA COVID-19 vaccine

Author Ruhe et al

Country: Germany

Date Published Online: 7/26/21

Vaccine: Pfizer

Diagnoses: TTCPP, MT

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311064/

Case: “Here, we report a case of severe TTP early after vaccination against COVID-19.”

“An 84-year-old female patient was admitted to the hospital with partial hemiplegia, scattered petechiae, and severe arterial hypertension. Cerebral magnetic resonance imaging (MRI) revealed multiple subacute emboli without vessel occlusion. Laboratory findings showed thrombocytopenia (45 × 109/l), Coombs negative hemolytic anemia (hemoglobin 7.9 g/dl; schistocytes 42‰, haptoglobin < 10 mg/dl; total serum bilirubin 2455 mg/dl; Fig. 1), and acute renal failure (serum creatinine 1.95 mg/dl).”

“Sixteen days before admission, the patient received the first vaccination dose of BNT162b2 (Comirnaty®; Biontech/Pfizer) against COVID-19.”

“To our knowledge, this is the first case of a primary manifestation of acquired TTP associated with vaccination with BNT162b2 especially in an older woman who is otherwise not particularly prone to having TTP. TTP should be considered in patients with thrombocytopenia after vaccination against COVID-19 and be added to the safety profile of BNT162b2 [10].”

67: Prothrombotic immune thrombocytopenia after COVID-19 vaccination

Author Tiede et al

Country: Germany

Date Published Online: 7/29/21

Vaccine: AstraZeneca

Diagnoses: CVST, TMA, ACE, TIA, SVT, ACT, PAT

Link: https://pubmed.ncbi.nlm.nih.gov/34323939/

Case: “We report 5 cases of prothrombotic immune thrombocytopenia after exposure to the ChAdOx1 vaccine (AZD1222, Vaxzevria) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients presented 5 to 11 days after first vaccination. The spectrum of clinical manifestations included cerebral venous sinus thrombosis, splanchnic vein thrombosis, arterial cerebral thromboembolism, and thrombotic microangiopathy. All patients had thrombocytopenia and markedly elevated D-dimer. Autoantibodies against platelet factor 4 (PF4) were detected in all patients, although they had never been exposed to heparin. Immunoglobulin from patient sera bound to healthy donor platelets in an AZD1222-dependent manner, suppressed by heparin. Aggregation of healthy donor platelets by patient sera was demonstrated in the presence of buffer or AZD1222 and was also suppressed by heparin. Anticoagulation alone or in combination with eculizumab or intravenous immunoglobulin (IVIG) resolved the pathology in 3 patients. Two patients had thromboembolic events despite anticoagulation at a time when platelets were increasing after IVIG. In summary, an unexpected autoimmune prothrombotic disorder is described after vaccination with AZD1222. It is characterized by thrombocytopenia and anti-PF4 antibodies binding to platelets in AZD1222-dependent manner. Initial clinical experience suggests a risk of unusual and severe thromboembolic events.”

68: Immune thrombocytopenic purpura and acute liver injury after COVID-19 vaccine | BMJ Case Reports

Author Hines et al

Country: US

Date Published Online: 7/30/21

Vaccine: Moderna

Diagnoses: ITPP

Link: https://casereports.bmj.com/content/14/7/e242678

Case: “A 26-year-old woman was sent to the emergency room by her primary care physician for a new petechial rash and thrombocytopenia 2 weeks after receiving the Moderna mRNA-1273 SARS-CoV-2 vaccine. Her hospital course was complicated by transaminitis. Her platelet count improved to normal on hospital day 5 after receiving intravenous steroids and intravenous immunoglobulin to treat her suspected diagnosis of immune thrombocytopenic purpura. Extensive workup for her thrombocytopenia and transaminitis was unremarkable including ruling out infectious, autoimmune and toxic causes. A liver biopsy was unrevealing and her transaminitis was improved on discharge. Although not proven, the temporal relationship of her vaccination with thrombocytopenia and abnormal liver enzymes points towards the Moderna mRNA-1273 SARS-CoV-2 vaccine as the most likely inciting factor.”

69: Vaccine Induced Immune Thrombotic Thrombocytopenia Causing a Severe Form of Cerebral Venous Thrombosis With High Fatality Rate: A Case Series - PubMed

Author Wiedmann et al

Country: Norway

Date Published Online: 7/30/21

Vaccine: AstraZeneca

Diagnoses: VITT, CVT, ICH, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34393988/

Case: “During a 2-week period, we have encountered five cases presenting with the combination of cerebral venous thrombosis (CVT), intracerebral hemorrhage and thrombocytopenia. A clinical hallmark was the rapid and severe progression of disease in spite of maximum treatment efforts, resulting in fatal outcome in for 4 out of 5 patients. All cases had received ChAdOx1 nCov-19 vaccine 1-2 weeks earlier and developed a characteristic syndrome thereafter. The rapid progressive clinical course and high fatality rate of CVT in combination with thrombocytopenia in such a cluster and in otherwise healthy adults is a recent phenomenon. Cerebral autopsy findings were those of venous hemorrhagic infarctions and thrombi in dural venous sinuses, including thrombus material apparently rich in thrombocytes, leukocytes and fibrin. Vessel walls were free of inflammation. Extra-cerebral manifestations included leech-like thrombi in large veins, fibrin clots in small venules and scattered hemorrhages on skin and membranes. CVT with thrombocytopenia after adenovirus vectored COVID-19 vaccination is a new clinical syndrome that needs to be recognized by clinicians, is challenging to treat and seems associated with a high mortality rate.”

70: Thrombocytopenia in a teen with sickle cell disease following COVID‐19 vaccination - PMC

Author Underdown & Nuss

Country: US

Date Published Online: 7/31/21

Vaccine: Pfizer

Diagnoses: TCP, VOE

Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8441926/

Case: “A 14‐year‐old male with homozygous sickle cell disease (SCD), chronically prescribed hydroxyurea and voxelotor, with variable adherence, presented with bilateral anterior hip and back pain that began 3 days earlier.”

“Following extension of the FDA emergency use authorization for the Pfizer‐BioNTech COVID‐19 vaccination to include adolescents 12–15 years of age, he received his first dose of the Pfizer COVID‐19 vaccine 23 days prior to presentation.”

“He was admitted to the hospital for 4 days for management of VOE. Labs were trended closely due to concern that thrombocytopenia was secondary to splenic sequestration.”

“Although we cannot state with certainty that this patient's VOE and thrombocytopenia were related to the Pfizer‐BioNTech COVID‐19 vaccine, it is highly suspicious.”

71: Cerebral venous sinus thrombosis associated with vaccine-induced thrombotic thrombocytopenia - PubMed

Author Yahyavi-Firouz-Abadi & Naik

Country: US

Date Published Online: 8/1/21

Vaccine: J&J

Diagnoses: CVST, VITT, DVT, VO

Link: https://pubmed.ncbi.nlm.nih.gov/34333995/

Case: “This is a report of a case of vaccine-induced thrombotic thrombocytopenia and associated cerebral venous sinus thrombosis with emphasis on imaging and clinical course.”

“A woman in her 30s developed headaches 10 days after receiving Ad26.COV2.S Janssen vaccine followed by thrombocytopenia (platelet 80 × 103/μL) and worsening head and neck pain 15 days after vaccination. Head CT (Figure 1(a)) was negative for acute infarct or hemorrhage but demonstrated subtle increased density of the right transverse and sigmoid sinuses suspicious for dural venous sinus thrombosis. A week later, she developed left lower extremity pain and weakness. Duplex ultrasound demonstrated acute deep venous thrombosis involving posterior tibialis and popliteal veins. Magnetic resonance venography (Figure 1(b)) and CT venography (Figure 1(c)) performed demonstrated a large near occlusive thrombus in the right transverse sinus extending to the right sigmoid sinus and jugular bulb (‘empty delta sign’).”

72: Three cases of acute venous thromboembolism in females after vaccination for coronavirus disease 2019 - PubMed

Author Andraska et al

Country: US

Date Published Online: 8/2/21

Vaccine: Moderna

Diagnoses: VTE, DVT, PE, MT

Link: https://pubmed.ncbi.nlm.nih.gov/34352418/

Case: “To the best of our knowledge, we are the first to report venous thrombotic complications within days of administration of the mRNA-1273 (Moderna) vaccine. We present a series of three women who developed venous thromboembolism after RNA-1273 vaccination at a single healthcare system.”

“Patient 1: An otherwise healthy 25-year-old woman had presented to the emergency department 2 days after receiving the first of the mRNA-1273 vaccine series with acute-onset shortness of breath and dyspnea on exertion. [..] An echocardiogram was performed, which revealed mild to moderate right ventricular strain. Computed tomography angiography (CTA) with a dedicated pulmonary embolism (PE) protocol (CTA-PE) revealed bilateral segmental PE (Fig 1 ).”

“Patient 2: A 77-year-old woman with a history of gastrointestinal bleeding had presented to the emergency department with a 4-day history of shortness of breath. She had received the first of the mRNA-1273 vaccine series 3 days before symptom onset. [..] The echocardiogram showed mild right ventricular strain. The CTA-PE was notable for bilateral segmental PE (Fig 2 ). Venous Doppler ultrasound scans revealed DVT of the right common femoral, femoral, and profunda veins.”

“Patient 3: An 84-year-old woman had presented with an 8-day history of left leg pain and swelling. Her symptoms had started 3 days after receiving the second injection of the mRNA-1273 vaccine series. The CTA-PE showed no PE but revealed thrombus in the common femoral vein (Fig 3 ). Venous duplex ultrasound confirmed left common femoral, popliteal, and peroneal DVT.”

73: Malignant cerebral infarction after ChAdOx1 nCov-19 vaccination: a catastrophic variant of vaccine-induced immune thrombotic thrombocytopenia - PubMed

Author De Michele et al

Country: Italy

Date Published Online: 8/2/21

Vaccine: AstraZeneca

Diagnoses: VITT, CVT, MCI, PVT, AT, PT, MT

Link: https://pubmed.ncbi.nlm.nih.gov/34341358/

Case: “Here we report two cases of malignant middle cerebral artery (MCA) infarct and thrombocytopenia 9-10 days following ChAdOx1 nCoV-19 vaccination. The two cases arrived in our facility around the same time but from different geographical areas, potentially excluding epidemiological links; meanwhile, no abnormality was found in the respective vaccine batches. Patient 1 was a 57-year-old woman who underwent decompressive craniectomy despite two prior, successful mechanical thrombectomies. Patient 2 was a 55-year-old woman who developed a fatal bilateral malignant MCA infarct. Both patients manifested pulmonary and portal vein thrombosis and high level of antibodies to platelet factor 4-polyanion complexes. None of the patients had ever received heparin in the past before stroke onset. Our observations of rare arterial thrombosis may contribute to assessment of possible adverse effects associated with COVID-19 vaccination.”

74: Immune thrombocytopenia associated with Pfizer-BioNTech's BNT162b2 mRNA COVID-19 vaccine

Author Akiyama et al

Country: Japan

Date Published Online: 8/4/21

Vaccine: Pfizer

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34381692/

Case: “We report the case of a 20-year-old woman who developed ITP after receiving Pfizer-BioNTech's BNT162b2 vaccine. She had generalized subcutaneous hemorrhage, 14 days after vaccination. At the time of our visit, she had marked thrombocytopenia and intraoral bleeding; she was diagnosed with ITP.”

75: Vaccine-induced severe thrombotic thrombocytopenia following COVID-19 vaccination: a report of an autoptic case and review of the literature - PubMed

Author Fanni et al

Country: Italy

Date Published Online: 8/6/21

Vaccine: AstraZeneca

Diagnoses: VITT, MIT, MT, FT, PVT, TCP, CT

Link: https://pubmed.ncbi.nlm.nih.gov/34355379/

Case: “A 58-year-old man, after 13 days from the first administration of ChAdOx1 nCoV-19 vaccine (AstraZeneca), presented with abdominal pain, diarrhea and vomitus. Laboratory tests revealed a severe thrombocytopenia, low fibrinogen serum levels and marked increase of D-dimer serum levels. The patient quickly developed a multiple organ failure, till death, three days after the hospital admission.”

“At histology, in the lungs, interalveolar septa appeared thickened with microthrombi in the capillaries and veins. Interalveolar septa appeared thickened and showed vascular proliferation. Thrombi were detected in the capillaries of glomerular tufts. In the hearth, thrombi were observed in veins and capillaries. In the liver, voluminous fibrin thrombi were diffusely observed in the branches of the portal vein. Microthrombi were also found in the vasa vasorum of the wall of abdominal aorta. In the brain, microthrombi were observed in the capillaries of the choroid plexuses. Diffuse hemorrhagic necrosis was observed in the intestinal wall with marked congestion of the venous vessels.”

“In our patient, the majority of data necessary for a VITT final diagnosis were present: thrombocytopenia and thrombosis in pulmonary, portal, hepatic, renal and mesenteric veins, associated with a marked increase of D-dimer serum levels. The finding of cerebral thrombosis in choroid plexuses, is a new finding in VITT. These features are suggestive for a very aggressive form of VITT.”

76: Intracerebral Hemorrhage due to Thrombosis with Thrombocytopenia Syndrome after Vaccination against COVID-19: the First Fatal Case in Korea - PubMed

Author Choi et al

Country: Korea

Date Published Online: 8/9/21

Vaccine: AstraZeneca

Diagnoses: ICH, TTS, CVST, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34402235/

Case: “Herein, we describe the first fatal case of thrombosis with thrombocytopenia syndrome in Korea, presenting with intracranial hemorrhage caused by cerebral venous sinus thrombosis. A 33-year-old Korean man received the first dose of the ChAdOx1 nCoV-19 vaccination. He developed severe headache with vomiting 9 days after the vaccination. Twelve days after vaccination, he was admitted to the hospital with neurological symptoms and was diagnosed with cerebral venous sinus thrombosis, which was accompanied by intracranial hemorrhage. Thrombocytopenia and D-dimer elevation were observed, and the result of the PF4 enzyme-linked immunosorbent assay antibody test was reported to be strongly positive. Despite intensive treatment, including intravenous immunoglobulin injection and endovascular mechanical thrombectomy, the patient died 19 days after vaccination.”

77: Relapse of immune thrombotic thrombocytopenic purpura following vaccination with COVID19 mRNA vaccine

Author Pavenski

Country: Canada

Date Published Online: 8/9/21

Vaccine: Pfizer

Diagnoses: ITTP

Link: https://pubmed.ncbi.nlm.nih.gov/34568744/

Case: “An 84 year old male with a previous history of immune thrombotic thrombocytopenic purpura (iTTP) received the first dose of COVID19 mRNA vaccine (Pfizer-Biontech). Seven days later he was diagnosed with iTTP relapse. He received in-patient treatment with therapeutic plasma exchange, high dose steroids and rituximab and subsequently recovered.”

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

Author Wiest et al

Country: US

Date Published Online: 8/9/21

Vaccine: Moderna

Diagnoses: PE

Link: https://pubmed.ncbi.nlm.nih.gov/34452028/

Case: “A 66-year-old male with past medical history of hypertension, hyperlipidemia, and surgically resected renal cell carcinoma (RCC) presented to the emergency department with a chief complaint of right flank pain and right pleuritic chest pain. He was in his usual state of health until he received his second dose of the Moderna SARS-CoV-2 vaccine dose 10 days prior. 24 h after the immunization he experienced fevers, chills, and arthralgias that transitioned to progressive right-sided flank pain and pleuritic chest pain.”

“However, PE-protocol CT angiogram of the chest demonstrated extensive multifocal pulmonary emboli involving both right and left lower lobe pulmonary arteries with evidence of right ventricular strain (Figure 1).”

79: Venous Thromboembolism and Mild Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination - PMC

Author Gabarin et al

Country: Canada

Date Published Online: 8/12/21

Vaccine: AstraZeneca

Diagnoses: VTE, TCP, PE, DVT, TCP, VITT, MT

Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8632250/

Case: “Here we report two patients with VITT presenting as lower limb venous thrombosis (one with concurrent pulmonary embolism) and mild thrombocytopenia.”

“Case 1: A 68-year-old male received his first dose of ChAdOx1 nCoV-19 vaccine (day 0). On day 31, he noted left leg swelling and erythema. Two days later he presented to an urgent care center with clinical evidence of left lower limb deep-vein thrombosis (DVT). [..] Doppler ultrasound demonstrated extensive left lower limb DVT involving the mid-superficial femoral vein and extending into the popliteal vein and its trifurcation.”

“Case 2: A 55-year-old male received his ChAdOx1 nCoV-19 vaccine (day 0). From day 8 to day 11, he experienced an intermittent, bitemporal headache (7/10 severity) that was pulsatile in nature, without focal neurologic deficits. On day 11, he experienced dyspnea on exertion and cough; his respiratory symptoms worsened over the next few days. On day 15, he experienced small-volume hemoptysis (without other bleeding) and attended the emergency department. The platelet count was 103 × 10 9 /L; the patient's usual platelet count was 265 × 10 9 /L ( Fig. 1B ). His D-dimer was >20 mg/L. Contrast tomography (CT) imaging of his chest demonstrated bilateral pulmonary emboli with evidence of saddle embolism. There were no echocardiographic findings of right heart strain and he was hemodynamically stable. Doppler ultrasound showed a left lower limb DVT, with partially occlusive thrombus in the distal superficial femoral vein extending into the popliteal vein.”

80: Immune-mediated thrombotic thrombocytopenic purpura following Pfizer-BioNTech COVID-19 vaccine

Author Giuffrida et al

Country: Italy

Date Published Online: 8/12/21

Vaccine: Pfizer

Diagnoses: ITPP, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34382388/

Case: “Case 1: In April 2021, an 83-year-old female patient was admitted to the emergency room with severe anemia and macrohematuria, in the absence of fever, neurological signs and renal impairment. On clinical examination, diffuse petechiae and venipuncture hematomas were observed. The patient suffered from undifferentiated connective tissue disease treated with low-dose steroids and steroid-induced diabetes mellitus. The woman had been administered the first dose of Pfizer-BioNTech COVID-19 vaccine 14 days prior to the admission. One week before the admission, the patient was treated briefly at another center because of fatigue and the appearance of petechiae. A complete blood count revealed grade 3 anemia (hemoglobin 6.1 g/dL) and thrombocytopenia (platelet count 46x109/L), requiring transfusion support. However, the patient refused hospital admission and was discharged. Seven days later, on admission to our center, the complete blood count again showed severe anemia (hemoglobin 5.6 g/dL) and thrombocytopenia (platelet count 23x109/L) with a normal white blood cell count. Markers of hemolysis were present, including increased reticulocytes, increased lactate dehydrogenase (1905 U/L, normal values [n.v:] 0-248), increased unconjugated bilirubin (5.5 mg/dL, n.v: 0.30-1.20) and reduced haptoglobin (<7 mg/dL) (Table 2). [..] A rapid ADAMTS13 test was performed demonstrating markedly reduced activity (below 10%) with a high titer of anti- ADAMTS13 antibodies according to enzyme-linked immunosorbent assay (ELISA) in serum (40 U/mL, n.v. 12-15), thus confirming the diagnosis of immune-mediated TTP.”

“Case 2: In June 2021, a 30-year-old woman, a b-thalassemia carrier, was admitted to the emergency room because of the appearance of diffuse petechiae, intense headache and fatigue. The patient had received her first dose of the Pfizer-BioNTech COVID-19 vaccine 18 days before the admission. On admission, a complete blood count revealed the presence of anemia (hemoglobin 8.9 g/dL) and thrombocytopenia (platelet count 11x109/L), with a normal white blood cell count (9.2x109/L). Total body computed tomography was negative. A peripheral blood smear showed the presence of schistocytes (5-10% per field). Investigations for hemolysis were positive, while both direct and indirect Coombs tests were negative.”

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

Author Jasaraj et al

Country: US

Date Published Online: 8/13/21

Vaccine: Pfizer

Diagnoses: ITPP, hemo

Link: https://pubmed.ncbi.nlm.nih.gov/34513446/

Case: “We present a case of a 67-year-old female who presented with ITP following the second dose of the Pfizer-BioNTech vaccine.

A 67-year-old Hispanic female with a past medical history of hypertension, type 2 diabetes mellitus, hypothyroidism, depression, vitamin B12 deficiency, and chronic cluster headaches was referred to our hospital from the clinic after she was found to have low platelet levels.”

“The patient had received the first dose of the Pfizer Bio-NTech COVID-19 vaccine about two months before hospitalization. She developed mild petechial rashes on her legs and chest after two weeks of the first dose of the vaccine. Rashes were insidious in onset and were non-pruritic. She denies any other adverse effects after her first dose of the vaccine. However, two days after her second dose of the vaccine, the patient noticed a rapid rash progression throughout her body without resolution of the rash (Figure 1). She also noticed bleeding in her gums when brushing her teeth and had an episode of epistaxis that resolved spontaneously. In addition, she developed a subconjunctival hemorrhage in the right eye (Figure ​(Figure2)2) and hemorrhagic lesions of the tongue and buccal mucosa. On a subsequent clinic follow-up, her platelet count was found to be 3,000/µL, and she was referred to our hospital.”

82: A rare case of vaccine-induced immune thrombosis and thrombocytopenia and approach to management

Author Kotal et al

Country: India

Date Published Online: 8/16/21

Vaccine: AstraZeneca

Diagnoses: VITT, TCP, CSVT

Link: https://pubmed.ncbi.nlm.nih.gov/34513173/

Case: “We report here a case of VITT in a young female who presented 11 days after receiving the first dose of the Covishield vaccine, with severe headache and hemiparesis. She was diagnosed with CSVT with a large intraparenchymal bleed, requiring decompressive craniectomy and extended period on mechanical ventilation.”

“The patient was successfully treated with intravenous immunoglobulin and discharged after 19 days in ICU. Although she was left with long-term neurological deficits, an early presentation and a multidisciplinary approach to management contributed toward a relatively short stay in hospital and avoided mortality.”

83: Imaging and Hematologic Findings in Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 (AstraZeneca) Vaccination - PubMed

Author Gangi et al

Country: UK

Date Published Online: 8/17/21

Vaccine: AstraZeneca

Diagnoses: VITT, TCP, VT, AT, MT

Link: https://pubmed.ncbi.nlm.nih.gov/34402666/

Case: “This case series reports six patients (four men and two women; median age, 38 years; interquartile range, 26-48 years) who presented with vaccine-induced thrombocytopenia and thrombosis beginning 3-26 days after receiving the first dose of the ChAdOx1 nCoV-19 (AstraZeneca) vaccine for COVID-19. The patients were admitted to a general hospital between 9 and 31 days after the first dose. All patients had strongly detected antiplatelet factor 4 antibodies and severe thrombosis. Laboratory features included thrombocytopenia and elevated d-dimer levels. Thrombotic events were predominantly venous; two patients had arterial or mixed arterial and venous thrombosis. All patients recovered after receiving intravenous immunoglobulin and nonheparin-based anticoagulation.”

84: Thrombotic thrombocytopenic purpura temporally associated with BNT162b2 vaccination in an adolescent successfully treated with caplacizumab

Author Kirpalani et al

Country: Canada

Date Published Online: 8/17/21

Vaccine: Pfizer

Diagnoses: TTCPP, iTTP

Link: https://pubmed.ncbi.nlm.nih.gov/34405400/

Case: “A 14‐year‐old female presented to a community hospital with a two‐day history of fatigue, headache, confusion, and bruising. She had a long‐standing history of anxiety, iron deficiency, and postprandial abdominal pain. She received the first dose of the BNT162b2 vaccine two weeks prior to presentation. Her neurological examination and head computed tomography (CT) were both normal. Her laboratory investigations showed a haemolytic anaemia with a haemoglobin of 63 g/l, platelets <10 × 1012/l, bilirubin 68 µmol/l, lactate dehydrogenase (LDH) 626 µ/l, haptoglobin <0·10 g/l, and the occasional red cell fragment noted on blood film. She had a PLASMIC score of 6 and was transferred to our tertiary‐care paediatric centre with a suspicion of TTP.

The diagnosis of iTTP was confirmed with urgent ADAMTS13 activity testing showing a level of <1% and ADAMTS13 IgG of 72 µ/ml.”

85: Adjunct Immune Globulin for Vaccine-Induced Immune Thrombotic Thrombocytopenia - PubMed

Author Bourguignon et al

Country: Canada

Date Published Online: 8/19/21

Vaccine: AstraZeneca

Diagnoses: VITT, AT, CVT

Link: https://pubmed.ncbi.nlm.nih.gov/34107198/

Case: “We describe the response to IVIG therapy in three of the first patients in whom VITT was identified in Canada after the receipt of the ChAdOx1 nCoV-19 vaccine. The patients were between the ages of 63 and 72 years; one was female. At the time of this report, Canada had restricted the use of the ChAdOx1 nCoV-19 vaccine to persons who were 55 years of age or older on the basis of reports that VITT had occurred primarily in younger persons. Two of the patients in our study presented with limb-artery thrombosis; the third had cerebral venous and arterial thrombosis. Variable patterns of serum-induced platelet activation were observed in response to heparin and platelet factor 4 (PF4), indicating the heterogeneity of the manifestations of VITT in serum. After the initiation of IVIG, reduced antibody-induced platelet activation in serum was seen in all three patients.”

86: Immune-Mediated Thrombocytopenia Associated With Ad26.COV2.S (Janssen; Johnson & Johnson) Vaccine

Author Banerjee et al

Country: US

Date Published Online: 8/20/21

Vaccine: J&J

Diagnoses: ITP, TCP

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415511/

Case: “Here, we present a case report of an elderly woman presenting with life-threatening thrombocytopenia after receiving the Ad26.COV2.S (Janssen; Johnson & Johnson, New Brunswick, NJ) vaccine. To the best of our knowledge, this is the first publication of isolated severe thrombocytopenia in a patient with no pre-existing risk factors after receiving the Ad26.COV2.S vaccine.”

“A 63-year-old woman with a medical history of cervical cancer status after total hysterectomy, presented to the hospital with complaints of bleeding from her gums for the past 3 days. Seventeen days before presentation, the patient had received the Ad26.COV2.S (Janssen; Johnson & Johnson) vaccine. She did not experience any major side effects after her vaccination except for muscle soreness at the administration site. [..] She started experiencing bleeding in her gums 3 days before presentation. She later had sudden onset nose bleeds which prompted her to go to the emergency department.”

87: Newly diagnosed immune thrombocytopenia in a pregnant patient after coronavirus disease 2019 vaccination - PubMed

Author Bennett et al

Country: US

Date Published Online: 8/22/21

Vaccine: Moderna

Diagnoses: ITP, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34420249/

Case: “A 32‐year‐old healthy G1P0 patient at 8 6/7 weeks of gestation was admitted for hospitalization in the setting of acute‐onset bruising and petechiae. The patient received the first injection of the Moderna mRNA‐1273 vaccine through her workplace 13 days before admission, with development of a petechial rash 11 days after vaccine administration (Figure 1).”

“A peripheral smear was obtained, which was notable only for thrombocytopenia on hematologic review.”

88: Thrombotic thrombocytopenic purpura presentation in an elderly gentleman following COVID vaccine circumstances

Author Chamarti et al

Country: US

Date Published Online: 8/27/21

Vaccine: Pfizer

Diagnoses: TTP

Link: https://pubmed.ncbi.nlm.nih.gov/34447649/

Case: “We present a case of an 80-year-old male with a known medical history of hypertension, type II diabetes mellitus, hyperlipidemia, gout, iron deficiency anemia, and Pfizer-BioNTech COVID-19 (coronavirus disease-19) vaccine administered two weeks before presentation to the ER for evaluation of generalized weakness and malaise. Laboratory findings showed severe anemia with hemoglobin of 4.8 g/dl, platelet count of 48 x 10^3/mcL, elevated lactate dehydrogenase (LDH), decreased haptoglobin, and peripheral smear showing schistocytes. The serum creatinine, total bilirubin, and troponin were elevated. All these findings were raising concern for presumptive diagnosis of TTP, which was confirmed with ADAMTS13 levels less than 10%. TTP was temporarily resolved in 10 days with plasma exchange therapy and high-dose corticosteroids.”

89: Renal thrombotic microangiopathy in concurrent COVID-19 vaccination and infection

Author Angelini et al

Country: Italy

Date Published Online: 8/28/21

Vaccine: Pfizer

Diagnoses: RTM

Link: https://pubmed.ncbi.nlm.nih.gov/34451509/

Case: “We report on the development of nephrotic proteinuria and microhematuria, with histological features of renal thrombotic microangiopathy (TMA), following the first dose of BNT162b2 COVID-19 vaccine (Pfizer-BioNTech) and COVID-19 diagnosis. A 35-year-old previously healthy man was admitted at our hospital due to the onset of foamy urine. Previously, 40 days earlier, he had received the first injection of the vaccine, and 33 days earlier, the RT-PCR for SARS-CoV-2 tested positive. Laboratory tests showed nephrotic proteinuria (7.9 gr/day), microhematuria, serum creatinine 0.91 mg/dL. Kidney biopsy revealed ultrastructural evidence of severe endothelial cell injury suggestive of a starting phase of TMA. After high-dose steroid treatment administration, complete remission of proteinuria was achieved in a few weeks. The association of COVID-19 with renal TMA has been previously described only in patients with acute renal injury. Besides, the correlation with COVID-19 vaccine has not been reported so far. The close temporal proximity (7 days) between the two events opens the question whether the histological findings should be ascribed to COVID-19 itself or to vaccine injection.”

90: Deterioration of vaccine-induced immune thrombotic thrombocytopenia treated by heparin and platelet transfusion: Insight from functional cytometry and serotonin release assay

Author Bérezné et al

Country: France

Date Published Online: 9/1/21

Vaccine: AstraZeneca

Diagnoses: VITT, CVST, SAH

Link: https://pubmed.ncbi.nlm.nih.gov/34485807/

Case: “We report a case of a 62-year-old man who developed cerebral venous sinus thrombosis with subarachnoid hemorrhage and concomitant thrombocytopenia, which occurred 13 days after ChAdOx1 nCov-19 injection. The patient died in the intensive care unit after heparin infusion and platelet transfusion. The key clinical purpose of this case report is to better understand how to confirm vaccine-induced immune thrombotic thrombocytopenia (VITT). VITT diagnosis was made using 14C-serotonin release and flow cytometry evaluating activation and platelet microvesicles on washed platelets. Four control patients were examined: a patient with heparin-induced thrombocytopenia (HIT), two patients with thrombotic events without thrombocytopenia after ChAdOx1 nCov-19 or BNT162b2, and a patient with suspected HIT and an excluded diagnosis. We evidenced in the VITT case a high level of IgG anti-platelet factor 4-heparin antibodies associated with a high level of platelet activation in the absence of heparin. Conversely, the functional assays were negative in the patients with thrombosis without thrombocytopenia.”

91: Central Venous Sinus Thrombosis with Subarachnoid Hemorrhage Following an mRNA COVID-19 Vaccination: Are These Reports Merely Co-Incidental?

Author Syed et al

Country: US

Date Published Online: 9/3/21

Vaccine: Moderna

Diagnoses: ICH, SAH, CVST

Link: https://pubmed.ncbi.nlm.nih.gov/34478433/

Case: “A healthy 45-year-old male patient without any risk factors presented with new-onset seizures 8 days after the receipt of the 2nd dose of Moderna (mRNA-1273), with concomitant SAH as a complication. One day prior to admission, he noted headaches and neck pain unrelieved by over-the-counter analgesics. Computed tomography (CT) scan brain without contrast revealed a left frontal lobe intracerebral hemorrhage (ICH) along with subarachnoid hemorrhage (SAH). A subsequent contrast-enhanced magnetic resonance imaging (MRI) brain confirmed the CT findings as well as anterior superior sagittal sinus thrombosis. He had normal platelet count with a negative thrombophilia work-up and cancer screening. He was successfully anticoagulated with heparin and discharged on warfarin without neurological sequelae or further seizures.”

92: ChAdOx1 nCoV-19 vaccine-associated thrombocytopenia: three cases of immune thrombocytopenia after 107 720 doses of ChAdOx1 vaccination in Thailand - PubMed

Author Uaprasert et al

Country: Thailand

Date Published Online: 9/7/21

Vaccine: AstraZeneca

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34483267/

Case: “We reported three cases of immune thrombocytopenia (ITP) that developed within 6 weeks after ChAdOx1 nCoV-19 vaccination. Antiplatelet factor 4 antibodies were undetectable in all three cases. Therefore, vaccine-induced immune thrombotic thrombocytopenia was very unlikely. Other potential causes of thrombocytopenia were excluded. Their clinical presentations, severity of thrombocytopenia and outcomes were varied. Only one ITP case, an 80-year-old man, received ITP treatments and achieved complete response after 2 weeks of eltrombopag. An 84-year-old man had spontaneous complete remission, and a 55-year-old woman had partial platelet recovery without ITP treatments.”

93: COVID-19 Vaccine-Induced Thrombotic Thrombocytopenia: A Case Series - PubMed

Author Alalwan et al

Country: UK

Date Published Online: 9/13/21

Vaccine: AstraZeneca

Diagnoses: VITT, AT, MT, PE, PVT, SVT, MI, VO, CVT

Link: https://pubmed.ncbi.nlm.nih.gov/34527501/

Case: “We report four individuals with VITT, who had positive platelet factor 4 (PF4) antibodies via enzyme-linked immunosorbent assays (ELISAs) after receiving their first dose of ChAdOx1 CoV-19 vaccine.”

“Case 1: A 47-year-old man, who has a history of hypertension and diverticular disease, presented seven days after vaccination with infero-posterior ST-segment elevation myocardial infarction requiring urgent percutaneous coronary intervention (PCI), thrombosis of distal right coronary artery (RCA) and the posterior descending artery (PDA), multiple pulmonary emboli, and left atrial appendage thrombus Figures1A, 1B).”

“Case 2: A previously healthy 48-year-old man presented five days after vaccination with the complete portal vein and splenic vein thrombosis, right kidney upper pole segmental infarct, acute right internal iliac artery thrombosis, and an occlusive thrombus within the straight sinus, inferior sagittal sinus, and right transverse sinus extending to the internal jugular vein (Figures ​(Figures2A2A-​-2C).2C).”

“Case 3: A 54-year-old man, with a previous history of Guillain-Barre syndrome two years ago, presented 15 days after vaccination with cerebral venous thrombosis (CVT) involving the left-sided transverse and sigmoid sinuses as well as the left jugular vein. The CVT was associated with recurrent tonic-clonic seizures for which he was kept on levetiracetam daily, requiring a short stay in the intensive care unit.”

“Case 4: A 29-year-old man, with a history of Janus kinase 2 (JAK-2) negative polycythemia, cardiomyopathy, and malabsorption, presented 12 days after vaccination with CVT affecting the transverse sinuses bilaterally and superior sagittal sinus. His CVT was complicated by an episode of tonic-clonic seizure and bilateral frontal venous infarcts.”

94: Recurrence of Thrombotic Thrombocytopenic Purpura after mRNA-1273 COVID-19 Vaccine Administered Shortly after COVID-19

Author Karabulut et al

Country: US

Date Published Online: 9/13/21

Vaccine: Moderna

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34552799/

Case: “The patient is a 48-year-old Caucasian male who presented complaining of acute-onset, transient right-sided weakness and slurred speech lasting approximately 30 minutes in addition to paresthesia five days after his first dose of COVID-19 mRNA vaccine (Moderna mRNA-1273 vaccine). [..] The constellation of hemolytic anemia, thrombocytopenia, and transient neurological symptoms was concerning for a TTP relapse. The PLASMIC score used to predict ADAMTS13 deficiency in suspected TTP patients was 7 points showing that the patient is at high risk of having severe ADAMTS13 deficiency, thus requiring emergent plasmapheresis.”

95: Intracerebral Hemorrhage and Thrombocytopenia After AstraZeneca COVID-19 Vaccine: Clinical and Diagnostic Challenges of Vaccine-Induced Thrombotic Thrombocytopenia - PubMed

Author Wilting et al

Country: Netherlands

Date Published Online: 9/13/21

Vaccine: AstraZeneca

Diagnoses: VITT, ICH, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34646685/

Case: “A 27-year-old woman presented at the emergency department with acute left-sided hemiparesis and persistent headache, nausea, and vomiting for six days. [..] Fourteen days before presentation, she received the first dose of the Oxford-AstraZeneca vaccine. Upon arrival at the emergency department, the initial neurological examination showed a Glasgow Coma Scale of E4M6V1 with anisocoria, roving eye movements, left spastic hemiparesis, and bilateral Babinski signs. Cerebral computed tomography (CT) showed a large intraparenchymal hemorrhage in the right hemisphere causing significant mass effect and midline shift, without evidence of an underlying vascular malformation or sinus thrombosis (Figure ​(Figure1). Laboratory1). Laboratory results revealed pronounced thrombocytopenia with extremely elevated D-dimer, elevated international normalized ratio (INR), and low fibrinogen (Table ​(Table11).”

96: Symptomatic peduncular, cavernous bleeding following SARS-CoV-2 vaccination induced immune thrombocytopenia - PubMed

Author Finsterer & Redzic

Country: Austria

Date Published Online: 9/16/21

Vaccine: Pfizer

Diagnoses: VITT, TCP, ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34549178/

Case: “The patient is a 68yo male who experienced gait disturbance and hypoesthesia of the left face and left upper extremity two days after the second dose of the mRNA-based SARS-CoV-2 vaccine BNT162b2 (Tozinameran). Clinical neurologic exam revealed hypoesthesia of the left face and the left upper extremity and ataxic gait. Blood tests revealed macrocytic anemia and marked thrombocytopenia, interpreted as vaccination induced immune thrombocytopenia (ITP). Cerebral MRI revealed subacute bleeding within a pre-existing solitary cavernoma located in the right cerebellar peduncle. With proceeding resorption of the bleeding, symptoms gradually regressed. This case shows that SARS-CoV-2 vaccinations may be followed by ITP and bleeding in pre-existing vascular malformations. In order to avoid cavernoma bleeding in patients with SARS-CoV-2 vaccination associated ITP and thrombocyte dysfunction, urgent treatment of ITP is warranted. In order to identify patients at risk for experiencing SARS-CoV-2 vaccination induced ITP, further studies are urgently warranted.”

97: A rare case of COVID-19 vaccine-induced thrombotic thrombocytopaenia (VITT) involving the veno-splanchnic and pulmonary arterial circulation, from a UK district general hospital - PubMed

Author Asmat et al

Country: UK

Date Published Online: 9/17/21

Vaccine: AstraZeneca

Diagnoses: VITT, PE, PVT

Link: https://pubmed.ncbi.nlm.nih.gov/34535492/

Case: “A 47-year-old woman presented with a headache to the acute medical unit, 10 days after receiving AstraZeneca vaccination for COVID-19. Brain imaging was normal, but her blood tests showed a remarkably low platelet count, mildly deranged liver function tests and a high D-dimer. Further within her hospital admission, she developed right-sided abdominal pain and chest pain, and subsequent cross-sectional imaging confirmed a small segmental pulmonary embolism, and an acute portal vein thrombosis extending to the splenic and superior mesenteric veins. On the basis of her investigations, she was diagnosed as a case of vaccine-induced thrombotic thrombocytopenia and was treated with intravenous immunoglobulins.”

98: Cerebral Venous Sinus Thrombosis After Pfizer-BioNTech COVID-19 (BNT162b2) Vaccination

Author Cheng

Country: Korea

Date Published Online: 9/17/21

Vaccine: Pfizer

Diagnoses: CVST, SAH, VI

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490890/

Case: “A 61-year-old Chinese male with diabetes mellitus had received his first dose of the BNT162b2 vaccine on March 19, 2021. He reported soreness at the local injection site lasting for a few days, but did not experience fever, headache, or flu-like symptoms. He was asymptomatic before receiving his second dose of the BNT162b2 vaccine on April 10, 2021. Five days thereafter he complained of worsening generalized headache associated with persistent vomiting over the following 2 days, leading to his hospital presentation. [..] A computed tomography (CT) scan of the brain on admission revealed acute subarachnoid hemorrhage (SAH) along the left frontal lobe sulci (Fig. 1A).

On the following day, the patient was witnessed to have a focal-onset motor seizure involving left head version and left upper limb tonic-clonic jerking lasting for 5 minutes. Repeat brain CT revealed several new acute intraparenchymal hematomas in the right frontal lobe with overlying hyperdense cortical draining veins (Fig. 1B and C).

Brain magnetic resonance imaging with venography subsequently showed thrombosis of the entire superior sagittal sinus extending to the medial portion of the right transverse sinus (Fig. 1D). Additional findings included bilateral frontal lobe cortical vein thrombosis, partial thrombosis of bilateral sigmoid sinuses, right frontal lobe intraparenchymal hemorrhage with edema that was consistent with a venous infarct, and bilateral frontal and parietal convexity SAH.”

99: Immune thrombocytopenia in 2 healthy young women after the Pfizer-BioNTech BNT16B2b2 messenger RNA coronavirus disease 2019 vaccination

Author Collins et al

Country: US

Date Published Online: 9/27/21

Vaccine: Pfizer

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34568869/

Case: “We present 2 cases of acute ITP after the Pfizer‐BioNTech coronavirus disease 2019 vaccine. The first is a 20‐year‐old woman presenting 2 days after her second dose of the vaccine (no significant adverse reaction to the first dose) with fevers, tachycardia, and no evidence of bleeding. The second is a 21‐year‐old woman presenting 11 days after the first dose of the vaccine with 2 days of a petechial rash located on the extremities and trunk and in her mouth as well as abnormal bruising on extremities.”

100: Acute ST-segment elevation myocardial infarction secondary to vaccine-induced immune thrombosis with thrombocytopaenia (VITT)

Author Flower et al

Country: UK

Date Published Online: 9/27/21

Vaccine: AstraZeneca

Diagnoses: VITT, AO, MI, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34580132/

Case: “A 40-year-old man with no cardiac history presented with central chest pain 8 days after receiving the ChAdOx1 nCov-19 vaccine against COVID-19. Initial blood tests demonstrated a thrombocytopaenia (24×109 μg/L) and a raised d-dimer (>110 000 μg/L), and he was urgently transferred to our tertiary referral central for suspected vaccine-induced immune thrombocytopaenia and thrombosis (VITT). He developed dynamic ischaemic electrocardiographic changes with ST elevation, a troponin of 3185 ng/L, and regional wall motion abnormalities. An occlusion of his left anterior descending coronary artery was seen on CT coronary angiography. His platelet factor-4 (PF-4) antibody returned strongly positive. He was urgently treated for presumed VITT with intravenous immunoglobulin, methylprednisolone and plasma exchange, but remained thrombocytopaenic and was initiated on rituximab. Argatroban was used for anticoagulation for his myocardial infarction while he remained thrombocytopaenic. After 6 days, his platelet count improved, and his PF-4 antibody level, troponin and d-dimer fell. He was successfully discharged after 14 days.”

101: Myocardial Infarction and Azygos Vein Thrombosis After ChAdOx1 nCoV-19 Vaccination in a Hemodialysis Patient

Author Chiang et al

Country: Taiwan

Date Published Online: 9/30/21

Vaccine: AstraZeneca

Diagnoses: VITT, VT, MI

Link: https://pubmed.ncbi.nlm.nih.gov/34650896/

Case: “We reported the case of a 75-year-old female with end-stage renal disease who received regular hemodialysis. She received Oxford-AstraZeneca COVID-19 vaccination eight days ago and then she suffered from intermittent chest tightness and epigastric pain with tarry stool passage for two days. Severe thrombocytopenia with elevated D-dimer value was noted and computed tomography of the chest showed azygos vein thrombosis. Elevated cardiac enzyme with ST-T change in 12-lead electrocardiogram was also noted. For positive anti-platelet factor 4 antibodies, VITT with myocardial infarction and azygos vein thrombosis was diagnosed.”

103: Case report: cerebral sinus vein thrombosis in two patients with AstraZeneca SARS-CoV-2 vaccination - PubMed

Author Fousse et al

Country: Germany

Date Published Online: 10/5/21

Vaccine: AstraZeneca

Diagnoses: CSVT

Link: https://pubmed.ncbi.nlm.nih.gov/34609603/

Case: “Two female patients (A 20 years old and B 28 years old) presented to our neurology emergency department with drug-refractory headache 11 and 16 days, respectively, after receiving their first dose of ChAdOx1-S vaccine (course in Fig. 1a). [..] Both patients had slightly elevated D-dimers [1.79 mg/l (A) and 0.83 mg/l (B)]. Magnetic resonance imaging (MRI) with axial and sagittal T1 with contrast (MP-RAGE) finally revealed a CSVT in both patients, however, without any sign of cerebral ischemic or hemorrhagic infarct (Fig. 1b–e). Patient A mentioned that she has noticed unilateral calf pain for already several weeks. Her ultrasound examination revealed a subacute thrombophlebitis of the small right saphenous vein. Patient B had a history of pulmonary embolism after patella surgery, which was followed rivaroxaban treatment for 1 year.

104: Successful Treatment of Vaccine-Induced Immune Thrombotic Thrombocytopenia in a 26-Year-Old Female Patient - PubMed

Author Kemper et al

Country: Germany

Date Published Online: 10/6/21

Vaccine: AstraZeneca

Diagnoses: VITT, DVT, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34614491/

Case: “Here, we report the case of a 26-year-old female patient, who developed bilateral deep vein thrombosis in the lower legs and severe thrombocytopenia after ChAdOx2 nCov-19 vaccination.”

105: Lung squamous cell carcinoma with hemoptysis after vaccination with tozinameran (BNT162b2, Pfizer-BioNTech)

Author Sumi et al

Country: Japan

Date Published Online: 10/6/21

Vaccine: Pfizer

Diagnoses: HPT

Link: https://pubmed.ncbi.nlm.nih.gov/34612003/

Case: “A 66-year-old man with squamous cell carcinoma had been receiving chemoradiation therapy after stereotactic radiotherapy for brain metastases. Atezolizumab was initiated as second-line therapy, after which the patient became progression- and recurrence-free. Four days after his second dose of tozinameran (BNT162b2, Pfizer-BioNTech), the patient developed persistent hemoptysis. The patient had no thrombocytopenia or coagulation abnormalities. Bronchoscopy revealed active bleeding from the left lingual tracheal branch. The patient was intubated and admitted to the intensive care unit because of increased bleeding. Subsequently, left bronchial artery embolization was performed using a Serescue. Hemostasis was achieved after the procedure, and the patient was discharged 7 days after the onset of hemoptysis. Vaccination against coronavirus disease has been reported to be associated with thrombosis and cerebral hemorrhage, and the hemoptysis in this case was suspected to be induced by vaccination.”

106: Vaccine-induced immune thrombotic thrombocytopenia after the BNT162b2 mRNA Covid-19 Vaccine: a case study

Author Rodríguez et al

Country: Spain

Date Published Online: 10/8/21

Vaccine: Pfizer

Diagnoses: VITT, PE, DVT, VT

Link: https://pubmed.ncbi.nlm.nih.gov/34649161/

Case: “We present a case report of an individual who developed VITT 5 days after administration of the BNT162b2 Covid-19 vaccine (Pfizer-BioNTech), a lipid nanoparticle–formulated, nucleoside-modified RNA vaccine that encodes a prefusion stabilized, membrane-anchored SARS-CoV-2 full-length spike protein [1].”

“A 78-year-old man presented to the emergency room on May 17, 2021 with a 3-day history of shortness of breath and right lower extremity swelling. The patient had received the first dose of the BNT162b2 Covid-19 vaccine 25 days prior to admission, and the second dose 5 days prior to admission.”

“Computed tomographic (CT) angiography of the chest demonstrated pulmonary embolism (PE) in the segmental and subsegmental arteries of both lungs, without right ventricle dilatation. Thrombosis of the right great saphenous vein and right distal (gastrocnemius) deep vein thrombosis (DVT) were diagnosed by compression ultrasonography.”

107: An unusual presentation of acute deep vein thrombosis after the Moderna COVID-19 vaccine-a case report - PubMed

Author Bhan et al

Country: US

Date Published Online: 10/9/21

Vaccine: Moderna

Diagnoses: DVT

Link: https://pubmed.ncbi.nlm.nih.gov/34790811/

Case: “We report an unusual presentation of acute deep vein thrombosis (DVT) in the right upper extremity of a 27-year-old Caucasian female, 3 days after receipt of her second dose of the Moderna COVID-19 vaccine. Her relevant thrombophilia workup was negative on initial presentation. She was treated with rivaroxaban for 3 months and her symptoms of right upper extremity swelling, and pain improved. Considering our case did not have any evidence of thrombocytopenia, we discuss the possible pathophysiology of acute DVT following Moderna COVID-19 vaccine in contrast to adenoviral vector COVID-19 vaccines (ChAdOx1 nCoV-19 and Ad26.COV2.S), including mRNA COVID-19 vaccine binding to pattern recognition receptors (PRR) in the endosomes and cytosol leading to a pro inflammatory cascade and coagulopathy.”

108: Immune thrombocytopenic purpura following administration of mRNA-based SARS-CoV-2 and mmr vaccinations: a cautionary tale

Author Thomas et al

Country: US

Date Published Online: 10/9/21

Vaccine: Pfizer

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34635874/

Case: “We report a case of immune thrombocytopenic purpura (ITP) in an otherwise healthy 31-year-old man following coadministration of the live measles, mumps, and rubella (MMR) vaccine with the Pfizer-BioNTech mRNA SARS-CoV-2 vaccine. The patient was hospitalized briefly and treated for ITP with glucocorticoids, IVIG, and platelet transfusion. Although our patient's clinical presentation and subsequent course are similar to those of other cases of ITP in association with SARS-CoV-2 vaccination, to our knowledge, this is the first reported case of ITP following MMR and mRNA SARS-CoV-2 vaccine coadministration. It would be impossible to conclusively prove that the patient's thrombocytopenia was secondary to the SARS-CoV-2 vaccine alone, the MMR vaccine, or an additive effect of both vaccines. However, with the CDC guidelines recommending the coadministration of the mRNA SARS-CoV-2 vaccine without regards to timing with other vaccines, we urge further caution as there is limited evidence to inform practice. This case highlights the need for further safety data regarding the coadministration and timing of the mRNA SARS-CoV-2 vaccine with other vaccines.”

109: Fatal vaccine-induced immune thrombotic thrombocytopenia (VITT) post Ad26.COV2.S: first documented case outside US

Author Rodriguez et al

Country: Belgium

Date Published Online: 10/9/21

Vaccine: J&J

Diagnoses: DVT, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34626338/

Case: “CA young woman without any medical history presented association of deep vein thrombosis and thrombocytopenia at day 10 after vaccine injection. The patient was treated with low-molecular weight heparin at a first medical institution. Twelve days post Ad26.COV2.S vaccination, the patient was admitted at our hospital for neurological deterioration and right hemiplegia. Medical imaging using MRI showed thrombosis of the major anterior part of the sagittal superior sinus with bilateral intraparenchymal hemorrhagic complications. [..] Despite immediate treatment with intravenous immunoglobulin, dexamethasone, danaparoid and attempted neurosurgery the patient evolved toward brain death.”

110: CAd26.COV2‑S vaccination can reveal inherited thrombophilia: a case of massive cerebral venous sinus thrombosis in a young man with normal platelet count - Polish Archives of Internal Medicine

Author Zur-Wyrozumska

Country: Poland

Date Published Online: 10/11/21

Vaccine: J&J

Diagnoses: CVST

Link: https://www.mp.pl/paim/issue/article/16114/

Case: “A previously healthy, nonsmoking, 25-year-old White man with no personal or family history of thrombosis received an Ad26.COV2-S COVID-19 vaccine (Janssen / Johnson & Johnson). A few hours post vaccination the patient developed a fever and started to vomit. The next day he reported a headache of increasing severity, and 7 days after vaccination he was admitted to the hospital.”

“Computed tomography angiography of the head showed extensive intracranial thrombotic lesions (Figure 1A–1C). The patient was heterogeneous for factor V Leiden mutation.”

111: Adenovirus-Vectored COVID-19 Vaccine-Induced Immune Thrombosis of Carotid Artery: A Case Report - PubMed

Author Walter et al

Country: Germany

Date Published Online: 10/12/21

Vaccine: AstraZeneca

Diagnoses: VI- ICAT, IT, AO

Link: https://pubmed.ncbi.nlm.nih.gov/34312301/

Case: “Eight days after having received the first dose of ChAdOx1 nCov-19 vaccine, a 31-year-old man was admitted to our stroke unit with acute headache, aphasia, and hemiparesis. D-dimers were slightly elevated, but platelet count and fibrinogen level were normal. MRI-confirmed mainstem occlusion of middle cerebral artery resolved within 1 hour after start of IV thrombolysis. A wall-adherent, non-occluding thrombus in the ipsilateral carotid bulb was identified as the source of embolism. Cardiac or paradoxical (venous) embolism was excluded. Screening for presence of heparin-induced thrombocytopenia-related antibodies was positive, and highly elevated serum IgG antibodies against PF4-polyanion complexes were subsequently proven. Treatment with aspirin and subcutaneous danaparoid, followed by phenprocoumon, led to thrombus shrinkage and dissolution within 19 days, and favorable clinical outcome.”

112: Cerebral Venous Sinus Thrombosis After BNT162b2 mRNA COVID-19 Vaccination - PubMed

Author Yamaguchi et al

Country: Japan

Date Published Online: 10/14/21

Vaccine: Pfizer

Diagnoses: CVST

Link: https://pubmed.ncbi.nlm.nih.gov/34796065/

Case: “We present a rare case of cerebral venous sinus thrombosis after the BNT162b2 mRNA COVID-19 vaccine. A 61-year-old Japanese man developed a headache 10 days after the first dose of the vaccine. Magnetic resonance venography and contrast-enhanced brain MRI showed thrombosis in the superior sagittal sinus and the right transverse sinus. Anticoagulation with intravenous unfractionated heparin followed by oral warfarin was started. His headache improved, and brain MRI on day 22 showed resolution of thrombus. He was maintained on anticoagulation with warfarin and discharged without any neurological sequelae.”

113: Deep Venous Thrombosis after Ad26.COV2.S Vaccination in Adult Male

Author Hussain et al

Country: US

Date Published Online: 10/14/21

Vaccine: J&J

Diagnoses: DVT, VO

Link: https://pubmed.ncbi.nlm.nih.gov/34659839/

Case: “A 21-year-old male without significant past medical history presented to the emergency department 8 days after receiving the Ad26.COV2.S vaccine, with complaints of left groin pain and inability to bear weight on the left leg. On initial evaluation, he was noted to have mild erythema and edema of the left leg with circumferential diameter 40 cm comparative to 38 cm of the right leg. He was recommended to follow supportive care with conservative approach and discharged home. A day later, he presented to the emergency department with worsening swelling of the left leg. On examination, left lower extremity edema was consistent with prior exam with new skin changes concerning for phlegmasia cerulea dolens. Lower extremity duplex showed absent blood flow in the left common femoral, profundal femoral, femoral, and calf veins due to occluding thrombus visualized from the iliac, femoral, popliteal to the left posterior tibial, and peroneal vein.

114: Immune thrombocytopenia exacerbation after COVID-19 vaccination in a young woman

Author Fujita et al

Country: Japan

Date Published Online: 10/18/21

Vaccine: Pfizer

Diagnoses: ITP, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34660131/

Case: “A 25-year-old woman, who was previously diagnosed with immune thrombocytopenia (ITP, stage I), had exacerbated severe thrombocytopenia (platelet count of 6,000/μL) with a headache, joint pain, general fatigue, and bleeding tendency three days after receiving her second dose of the Pfizer BioNTech COVID-19 vaccine. Pulsed high-dose dexamethasone therapy rapidly ameliorated the ITP. Although it is difficult to confirm a causal association between Pfizer BioNTech COVID-19 vaccination and ITP exacerbation, abrupt onset of ITP exacerbation after vaccination suggests that the ITP may be vaccination-induced thrombocytopenia exacerbation.”

115: mRNA COVID-19 Vaccine–Related Anaphylactoid Reaction and Coronary Thrombosis - PMC

Author Hinton et al

Country: UK

Date Published Online: 10/22/21

Vaccine: Pfizer

Diagnoses: CT, AO, AT

Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8531274/

Case: “We present a case of a young man who presented with an anaphylactoid reaction a day after having the Pfizer-BioNTech COVID-19 vaccine with thrombotic occlusion of his left anterior descending (LAD) artery.

Paramedics attended a 38-year-old man with a sudden onset widespread erythematous rash, dyspnea, and stridor 18 hours after receiving his first dose of the Pfizer-BioNTech COVID-19 vaccine. [..] Serial electrocardiograms revealed evolving ST-segment elevation — initially inferiorly and then anteriorly (Figure, A). He was therefore transferred to hospital and underwent urgent coronary angiography which surprisingly showed severe thrombotic stenosis of the proximal LAD with distal embolization (Figure, B). Optical coherence tomography confirmed significant LAD thrombus (Figure, C; white arrows) but no evidence of underlying atherosclerotic plaque rupture and normal smooth vessel wall segments (Figure, C; interrupted blue arrows). [..] Transthoracic echocardiography showed an apical left ventricular thrombus.”

116: New-onset Evans syndrome associated with systemic lupus erythematosus after BNT162b2 mRNA COVID-19 vaccination

Author Hidaka et al

Country: Japan

Date Published Online: 10/23/21

Vaccine: Pfizer

Diagnoses: AIHA, ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34687421/

Case: “We herein report a case of new-onset Evans syndrome associated with SLE after BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccination in a 53-year-old woman. Blood examination at diagnosis showed hemolytic anemia with a positive Coombs test and thrombocytopenia. Hypocomplementemia and the presence of lupus anticoagulant indicated a strong association with SLE. Prednisolone administration rapidly restored hemoglobin level and platelet count. This case suggests that mRNA COVID-19 vaccination may cause an autoimmune disorder.”

117: A Case of Idiopathic Thrombocytopenic Purpura After Booster Dose of BNT162b2 (Pfizer-Biontech) COVID-19 Vaccine - PubMed

Author Malayala et al

Country: US

Date Published Online: 10/23/21

Vaccine: Pfizer

Diagnoses: VITT, IdTPu

Link: https://pubmed.ncbi.nlm.nih.gov/34820240/

Case: “A 75-year-old female patient presented to the emergency room for thrombocytopenia found on routine bloodwork ordered by her primary care physician. [..] The patient was found to have a low platelet count of 75,000/mm3 which fell further down to 18,000/mm3 in a span of five days at which point the patient was sent to the emergency room for further evaluation. The patient denied any overt bleeding but reported noticing a small left lower extremity and a few petechiae five days before arrival to the emergency room. [..] The patient received her third dose of Pfizer COVID-19 vaccine four days before the lab work that showed low platelet count for the first time. The patient's platelet count was 198,000/mm3 one week prior to the vaccine (Table ​(Table11).”

“There were no factors that could cause the thrombocytopenia and she was admitted with the chief diagnosis of idiopathic thrombocytopenic purpura (ITP).”

118: Severe immune thrombocytopenic purpura after SARS-CoV-2 vaccine - PubMed

Author Cooper & Switzer

Country: US

Date Published Online: 10/27/21

Vaccine: Pfizer

Diagnoses: ITCPP, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34754937/

Case: “Here we present the case of a 24-year-old female with mucocutaneous bleeding ten days after receiving her first dose of SARS-CoV-2 vaccine, who was subsequently found to have severe thrombocytopenia. Extensive work up for new thrombocytopenia was unremarkable suggesting a diagnosis of ITP, potentially secondary to vaccination. Empiric treatment with glucocorticoids was initiated without response prompting the use of intravenous immunoglobulin G. The patient was discharged on hospital day five with a platelet count over 20,000 platelets per microliter. In summary, ITP is a potential sequela of the SARS-CoV-2 vaccine, and otherwise healthy young individuals may be at risk for hematologic side effects.”

119: Cerebral venous sinus thrombosis after ChAdOx1 vaccination: the first case of definite thrombosis with thrombocytopenia syndrome from India - PubMed

Author Maramattom et al

Country: India

Date Published Online: 10/27/21

Vaccine: AstraZeneca

Diagnoses: TTS, CVST, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34706921/

Case: “We report the first case of CVST associated with ChAdOx1 vaccination, with positive anti-platelet factor 4 (PF4) antibodies, from India. A 44-year-old woman developed a thunderclap headache 4 days after the first dose of the adenoviral vector vaccine ChAdOx1 (Covishield). Physical examination was unremarkable barring mild neck stiffness with no focal neurological deficits. MRI identified right transverse sinus thrombosis. Laboratory tests revealed raised D-dimer and thrombocytopenia; anti-PF4 antibodies were subsequently identified, consistent with thrombosis with thrombocytopenia syndrome (TTS). She was treated with non-heparin anticoagulation and intravenous immunoglobulin and made an uneventful recovery.”

120: Acute immune thrombocytopenia following SARS-CoV-2 vaccination in chronic ITP patients and a healthy individual

Author Ogai et al

Country: Japan

Date Published Online: 10/30/21

Vaccine: Pfizer, Moderna

Diagnoses: ITP, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34716890/

Case: “We herein report three cases of severe and acute immune thrombocytopenia following SARS-CoV-2 vaccination in two patients with chronic ITP in remission and in one healthy individual.”

“Case 1 was a 64-year-old woman with chronic ITP managed without medication for 23 years. Her platelet count had been stable around 40 × 109/L. She visited our hospital complaining of oral mucosal bleeding and petechiae on the extremities. Two days before the visit, she received the first dose of the BNT162b2 mRNA covid-19 vaccine (Comirnaty, Pfizer) for SARS-CoV-2 (Fig. ​(Fig.1A).1A). She did not take any medication or supplements before or after vaccination. Oral bleeding and generalized petechiae were observed on physical examination. Laboratory testing showed severe thrombocytopenia with 1 × 109/L platelets, while white blood cells (WBCs), red blood cells (RBCs) and hemoglobin (Hb) levels were within normal limits (Fig. ​(Fig.1A).1A).”

“Case 2 was a 61-year-old woman with scleroderma (SSc), Sjogren syndrome (SS) and ITP who presented with petechiae on both legs after the second dose of SARS-CoV-2 vaccine. [..] She had received the first and second doses of BNT162b2 mRNA covid-19 vaccine (Pfizer) 42 days and 21 days prior to the visit, respectively (Fig. ​(Fig.1B).1B). She noticed subcutaneous bleeding 17 days after the second vaccination and visited the hospital 21 days after the second vaccination. Diffuse petechiae on the legs with no active bleeding were observed on physical examination. Laboratory tests showed severe thrombocytopenia with a platelet count of 1 × 109/L, but other CBC parameters, coagulation parameters including PT-INR, APTT, fibrinogen, FDP and D-dimer, and blood chemistry parameters were otherwise normal (Fig. ​(Fig.1B).1B). Based on these findings, she was diagnosed with exacerbation of ITP. Drug-induced thrombocytopenia was ruled out based on her history.”

“Case 3 was a 73-year-old woman being followed for hypertension and hyperlipidemia who presented to our hospital with generalized petechiae. Eleven days before the hospital visit, she received the first dose of mRNA-1273 SARS-CoV-2 vaccine (Moderna) (Fig. ​(Fig.1C).1C). [..] Bleeding from the oral mucosa and petechiae on her face, body and both legs were observed on physical examination. [..] However, platelet count further decreased to less than 1 × 109/L and bleeding symptoms had exacerbated on day 4. In addition to purpura and petechiae on her skin, she began experiencing melena due to diffuse bleeding from the gastric mucosa.”

121: Case Report: Vaccine-Induced Immune Thrombotic Thrombocytopenia in a Pancreatic Cancer Patient After Vaccination With Messenger RNA-1273 - PubMed

Author Su et al

Country: Taiwan

Date Published Online: 11/1/21

Vaccine: Moderna

Diagnoses: VITT, IS, TE

Link: https://pubmed.ncbi.nlm.nih.gov/34790684/

Case: “Vaccine-induced thrombotic thrombocytopenia (VITT) is a major adverse effect that could be lethal. For cancer patients, cancer-related thromboembolism is another lethal complication. When cancer patients receive their COVID-19 vaccines, the following thromboembolic events will be more complicated. We presented a case recently diagnosed with pancreatic cancer, who had received the mRNA-1273 (Moderna) vaccination 12 days prior. Ischemic stroke and VITT were also diagnosed. We aggressively treated the patient with steroids, immunoglobulin, and plasma exchange. The titer of anti-platelet factor four and d-dimer level decreased, but the patient ultimately died. The complicated condition of VITT superimposed cancer-related thromboembolism was considered.”

122: [Development of thrombocytopenic purpura following BNT162b2 mRNA COVID-19 vaccination]

Author Shibata et al

Country: Japan

Date Published Online: 11/5/21

Vaccine: Pfizer

Diagnoses: TCP, TTCPP

Link: https://pubmed.ncbi.nlm.nih.gov/34732627/

Case: “We herein report the case of a 37-year-old woman who experienced thrombocytopenia following BNT162b2 mRNA COVID-19 vaccination. The patient presented with purpura on the extremities 10 days after the first vaccination. She had marked thrombocytopenia and no thrombosis. Thrombocytopenia resolved spontaneously. Given the possibility of occurrence of post-vaccination thrombocytopenia, vaccinated persons should be instructed to consult a medical institution if they experience bleeding symptoms.”

123: A Case Report of Immune Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination - PubMed

Author Kim et al

Country: Korea

Date Published Online: 11/8/21

Vaccine: AstraZeneca

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34751013/

Case: “Herein, we report a case of ITP occurring after vaccination with ChAdOx1 adenovirus vector nCoV-19 (AstraZeneca) vaccine in Korea. A 66-year-old woman presented with multiple ecchymoses on both upper and lower extremities and gingival bleeding, appearing 3 days after receiving the first dose of ChAdOx1 nCoV-19. Her laboratory results showed isolated severe thrombocytopenia without evidence of combined coagulopathy. She was diagnosed with ITP and successfully treated with high-dose dexamethasone and intravenous immunoglobulin. Clinical suspicion to identify vaccine-related ITP is important to promptly initiate appropriate treatment.”

124: Vaccine-Induced Thrombotic Thrombocytopenia Due to Coronavirus Disease 2019 Vaccine From a Deceased Donor: A Case Report

Author Guditi et al

Country: India

Date Published Online: 11/12/21

Vaccine: AstraZeneca

Diagnoses: VITT, CVT

Link: https://www.sciencedirect.com/science/article/pii/S0041134521007946

Case: “We report a case of successful organ donation from an 18-year-old woman who presented with cerebral venous thrombosis caused by vaccine-induced thrombotic thrombocytopenia following the first dose of the COVID-19 vaccine (AstraZeneca, University of Oxford, and Serum Institute of India), which caused brain death. Four recipients received 5 organs, kidneys (2), liver (1), and combined heart and lung (1). All 4 recipients had normal graft function without any thrombotic complications after 16 weeks of transplantation. This is first such case being reported from Asian countries.”

“An 18-year-old woman presented to the hospital on June 9, 2021, with symptoms of headache and fever of 3 days duration, vomiting and swaying while walking of 1 day duration, and 1 episode of a seizure on the day of presentation. She had received the first dose of COVID-19 vaccine (AstraZeneca, University of Oxford, and Serum Institute of India) on May 30, 2021. [..] Neuroimaging studies showed extensive cerebral venous thrombosis with right frontal hemorrhage and surrounding perilesional edema and mass effect with midline shift and intraventricular extension of hemorrhage.”

“Postmortem examination showed extensive thrombosis and hemorrhage in the brain but no evidence of disseminated intravascular coagulation in any of the visceral organs.”

125: A Case of COVID-19 Vaccine-Induced Thrombotic Thrombocytopenia

Author Chittal et al

Country: US

Date Published Online: 11/15/21

Vaccine: Moderna

Diagnoses: VITT, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34804389/

Case: “In this report, we present the case of a 34-year-old, otherwise, healthy female who presented with easy bruising and thrombocytopenia following completion of the two-dose Moderna COVID-19 vaccine, suspicious for a diagnosis of VITT. The patient was managed conservatively with steroids.”

126: Isolated pulmonary embolism following COVID vaccination: 2 case reports and a review of post-acute pulmonary embolism complications and follow-up - PubMed

Author Ifeanyi et al

Country: UK, Nigeria

Date Published Online: 11/15/21

Vaccine: AstraZeneca

Diagnoses: PE

Link: https://pubmed.ncbi.nlm.nih.gov/34804412/

Case: “Case 1: A 61-year-old man with a past medical history of hypertension, type 2 diabetes mellitus, and hypercholesterolemia attended the emergency department following a syncopal episode. Five days prior, the patient endorsed worsening exertional shortness of breath, lethargy, and a day history of bilateral calf pain. Of note, these symptoms began 8 days post 2nd dose of the ChAd0x1 nCoV-19 vaccine. [..] CT angiogram chest showed multiple filling defects in the segmental and subsegmental branches of both lobes in keeping with extensive pulmonary embolism (Figure S2). Echocardiogram was significant for right heart strain, raised pulmonary pressure PASP40-45 mmHg, and mild tricuspid regurgitation.”

“Case 2: A 51-year-old man with a past medical history of hypertension presented to the emergency department with acute onset shortness of breath and cough of less than 24 hours duration. [..] He had his 1st dose of the ChAd0x1 nCoV-19 vaccine 4 weeks before the presentation. [..] CT angiogram chest showing multiple filling defects in the distal right and left main pulmonary arteries consistent with bilateral pulmonary embolism, with consolidations of the right lobe of the lungs (Figure S4).

127: Cerebral venous sinus thrombosis after mRNA-based COVID-19 vaccination

Author Yagi et al

Country: Japan

Date Published Online: 11/16/21

Vaccine: Pfizer

Diagnoses: CVST, VT,

Link: https://pubmed.ncbi.nlm.nih.gov/34783932/

Case: “Here, we report a case of CVST with prolonged mild headache after mRNA-based COVID-19 vaccination.”

“A man in his 50 s without remarkable medical history visited our department complaining of 1-week headache, which started 26–30 h after his second dose of tozinameran (Comirnaty® from Pfizer–BioNtech). He was evaluated by blood test, brain computed tomography (CT), and magnetic resonance imaging (MRI). [..] Brain CT and MRI (Fig. 1), which were both conducted 7 days after second vaccination, showed thrombosis in the superior sagittal sinus, right transverse sinus, right sigmoid sinus, and right internal jugular vein [3].

128: Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia-A Case Report - PubMed

Author Brämer et al

Country: Germany

Date Published Online: 11/17/21

Vaccine: AstraZeneca

Diagnoses: VITT, ICH, CVST

Link: https://pubmed.ncbi.nlm.nih.gov/34835275/

Case: “Here, we report the complicated long-term course of a VITT patient with extremely high titers of pathogenic anti-platelet factor 4 (PF4)-IgG antibodies.”

“The patient presented with extended superior sagittal sinus thrombosis with accompanying bifrontal intracerebral hemorrhage. Repeated treatment with intravenous immune globuline (IVIG) resolved recurrent episodes of thrombocytopenia. Moreover, the patient's serum remained strongly positive for platelet-activating anti-PF4-IgG over three months. After a period of clinical stabilization, the patient suffered a recurrent and fatal intracranial hemorrhage.”

129: Immune thrombocytopenia relapse post covid-19 vaccine in young male patient - PubMed

Author Qasim et al

Country: Qatar

Date Published Online: 11/17/21

Vaccine: Pfizer

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/34804803/

Case: “We present a 28-year-old Asian male, a known patient of ITP and in partial remission for eighteen months, who presented to the emergency department with ITP relapse (platelets count of 1 × 10^3 /µL), four days after receiving the second dose of Pfizer SARS-CoV-2 vaccine, which required treatment with intravenous immunoglobulins and dexamethasone.”

130: VITT following Ad26.COV2.S vaccination presenting without radiographically demonstrable thrombosis

Author Kennedy et al

Country: US

Date Published Online: 11/17/21

Vaccine: J&J

Diagnoses: VITT, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34587255/

Case: “We report a case of vaccine-induced immune thrombotic thrombocytopenia (VITT) in a young man diagnosed 13 days after Ad26.COV2.S COVID-19 (Johnson & Johnson/Janssen) vaccination. He presented to us with 5 days of progressive left leg pain, thrombocytopenia, hypofibrinogenemia, and markedly elevated d-dimers, but without radiographically demonstrable thrombosis. Despite negative imaging, we initiated treatment of presumptive VITT given the striking clinical picture that included the timing of his recent adenovirus-based COVID-19 vaccine, leg symptoms, marked thrombocytopenia, and consumptive coagulopathy. He received intravenous immune globulin, prednisone, and argatroban and was discharged 7 days later much improved. His positive platelet factor 4 enzyme-linked immunosorbent assay antibody test returned after treatment was initiated. To our knowledge, this is the first reported case of VITT following Ad26.COV2.S vaccination presenting without radiographically demonstrable thrombosis. Our patient highlights the importance of knowing vaccine status and initiating treatment as soon as possible in the right clinical setting, even in the absence of radiographic evidence of thrombus.”

131: Heterogeneity of Vaccine-Induced Immune Thrombotic Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination and Safety of Second Vaccination with BNT162b2

Author Lindhoff-Last et al

Country: Germany

Date Published Online: 11/18/21

Vaccine: Pfizer, AtraZeneca

Diagnoses: VITT, TCP, AT, VT

Link: https://pubmed.ncbi.nlm.nih.gov/34794199/

Case: “We report four cases of VITT (3 females, aged 38, 56, and 76 years; and 1 male, aged 32 years) that illustrate its diverse clinical spectrum (see Fig. 1A–D for details). Two patients (patients 1 and 2) had thrombocytopenia associated with both arterial and venous thromboses, while one (patient 3) had lower limb venous thrombosis without thrombocytopenia. The most unusual case was patient 4, who had thrombocytopenia together with severe, persistent headache and abdominal pain/transaminitis; however, imaging studies were negative for cerebral and abdominal thromboses, and symptoms resolved in association with early anticoagulation therapy.”

132: Repeated cardioembolic stroke after COVID-19 mRNA vaccination: A case report: Repeated cardioembolic stroke after COVID-19 RNA vaccination - ScienceDirect

Author Yoshida et al

Country: Japan

Date Published Online: 11/22/21

Vaccine: Pfizer

Diagnoses: CES, AO

Link: https://www.sciencedirect.com/science/article/pii/S1052305721006388

Case: “An 83-year-old Japanese woman developed right hemiplegia and motor aphasia three days after receiving her first dose of the BNT162b2 (Pfizer) COVID-19 mRNA vaccine. She had been taking rivaroxaban for persistent atrial fibrillation for 10 years, but had no symptomatic ischemic strokes. On magnetic resonance imaging (MRI) the left middle cerebral artery (MCA) was occluded. Intravenous recombinant tissue-plasminogen activator (rt-PA) therapy and mechanical thrombectomy were performed, and she recovered almost fully. However, three days after the second dose, she developed left hemiplegia and left hemispatial neglect. MRI showed occlusion of the right MCA. Only mechanical thrombectomy was performed again, but it could not be resumed due to the hard thrombus.”

“In this case, it is difficult to exclude a causal relationship between the COVID-19 mRNA vaccine and ischemic stroke. This association needs to be carefully monitored.”

133: Venous sinus thrombosis after the second jab of an mRNA-based SARS-CoV-2 vaccine

Author Finsterer & Nics

Country: Austria

Date Published Online: 12/8/21

Vaccine: Pfizer

Diagnoses: VST

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8651552/

Case: “The patient is a 33yo male who experienced an episode of sudden onset focal, stabbing headache in the left temporal region for about 4 h. Three days later a similar episode occurred accompanied by a focal seizure. Twenty days before he had received the second dose of the Pfizer vaccine. Clinical exam was normal but MRI of the brain revealed a VST of the left transverse and sigmoid sinuses. Anticoagulation with low molecular weight heparin followed by dabigatran resulted in complete recovery.”

134: Retinal Vein Occlusion Following Two Doses of mRNA-1237 (Moderna) Immunization for SARS-Cov-2: A Case Report

Author Sacconi et al

Country: Italy

Date Published Online: 12/9/21

Vaccine: Moderna

Diagnoses: RVO

Link: https://pubmed.ncbi.nlm.nih.gov/34881416/

Case: “In this report, we describe the case of a patient who had a hemispheric retinal vein occlusion potentially associated with being vaccinated with the second dose of the SARS-Cov-2 mRNA-1237 vaccine.”

“A 74-year-old woman presented with painless vision loss in the right eye experienced 48 hours after receiving a second dose of the mRNA-1237 vaccine. The patient was receiving oral anticoagulant therapy for atrial fibrillation. Her best-corrected visual acuity (VA) was 20/32, and fundus examination showed venous congestion and widespread blot haemorrhages in the inferior quadrants. Based on multimodal imaging evaluation, the diagnosis of hemispheric retinal vein occlusion was made. Due to the development of cystoid macular oedema with intraretinal fluid and the decline in VA, the patient was treated with two injections of intravitreal ranibizumab, leading to functional improvement and regression of oedema.”

135: First diagnosis of thrombotic thrombocytopenic purpura after SARS-CoV-2 vaccine - case report

Author Osmanodja et al

Country: Germany

Date Published Online: 12/11/21

Vaccine: Moderna

Diagnoses: aTTP

Link: https://pubmed.ncbi.nlm.nih.gov/34895163/

Case: “We report a case of a 25-year-old male patient, who developed acquired thrombotic thrombocytopenic purpura (aTTP) after receiving a first dose of mRNA-based SARS-CoV-2 vaccine Spikevax (mRNA-1273, Moderna Biotech, USA). While this is the first case in literature describing a case of aTTP after receiving the Spikevax vaccine, there are two other cases after mRNA-based Covid-19 vaccine and two after adenoviral SARS-CoV-2 vaccine.”

“The patient presented with persisting malaise, fever, headache, word-finding difficulties, nausea, vomiting, petechial bleeding, and hematuria 13 days after receiving a first dose of vaccination. Laboratory testing showed low platelet count, Coombs-negative hemolytic anemia, and mild acute kidney injury. We excluded vaccine induced immune thrombotic thrombocytopenia (VITT) as another important differential diagnosis and the final diagnosis was established after ADAMTS-13 (A Disintegrin And Metalloproteinase with a ThromboSpondin type 1 motif, member 13) activity was found to be < 1% (reference range > 40%) and ADAMTS-13 antibodies being 72.2 IU/L (reference range < 12 IU/L). We initiated empiric therapy of plasmapheresis and corticosteroids on admission and started caplacizumab the day after. The patient's thrombocyte count normalized 3 days after admission, hemolysis and acute kidney injury resolved after 2 weeks. The patient received 2 doses of rituximab (1 g each) after the diagnosis of immune TTP was established. One month after the initial presentation, the patient is in good overall condition, but still receives daily caplacizumab due to ADAMTS-13 activity of < 1%.”

136: Acquired Thrombotic Thrombocytopenic Purpura Following Pfizer COVID-19 Vaccination

Author Alislambouli et al

Country: US

Date Published Online: 12/15/21

Vaccine: Pfizer

Diagnoses: aTTP, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/34909764/

Case: “A 61‐year‐old Korean‐American man with no past medical history presented with confusion, fever, headache, emesis, dark urine, and leg ecchymosis that developed 5 days following his first dose of Pfizer COVID 19 vaccine. Physical examination was notable for altered mentation, pallor, scleral icterus and bilateral lower extremity petechiae and ecchymosis. He developed a witnessed generalised tonic seizure and was intubated for airway protection at the emergency department.”

“Given his fever, altered mentation, neurological deficits, evidence of hemolysis, thrombocytopenia, kidney injury and a PLASMIC score of six, he received emergent therapeutic plasmapheresis (FFP 1.5 × total plasma volume) in combination with methylprednisolone (1000 mg daily for three consecutive days). TTP was confirmed with an ADAMTS13 activity level of less than three. Initial CT head, CT angiogram of head and neck obtained before seizure episode were unremarkable. Repeat brain imaging following the seizure episode revealed a new small right parietal subdural hematoma 5 mm depth which did not increase in size. He remained seizure‐free and was extubated on the third day of admission.”

137: Immune Thrombocytopenia Induced by the Chimpanzee Adenovirus-Vectored Vaccine against SARS-CoV-2 Infection

Author Liao et al

Country: Taiwan

Date Published Online: 12/16/21

Vaccine: AstraZeneca

Diagnoses: ITP

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8707922/

Case: “One week after receiving the first dose of the ChAdOx1 nCoV-19 vaccine, a 79-year-old man was admitted to the emergency room for low platelet count detected during routine blood examination at a nursing home. [..] Since ITP is a diagnosis of exclusion, this patient was diagnosed to have acute ITP after having excluded other possible etiologies.”

138: Exacerbation of branch retinal vein occlusion post SARS-CoV2 vaccination: Case reports

Author Tanaka et al

Country: Japan

Date Published Online: 12/17/21

Vaccine: Pfizer

Diagnoses: RVO

Link: https://pubmed.ncbi.nlm.nih.gov/34918688/

Case: “In this paper, we report on 2 patients who developed branch retinal vein occlusion (BRVO) exacerbation 1 day after administration of the BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine.”

“Case 1: A 71 year-old female developed vision loss in her left eye 1 day after receiving a second dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal inferior BRVO and secondary macular edema (ME) in her left eye. ME resolved after 3 doses of intravitreal aflibercept (IVA). After treatment, no recurrence of ME was observed.”

“Case 2: A 72 year-old man developed vision loss in his right eye 1 day after receiving the first dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal superior BRVO in the right eye without ME. The patient was followed up and did not undergo any additional treatment.”

139: Vaccine-induced massive pulmonary embolism and thrombocytopenia following a single dose of Janssen Ad26.COV2.S vaccination

Author Curcio et al

Country: Italy

Date Published Online: 1/1/22

Vaccine: J&J

Diagnoses: VITT, PVT, TCP, PE

Link: https://pubmed.ncbi.nlm.nih.gov/34986404/

Case: “This report describes a case of severe thrombocytopenia associated with massive pulmonary embolism and portal vein thrombosis occurring 13 days after the administration of the single-dose adenoviral vector-based vaccine Ad26.COV2.S (Janssen Vaccines). Based on early clinical suspicion, the patient quickly received treatment with corticosteroids and intravenous immunoglobulin, followed by a rapid increase in platelet count that allowed timely administration of full-dose anticoagulation. Treatment with intravenous immunoglobulin, however, could mask the ability of anti-platelet factor 4-heparin antibodies to bind and activate platelets in the presence of heparin, leading to false-negative results on the immunoassay functional test. Therefore, if VITT is suspected, blood samples for diagnostic confirmation should be collected prior to any treatment to improve diagnostic performance.”

140: Immune Thrombotic Thrombocytopenic Purpura following Pfizer-BioNTech anti-COVID-19 vaccination in a patient healed from lymphoma after allogeneic hematopoietic stem cell transplantation

Author Innao et al

Country: Italy

Date Published Online: 1/3/22

Vaccine: Pfizer

Diagnoses: ITTP

Link: https://pubmed.ncbi.nlm.nih.gov/35033862/

Case: “Our case describes a 33-year-old white female who was admitted to Emergency Room of our hospital for marked asthenia, drowsiness, headache, nausea with abdominal pain, and lower extremity purpura, 9 days after I dose of Pfizer-BioNTech COVID19 vaccine. Physical examination revealed a Glasgow Coma Scale (GCS) score 4. Laboratory tests revealed severe anemia (hemoglobin 68 g/L) with reticulocytosis and critical thrombocytopenia (platelets 12109/L), elevated lactate dehydrogenase (1.280 U/L) and total bilirubin (2.3 mg/dL), and decreased haptoglobin level (<0.06 g/L), suggesting a hemolysis. [..] Peripheral blood smear (PBS) test showed the presence of 3% schistocytes, which indicated iTTP diagnosis. [..] Brain Computed Tomography scan documented the presence of hyper-attenuating micro-lesions, while microbiological tests on blood and urine showed negative results.”

“The immunocompromised status of our patient, due to previous chemotherapy and autologous and allogeneic stem cell transplantations, could be assumed to be a contributing factor in triggering immune TTP. However, she has not shown more susceptibility to infections over the years, following allogeneic transplantation, and we have not sufficient data to claim that the dysregulation of her immune system may have encouraged the development of TTP.”

141: Abrupt worsening of occult IgA nephropathy after the first dose of SARS-CoV-2 vaccination

Author Fujita et al

Country: Japan

Date Published Online: 1/6/22

Vaccine: Pfizer

Diagnoses: TCP, IgAN

Link: https://pubmed.ncbi.nlm.nih.gov/34988883/

Case: “Here, we report a case of abrupt onset of gross hematuria and nephrotic range proteinuria after the first dose of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, which led to a diagnosis of immunoglobulin A nephropathy (IgAN). A Japanese woman in their forties with a significant medical history of occult blood by urine dipstick test (over the past 3 years) presented with fever, chills, shivering, marked thrombocytopenia, and gross hematuria 9 days after the first dose of the BNT162b2 mRNA vaccine (Pfizer) against SARS-CoV-2 infection. Although thrombotic microangiopathy (TMA) was first suspected as the cause of the severe thrombocytopenia, TMA was clinically excluded after two sessions of plasma exchange were performed. Renal biopsy was performed as the patient's platelet count improved. We made a diagnosis of acute worsening IgAN, triggered by the first dose of SARS-CoV-2 vaccination. In this case, we speculated that vaccine-induced immune activation may be involved in the exacerbation of occult IgAN, leading to the definite diagnosis. We should pay more attention to the development/worsening of clinically significant kidney disease after SARS-CoV-2 vaccination not only in those with known glomerular disease but also in those with only mild urinary abnormality.”

142: [Immune thrombocytopenia after BNT162b2 mRNA COVID-19 vaccination]

Author Sato et al

Country: Japan

Date Published Online: 1/13/22

Vaccine: Pfizer

Diagnoses: iTTP

Link: https://pubmed.ncbi.nlm.nih.gov/35022338/

Case: “A 95-year-old male developed general subcutaneous petechiae, tongue hematoma, and melena two days after receiving the second BNT162b2 mRNA COVID-19 vaccine. Two days later, his platelet count decreased to below 1,000/µl. Laboratory testing was positive for a slight increase in D-dimer, Helicobacter pylori (H. pylori) immunoglobulin G (IgG) antibody, lupus anticoagulant, and anticardiolipin IgG antibody levels. There were no severe infections or symptomatic thrombosis. Platelet transfusions were transiently effective. He was diagnosed with newly developed immune thrombocytopenia (ITP).”

143: Central Retinal Vein Occlusion Following BNT162b2 (Pfizer-BioNTech) COVID-19 Messenger RNA Vaccine

Author Shah (P) et al

Country: US

Date Published Online: 1/13/22

Vaccine: Pfizer

Diagnoses: RVO

Link: https://pubmed.ncbi.nlm.nih.gov/35025191/

Case: “A 27-year-old female was diagnosed with central retinal vein occlusion (CRVO) a few days after her first dose of the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. Detailed elicitation of her history and a full hypercoagulable workup did not reveal any primary risk factors that could have explained her disease process. After the patient received the second dose, her symptoms deteriorated significantly and worsening peripapillary hemorrhage were seen on DFE. The patient was treated with intravitreal injections of ranibizumab and followed closely, which showed improvement of her CRVO.”

144: Combined Central Retinal Artery and Vein Occlusion with Ischemic Optic Neuropathy After COVID-19 Vaccination

Author Lee et al

Country: US

Date Published Online: 1/16/22

Vaccine: Pfizer

Diagnoses: RAO, ION, RVO, AO

Link: https://pubmed.ncbi.nlm.nih.gov/35079224/

Case: “A 34-year-old Caucasian male underwent vaccination with the Pfizer vaccine, one of two mRNA vaccines currently available in the United States,1 receiving the first dose on March 1, 2021, and the second dose on March 22, 2021. Approximately 10 to 12 days after the second injection, he noticed blurred vision in his left eye. He was seen by a retina specialist who diagnosed an early vein occlusion and prescribed baby aspirin and observation. The following day, he noticed his vision deteriorating further, at which time he became count fingers and saw a specialist at another institution who felt a combined central retinal artery occlusion (CRAO) and central vein occlusion (CRVO) was the diagnosis for which the patient was advised that there was no proven treatment. Hyperbaric oxygen was offered as an experimental intervention, which he received one treatment of, but the following day he felt he was worse. Indeed, there were increasing retinal hemorrhages, particularly around the disc, and his vision remained count fingers. At that time, we saw the patient and diagnosed a CRVO based on the fundus appearance of dilated and tortuous retinal veins, a few scattered blot hemorrhages in all 4 quadrants, disc edema, and exudative macular detachment on the macular OCT (Figure 1). A history of retinal whitening with a cherry red spot was reportedly noted the day before at the other institution and given the minimal intraretinal edema, a diagnosis of combined CRAO-CRVO was also made. Fluorescein angiography (FA) demonstrated delayed central retinal vein filling, and the retina was mildly thickened on OCT, but frank cystoid macular edema was not present (Figures 1 and ​and2).2). There is also delayed arterial filling, particularly in the more distant branches even after 50 seconds, which is consistent with partial obstruction of the central retinal artery (Figure 2). The few blot hemorrhages are highlighted by the FA. Baseline average RNFL thickness was 93um OD and 153 um OS. Given the new exudative detachment, venous stasis, and a diagnosis of CRVO, it was felt that aflibercept might give the best chance of restoration of vision.”

“Given the mildly elevated ESR, suspected inflammatory immune response, and data that systemic steroids can suppress the systemic inflammatory response associated with COVID-19 infection,13 the patient was prescribed oral methylprednisolone 4mg. The following day, he continued to deteriorate with increasing disc edema (23um increase in RNFL thickness to 176um), increasing macular edema (37um increase in CMT to 358um), and further darkening of his vision. A hematology consult had been obtained and anticoagulation was recommended with low molecular weight heparin (LMWH), which might provide the benefit of rapid onset that was also reversible.”

“While the patient recovered 20/30 vision, he continued to note light and color desaturation and exhibited a 2+ relative afferent pupillary defect in the left eye. The most recent RNFL study demonstrated nerve fiber layer loss in the superior pole of the nerve consistent with the diagnosis of NAION. There was also a residual inferior altitudinal visual field defect (Figure 4).”

145: Four cases of acquired hemophilia A following immunization with mRNA BNT162b2 SARS-CoV-2 vaccine

Author Leone et al

Country: Italy

Date Published Online: 1/19/22

Vaccine: Pfizer

Diagnoses: AHA

Link: https://pubmed.ncbi.nlm.nih.gov/35081484/

Case: “In the province of Reggio Emilia, Northern Italy, we observed four cases of AHA following SARS-CoV-2 immunization with mRNA BNT162b2 vaccine (produced by Pfizer-BioNTech) during the first eight months from the beginning of SARS-CoV-2 vaccination campaign.”

“Case 1: On April 2, 2021, a 86 year-old man, affected by rheumatic polymyalgia under low dose steroid therapy was admitted to our Hospital for spontaneous disseminated hematomas, with severe anemia (hemoglobin concentration 66 g/L) and increased activated partial thromboplastin time (APTT) ratio (1.91; reference interval: 0.8–1.2), persisting after mixing study.”

“Case 2: On May 29, 2021, a 73 year-old woman with a remote diagnosis of rheumatoid arthritis and Sjogren syndrome was admitted to our Hospital for spontaneous tongue, jaw and right knee hematomas. She had been injected with BNT162b2 on May 3 (2nd dose). She noticed a first haematoma on the tongue 14 days after the first dose and knee and jaw hematomas few days after the second dose.”

“Case 3: On August 4, 2021, a 67 year-old man was admitted to the Emergency Room for urgent otolaryngological assessment due to a large hematoma of the tongue, extending in the cervical region. His medical history was unremarkable. He received the second dose of BNT162b2 on June 16.”

“Case 4: On August 19, 2021, a 77 year-old man with relapsed bladder carcinoma was admitted to the Emergency Room for hematuria. No personal or family history of hemorragic disorders was reported. On June 28, he received the second dose of BNT162b2.”

146: Acute ST-Segment Elevation Myocardial Infarction After ChAdOx1 nCoV-19 Vaccination in a 33-Year-Old Man

Author Hsu et al

Country: Taiwan

Date Published Online: 1/19/22

Vaccine: AstraZeneca

Diagnoses: VITT, TCP, CVST, VT, AT, MI, ICH, MT

Link: https://pubmed.ncbi.nlm.nih.gov/35065747/

Case: “A 33-year-old man with an unremarkable medical history apart from obesity and mild hyperlipidemia (body mass index 34.6 kg/m2, cholesterol 204 mg/dL, triglycerides 138 mg/dL, low-density lipoprotein 142 mg/dL on the index day) presented to our emergency department after 1 day of crescendo chest pain. On arrival, ECG showed ST-segment elevation in leads II, III, and aVF, with reciprocal changes in leads I and aVL. Under the impression of acute STEMI, he was sent to the catheterization laboratory. Coronary arteriography revealed 83% stenosis with a heavy thrombus burden in the middle segment of the left circumflex artery.”

“The initial laboratory results were later available and showed unpredicted thrombocytopenia (57 × 103/μL). A history of receiving his first dose of ChAdOx1 nCoV-19 vaccine 9 days before symptom onset was obtained.”

“Whole-body imaging studies with CT/MRI/MRA were done and disclosed multiple thrombi at the straight, left transverse cerebral venous sinuses down to the left internal jugular veins, subsegmental pulmonary arteries, descending aorta, and hepatic veins. Tiny ischemic infarcts in the right centrum semiovale and temporal cortex and segmental infarctions in the spleen were also found. His clinical course was very complicated, and his persistent thrombocytopenia, decreased fibrinogen level, and very high D-dimer level were refractory to treatment with intravenous immunoglobulin, methylprednisolone, a direct oral anticoagulant, and cryoprecipitate. A severe headache happened on day 7 of hospitalization. An emergency decompressive craniotomy was undertaken for an intracerebral hemorrhage in his left cerebrum, followed by a retrograde thrombectomy of his intracranial venous sinuses on the next day. His cardiac troponin level was elevated again on day 9. A total occlusion of the left circumflex artery at the ostium and heavy thrombi in the right coronary artery were disclosed and treated. Although his platelet count and fibrinogen and D-dimer levels began to improve with plasma exchanges, his condition deteriorated, he had multiple organ failures, and he succumbed on day 14 of hospitalization.”

147: Ultrastructural findings of lung injury due to Vaccine-induced Immune Thrombotic Thrombo- cytopenia (VITT) following COVID-19 vaccination: a scanning electron microscopic study

Author Congiu et al

Country: Italy

Date Published Online: 1/20/22

Vaccine: AstraZeneca

Diagnoses: VITT

Link: https://pubmed.ncbi.nlm.nih.gov/35049004/

Case: “Here we report the lung ultrastructural findings in the course of VITT of a 58-year-old male patient. Alveoli were mainly dilated, irregular in shape, and occupied by a reticular network of fibrin, while interalveolar septa appeared thickened. The proliferation of small capillaries gave rise to plexiform structures and pulmonary capillary hemangiomatosis-like features. Near the alveoli occupied by a dense fibrin network, the medium-sized arteries showed a modified wall and an intraluminal thrombus. This scenario looks quite similar to that found during COVID-19, where the lungs suffer from the attack of the antigen-antibodies complexes and the virus respectively. In both diseases, the final outcome is a severe inflammation, activation of the haemostatic system and fibrinolysis.”

148: Autoimmune Hemolytic Anemia After mRNA COVID Vaccine

Author Fatima et al

Country: US

Date Published Online: 1/20/22

Vaccine: Moderna

Diagnoses: AIHA

Link: https://pubmed.ncbi.nlm.nih.gov/35045762/

Case: “The patient is a 66-year-old woman with long-term psoriatic arthritis on adalimumab therapy for more than 5 years. [..] A review of the peripheral blood smear by a hematologist showed a moderate number of spherocytes. Direct antiglobulin testing (DAT) showed 4+ IgG without C3, confirming IgG-mediated (warm) AIHA diagnosis.”

149: Acute Myocardial Infarction After Coronavirus Vaccine: A Rare Adverse Effect

Author Iqbal et al

Country: Pakistan

Date Published Online: 1/24/22

Vaccine: Moderna

Diagnoses: MI

Link: https://pubmed.ncbi.nlm.nih.gov/35223317/

Case: “A 61-year-old male presented to the emergency department with left arm and jaw pain for three hours which started 90 minutes after receiving the first dose of Moderna vaccine for coronavirus disease 2019 (COVID-19). He had a prior history of ischemic heart disease. Initial investigations confirmed the diagnosis of acute coronary syndrome. The patient was managed for non-ST-elevation myocardial infarction and percutaneous coronary intervention to the right posterior descending artery was done, and he was discharged after two days of hospital stay. As the patient was doing well for many years and was compliant with medications, this event was likely triggered by the coronavirus vaccine.”

150: A Case of Diffuse Alveolar Hemorrhage With COVID-19 Vaccination

Author Sharma et al

Country: US

Date Published Online: 1/27/22

Vaccine: Moderna

Diagnoses: DAH, TCP

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881991/

Case: “We report a case of a 59-year-old male with a recent COVID-19 infection who presented with DAH within eight hours of the first dose of mRNA vaccination (Moderna, Cambridge, MA). Bronchial alveolar lavage was performed, along with imaging of the chest, to confirm the diagnosis. Immunological workup with rheumatoid factor, anti-citrullinated peptide, anti-neutrophil cytoplasmic antibodies (P-ANCA and C-ANCA), anti-glomerular basement antibodies, Anti-double-stranded DNA, C3 and C4 complement levels, and cryoglobulin were all negative. Infectious workup with cultures and PCR from bronchial lavage was also negative. In the absence of any other causes, the etiology was likely deemed to be vaccine-induced DAH. Herein, we also discuss the possible mechanism of vaccine-related DAH and emphasize the need for further studies on vaccine-related adverse events.”

151: Acquired Hemophilia A following Pfizer-BioNTech SARS CoV-2 mRNA vaccine, successfully treated with prednisolone and rituximab

Author Murali et al

Country: Australia

Date Published Online: 1/28/22

Vaccine: Pfizer

Diagnoses: AHA

Link: https://pubmed.ncbi.nlm.nih.gov/35088622/

Case: “We report the case of a 95-year-old female who was immunised with the Pfizer-BioNTech SARS CoV-2 mRNA vaccine, with doses given three weeks apart. Spontaneous bruising over her extremities appeared one week after the initial dose, with hospital admission occurring three weeks after the second. Examination revealed a large haematoma on the dorsum of the right hand with resultant bleeding and widespread ecchymoses. Investigations confirmed a diagnosis of AHA.”

152: Branch Retinal Vein Occlusion after Messenger RNA-Based COVID-19 Vaccine

Author Sugihara et al

Country: Japan

Date Published Online: 1/31/22

Vaccine: Pfizer

Diagnoses: RVO

Link: https://pubmed.ncbi.nlm.nih.gov/35221977/

Case: “Two days after the second dose of the messenger RNA-based COVID-19 vaccine (BNT162b2), a healthy 38-year-old man developed branch retinal vein occlusion (BRVO) in his left eye (OS). His previous medical history was unremarkable and he was a nonsmoker. His blood pressure was 117/78 mm Hg. Blood examination did not suggest thrombophilia. His best-corrected visual acuity (BCVA) was 0.9 OS with myopic correction. A fundus examination showed a retinal hemorrhage and cotton wool spots in the superotemporal region of the posterior pole OS. Optical coherence tomography macular scans showed subfoveal fluid accumulation and retinal thickening in the superior macular region OS. Two intravitreal injections of aflibercept were administered 2 months apart. By 7 months after the initial visit, the BCVA was 1.2 OS and the retinal hemorrhage and macular edema have resolved. BRVO can be seen after BNT162b2 vaccinations. Because the third doses of the vaccine are beginning to be administered more widely, ocular complications including RVO can develop and require attention.”

153: A case report of vaccine-induced immune thrombocytopenia and thrombosis syndrome after Ad26.COV2.S vaccine (Janssen/Johnson & Johnson)

Author Castan et al

Country: France

Date Published Online: 1/31/22

Vaccine: J&J

Diagnoses: VITT, IS, PVT, VT, AT, DVT

Link: https://pubmed.ncbi.nlm.nih.gov/35135671/

Case: “On August 2, 2021, ten days after receiving a dose of Ad26.COV2.S vaccine (Janssen/Johnson & Johnson), a 57-years-old man was admitted for left hemiplegia. The rest of clinical examination was unremarkable. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing by nasopharyngeal swab was negative. He has no significant medical history and does not take any long-term treatment. Ischemic stroke, of thromboembolic origin with description of a proximal occlusion of the right internal carotid artery, was confirmed on brain magnetic resonance imaging (MRI).”

“Arterial Doppler ultrasound of the supra-aortic trunks confirmed a complete thrombosis of the right internal carotid artery. Ultrasound and abdomino-pelvic CT scan revealed partial portal vein thrombosis and right and middle hepatic vein thrombosis. Pain in the left leg prompted the realization of a venous Doppler ultrasound of the lower limbs, finding a distal deep venous thrombosis.”

154: Post COVID-19 Vaccination-Associated Neurological Complications

Author Assiri et al

Country: Saudi Arabia

Date Published Online: 2/2/22

Vaccine: Pfizer, AtraZeneca

Diagnoses: IS, VITT, CVT, ICH, VI, PI, CVT

Link: https://pubmed.ncbi.nlm.nih.gov/35140464/

Case: “Three patients who received the first dose of the Vaxzevria vaccine experienced severe cerebral venous thrombosis, two of them were complicated by intracranial hemorrhage. Their laboratory investigations showed very high d-dimers and severe thrombocytopenia, which have been linked to higher mortality and poor outcome. Ischemic stroke occurred in eight cases (44.4%) with a predominance in older male patients. Three patients presented with seizures, two had optic neuritis. Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS) occurred in two male patients following vaccination with Comirnaty.”

155: Clinical relapse of immune-mediated thrombotic thrombocytopenic purpura following COVID-19 vaccination

Author Deucher et al

Country: US

Date Published Online: 2/7/22

Vaccine: Pfizer

Diagnoses: ITPP

Link: https://pubmed.ncbi.nlm.nih.gov/35155977/

Case: “Here, we present a case of a 28-year-old woman who received the tozinameran (BNT162b2, Pfizer-BioNtech) vaccine for COVID-19 and experienced an iTTP relapse during longitudinal follow-up. She received the vaccine 30 months after her initial diagnosis, while she was in clinical remission. She was not in complete ADAMTS-13 remission, as she had undetectable ADAMTS-13 activity during follow-up except for one isolated measurement of 48%. Shortly after vaccination, she developed complaints of bruising, petechiae, ataxia, and an episode of slurred speech. Laboratory testing demonstrated thrombocytopenia, schistocytes, and eventually undetectable ADAMTS-13 activity. She was successfully treated with caplacizumab, rituximab, and corticosteroids without plasma exchange. She achieved complete clinical and ADAMTS-13 remission after treatment. We recommend caution in the administration of COVID-19 vaccines for survivors of iTTP in remission with severely deficient ADAMTS-13 activity.”

156: Extensive Cerebral Venous Sinus Thrombosis (CVST) After the First Dose of Pfizer-BioNTech BNT162b2 mRNA COVID-19 Vaccine without Thrombotic Thrombocytopenia Syndrome (TTS) in a Healthy Woman

Author Alhashim et al

Country: Saudi Arabia

Date Published Online: 2/9/22

Vaccine: Pfizer

Diagnoses: CVST, JVT

Link: https://pubmed.ncbi.nlm.nih.gov/35136010/

Case: “A 28-year-old healthy woman presented with a 2-week history of persistent and progressive headache 4 days after receiving an mRNA COVID-19 vaccine (Pfizer-BioNTech). Cerebral computed tomography (CT) and CT venography confirmed the presence of extensive thrombus involving the left transverse and sigmoid sinus as well as the internal jugular vein. Furthermore, other than recent the COVID-19 vaccination, there were no precipitant risk factors in her clinical history or in the detailed laboratory work-up.”

157: A challenging case of heparin-induced skin necrosis without thrombocytopenia

Author Chidharla et al

Country: US

Date Published Online: 2/10/22

Vaccine: Moderna

Diagnoses: PE, TCP

Link: https://pubmed.ncbi.nlm.nih.gov/35140192/

Case: “Heparin-induced skin necrosis (HISN) is a rare complication of heparin anticoagulation. The condition occurs in various situations, including in heparin-naive and exposed individuals, in areas local or distant from the heparin injection site, and with or without frank thrombocytopenia. We present a case in which a patient treated for a pulmonary embolism with therapeutic unfractionated heparin (UFH) develops this adverse event. Symptoms were reversed with cessation of UFH and transition to bivalirudin without surgical debridement. The patient initially had anti-PF4 antibodies present but subsequent testing showed borderline antibodies and a negative serotonin release assay. After starting bivalirudin, the patient was later switched to fondaparinux without further consequences. This case illustrates the pathogenesis of HISN and provides an example of inconsistently abnormal laboratory values. Additionally, it provides two novel exposures the mRNA-1273 vaccine and the immune checkpoint inhibitor pembrolizumab that, to our knowledge, have not been previously reported.”

158: Deep Vein Thrombosis and Pulmonary Thrombosis After BNT162b2 mRNA SARS-CoV2 Vaccination

Author Sawatari et al

Country: Japan

Date Published Online: 2/15/22

Vaccine: Pfizer

Diagnoses: DVT, PE

Link: https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-21-1055/_article

Case: “We report a rare case of a 14-year-old male presenting with deep vein thrombosis after receiving the SARS-CoV2 vaccine. The day after receiving the second dose of the vaccine, 23 days after the first vaccination, the patient visited Chutoen Medical Center complaining of pain in the lower region of his left leg. He had no family history of juvenile thrombosis or a medical history of thrombosis. [..] Contrast-enhanced computed tomography revealed thrombosis in multiple organs (Figure). [..] 1 In this case, the mechanism of thrombosis development was unknown. Therefore, it is important to remain vigilant for similar adverse effects of the mRNA-1273 vaccine in the future.”

159: Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of Pfizer-BioNTech BNT162b2 mRNA COVID-19 Vaccine: A Case Report

Author Al-Rasbi et al

Country: Oman

Date Published Online: 2/17/22

Vaccine: Pfizer

Diagnoses: TCP, Myo

Link: https://pubmed.ncbi.nlm.nih.gov/35173141/

Case: “A 37-year-old man presented to the Emergency Department (ED) with a 3-day history of back pain and a 1-day history of left upper limb swelling with paresthesia and shortness of breath, 12-days after receiving the first dose of Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine. He was diagnosed with severe myositis complicated with rhabdomyolysis and non-oliguric acute kidney injury, thrombocytopenia, myocarditis with pulmonary edema, and pulmonary hemorrhage. Screens for potential toxic, infectious, paraneoplastic, and autoimmune disorders were unremarkable. The patient was treated with a 5-day course of intravenous methylprednisolone and intravenous immunoglobulin, with a good response. He was hospitalized for 16 days and discharged home on a tapering dose of oral prednisolone for 6 weeks.”

“The case describes a possible link between Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine and immune-mediated myocarditis, pulmonary vasculitis, myositis, and thrombocytopenia. However, further data are required to confirm such an association.”

160: Fatal thrombotic microangiopathy with rhabdomyolysis as an initial symptom after the first dose of mRNA-1273 Vaccine: A case report

Author Kamura et al

Country: Japan

Date Published Online: 2/17/22

Vaccine: Moderna

Diagnoses: TMA, MT

Link: https://pubmed.ncbi.nlm.nih.gov/35189339/

Case: “We report a case of a Japanese man with severe rhabdomyolysis and multiple thrombosis of arterioles after the first dose of mRNA-1273 vaccine. He developed rapidly progressive rhabdomyolysis and infarctions of multiple organs. Antiplatelet factor 4 antibody test was negative. Despite the intensive supportive care, including aggressive fluid administration, hemodialysis, administration of anticoagulants, high-dose steroid, and eculizumab, the patient ultimately died of multiple organ failure. Autopsy revealed multiple thrombosis in the arterioles and organ necrosis. Low serum complements and C3 deposition in the renal glomeruli detected by immunofluorescence suggested a possible immune-mediated mechanism. To our knowledge, this is the first case report of rhabdomyolysis and multiple thrombosis of the arterioles as an adverse event following COVID-19 vaccination.”

161: Branch retinal vein occlusion in a healthy young man following mRNA COVID-19 vaccination

Author Pur et al

Country: Canada

Date Published Online: 2/18/22

Vaccine: Pfizer

Diagnoses: RVO

Link: https://pubmed.ncbi.nlm.nih.gov/35211659/

Case: “A 34-year-old healthy male presented with blurriness in the inferior visual field, intermittent photopsia, multiple retinal hemorrhages, dilated and tortuous retinal vessels, and cotton wools spots in the right eye. The clinical examination and ancillary tests confirmed the diagnosis of a right eye BRVO. The visual symptoms started 2 days following first dose COVID-19 vaccination with the BNT162b2 (Pfizer-BioNTech) mRNA vaccine.”

“This is a rare case of BRVO in an otherwise healthy young man, presenting after vaccination for COVID-19 in the absence of other coagulable risk factors. As the literature on venous thrombosis after COVID-19 vaccinations remains sparse, it is critical to raise awareness that BRVO could be a vaccine-related thrombotic adverse event. We highlight that as more of the population is vaccinated, an increased incidence of BRVO may confirm the link to COVID-19 vaccination.”

162: A Rare Case of Coronavirus Disease 2019 Vaccine-Associated Cerebral Venous Sinus Thrombosis Treated with Mechanical Thrombectomy

Author Gurjar et al

Country: US

Date Published Online: 2/19/22

Vaccine: Moderna

Diagnoses: CVST

Link: https://pubmed.ncbi.nlm.nih.gov/35181646/

Case: “We describe a case of 56-year-old postmenopausal, obese woman with hypothyroidism and hyperlipidemia, who presented to the Emergency Department (ED) with fluctuating mental status and left-side weakness for 5 days. She received her first and second dose of mRNA-1273 vaccine (Moderna) at 12 and 8 weeks, respectively, prior to presentation. She was found to have multiple hemorrhages and infarcts on a computed tomography (CT) scan of the head. She was intubated in the ED for airway protection and mechanically ventilated. Magnetic resonance angiogram and venogram showed multiple infarcts in right frontal, parietal, and left parietal lobes, along with occlusion of left-side transverse sinus, sagittal sinuses, and left internal jugular vein, suggesting cerebral venous sinus thrombosis (CVST). Despite anticoagulation, her clinical condition continued to worsen, and she was referred for emergent endovascular thrombectomy. Her clinical condition improved after thrombectomy, and she was discharged on warfarin.”

163: İmmune-mediated Thrombotic Thrombocytopenic Purpura after BNT162b2 Vaccine

Author Güney et al

Country: Turkey

Date Published Online: 2/23/22

Vaccine: Pfizer

Diagnoses: ITPP

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8886268/

Case: “A 48-year-old female patient was admitted to the hematology outpatient clinic on June 26 with complaints of weakness, nausea, dizziness, and bruising. There was no positive finding in her history, except that she had received the first dose of the BNT162b2 vaccine on June 14, 2021. She was taking no medications. She stated that ecchymoses had developed from the third day after vaccination. [..] ADAMTS13 enzyme activity was dramatically reduced to <0.2% with a high antibody titer level of >90 U/mL.”

164: Acquired Hemophilia A Developed Post COVID-19 Vaccine: An Extremely Rare Complication

Author Soliman et al

Country: Qatar

Date Published Online: 2/25/22

Vaccine: Pfizer

Diagnoses: AHA

Link: https://pubmed.ncbi.nlm.nih.gov/35211227/

Case: “We report a 39-year-old single female who presented to emergency department with sudden onset gross hematuria 10 days following her first dose of Pfizer-BioNTech severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA (coronavirus disease 2019 (COVID-19)) vaccine. Coagulation profile revealed isolated prolongation of the activated partial thromboplastin time due to FVIII deficiency with normal von Willebrand factor and activity.”

165: Cardiogenic shock temporally associated with COVID-19 vaccination after prior COVID-19 infection: A case report

Author Jean-Marie et al

Country: US

Date Published Online: 3/5/22

Vaccine: Pfizer

Diagnoses: MI

Link: https://pubmed.ncbi.nlm.nih.gov/35282400/

Case: “Here we report a case of a previously healthy 21-year-old male who developed Multisystem Inflammatory Syndrome in Adults (MIS-A) and following the second dose of the Pfizer-BioNtech vaccine. The young male initially presented with fever, leukocytosis with high neutrophil-lymphocyte ratio, severe cardiac illness, and positive COVID-19 nucleocapsid serology, consistent with MIS-A diagnosis. His case was complicated by cardiogenic shock, requiring brief venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. While this report does not detract from the overwhelming benefit of vaccination from COVID-19, clinicians should be aware of this possible relationship in the future.”

166: A case of acquired hemophilia A and bullous pemphigoid following SARS-CoV-2 mRNA vaccination

Author Fu et al

Country: Taiwan

Date Published Online: 3/14/22

Vaccine: Moderna

Diagnoses: AHA

Link: https://pubmed.ncbi.nlm.nih.gov/35321820/

Case: “We report a 77-year-old Taiwanese man presented with multiple ecchymoses and some hemorrhagic blisters three weeks after SARS-CoV-2 mRNA (Moderna) vaccination. Isolated activated partial thromboplastin time (aPTT) prolongation was found. Acquired hemophilia A (AHA) was confirmed by low factor VIII (FVIII) activity and high titer of FVIII inhibitor. The pathohistology of skin biopsy further supported the concomitant diagnosis of bullous pemphigoid.”

167: Acute Budd-Chiari syndrome with thrombotic thrombocytopenia after BNT162b2 mRNA vaccination

Author Sung et al

Country: Korea

Date Published Online: 3/15/22

Vaccine: Pfizer

Diagnoses: TTCP, BCS, PE

Link: https://pubmed.ncbi.nlm.nih.gov/35289465/

Case: “A 34‐year‐old female visited the clinic with increased abdominal circumference and pitting oedema of the lower extremities for 3 weeks [..] Importantly, she received the first dose of the BNT162b2 mRNA vaccination 6 weeks prior. [..] Contrast‐enhanced abdominal CT scan revealed poor liver enhancement, abruptly collapsed hepatic veins without membranous structure, decreased portal vein flow without collateral vessels or splenomegaly, and concomitant ascites (Figure 1A). Pulmonary thromboembolism was noted in the right inferior pulmonary artery without any specific symptoms. Hepatic venography identified only small branches of the venous outflow as ‘spiderweb appearance’ (Figure 1B). Liver biopsy demonstrated dilated sinusoids with extensive perisinusoidal hepatocyte dropout (Figure 1C). Masson Trichrome staining demonstrated no fibrosis in the portal tract and perisinusoidal area (Figure 1D). Collectively, these findings suggested Budd‐Chiari syndrome (BCS) which occurred relatively recently. For the treatment, intravenous immunoglobulin and direct oral anticoagulants were given to the patient. One month later, thrombocytopenia disappeared and venous flow in Doppler ultrasonography showed markedly restored.”

168: Vaccine-Induced Thrombotic Thrombocytopenia: A Case Report

Author Silva et al

Country: Portugal

Date Published Online: 3/15/22

Vaccine: J&J

Diagnoses: VITT

Link: https://pubmed.ncbi.nlm.nih.gov/35449682/

Case: “We report a case of vaccine-induced thrombotic thrombocytopenia (VITT) in a 30-year-old previously healthy male after vaccination with Ad26.COV2.S. The patient presented to the emergency department (ED) with abdominal pain and headache. Laboratory tests revealed thrombocytopenia, high D-dimer levels, and fibrinogen consumption. Thoracoabdominal CT scan showed a thrombus in the portal mesenteric venous axis. A positive PF4 heparin enzyme-linked immunosorbent assay confirmed the VITT diagnosis, and the patient was started on intravenous immunoglobulin. Both clinical complaints and laboratory findings resolved within six days, and he was discharged to follow-up. This case shows that general symptoms after vaccination should not be depreciated, highlights the importance of early diagnosis and treatment, and raises new questions about the follow-up and further study of these patients.”

169: Severe immune thrombocytopenia following COVID-19 vaccination (Moderna) and immune checkpoint inhibitor: A case report

Author Chong et al

Country: Taiwan

Date Published Online: 3/18/22

Vaccine: Moderna

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/35339338/

Case: “Here, we report a rare case of severe immune thrombocytopenia occurring 3 days after receiving the mRNA-1273 (Moderna) COVID-19 vaccine in an Asian woman with a history of refractory lung adenocarcinoma treated with durvalumab, an immune checkpoint inhibitor. Treatment with platelet transfusion (12 units) and oral prednisolone (1 mg/kg per day) significantly improved her hemoptysis with thrombocytopenia.”

170: Development of Venous Thromboembolism After COVID-19 mRNA-1273 Vaccine Inoculation

Author Mahgoub et al

Country: US

Date Published Online: 3/20/22

Vaccine: Moderna

Diagnoses: VTE, DVT, PE

Link: https://pubmed.ncbi.nlm.nih.gov/35308698/

Case: “A 79-year-old man suddenly developed right lower extremity (RLE) pain and swelling a few days after receiving his 1st dose of the mRNA-1273 COVID-19 vaccine. Despite this, he proceeded to receive the 2nd dose of his mRNA-1273 COVID-19 vaccine. Investigations confirmed extensive acute deep venous thrombosis and a concurrent acute pulmonary embolism. Therapeutic anticoagulation was initiated and he was eventually discharged home on supplemental oxygen. The overall benefits of the vaccine in curbing severe disease overwhelmingly outweigh the handful of cases of reported adverse events.”

171: Thrombotic thrombocytopenic purpura following administration of the Moderna booster vaccine

Author Herrman et al

Country: US

Date Published Online: 3/24/22

Vaccine: Moderna

Diagnoses: TTCPP

Link: https://pubmed.ncbi.nlm.nih.gov/35332007/

Case: “We present a case of TTP following administration of the Moderna booster vaccine.”

172: Case Report: Recanalization of Branch Retinal Artery Occlusion Due to Microthrombi Following the First Dose of SARS-CoV-2 mRNA Vaccination

Author Kang et al

Country: Korea

Date Published Online: 3/24/22

Vaccine: Pfizer

Diagnoses: RAO, MIT, RAO

Link: https://pubmed.ncbi.nlm.nih.gov/35401231/

Case: “We report on a patient with a branch retinal artery occlusion (RAO) and its recanalization based on multimodal retinal and angiographic images after he was administered the first dose of the SARS-CoV-2 mRNA vaccine.”

“A 64-year-old man complained of a right, painless, inferior field defect 3 days after the first dose of BNT162b2 vaccination. Fundus examination revealed decolorization of the right upper macula, including microthrombi in the superior proximal branch of the retinal artery. Optical coherence tomography angiography revealed upper macular hypoperfusion. Fluorescein angiography revealed prolonged arteriovenous transit to the macula. After paracentesis with antiplatelet medications, the artery was recanalized as the thrombi dissolved, and the right visual field was recovered. Re-occlusion did not occur during the 3 months after the second mRNA vaccination.”

173: A Case of Systemic Capillary Leak Syndrome with Severe Cardiac Dysfunction after mRNA Vaccination for COVID-19

Author Araki et al

Country: Japan

Date Published Online: 3/24/22

Vaccine: Pfizer

Diagnoses: CS

Link: https://pubmed.ncbi.nlm.nih.gov/35345835/

Case: “A 53-year-old woman with no significant medical history developed cardiogenic shock four days after receiving the second dose of the COVID-19 mRNA vaccine (BNT162b2, Pfizer/BioNtech). The patient required extracorporeal membrane oxygenation and an Impella device. Based on significant hemoconcentration, decreased plasma protein levels, and pathological findings in myocardial specimens, the patient was diagnosed with vaccination-induced fulminant systemic capillary leak syndrome (SCLS) with severe cardiac dysfunction. This Case highlights that SCLS can occur after COVID-19 mRNA vaccination and may be associated with cardiac dysfunction. In patients with cardiogenic shock, hemoconcentration, and hypoalbuminemia after vaccination, SCLS should be considered.”

174: Vaccine-Induced Thrombotic Thrombocytopenia: A Case of Splanchnic Veins Thrombosis

Author Abbasi et al

Country: Saudi Arabia

Date Published Online: 3/26/22

Vaccine: AstraZeneca

Diagnoses: VITT, SVT

Link: https://pubmed.ncbi.nlm.nih.gov/35494984/

Case: “We describe a case of a 36-year-old female who presented with epigastric pain two weeks after receiving her first dose of the AstraZeneca vaccine, and upon workup, was subsequently found to have thrombosis of her right portal and right common iliac vein.”

175: COVID‐19 vaccine (mRNA BNT162b2) and COVID‐19 infection‐induced thrombotic thrombocytopenic purpura in adolescents

Author Vorster et al

Country: US

Date Published Online: 4/4/22

Vaccine: Pfizer

Diagnoses: TTCPP

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9088367/

Case: “We present a case series of adolescents presenting with TTP (including both de novo and relapsed disease) following administration of the Pfizer‐BioNTech mRNA BNT162b2 anti‐COVID‐19 vaccine or after COVID‐19 infection.”

“Patient 1 is a 19‐year‐old female previously diagnosed with acquired TTP at age 14 years who developed fever, ecchymoses, and hemoglobinuria 2 days after receiving the initial dose of the Pfizer‐BioNTech COVID‐19 vaccine. Her physical examination was notable for bilateral suborbital and lower extremity petechiae and bruising at IV insertion sites. Admission labs were significant for thrombocytopenia and signs of intravascular hemolysis (Table 2). ADAMTS13 activity at presentation resulted <5%, confirming a relapse of TTP. Of note, her prior disease course had been complicated by the development of systemic lupus erythematosus (SLE)‐specific autoantibodies without evidence of organ dysfunction, and a prior TTP relapse at age 18.”

“Patient 2 is a 15‐year‐old female who presented with fatigue, ecchymoses, and headache 3 days after the first dose of Pfizer‐BioNTech COVID‐19 vaccine. Laboratory evaluation revealed severe thrombocytopenia, anemia with reticulocytosis, and ADAMTS13 activity <5% (Table 2). She received TPE for 4 days, methylprednisolone 1 g daily for 3 days followed by a taper, and rituximab 375 mg/m2 weekly for four doses. Her treatment course was complicated by a vesicular rash and neuropathy, presumably due to Herpes Zoster.”

“Patient 3 is a 17‐year‐old male with a history of precocious puberty previously on hormonal treatment who presented to an outside institution with bruising 3 weeks after PCR‐testing confirmed symptomatic COVID‐19 infection. He was initially treated with intravenous immunoglobulin for presumed immune thrombocytopenia (ITP). One week later, he presented to an outside hospital with jaundice, pallor, and altered mental status. His ADAMTS13 activity returned at <5% (Table 2), confirming a diagnosis of TTP. He received TPE for 5 days, prednisone 60 mg BID with prolonged taper, and rituximab 375 mg/m2 weekly for 4 doses. He also received two 28‐day courses of caplacizumab with improved platelet counts, but with recurrent thrombocytopenia and hemolytic anemia upon cessation. Cylcosporine 150 mg twice daily was initiated due to poor response with prior immunosuppression. ADAMTS13 gene sequencing was obtained.”

176: TAFRO syndrome with a fatal clinical course following BNT162b2 mRNA (Pfizer-BioNTech) COVID-19 vaccination: A case report

Author Yamada et al

Country: Japan

Date Published Online: 4/10/22

Vaccine: Pfizer

Diagnoses: TCP, TAFRO

Link: https://pubmed.ncbi.nlm.nih.gov/35428576/

Case: “TAFRO syndrome is a rare disorder that manifests as thrombocytopenia, anasarca, fever, reticulin myelofibrosis, renal dysfunction, and organomegaly. Although this disease often follows a severe clinical course, the cause remains unknown. The coronavirus disease 2019 (COVID-19) pandemic is a major global problem. Vaccination against COVID-19 has been successful; however, there are concerns about severe adverse events. Herein, we report a rare presentation of TAFRO syndrome triggered by the COVID-19 vaccine with a fatal clinical course. A 42-year-old Japanese man presented to our hospital complaining of fever lasting for 2 weeks that occurred a day after receiving the BNT162b2 mRNA (Pfizer-BioNTech) COVID-19 vaccine. The patient had a low platelet count, ascites, reticulin myelofibrosis, renal failure, and lymphadenopathy and was diagnosed with TAFRO syndrome. Despite administering several immunosuppressive drugs, the condition did not improve. The patient repetitively developed and eventually died of bacteremia caused by multidrug-resistant Klebsiella pneumoniae. We highlight the first reported case of TAFRO syndrome after COVID-19 vaccination.”

177: Successful Treatment of Immune Thrombocytopenic Purpura with Intracranial Hemorrhaging and Duodenal Bleeding Following SARS-CoV-2 Vaccination

Author Baba et al

Country: Japan

Date Published Online: 4/11/22

Vaccine: Pfizer

Diagnoses: ITPP, ICH

Link: https://pubmed.ncbi.nlm.nih.gov/35400701/

Case: “We herein report a 90-year-old man who received the Pfizer-BioNTech SARS-CoV-2 vaccine (BNT162b2) and developed severe thrombocytopenia with intracranial hemorrhaging and duodenal bleeding, consistent with vaccine-related ITP. He was successfully treated with intravenous immunoglobulin, prednisolone, and eltrombopag and discharged without cytopenia.”

178: BNT162b2 COVID-19 Vaccine Induced Immune Thrombocytopenic Purpura

Author Ghosh et al

Country: US

Date Published Online: 4/12/22

Vaccine: Pfizer

Diagnoses: ITP

Link: https://pubmed.ncbi.nlm.nih.gov/35464782/

Case: “Herein, we present a patient who presented with severe ITP with a platelet count of 0 after receiving the second dose of the BNT162b2 mRNA COVID-19 vaccine (also known as the Pfizer BioNTech). She subsequently recovered with a prolonged treatment course.”

“A 63-year-old female presented to the emergency department with a rash and easy bruising that started a day after her second dose of BNT162b2 vaccination. The rash was initially noted on both her legs and then spread to the rest of her body. Two days after the second COVID-19 vaccination, the patient noticed a large bruise on her lower back, without prior trauma. In addition, she also noted mild bruising of her tongue but no active bleeding. She reported mild dyspnea after receiving her first COVID-19 vaccine 3 weeks earlier and noted similar symptoms soon after her second dose of the vaccine. Physical examination revealed generalized petechiae and subcutaneous bruises on the lower back.”

“Based on these findings, the patient was diagnosed with immune thrombocytopenic purpura (ITP), believed to be secondary to the COVID-19 vaccine.”

179: Cerebral Venous Sinus Thrombosis due to Thrombosis with Thrombocytopenia Syndrome Following Ad26.COV2.S: A First Real-World Case Report of a Male Subject

Author Asif et al

Country: US

Date Published Online: 4/14/22

Vaccine: J&J

Diagnoses: TTS, CVST, PE

Link: https://pubmed.ncbi.nlm.nih.gov/35419151/

Case: “We report the first case of a young male with TTS and CVST following Ad26.COV2.S vaccine presented with severe headache and diagnosed with acute right transverse and sigmoid cerebral venous sinus thrombosis, multiple right-sided pulmonary emboli, and right hepatic vein thrombosis. He was treated with parenteral anticoagulation with argatroban and intravenous immune globulin with the improvement of his symptoms. A heparin-induced thrombocytopenia with thrombosis (HITT) like syndrome caused by the genesis of a platelet-activating autoantibody against platelet factor 4 (PF4) triggered by adenoviral vector-based COVID-19 vaccinations is understood to be the underlying pathophysiology.”

180: Ischemic retinal events after COVID-19 vaccination

Author Priluck et al

Country: US

Date Published Online: 4/18/22

Vaccine: Moderna, J&J

Diagnoses: RI, RVO

Link: https://pubmed.ncbi.nlm.nih.gov/35465337/

Case: “We report 2 cases of ischemic retinal events occurring soon after administration of the Moderna and Johnson & Johnson/Janssen COVID-19 vaccines”

“A 57-year-old female had new onset floaters of the left eye within days of her second Moderna COVID-19 vaccination, which progressively worsened prompting her to present for evaluation. She was diagnosed with a branch retinal vein occlusion in the left eye. A 20-year-old female presented with persistent central scotomata in both eyes, which she first noticed two days after her Johnson & Johnson/Jannsen COVID-19 vaccination. She was diagnosed with acute macular neuroretinopathy of both eyes.”

181: Thrombosis post-mRNA-based SARS-CoV-2 vaccination (BNT162b2) – Time to think beyond thrombosis with thrombocytopenia syndrome (TTS)

Author Yousaf et al

Country: Qatar

Date Published Online: 4/18/22

Vaccine: Pfizer

Diagnoses: DVT, MT, AT, VT

Link: https://www.sciencedirect.com/science/article/pii/S2666572722000086

Case: “A 57-year-old non-smoker Filipino lady with a history of dyslipidemia presented with the first episode of progressive severe left leg pain, erythema, and swelling for two weeks. She received amoxicillin/clavulanate from primary care 11 days before presentation for suspected cellulitis, but the symptoms progressed.”

“The examination was normal except for an erythematous, tender, hot, and swollen left lower limb with the left calf 3cm larger than the right.”

“Due to a high Well's score for deep venous thrombosis (DVT), a duplex and doppler ultrasound of the lower limbs was performed and showed left popliteal, posterior tibial, superficial femoral, common femoral, and external iliac thrombosis extending up to the infrarenal inferior vena cava. Thrombus was also noted in the great saphenous vein and short saphenous vein (Fig. 1).”

182: Acquired Thrombotic Thrombocytopenic Purpura After BNT162b2 COVID-19 Vaccine: Case Report and Literature Review

Author Hammami et al

Country: France

Date Published Online: 4/28/22

Vaccine: Pfizer

Diagnoses: aTTP

Link: https://pubmed.ncbi.nlm.nih.gov/35482291/

Case: “We present a case study of a patient wth TTP occurring after a second dose of the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine along with a review of the literature. A 55-year-old patient presented with gastrointestinal symptoms, anemia, and severe thrombocytopenia. The blood film revealed the presence of schistocytes. A diagnosis of aTTP was established because the patient had severe ADAMTS 13 deficiency and autoantibodies against ADAMTS 13 were positive. This episode occurred 10 days after the patient received the COVID-19 vaccine. The patient received plasma exchanges, prednisone, rituximab, and caplacizumab and achieved complete remission.”

183: "Vitreous Hemorrhage and Long-Lasting Priapism After COVID-19 m-RNA Based Vaccine: A Case Report"

Author Casarini et al

Country: Italy

Date Published Online: 5/3/22

Vaccine: Pfizer

Diagnoses: Ret VH

Link: https://pubmed.ncbi.nlm.nih.gov/35505605/

Case: “A 60-year-old man presented with blurred vision in the left eye lasting 1 month but started within 24 hours from the 2nd dose of BNT162b2 vaccine inoculation. He also reported a long-lasting but self-limiting priapism which started about 4 h after the vaccination. [..] Ocular examination of the affected eye revealed vitreous hemorrhage which limited the observation of details of the fundus. After a 2-week follow-up without any clinical improvement, parsplana vitrectomy (PPV) with cataract extraction was performed. Surgical aspiration of a large preretinal hemorrhage revealed intraretinal flame-shaped hemorrhages and some cotton wool spots. Further intraoperative examination and post-operative fluorescein angiography excluded the rhegmatogenaous and the neovascular origin of the intraocular bleeding.”

“Due to the several predisposing factors such as diabetes, aspirin assumption, history of blood dyscrasia and infectious retinitis, the relationship between the acute intraocular bleeding and the BNT162b2 inoculation remains difficult to ascertain in this patient. However, the occurrence of lasting priapism and vitreous hemorrhage within 24 h from the vaccination is a critical event which deserves to be mentioned.”

184: Liver injury and cytopenia after BNT162b2 COVID-19 vaccination in an adolescent

Author Kawasaki et al

Country: Japan

Date Published Online: 5/5/22

Vaccine: Pfizer

Diagnoses: TCP

Link: https://pubmed.ncbi.nlm.nih.gov/35510521/

Case: “A previously healthy 15-year-old female received the first dose of the BNT162b2 vaccine from a primary care physician. Approximately 8 h after vaccination, the patient complained of fever and headache. She revisited the physician and was treated with acetaminophen (400 mg, 1–3 times daily). Three days later, the fever and headache had not subsided and she visited the physician for the third time.”

“Thus, we made a diagnosis of liver injury and cytopenia related to the vaccination.”

185: Aortic Mural Thrombosis Diagnosed After a Second Dose of mRNA-1273 SARS-CoV-2 Vaccine

Author Pujwani et al

Country: US

Date Published Online: 5/9/22

Vaccine: Moderna

Diagnoses: AMT

Link: https://journals.lww.com/americantherapeutics/Citation/2022/06000/Aortic_Mural_Thrombosis_Diagnosed_After_a_Second.13.aspx

Case: Unavailable

186: Lobar bleeding with ventricular rupture shortly after first dosage of an mRNA-based SARS-CoV-2 vaccine

Author Finsterer

Country: Ausrtia

Date Published Online: 10/28/21

Vaccine: Pfizer

Diagnoses: VR, ICH

Link: https://pubmed.ncbi.nlm.nih.gov/34729467/

Case: We report a 67yo female who developed visual impairment, dysarthria, confusion, and fatigue a few hours after a first dosage with an mRNA-based SARS-CoV-2 vaccine (Pfizer). Her previous history listed diabetes, arterial hypertension, arterial occlusive disease, a single renal cyst on the left side, smoking, and ischemic stroke 20y earlier. Stroke was complicated by normal pressure hydrocephalus requiring placement of a ventriculo-atrial (VA)-shunt. Cerebral imaging revealed a right-sided intracerebral bleeding with ventricular rupture and correct placement of the VA-shunt. Neurosurgeons decided against surgical treatment. The further course was dominated by prolonged confusion, visual impairment, and disorientation but ultimately only minor deficits. In conclusion, a single patient experienced intracerebral bleeding with ventricular rupture shortly after application of the first jab of an mRNA-based SARS-CoV-2 vaccine.

187: Large hemorrhagic stroke after ChAdOx1 nCoV-19 vaccination: A case report - PubMed

Author: de Mélo Silva Jr &

Country: Brazil

Date Published Online: 7/17/21

Vaccine: AstraZeneca

Diagnoses: Hema, VITT

Link: https://pubmed.ncbi.nlm.nih.gov/34620638/

Case: “A woman, 57 years old, took the first dose of the ChAdOx1 nCoV-19 vaccine and shortly thereafter presented mild systemic symptoms and started on aspirin. On day 5, she had a sudden onset of sweating and paleness, which has followed by left hemiparesis, vomiting, and somnolence. Computed tomography showed a large right deep frontal lobe parenchymal hematoma with the inundation of the entire ventricular system.”

188: Haematuria, a widespread petechial rash, and headaches following the Oxford AstraZeneca ChAdOx1 nCoV-19 Vaccination - PubMed

Author: Waraich & Williams

Country: UK

Date Published Online: 10/7/21

Vaccine: AstraZeneca

Diagnoses: CVST, SAH

Link: https://pubmed.ncbi.nlm.nih.gov/34459725/

Case: “With increasing presentations of headaches following COVID-19 vaccination, we present one of the UK's earliest proven cases of vaccine-induced thrombotic thrombocytopaenia (VITT), with the aim of giving colleagues a case to compare other patients against. Our patient was a 48-year-old man who presented with frank haematuria, a widespread petechial rash, and headaches, 2 weeks after receiving the first dose of the Oxford AstraZeneca ChAdOx1 nCoV-19 vaccine. He had a platelet count of 14×109/L and an extensive cerebral venous sinus thrombosis (CVST) with subarachnoid haemorrhage on imaging. He developed localising neurological signs and experienced a cardiopulmonary arrest. He was successfully resuscitated and transferred to a tertiary care centre for urgent thrombectomy. This case illustrates how the diagnosis of VITT should be based on the platelet count and imaging-and how patients with VITT should be cared for in centres with urgent neurosurgical and interventional radiology services.”

189: Fatal Systemic Capillary Leak Syndrome after SARS-CoV-2Vaccination in Patient with Multiple Myeloma - PubMed

Author: Choi GJ et al

Country: Korea

Date Published Online: 8/31/21

Vaccine: J&J

Diagnoses: SCLS

Link: https://pubmed.ncbi.nlm.nih.gov/33928772/

Case: “A 38-year-old man reporting vomiting and dizziness sought treatment at an emergency department. Smoldering multiple myeloma had been diagnosed 1.5 years before, but no laboratory abnormalities had been found in his most recent hospital visit 5 months earlier. He had received the Ad26.COV2.S vaccine 2 days before the emergency department visit and experienced fever, chills, and myalgia 12–24 hours postvaccination, then nausea, recurrent vomiting, and general weakness 24–48 hours postvaccination. At admission, he was afebrile, his heart rate was 130 beats/min, and his blood pressure was 100/90 mm Hg, with no noticeable edema. We administered isotonic saline and initiated diagnostic evaluations: laboratory tests, imaging, and COVID-19 reverse transcription PCR. Test results (Table) showed marked hemoconcentration and hypoalbuminemia. Chest and abdominal computed tomography results were unremarkable. Six hours after admission, the patient was hypotensive (blood pressure 60/40 mm Hg), had a heart rate of 132 beats/min, and reported dyspnea. We obtained blood cultures and treated the patient with broad-spectrum antimicrobials, intravenous fluids, and inotropes. Despite these measures, the patient’s hypotensive shock worsened, and he died 10 hours after admission.”

190: Fatal cerebral haemorrhage after COVID-19 vaccine - PubMed

Author: Bjørnstad-Tuveng et al

Country: Norway

Date Published Online: 4/29/21

Vaccine: AstraZeneca

Diagnoses: TCP, VITT, CH

Link: https://ashpublications.org/blood/article/137/26/3670/475905/COVID-19-vaccines-induce-severe-hemolysis-in

Case: “The patient was a previously healthy woman in her thirties with headaches that developed one week after vaccination with ChAdOx1 nCoV-19. Three days later, her condition deteriorated rapidly, and she presented to the emergency department with slurred speech, uncoordinated movements and reduced consciousness. Symptoms progressed to left-sided hemiparesis and her level of consciousness deteriorated. Computed tomography (CT) of the head showed a large right-sided haemorrhage and incipient herniation. She was found to have severe thrombocytopenia 37 x 109/l, (ref 145 - 390 x 109/l). In spite of efforts to reduce intracranial pressure, the patient died the following day. Post mortem examination revealed antibodies to PF4, and fresh small thrombi were found in the transverse sinus, frontal lobe and pulmonary artery.”

191: COVID-19 vaccines induce severe hemolysis in paroxysmal nocturnal hemoglobinuria | Blood | American Society of Hematology

Author: Gerber et al

Country: US

Date Published Online: 5/5/21

Vaccine: PfizerModerna

Diagnoses: Hemolysis, PNH

Link: https://pubmed.ncbi.nlm.nih.gov/34656887/

Case: “Here, we describe significant adverse reactions to COVID-19 vaccines in 4 patients with PNH.”

“Patient 1 is a 25-year-old man diagnosed with PNH 6 months prior in the setting of hemoglobinuria and had limited disease manifestations not requiring PNH-directed therapy. Five days after receiving the second dose of the Pfizer-BioNTech vaccine, he developed abdominal pain leading to evaluation in an emergency department. Computed tomography with contrast showed peripancreatic fat stranding with normal lipase, concerning for possible small bowel microvascular thrombosis. D-dimer was elevated to 0.73 µg/mL fibrinogen-equivalent units from 0.21 µg/mL. His symptoms resolved after 5 days. He subsequently was initiated on ravulizumab, a terminal complement inhibitor.

Patient 2 is a 45-year-old man with a 20-year history of PNH. His last dose of ravulizumab was 4 weeks prior to vaccination. On the evening after his first dose of the Pfizer-BioNTech vaccine, he experienced fever, headache, myalgia, and severe fatigue, which lasted 6 days. He also developed hemoglobinuria on postvaccination days 1 and 2, associated with 2.7 g/dL hemoglobin decrease.

Patient 3 is a 32-year-old woman with a 10-year history of PNH on ravulizumab with her last dose 4 weeks prior to vaccination. She was also part of a clinical trial with danicopan, an oral complement factor D inhibitor. She missed 2 doses of danicopan immediately after her second vaccination due to concerns that the drug may interfere with vaccine potency; therefore, danicopan was not at therapeutic levels at the time of her reaction. Notably, she took danicopan throughout her first vaccination and did not experience breakthrough hemolysis. Approximately 12 hours after receiving the second dose of the Moderna mRNA-1273 COVID-19 vaccine, she had a fever (39°C) and rigors. She presented to a local hospital, where she was noted to have a 3 g/dL hemoglobin decrease and received 2 units of packed red blood cells.

Patient 4 is a 63-year-old man diagnosed with PNH 30 years ago, currently treated with ravulizumab. He experienced fatigue and darkening of his urine following his first dose of the Moderna vaccine. He had an ∼1 g/dL hemoglobin decrease on laboratory tests 3 days following his first vaccination. In addition, his total bilirubin rose to 7.1 mg/dL from baseline 2.4 mg/dL. Following his second dose, he noted fevers, diarrhea, vomiting, severe fatigue, and dark urine. Laboratory tests 1 week later, as symptoms were resolving, showed >4 g/dL hemoglobin decrease from his baseline.”

192: Brain death in a vaccinated patient with COVID-19 infection - PubMed

Author: Watchmaker & Belani

Country: US

Date Published Online: 10/11/21

Vaccine: Pfizer

Diagnoses: infarcts

Link: https://www.dovepress.com/bone-marrow-suppression-secondary-to-the-covid-19-booster-vaccine-a-ca-peer-reviewed-fulltext-article-JBM

Case: “We present a case of brain death in a vaccinated, immunocompromised patient who presented with COVID-19 pneumonia. Imaging was characterized by diffuse cerebral edema, pseudo-subarachnoid hemorrhage, and no antegrade flow above the terminal internal carotid arteries. To our knowledge, this is the first case report with such findings in a vaccinated patient.”

“A 60-year-old woman with medical history notable for type II diabetes, hypertension, atrial fibrillation on apixaban, and systemic lupus erythematosus, treated with a combination of steroids, rituximab, and methotrexate (25 mg per week, held upon hospital admission), presented on May 2, 2021 with a one-week history of fever (Tmax 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; she was asymptomatic at that time. She subsequently developed the aforementioned symptoms on April 24, 2021 prompting hospital presentation. PCR testing for COVID-19 on day of hospital presentation returned positive. The patient was negative for SARS-CoV-2 antibodies upon hospital admission on May 3, 2021. Blood cultures taken at admission and on hospital day 6, 9, 14, 18, 21, 23, 25, 27, 29 were all negative.

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. Of note, the patient received her home dose of apixaban during the initial 5 days of hospitalization; this was subsequently stopped given development of disseminated intravascular coagulopathy (DIC) with platelet count dropping to a nadir of 20 × 103/μL (platelet count on presentation 164 × 103/μL) on hospital day 8.

On hospital day 13, the patient reported headache, and altered mental status was observed. She was intubated at this time for airway protection. Subsequent head CT demonstrated a new acute to subacute infarct involving the right frontal operculum and insular region, new parenchymal hemorrhages versus hemorrhagic infarcts involving the left parietal lobe and left cerebellar hemisphere, and multifocal acute subarachnoid hemorrhage (Fig. 1A, B). CT angiogram of the head and neck performed later the same day demonstrated no definite evidence of an acute large vessel intracranial arterial occlusion or substantial arterial stenosis, however did demonstrate multifocal irregularity within the superior sagittal sinus, with differential notable for prominent arachnoid granulations and/or sinus venous thrombosis (Fig. 1C).

193: Bone Marrow Suppression Secondary to COVID Booster Vaccine | JBM

Author: Shastri et al

Country: US

Date Published Online: 2/18/22

Vaccine: Pfizer

Diagnoses: PCP

Link: https://pubmed.ncbi.nlm.nih.gov/34884407/

Case: “A temporal relationship has been previously reported between the first or second dose of the COVID-19 vaccine and the development of thrombocytopenia. However, adverse events related to the third COVID-19 vaccine are still being reported and studied. We report a 74-year-old male who developed bone marrow suppression and pancytopenia recorded seven days after receiving the Pfizer SARS-CoV-2 vaccine. During his hospital stay, the patient’s hemoglobin, white blood cell, and platelet levels continued to trend downwards. However, all three levels showed improvement one week after discharge without robust intervention. Global vaccination is of utmost importance, as is understanding and documenting post-vaccination reactions including bone marrow suppression. Prompt evaluation and patient education are imperative to improve patient outcomes and combat hesitancy against vaccine administration.”

194: Retinal Hemorrhage after SARS-CoV-2 Vaccination - PubMed

Author: Park et al

Country: Korea

Date Published Online: 12/5/21

Vaccine: PfizerAstraZeneca

Diagnoses: AMD, RVO

Link: https://pubmed.ncbi.nlm.nih.gov/34477089/

Case: “Clinical data including fundus photographs and optical coherence tomography (OCT) scans were reviewed. Twenty-three eyes of 21 patients were included with the median age at symptom presentation being 77 years (range: 51-85 years). Twelve eyes (52.2%) had submacular hemorrhage and 11 (47.8%) had RVO. Twelve patients (60.9%) had been vaccinated with the Pfizer vaccine (BNT162b2) and 8 with the AstraZeneca (ChAdOx1) vaccine. Sixteen patients (76.2%) experienced ocular disease exacerbation after the first vaccination and 4 (19.0%) after the second vaccination. The median visual acuity (logarithm of the minimal angle of resolution; logMAR) before symptom development was 0.76 (interquartile range: 0.27-1.23); the median logMAR at symptom presentation was 1.40 (interquartile range 0.52-1.70). The median time between vaccination and symptom exacerbation was 2.0 days (interquartile range: 1.0-3.0 days). Five patients (23.8%) underwent tests for hematological abnormalities, including the presence of anti-PF4 antibodies; all were negative. Further studies with larger patient group for evaluation of effect of SARS-CoV-2 vaccination on retinal hemorrhage are necessary.”

195: [Intracerebral haemorrhage twelve days after vaccination with ChAdOx1 nCoV-19] - PubMed

Author: Wolthers et al

Country: Denmark

Date Published Online: 8/30/21

Vaccine: AstraZeneca

Diagnoses: VITT, TCP, ICH,

Link: https://pubmed.ncbi.nlm.nih.gov/34477089/

Case: “In this case report a previously healthy man had thrombocytopenia with fatal intracerebral haemorrhage which was suspected to be related to vaccine.” (It’s in German)

“The aim of this study was to report uveitis and other ocular complications following COVID-19 vaccination. The study included 42 eyes of 34 patients (20 females, 14 males), with a mean age of 49.8 years (range 18–83 years). The cases reported were three herpetic keratitis, two anterior scleritis, five anterior uveitis (AU), three toxoplasma retinochoroiditis, two Vogt-Koyanagi-Harada (VKH) disease reactivations, two pars planitis, two retinal vasculitis, one bilateral panuveitis in new-onset Behçet’s disease, three multiple evanescent white dot syndromes (MEWDS), one acute macular neuroretinopathy (AMN), five retinal vein occlusions (RVO), one non-arteritic ischemic optic neuropathy (NAION), three activations of quiescent choroidal neovascularization (CNV) secondary to myopia or uveitis, and one central serous chorioretinopathy (CSCR). Mean time between vaccination and ocular complication onset was 9.4 days (range 1–30 days). Twenty-three cases occurred after Pfizer-BioNTech vaccination (BNT162b2 mRNA), 7 after Oxford-AstraZeneca vaccine (ChAdOx1 nCoV-19), 3 after ModernaTX vaccination (mRNA-1273), and 1 after Janssen Johnson & Johnson vaccine (Ad26.COV2). Uveitis and other ocular complications may develop after the administration of COVID-19 vaccine.”

196: Uveitis and Other Ocular Complications Following COVID-19 Vaccination

Author: Bolletta et al

Country: Italy

Date: Published Online: 12/24/21

Vaccine: Pfizer, Moderna, AstraZeneca

Diagnoses: HK, AS, NGAU, CMV, U, TPR, VKHD, PP, RV, MEWDS, AMN, RVO, NAION, Uveitic CNV, CSR

Link: https://pubmed.ncbi.nlm.nih.gov/34945256/

Case: “The aim of this study was to report uveitis and other ocular complications following COVID-19 vaccination. The study included 42 eyes of 34 patients (20 females, 14 males), with a mean age of 49.8 years (range 18–83 years). The cases reported were three herpetic keratitis, two anterior scleritis, five anterior uveitis (AU), three toxoplasma retinochoroiditis, two Vogt-Koyanagi-Harada (VKH) disease reactivations, two pars planitis, two retinal vasculitis, one bilateral panuveitis in new-onset Behçet’s disease, three multiple evanescent white dot syndromes (MEWDS), one acute macular neuroretinopathy (AMN), five retinal vein occlusions (RVO), one non-arteritic ischemic optic neuropathy (NAION), three activations of quiescent choroidal neovascularization (CNV) secondary to myopia or uveitis, and one central serous chorioretinopathy (CSCR). Mean time between vaccination and ocular complication onset was 9.4 days (range 1–30 days). Twenty-three cases occurred after Pfizer-BioNTech vaccination (BNT162b2 mRNA), 7 after Oxford-AstraZeneca vaccine (ChAdOx1 nCoV-19), 3 after ModernaTX vaccination (mRNA-1273), and 1 after Janssen Johnson & Johnson vaccine (Ad26.COV2). Uveitis and other ocular complications may develop after the administration of COVID-19 vaccine.”

197: COVID-19 Recombinant mRNA Vaccines and Serious Ocular Inflammatory Side Effects: Real or Coincidence?

Author: Maleki et al

Country: US

Date Published Online: 6/29/21

Vaccine: Pfizer, Moderna

Diagnoses: AAION, AZOOR

Link: https://pubmed.ncbi.nlm.nih.gov/34394876/

Case: “The first patient was a 79-year-old female was presented to us 35 days after a sudden bilateral loss of vision, which occurred two days after receiving the second recombinant mRNA vaccine (Pfizer) injection. Temporal artery biopsy was compatible with AAION. At presentation, the best-corrected visual acuity was 20/1250 and 20/40 in the right and left eyes on the Snellen acuity chart, respectively. There was 3+ afferent pupillary defect in the right eye. The anterior segment and posterior segment exams were normal except for pallor of the optic nerve head in both eyes. Intraocular pressure was normal in both eyes. She was diagnosed with bilateral AAION and Subcutaneous tocilizumab 162 mg weekly was recommended with monitoring her ESR, CRP, and IL-6.

The second patient was a 33-year-old healthy female who was referred to us for a progressive nasal field defect in her left eye, and for flashes in both eyes. Her symptoms started 10 days after receiving the second recombinant mRNA vaccine (Moderna) injection. Complete bloodwork performed by a uveitis specialist demonstrated high ESR (25) and CRP (19) levels. As a result, she was diagnosed with unilateral AZOOR in her left eye and was subsequently treated with an intravitreal dexamethasone implant in the same eye. At presentation, vision was20/20 in both eyes. The anterior segment and posterior segment exams were completely normal except for the presence of abnormal white reflex in the temporal macula of her left eye. We diagnosed her with bilateral AZOOR. Since she was nursing, intravitreal dexamethasone implant was recommended for the right eye.”

---

If anyone sees any errors, or knows of a study I missed, please feel free to comment or email me. Thanks so much :)

1

Abbreviation      Diagnosis

AAION                  arteritic anterior ischemic optic neuropathy

AC                          anterior scleritis

ACE                        Arterial cerebral embolism

ACT                        Arterial cerebral thrombosis

AHA                       Acquired Hemophilia A

AIHA                      Autoimmune Hemolytic Anemia

AMD                      age-related macular degeneration

AMR                      acute macular neuroretinopathy

AMT                      Aortic Mural Thrombosis

AT                           arterial thrombosis

AVT                        artero-venous thrombosis

AZOOR                 acute zonal occult outer retinopathy

BCS                        Budd-Chiari syndrome

BD                          Behçet’ s disease

CA                          cardiac arrest

CES                         Cardioembolic Stroke

CI                            cereberal infarction

CM                         Cardiomyopathy

CMD                      chronic myocardial damage

CMV                      Citomegalovirus

CMyo                    Chronic myocarditis

CNV                       choroidal neovascularization

CRS                        Cytokine release syndrome

CS                           cardiogenic shock

CSR                        central serous retinopathy

CSVT                      cerebral sinus vein thrombosis

CT                           Coronary Thrombosis

CTT                         Coronary Tree Thrombosis

CVCTP                   cerebral venous Thrombocytopenia

CVST                      cerebral venous sinus thrombosis

CVT                        Cerebral Venous Thrombosis

DAH                       diffuse alveolar hemorrhage

DIC                         disseminated intravascular coagulation

DVT                        deep vein thrombosis

ES                           embolic stroke

FGI                         Focal granulomatous inflammation

FT                           Fibrin Thrombi

GH                          gross hematuria

HAIDR                   Hematologic autoimmune disease recrudescence

Hema                    Hematoma

Hemo                    hemorrhage

HK                          herpetic keratitis

HPT                        hemoptysis

I                               ischemia

ICAT                       isolated carotid arterial thrombosis

ICH                         Intracerebral Hemorrhage

ICRH                      Intracranial Hemorrhage

ICVST                    Intracranial Venous Sinus Thrombosis

IdTPu                    Idiopathic Thrombocytopenic Purpura

IgAN                      IgA nephropathy

ION                        Ischemic Optic Neuropathy

IS                            Ischaemic stroke

IT                            immune thrombosis

ITP                          Immune thrombocytopenia

ITPP                       Immune thrombocytopenic purpura

ITT                          Immune Thrombotic Thrombocytopenia

JVT                         jugular vein thrombosis

JVT                         jugular vein thrombosis

KS                           Kounis syndrome

LI                             Limb ischemia

MCA                      middle cerebral artery

MCI                        Malignant cerebral infarction

MEWDS                multiple evanescent white dot syndrome

MI                          myocardial injury

Minf                      myocardial infarction

MIT                        micro thrombi

MltpT, MT           multiple thromboses

MuT                       mural thrombosis

NAION                  non-arteritic ischemic optic neuropathy

NGAU                   non-granulomatous anterior uveitis

PAT                        Popliteal artery thrombosis

PAT                        pulmonary artery thrombosis

PCP                        Pancytopenia

PE                           pulmonary embolism

PI                            pontine infarction

PP                           pars planitis

PT                           Pulmonary Thrombosis

PVT                        portal vein thrombosis

RAO                       Retinal arterial occlusion

RI                            retinal ischemia

RTCP                      refractory thrombocytopenia

RTM                       Renal Thrombotic Microangiopathy

RV                          retinal vasculitis

RVO                       retinal vein occlusion

S                              stroke

SAH                        subarachnoid hemorrhage

SCLS                       systemic capillary leak syndrome

SMH                      submacular hemorrhage

SVT                        Splanchnic-vein thrombosis

TCP                        thrombocytopenia

TE                           Thromboembolism

Th                           thrombosis

TIA                         transitory ischemic attack

TMA                      thrombotic microangiopathy

TPR                        Toxoplasma retinochoroiditis

TTCP / TTP           thrombotic thrombocytopenia

TTCPP                   Thrombotic thrombocytopenic purpura

TTS                         thrombosis with thrombocytopenia syndrome

TTS                         Takotsubo syndrome / cardiomyopathy

U                             uveitis

VH                          Vitreous Hemorrhage

VI                            venous infarction

VI-                          vax induced

VIPT ITS                 vaccine-induced pro-thrombotic immune TCP syndrome

VIT                         vaccine-induced thrombocytopenia

VITT                       vaccine-induced thrombotic thrombocytopenia

VKHD                    Vogt-Koyanagi-Harada Disease

VOE                       vaso‐occlusive event

VR                          ventricular rupture

VT                           venous thrombosis

VTE                        venous thromboembolism