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First published online June 17, 2022

A probable case of vaccine-induced immune thrombotic thrombocytopenia secondary to Pfizer Comirnaty COVID-19 vaccine

Abstract

The accelerated development of various vaccines against COVID-19 was a global effort to curb the COVID-19 pandemic. As a result, several unique vaccine-related adverse events were observed. Vaccine-induced immune thrombotic thrombocytopenia (VITT) has been recognised as a clinically distinct entity with a predisposition for thrombosis at unusual sites with laboratory features of consumptive coagulopathy in addition to anti-PF4 assay seropositivity. The majority of cases reported were associated with adenoviral-based vectors such as ChAdOx1 nCoV-19 (Oxford-AstraZeneca) and Janssen Ad26.COV2.S (Johnson & Johnson). In our online search, we have not found any reports to date of VITT associated with Pfizer–BioNTech Comirnaty mRNA vaccine. We report a case of a previously healthy 76-year-old man who received his first-dose Pfizer Comirnaty vaccine on 11 October 2021 who developed left upper limb swelling on day 2 post-vaccination, which progressively worsened on day 4 post-vaccination. He was confirmed to have left axillary vein thrombosis on computer tomography arteriography/computed tomography venography of left upper limb on day 5 post-vaccination with new onset aphasia with unilateral limb weakness on day 8 post-vaccination. Magnetic resonance imaging/magnetic resonance angiography of the brain confirmed acute left middle cerebral artery thrombosis with infarction. Blood investigations showed thrombocytopenia, elevated D-dimer, hypofibrinogenemia in addition to his unusual sites of thrombosis involving both arterial and venous circulation. His IgG ELISA assay for anti-PF4 antibody was positive.

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Published In

Article first published online: June 17, 2022
Issue published: June 2022

Keywords

  1. vaccine-induced immune thrombotic thrombocytopenia
  2. Pfizer Comirnaty vaccine
  3. unusual thrombosis
  4. anti-PF4 assay

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© The Author(s) 2022.
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PubMed: 36146992

Authors

Affiliations

Carol Goh CY
Haematology Unit, Department of Medicine, Hospital Pulau Pinang, Penang, Malaysia
Chew Teng Keat
Haematology Unit, Department of Medicine, Hospital Pulau Pinang, Penang, Malaysia
Chiang Su Kien
Haematology Unit, Department of Medicine, Hospital Pulau Pinang, Penang, Malaysia
Goh Ai Sim
Haematology Unit, Department of Medicine, Hospital Pulau Pinang, Penang, Malaysia

Notes

Carol Goh CY, Haematology Unit, Department of Medicine, Hospital Pulau Pinang Jalan Residensi, Georgetown, Penang 10990, Malaysia. Email: [email protected]

Author contributions

Carol Goh CY analysed the case and contributed to the writing of the manuscript. Chew TK, Chiang SK and Goh AS made critical revisions and approved the final manuscript.

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This article was published in Journal of the Royal College of Physicians of Edinburgh.

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