Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: High density lipoprotein decreased, Inflammation, International normalised ratio increased, Lipids normal, Liver function test normal
Clinical narrative: On 5/15/2021, I received my second Pfizer vaccine at around 1:40PM.  Around 10:30PM, I developed hot sensation throughout my entire body and my left arm that received the injection as well as my bilateral inguinal lymph nodes became painful.  I had restless sleep during the night because of generalized hot sensations and a sore arm.  On 5/16/2021 at 11:45AM, I had bilateral groin lymph node pain.  I also had tinnitus which was very apparent when there was silence.   On 5/17/2021 a 5:40PM, I continued to have tinnitus, a sore left arm and sore bilateral inguinal lymph nodes. On 5/18/2021 at 4:17PM, overall, the number of side effects and their severity were less with Pfizer Vaccine #2 than with Pfizer Vaccine #1.  The main side effects for Pfizer Vaccine #2 were fatigue and tiredness, tinnitus, arm pain, bilateral inguinal lymph node pain and nausea.  Earlier in the day, I went to the lab to get an INR and wrote an e-mail about my symptoms to my hematologist office. By 5/22/2021, the fatigue/tiredness, arm pain, nausea and bilateral inguinal lymph node pain had subsided.  The tinnitus and occasional ear pain on the left side continued but seemed to be improving.  Between 5/23/2021 through 6/14/2021, my sinus pain/pressure and congestion on the left side reoccurred and lasted for about 2 days.  I also continued to have intermittent sharp pain in my left ear and tinnitus.  I also noticed that I was unable to hear birds chirping which I had been able to hear previously.  My left ear felt shut and full and seemed to have two different pitches of tinnitus especially noticeable when the environment was quiet. I also had some tinnitus in the right ear which was of a different pitch than the left ear.  My hearing did not seem as good. On 6/15/2021, I went to the local ENT to have him examine my nose/sinuses and my ear.  I told him that the mometasone nasal sinus washes did appear to help the nasal pain/pressure and congestion but that a day or two after both the first and second Pfizer vaccines, the sinus nasal pain and pressure seemed to come back (despite the mometasone) and lasted for several days.  I also told the ENT that after having had the first and second Pfizer vaccines that I had tinnitus; and that the tinnitus was worse in my left ear than my right ear.  In addition, my hearing was not as good especially on the left side and that I was having intermittent sharp left ear pains.  The ENT performed a rhinoscopy and said I did appear to still have some inflammation and congestion especially in the left side of my nose.  He also examined my ears and said I had minimal ear wax and otherwise my ear exam visually looked normal.  He told me tinnitus can mean hearing loss.  He did a tympanogram which was normal in both ears.  He did an audiogram (hearing test) which showed that the right ear had a mild loss at 250Hz then grossly normal hearing with excellent (100%) word understanding at a normal conversational level in a quiet environment.  The hearing test showed the left ear had mild to slight Sensorineural Hearing Loss (SNHL) with excellent (96%) word understanding at a louder than normal conversational level, in a quiet environment.  The ENT instructed me to continue my mometasone nasal sinus washes. On 6/16/2021, I went to the local PCP and explained to her that after the first Pfizer vaccine and the second Pfizer vaccine that I developed tinnitus primarily in the left ear but also the right ear. I told her I was having hearing loss, intermittent left ear pains and left sided sharp pain/pressure in my sinus and nose.  I also told her that I had been having episodes of eye pains and headaches that were made worse with light.  I also told her about the very painful bilateral inguinal lymph node pain that I experienced after both vaccines.  I expressed concern as to the vaccine causing these symptoms via some autoimmune reaction.  She prescribed for me a Medrol Dose Pack:  Methylprednisolone 4mg to be taken 6 tabs on day 1 then 5 tabs then 4 tabs then 3 tabs then 2 tabs then 1 tablet.On 6/23/2021, I went to the local hematologist and discussed my sinus symptoms, left sided ear pain, tinnitus and hearing lost that occurred post-Pfizer vaccines.  I explained that on 6/22/2021, I had completed the Medrol dosepack that my PCP prescribed and that the severity and number of occurrences of the loud high pitched tinnitus had decreased; but, I still had the low pitched tinnitus and hearing loss.  I showed the hematologist the article, "Sudden Sensorineural Hearing Loss: Primary Care Update,". 2016 Jun; 75 (6): 172-4.  I pointed out p. 173, Table, 1 which showed that Prednisone is an optimal drug for tinnitus and hearing loss:  "Prednisone 60mg daily X 7 days then 40mg daily X 3 days then 20mg daily X 2 days then 10 mg daily X 2 days."  The article also states, "Methylprednisolone dose packs are inadequate for therapy because of lower dosing and shorter length of treatment."  My hematologist agreed it was reasonable to try a higher dose of Prednisone for a longer period of time. He also referred me a local rheumatologist for further discussion. On 6/24/2021, my local PCP prescribed the 2 week Prednisone taper outlined in the previous paragraph.  I had sweating and generalized hot sensations throughout my entire body about 2-3 episodes a day (mostly at night) and lasting about 5-10  minutes while on the Prednisone Taper.  My nasal congestion and sinus symptoms improved on the Prednisone taper. My ear pain has improved.  I had ear popping sensations on the Prednisone Taper. The loud, harsh high-pitched tinnitus episodes decreased in frequency and intensity.  I still have some low pitched tinnitus but it is not as loud. The tinnitus is worse when the surroundings are quiet.  I also still have some hearing loss. On 6/29/2021, I obtained an INR which was high at 3.4.  I e-mailed my hematolgist office and they felt the high INR was from the high dose Prednisone Taper.  My Coumadin dose was adjusted.