Sex: F
Vaccine: COVID19
Symptoms: Anti-thyroid antibody, Blood pressure diastolic, Blood pressure systolic, Blood thyroid stimulating hormone, Echocardiogram
Clinical narrative: Postural orthostatic tachycardia syndrome; This is a literature report.  Authors report five patients who presented to evaluate orthostatic intolerance that developed after receiving the COVID-19 vaccine. They were diagnosed with postural orthostatic tachycardia syndrome (POTS) after extensive evaluation. All patients underwent a head-up tilt table (HUTT) test. Furthermore, patient 3 underwent heart rate variability (HRV) spectral Fourier analysis. A 46-year-old female developed new onset of lightheadedness, nausea, fatigue, poor concentration, palpitations, and brain fog about 2 weeks after receiving the first dose of BioNTech-Pfizer COVID vaccine. She has no significant past medical history (PMH) and takes no medication. Her echocardiogram, Electrocardiogram (EKG), and Holter were normal. Thyroid-stimulating hormone (TSH) and complete blood count (CBC) were normal. HUTT showed orthostatic tachycardia without orthostatic hypotension (OH), consistent with a diagnosis of POTS. COVID-19 Vaccine to autonomic symptoms: 14 days. Symptoms to HUTT: 168 days. Autonomic symptoms: orthostatic, lightheadedness, palpitations, nausea, brain fog and fatigue. Autonomic diagnosis: POTS. HUTT symptoms: Nausea and short of breath. Maximum systolic blood pressure (BP): 24; Max diastolic BP: 12; Max heart rate (HR): 38; Max HR: 110; complete blood count (CBC): normal (NL); thyroid-stimulating hormone (TSH): NL; Possible markers of autoimmunity: Positi¬ve serum peroxidase anti¬body (65 IU/ml, normal < 9 IU/ml). Heart rate variability (HRV) spectral Fourier analysis showed a significant increase in sympathetic activity after the head-up position. Autoimmune panel showed mildly elevated serum anti-peroxidase antibodies. The patient responded well to the combination of fludrocortisone and propranolol. Discussion: All patients met the diagnostic criteria for POTS. No other causes of sinus tachycardia were identified, including hyperthyroidism, anemia, dehydration, inappropriate sinus tachycardia, or medications (e.g., sympathomimetics, anticholinergics). Finally, authors can only report an association between the POTS and COVID-19 vaccine, and authors cannot report a solid conclusion regarding the causative relationship or the underlying mechanism.; Sender's Comments: There is a possible causal association between BNT162B2 and postural orthostatic tachycardia syndrome (POTS) considering a plausible temporal relationship, also no other causes of sinus tachycardia were identified, including hyperthyroidism, anemia, dehydration, inappropriate sinus tachycardia, or medications (e.g., sympathomimetics, anticholinergics) as stated by the literature author.  The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.,Linked Report(s) : US-PFIZER INC-PV202200033614 Same article/ drug/event and different patient.;