Sex: M
Vaccine: COVID19
Symptoms: Blood electrolytes, Blood pressure measurement, Body temperature, COVID-19, Drug ineffective
Clinical narrative: COVID-19; COVID-19; This is a literature report for the following literature source(s).  A 32-year-old male patient received BNT162b2 (BNT162B2), as dose 1, single (Batch/Lot number: unknown), as dose 2, single (Batch/Lot number: unknown) and as dose 3 (booster), single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history included: "retinal migraine with occasional floaters in his vision" (unspecified if ongoing); "nonsmoker" (unspecified if ongoing); "bilateral Central retinal vein occlusion (CRVO)" (unspecified if ongoing). There were no concomitant medications. The following information was reported: DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant), outcome "recovered" and all described as "COVID-19". Clinical course: A 32-year-old man was referred to the infectious disease clinic for further evaluation of the cause of his newly diagnosed bilateral CRVO. He had a significant history of retinal migraine with occasional floaters in his vision. He had regular follow-ups with an ophthalmologist and was found to have a normal ophthalmological examination with no retinal traction. He was not on any medications, including over-the-counter medications. He was a nonsmoker with no family history of malignancy or thromboembolic disease and had no history of recent travel. He had been vaccinated with 2 primary doses and a booster dose of the Pfizer (BNT162b2) vaccine, the last dose 7 months before the onset of his symptoms. Four months before presentation, he developed acute onset blurring of vision in the left eye described as multiple flashes of light followed by the sensation of a rainbow-colored kaleidoscope. The initial episode occurred in the morning hours, and it resolved spontaneously after 20 minutes. The same evening, he had another similar episode while driving, involving the left eye again along with impaired vision worsened by multiple speckled lights, which persisted. He denied any eye pain, discharge, or a sensation of a curtain dropping in front of his eye. An optometrist's evaluation at an urgent care clinic diagnosed him to have nonischemic CRVO with dot-blot hemorrhages of the left eye. Ophthalmological evaluation 2 weeks later revealed that his best-corrected visual acuity was 20/20 in both eyes. Intraocular pressure was 22 and 19 mm Hg in OD (right eye) and OS (left eye), respectively. Pupils were equal, round, and reactive to light with no afferent defect. Motility and confrontational visual fields were normal. He was able to identify 24/24 Ishihara color plates. The anterior segment was within normal limits on slit lamp. On fundus examination, OS revealed tortuous vessels and multiple flame-shaped and dot hemorrhages on the left superior central, left superior temporal, left inferior nasal, and left inferior temporal macula and moderate extrafoveal macular edema, hyperemic disc, and dilated retinal vessels suggestive of nonischemic CRVO. There was a normal fundus in OD. Optical coherence tomography (OCT) revealed OS CRVO. Central retinal thickness was 277 um for OD and 287 um for OS. He was diagnosed with a nonischemic CRVO of the left eye. He was started on aspirin 81 mg daily and managed conservatively because of a spontaneous improvement in his visual acuity and no foveal involvement. Three weeks later, he developed symptoms of cough and shortness of breath and was found to be positive for COVID-19 through a reverse transcriptase-polymerase chain reaction assay. He was managed with nirmatrelvir/ritonavir, which he received for 5 days with resolution of symptoms and without the need for hospitalization. On a follow-up visit, his heart rate was 78 beats/minute, blood pressure was 128/68 mm Hg, respiratory rate was 24 breaths/minute, temperature was 37C, and oxygen saturation was 97% on room air. His systemic examination was within normal limits, along with normal complete blood count, electrolytes, and renal function. Four weeks after his COVID-19 infection, a repeat fundoscopic evaluation by the ophthalmologist demonstrated resolving hemorrhages in OS but a new CRVO in OD, without any symptoms before diagnosis. This was confirmed on OCT, and fluorescein angiography revealed engorged, attenuated, leaky, and tortuous vessels in OD with blocked fluorescence and leakage in the macula and periphery. He was continued on the aspirin, and antivascular endothelial growth factor (anti-VEGF) injections were deferred because of normal visual acuity. His thrombophilia workup was negative, including testing for anti-thrombin III, protein C, protein S, lupus anticoagulant, factor V Leiden, factor II, anticardiolipin antibodies, human immunodeficiency virus, hepatitis B, hepatitis C, syphilis, and B-2-glycoprotein. His vasculitis workup was also negative including a negative antinuclear antibody, anti-double-stranded DNA, anti-Sjogren-syndrome-related antigen A and B, and U1 small nuclear ribonucleoprotein. He was evaluated by hematology and recommended to be continued on aspirin. He had a normal magnetic resonance imaging of the brain and a normal bilateral carotid duplex, and no intervention for the ocular migraine was necessary. He was planned for close follow-up with ophthalmology on an outpatient basis.  Therapeutic measures were taken as a result of drug ineffective, covid-19.; Sender's Comments: A causal relationship to the suspect drug BNT162b2 cannot be excluded for event drug ineffective. This case will be reassessed upon receipt of additional information.,Linked Report(s) : US-PFIZER INC-PV202400138770 Same article/drug/patient, different event;