Sex: F
Vaccine: COVID19
Symptoms: Autonomic nervous system imbalance, Blood pressure measurement, Heart rate, Hypertension, Hypotension
Clinical narrative: Over time, she developed transient episodes of hypertension and tachycardia; paralyzed; sedated; Over time, she developed transient episodes of hypertension and tachycardia; dysautonomia; hypotensive; This is a literature report   A 37-year-old female patient received BNT162b2 (BNT162B2), as dose number unknown, single (Batch/Lot number: unknown) for 1 day for covid-19 immunisation. The patient's relevant medical history included: "lupus nephritis" (unspecified if ongoing), notes: on immunosuppressant therapy; "intensive care unit" (unspecified if ongoing), notes: remained intubated, sedated, and paralyzed for a mont; "intubated" (unspecified if ongoing), notes: for a month; "tracheostomy" (unspecified if ongoing), notes: on hospital day 40 and eventually tolerated tracheostomy collar; "immunosuppressant therapy" (unspecified if ongoing). The patient's concomitant medications were not reported. The following information was reported: TACHYCARDIA (hospitalization, medically significant, life threatening), HYPERTENSION (hospitalization, medically significant, life threatening), outcome "unknown" and all described as "Over time, she developed transient episodes of hypertension and tachycardia"; PARALYSIS (hospitalization, medically significant, life threatening), outcome "unknown", described as "paralyzed"; SEDATION (hospitalization, medically significant, life threatening), outcome "unknown", described as "sedated"; AUTONOMIC NERVOUS SYSTEM IMBALANCE (hospitalization, life threatening), outcome "unknown", described as "dysautonomia"; HYPOTENSION (hospitalization, life threatening), outcome "unknown", described as "hypotensive". The patient underwent the following laboratory tests and procedures: Blood pressure measurement: normalized after overall resolution of her illness; Heart rate: normalized after overall resolution of her illness; SARS-CoV-2 test: Positive, notes: COVID-19. Therapeutic measures were taken as a result of tachycardia, paralysis, sedation, hypertension, autonomic nervous system imbalance, hypotension.  In 2021, the Delta variant of the SARS-COV2 virus became the predominant strain causing respiratory failure, and younger, unvaccinated patients became the majority requiring hospitalization. This case explores dysautonomia seen in a young patient who experiences a prolonged hospitalization for her illness. Case: 37-year-old woman with past medical history of lupus nephritis on immunosuppressant therapy tested positive for COVID-19 between doses of the Pfizer vaccine. Her condition deteriorated, requiring intubation and prolonged intensive care unit admission. She remained intubated, sedated, and paralyzed for a month. Over time, she developed transient episodes of hypertension and tachycardia with no response to increasing sedation or short-acting anti-hypertensive therapies. These episodes were quickly followed by prolonged hypotensive periods which required use of vasopressors. She underwent tracheostomy on hospital day 40 and eventually tolerated tracheostomy collar on day 67 with discharge to long-term acute care facility with no further episodes of autonomic dysfunction. Decision-making: Initially, dysautonomia was thought to be a sign of inadequate sedation on paralytics, but no meaningful change was noted after increasing or even changing the sedatives and analgesic agents, and the episodes were more frequent when she was difficult to ventilate and required high peak pressures and 18:8 prone:supine schedule. The dysautonomia persisted weeks after discontinuation of paralytics and sedatives, but became more infrequent, making her infection more likely to be the etiology of the occurrences. Her course was consistent with post-acute COVID, also known as 'long' COVID and her dysautonomia appeared to resolve about 3 months after onset of illness. Conclusion(s): This case is an example of dysautonomia that is thought to be a direct cause of COVID-19 illness. The virus is known to induce a cytokine storm leading to direct damage to sympathetic and parasympathetic pathways, producing labile heart rate and blood pressure. Our patient went on to have recovery of her autonomic pathway as her blood pressure and heart rate normalized after overall resolution of her illness.; Sender's Comments: Based on the information provided and plausible temporal association, the causality between the suspect drug and the events cannot be excluded. 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.