Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Electrocardiogram normal, Exercise electrocardiogram normal, Facial paralysis, Fatigue, Full blood count normal
Clinical narrative: Within a day of my second Pfizer vaccine dose, I experienced a high fever, fatigue, slow thinking, an inability to work at my engineering effectively, sleepiness, and body aches.  I took a Tylenol and my fever dropped.  By 48 hours, the aches and fever had disappeared, but the fatigue and slow thinking and low energy persisted.  My blood pressure seemed to stay normal when checked periodically and I continued the medicines above prescribed by my doctor, including the aspirin  No headache, but I had pain in my neck, shoulders, and occasional body aches for the next few weeks--the biggest symptom was ongoing fatigue, poor sleep, slow thinking, and daytime sleepiness.  I am not obese, take my meds diligently, do not have diabetes, eat a vegetarian and occasionally pescaterian low-salt diet, mostly cooked at home with olive oil.  My BP was never over 130/80 even when stressed.  I exercised 3-4 times a week, walking 7-10 miles each time, as well as working around the house.  No history of falls.  My internist had me on ASA because I had an uncle with a DVT at age 70, but I had no other family history of clots, bleeding, hemorrhage, or cardiovascular disease.  My mother died "of old age", still sharp at 93, after declining to eat; and my father died at 83 of metastatic prostate cancer, while still physically fit.  My lipids and CV exams including treadmill test were normal.  At age 12, however, in another country, I developed ITP after a viral infection, and was hospitalized for 2 weeks with a purpuric rash, and followed for 2 years after.  Believe it was a "childhood disease", but do not recall the pathogen.  I have not had a recurrence of ITP or abnormal CBC's since.  No known allergies.  I rarely get sick, have fevers, or even colds.  I quit smoking entirely in 1988, and drink a glass of red wine 2-3 x a week only.  I continued to feel tired, sluggish, and slow with mild neck aches off and on for a month.   The arm tenderness disappeared in a few days. Then I started developing esophageal tightness and tightness with swallowing. I also developed symptoms of acid reflux, rare for me.   I consulted with a doctor friend and switched my diet to soft and liquid foods for a few days., avoided acidic foods, and took occasional Tums.  I had no changes in my heart, lungs, or a sore throat.  My voice did become more raspy and my muscles stiff.  I was planning to see my MD for my annual physical in the upcoming two weeks, but with the diet change, my dysphagia and reflux seemed to resolve, so I didn't arrange an earlier visit.  I was not under unusual or excessive stress during these weeks.  I did start having hiccups and needing to cough more to clear my throat.  My wife did notice a sudden change in my cognition/personality, in that I was irritable, not as quick conversationally, and was forgetting where I put things, all in a couple weeks before my event.  The day of my event below, she said I asked a couple of questions twice, unusual for me as my IQ was 160 and I was always a good multitasker and had a good memory.  We had a gentle day on May 20, but I noticed, for the first time in my 40 years teaching (I am a Professor of Engineering), that I mixed up entering my students' grades into the system.  Never happened before.  I was stunned, but was able to correct the entries.  We had a quiet evening with my wife, and she went to bed while I prepared for bed around 11:30. in our upstairs bathroom.  My 100 year old father in law lives with us. downstairs.   My wife heard a noise and called for me to check on her father.  I tried to answer but couldn't speak loudly or clearly.  I staggered and caught myself from hitting the ground on the sink and did not bump my head, but the noise and no response from me got her to come to the bathroom, where she saw me staggering, with a sagging L arm, L facial droop, and a weak L leg.  My speech was slurred, though my vocabulary was good.  She led me to a seat and immediately called emergency services, telling them I was having a stroke.  Emergency services sent a special ambulance with a CT scanner and it arrived in about 5-10 minutes, and they carried me in a bed downstairs and off to the hospital stroke unit.  I could not believe it.  In the ambulance, they did a CT scan, and saw that I had a R intracranial hemorrhage in the fronto-temporal area.  I arrived in the ER in 15 minutes and they gave me DDAVP, platelets, did blood tests, did CTs, MRIs, angiograms, EKGs, carotid studies, and lab tests.  I had a golf-ball sized bleed, but otherwise my cardiovascular exams were fine, my carotids clear, no clots or ischemia seen.  My labs were all normal except my platelets, which, even after the transfusion were 120-130,000.  My bleeding stopped, and I was admitted to the ICU.  I was placed on Keppra for a week to avoid a seizure, which I've never had.  My BP stayed under 140/85, and went lower (110/70) when they added amlodipine.  They stopped the ASA.  My lipids were normal.  I was in the ICU slowly improving for 3 days, then transferred to the step-down ward for 3 days, then transferred to the a rehabilitation facility for 2 1/2 weeks.  At the facility, I continued to improve, moving from bed to chair to walking with support, then a walker, and then on my own.  My left leg strength returned fairly soon, and I was able to feed myself soft foods and then a regular diet.  I was able to relearn Activities of Daily Living, such as brushing my teeth, toileting, tying my shoes, dressing, etc, but was slower than normal and not as adept with my L arm and hand.  My droop lessened and my swallowing improved, and I was able to speak more clearly.  I was originally told I would be discharged on June 22, but they discharged me a week early as I was doing so well.  I was given a referral to a home rehab service, but they visited me a week later and said I was doing too well to be eligible for their services, so I am now going to be starting outpatient rehab.  At home I am now fully mobil, walk 1-2 miles a day without support, walk up and down stairs without rail support; do all ADLs; speak better, but not as clearly and droop more when I am tired.  My left arm is pretty good for most things, but I miss the intended key when I am typing often.  I have read about the incidences of both clotting with Pfizer, and hemorrhage, as well as thrombocytopenic purpura.  I had been in very good health for my age, and could not identify any precipitating factors other than the vaccine.  I don't recall my platelets being low on a CBC as an adult as they were in the hospital.  I am concerned that the second Pfizer dose might have triggered a simmering immune system reaction that attacked my platelets and, coupled with the well-intentioned ASA, from my internist, led to the hemorrhage.  So I am reporting to VAERS.  Please research these types of events.  If I have to have a booster, I will be frightened if there is a potential side effect of a recurrent intracranial bleed.