Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Cerebral venous sinus thrombosis, Headache, Intensive care, International normalised ratio increased, Magnetic resonance imaging head abnormal
Clinical narrative: VENOUS SINUS THROMBOSIS; VOMITING; SEVERE HEADACHE; This spontaneous report received from a pharmacist via the VAERS (Vaccine Adverse Event Reporting System) [VAERS number 1201967] concerned a 36-year-old female, ethnicity was unknown. The patient's weight and height were not reported. She had no chronic or long-standing health conditions, no known allergies and had not had any current illnesses at the time of her vaccine and up to one month prior. Patient was not currently pregnant. Patient's family has no history of blood clots; and her father had a stroke in his sixth decade.  No concomitant medications were reported and patient was not on any over the counter medications, dietary supplements or herbal remedies. On 25-MAR-2021, the patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 1808609) dose was not reported, administered for prophylactic vaccination in her right arm.  Following the vaccine, she had a mild headache which she attributed to the vaccine.  On 09-APR-2021 the headache became severe (also reported as 3 days after the vaccination). The pain became excruciating and was associated with vomiting. The patient went to the emergency department where she was treated with Dilaudid and was discharged home. At home she began using her mother's "headache cocktail" with some transient relief.  On an unspecified date she presented back to emergency department with continued symptoms. On an unspecified date she received a MRI venogram sagittal sinus without contrast with results  suggesting thrombosis of the superior sagittal, transverse and straight sinus; with no significant flow in the sigmoid sinuses and jugular vein which may be related to decreased flow and/or thrombosis as well. A brain MRI with and without contrast was performed with results suggesting a diffuse transverse and sigmoid sinus thrombosis. Poor flow void visualization of the jugular veins as well and was possible it could be occluded. No prominent hematoma was detected but on the gradient echo sequences there was a prominent diminished signal in the sulci bilaterally that can be seen in a minor subarachnoid hemorrhage. No midline shifting or mass effect was detected. Additional laboratory data (dates unspecified) included: INR (NR: not provided) 1.2, MRI (NR: not provided) Suggest thrombosis of sagittal, transverse and straight sinuses, MRI brain (NR: not provided) Suggest diffuse transverse and sigmoid sinus thrombosis, Platelet count (NR: not provided) 64 kU/L, and Prothrombin time (NR: not provided) 15.4 sec.  Neurology was consulted. The patient denied any other associated speech or vision change, extremity weakness, coordination difficulty or dizziness.  On an unspecified date she was admitted to the neurology ICU and started on anticoagulation. Action taken with covid-19 vaccine ad26.cov2.s was not applicable The patient had not recovered from venous sinus thrombosis, severe headache, and vomiting. This report was serious (Life Threatening, Hospitalization Caused / Prolonged, Other Medically Important Condition).; Sender's Comments: V0: This case concerns a 36-year-old female patient who was hospitalized with a diffuse transverse and sigmoid sinus thrombosis approximately 15 days after receiving covid-19 vaccine ad26.cov2.s for prevention of symptomatic SARS-CoV-2 virus infection. She was noted to have no chronic or long-standing health conditions, no known allergies, and was not currently pregnant. She did not have a family history of blood clots. Her father had a stroke in his sixth decade. She was reported to have a mild headache after vaccination that became severe and was associated with vomiting, prompting a visit to the emergency department (ED) on an unspecified date. She was treated with dilaudid and discharged home. After discharge she used an unspecified "headache cocktail" with some transient relief but due to continued symptoms the patient reported back to the ED. An MRI of the brain and MRI venogram were suggestive of thrombosis of the superior sagittal sinus and transverse sinuses and straight sinus. There was no significant flow in the sigmoid sinuses and jugular vein which may be related to decreased flow and/or thrombosis as well. No prominent hematoma was detected but there was some suggestion of a possible minor subarachnoid hemorrhage. No midline shifting or mass effect was detected. The platelet count was noted to be 64,000/uL on an unspecified date. She was admitted to the ICU and started on anticoagulation. Based on evolving knowledge of Thrombosis with Thrombocytopenia Syndrome (TTS, per definition from Brighton Collaboration) and temporal relationship to vaccination, we consider the events to have a plausible relationship with vaccination.