Sex: M
Vaccine: COVID19
Symptoms: Chills, Disease recurrence, Fatigue, Myalgia, Rash morbilliform
Clinical narrative: chills; fatigue; myalgias; recurrent morbilliform eruption most prominent on the bilateral flanks and fleshcolored papules on the right flank; recurrent morbilliform eruption most prominent on the bilateral flanks and fleshcolored papules on the right flank; This is a literature report from the Journal.   A 30-year-old male healthcare worker with no past medical history presented for vaccination with the SARS-CoV2, the Pfizer-BioNTech COVID-19 vaccine. The day after vaccination the patient experienced mild subjective fevers, headache, and injection site soreness in the deltoid region without overlying skin changes. Forty-eight hours after administration of the vaccine, the patient developed a mildly pruritic erythematous macular morbilliform eruption on the lower back. Over the course of the following 24 hours, the patient's rash resolved without intervention. Twenty-one days following the initial vaccine, the patient received the second dose of the Pfizer/BioNTech COVID-19 vaccine, after which he experienced chills, fatigue and myalgias. Forty-eight hours after administration of the second dose, the patient developed a recurrent morbilliform eruption most prominent on the bilateral flanks and fleshcolored papules on the right flank with significantly increased pruritus and body surface area involvement. Notably, areas which were previously spared by the first rash including the flanks, proximal extremities and upper back were involved. Of note, regions affected in the first rash (lower back) were similarly affected in the recurrent rash. This rash similarly resolved over the following 24 hours without treatment.  Accordingly, it is possible that the morbilliform rash observed in authors patient was similarly caused by immune activation, as the timing of rash onset closely coincided with vaccine administration. Herein, authors report a case of morbilliform rash secondary to the Pfizer-BioNTech COVID-19 vaccine, like that seen in COVID-19 infection. The presence of similar eruptions in SARS-CoV-2 positive patients and in this patient following vaccination with a mRNA vaccine suggests a similar underlying etiology of immune activation leading to the development of a morbilliform rash. An immune-mediated etiology is plausible in our patient's vaccine-related rash, as it was recurrent and notably more extensive following the second dose of the vaccine suggesting a more robust immune response. Thus far, rash has not been reported as an adverse effect in the Pfizer-BioNTech briefing document.; Sender's Comments: Based on the clinical information provided in this spontaneous publication, the company deems there is a reasonable possibility that all the reported events are related to the  Pfizer-BioNTech COVID-19 mRNA vaccine. For all the reported events there is a plausible temporal association and, for the 'mildly pruritic erythematous macular morbilliform eruption' there is also a positive re-challenge, while chills, fatigue and myalgia, are known aspects of the product safety profile.  The impacts 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-2021213333 Same author, patient, drug; different event