Age: 43.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Red blood cell nucleated morphology, Red blood cell sedimentation rate, Reticulocyte count, Russell's viper venom time, SARS-CoV-2 test
Clinical narrative: 3/2 - Received the first round of Moderna vaccination. No immediate side-effects noted.  I talked with my physician prior to getting the vaccine due to medical conditions and medications that I am taking. I was taking Xarelto due to chronic DVT/Blood clots in my left leg.   After 2.5 weeks I noted my left leg was swelling and I started to have discomfort in my leg. No noticeable changes to my leg at this time that made me concerned about getting the second vaccine.   3/30 - I received my second vaccination in the morning. I ended up going into the hospital at 4 pm due to numbness and pain in my left leg. I ended up being admitted to the hospital due to a DVT behind my L knee and in my femoral/iliac veins. I was also diagnosed with May-Thurbers syndrome. All the physicians, hematologists, and surgeons were surprised that I ended up with a severe blood clot as I was on Xarelto for over two years without an incident or problem. I did not have a fall or any change in my life that would have caused this issue to happen and they were all stumped.  I was switched to a heparin drip while Xarelto was clearing out of my system and in two days I had two stints put in my femoral/iliac vein on my left leg.  I was changed over to Lovenox and Coumadin 5-7.5 mg before leaving the hospital. There were no concerns and I was in the hospital from 3/30 to 4/3/21.  After I was discharged from the hospital I went to my primary care follow up on Tuesday 4/6/21. I was having increased pain behind my knee and overall not feeling well. I ended up having more labs completed and another ultrasound to indicate I had a small DVT behind my knee from my procedure.   On Friday 4/9/21 I went in for my INR and found my coumadin was within therapeutic range. When I got home I changed into comfy clothing and noted that I had a red/purplish rash looking dots/bumps from my toes to my knees on both LE, my Left was more significant than my right. I went back into the doctor and I was prescribed a topical steroid to help decrease the edema, pain and redness.   Saturday 4/10/21 - my legs became painful to the touch, they felt like they were going to burst due to pressure, and the rash/reddness was looking worse and spreading. I was sent back to the ER and was admitted back to the hospital. They diagnosed me with heparin-induced thrombocytopenia, removed me off of coumadin, and started me on Arixtra. The hematologist, physicians and staff did not know what to do and I was now deemed medically complex and had to be monitored for a few days and gave me prednisone. Once removed from coumadin the rash/pain/swelling subsided and started to diminish. I was discharged from the hospital.  I returned to work on Tuesday 4/13 and after returning home I had increased pain, pressure and rash that now was visible from my knees to my hips and this was not present in the hospital. My physician is asking for a biopsy and increased my prednisone to stay at 20 mg a day.  At night I have to elevate my legs or they become swollen and will become painful.   4/16/21 I wore compression tights per physician guidelines and when I came home from work I had new spots and rashes on my feet, they were swollen and had increased pain. My left ankle had a rash on it as well. After elevation and a nights rest the rash started to diminish and the rest of my legs have started to diminish or disappear.