Age: 34.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Headache, Jugular vein thrombosis, Mastoid effusion, Musculoskeletal stiffness, Nausea
Clinical narrative: HEADACHE; BLURRY VISION; NECK STIFFNESS; NAUSEA; VOMITING; CEREBRAL VENOUS SINUS THROMBOSIS; DURAL VENOUS SINUS THROMBOSIS; RIGHT INTERNAL JUGULAR VEIN THROMBOSIS; INTRAPARENCHYMAL HEMORRHAGE; LOW PLATELET COUNT; This spontaneous report received from a patient via the VAERS (Vaccine Adverse Event Reporting System)(VAERS ID: 1224712) and concerned a 34-year-old female. The patient's weight and height were not reported. The patient medical history included being 4 months post-partum. The patient had no drug, food or other product allergies, and had no chronic or long-standing conditions. The patient received COVID-19 vaccine Ad26.CoV2.S (suspension for injection, route of administration and batch number not reported), dose was not reported, administered on 23-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. From an unspecified date, the patient had 2 weeks of headaches and blurry vision, 2 to 3 days of neck stiffness and nausea with 1 episode of vomiting and had been transferred to the current hospital from another. On 04-APR-2021 (12 days post-vaccination), the patient was diagnosed with dural venous sinus thrombosis (DVST), transverse/sigmoid (cerebral venous) sinus thrombus (CVST) with associated intraparenchymal hemorrhage in the right temporal lobe as well as thrombosis of the right internal jugular vein (thrombus). Magnetic resonance imaging (MRI) impressions showed there was a re-demonstrated of intraparenchymal hematoma in the right posterior temporal lobe measuring approximately 6.2 x 3.6 cm in maximal axial dimensions. There was surrounding edema and associated mass effect with effacement of the right temporal horn and right-to-left midline shift measuring 5 mm. There was medialization of the right uncus without transtentorial herniation. The basal cisterns were otherwise patent. There was dural thickening and hyperenhancement overlying the hemorrhage. There was prominent cortical veins along the right frontal temporoparietal convexity consistent with venous congestion. There was also a small are of vasogenic edema in the right anterior temporal lobe separate from the hematoma. There was a right mastoid effusion, but normal orbitals and the calvarium and skull base were unremarkable. Magnetic resonance venography (MRV) results revealed non-opacification of the torcula, right transverse sinus, right sigmoid sinus and upper internal jugular vein compatible with occlusive thrombosis. A small amount of thrombus also extended into the left transverse sinus. The superior sagittal sinus, remainder of the left transverse sinus, left sigmoid sinus, left upper internal jugular vein, straight sinus, vein of Galen and bilateral internal cerebral veins demonstrated normal contrast opacification. The patient's platelet count was 126 upon admission (normal range [NR] not provided), with other workup laboratory test results reported as pending. The action taken with COVID-19 vaccine Ad26.CoV2.S was not applicable. The outcome of the right internal jugular thrombus, intraparenchymal hemorrhage, DVST, CVST, headache, blurry vision, neck stiffness, nausea and vomiting was reported as unknown. This report was serious (caused/prolonged hospitalization and other medically important condition).; Sender's Comments: V0: This case concerns a 34-year-old female who experienced cerebral venous sinus thrombosis (CVST), dural venous sinus thrombosis, right internal jugular vein thrombosis, and cerebral hemorrhage 12 days after receiving covid-19 vaccine ad26.cov2.s for prevention of symptomatic SARS-CoV-2 virus infection. The patient was noted to be 4 months post-partum. She presented for medical assistance with a 2-week history of headaches, blurry vision, and neck stiffness for 2 to 3 days as well as nausea with 1 episode of vomiting. Magnetic resonance imaging showed a large hematoma in the right posterior temporal lobe with surrounding edema and associated mass effect resulting in effacement of the right temporal horn and right-to-left midline shift measuring 5 mm and occlusive thrombus within the torcula, right transverse sinus, right sigmoid sinus, and upper internal jugular vein.  A small amount of thrombus extended into the medial aspect of the left transverse sinus. The platelet count on admission was 126,000. Although the post-partum status of the patient may have contributed, based on evolving knowledge of Thrombosis with Thrombocytopenia Syndrome (TTS, per definition from Brighton Collaboration) and considering the low platelet count and temporal relationship to vaccination, we consider the events to have a plausible relationship with vaccination.