Sex: M
Vaccine: COVID19
Symptoms: Magnetic resonance imaging thoracic, Mycoplasma test, Nerve conduction studies, Neuralgic amyotrophy, Physical examination
Clinical narrative: COVID-19 Vaccine-Induced Parsonage-Turner Syndrome; The initial case was missing the following minimum criteria: [no suspect product]. Upon receipt of follow-up information on [13Jul2022], this case now contains all required information to be considered valid.  This is a literature report.  A 78-year-old male patient received BNT162b2 (BNT162B2), as dose 2, single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history included: "non-smoker" (unspecified if ongoing); "coronary artery disease" (unspecified if ongoing), notes: presented with nonexertional. The patient's concomitant medications were not reported. Vaccination history included: Bnt162b2 (Dose 1), for Covid-19 Immunization. The following information was reported: NEURALGIC AMYOTROPHY (hospitalization, medically significant), 3 weeks after the suspect product(s) administration, outcome "recovering", described as "COVID-19 Vaccine-Induced Parsonage-Turner Syndrome". The patient underwent the following laboratory tests and procedures: Antineutrophil cytoplasmic antibody: negative; Antinuclear antibody: negative; Cytomegalovirus test: negative; Electromyogram: Normal, notes: Insertional (L first dorsal interosseous); Normal, notes: Insertional (R deltoid); Normal, notes: Insertional (R biceps brachii); Normal, notes: Insertional (RR triceps brachii); Normal, notes: Insertional (R flexor carpi ulnaris); Normal, notes: Insertional (R first dorsal interosseous); None, notes: Spontaneous (L first dorsal interosseous ). Fibrillation/PSW; 1, notes: Spontaneous (R deltoid ). Fibrillation/PSW; None, notes: Spontaneous (R biceps brachii  ). Fibrillation/PSW; None, notes: Spontaneous (R triceps brachii). Fibrillation/PSW; None, notes: Spontaneous (R flexor carpi ulnaris). Fibrillation/PSW; None, notes: Spontaneous (R first dorsal interosseous). Fibrillation/PSW; None, notes: Spontaneous (L first dorsal interosseous). Fasciculations; Few, notes: Spontaneous (R deltoid). Fasciculations; None, notes: Spontaneous (R biceps brachii). Fasciculations; None, notes: Spontaneous (R triceps brachii). Fasciculations; None, notes: Spontaneous (R flexor carpi ulnaris). Fasciculations; None, notes: Spontaneous (R first dorsal interosseous). Fasciculations; None, notes: Spontaneous (L first dorsal interosseous). Other; None, notes: Spontaneous (R deltoid). Other; None, notes: Spontaneous (R biceps brachii). Other; None, notes: Spontaneous (RR triceps brachii). Other; None, notes: Spontaneous (R flexor carpi ulnaris). Other; None, notes: Spontaneous (R first dorsal interosseous). Other; 1, notes: Amplitude; 2, notes: Amplitude; 2, notes: Amplitude; 1, notes: Amplitude; Normal, notes: Amplitude; -1, notes: Amplitude; None, notes: Polyphasia; 3, notes: Polyphasia; 3, notes: Polyphasia; None, notes: Polyphasia; 1, notes: Polyphasia; 2, notes: Polyphasia; Reduced, notes: Recruitment; Reduced, notes: Recruitment; Reduced, notes: Recruitment; Reduced, notes: Recruitment; Reduced, notes: Recruitment; Single unit, notes: Recruitment; Normal, notes: Activations; Normal, notes: Activations; Normal, notes: Activations; Normal, notes: Activations; Normal, notes: Activations; Normal, notes: Activations; N, notes: Duration; 1, notes: Duration; 2, notes: Duration; N, notes: Duration; N, notes: Duration; N, notes: Duration; decreased motor unit recruitment in the bilateral, notes: decreased motor unit recruitment in the bilateral first dorsal interosseous and right deltoid, biceps, and triceps muscles; Epstein-Barr virus antibody: negative; HIV antibody: negative; Lyme disease: negative; negative; negative; Magnetic resonance imaging: showing multilevel degenerative, notes: disc disease and no signs of demyelination, fracture deformity, traumatic subluxation, or compressive myelopathy; Magnetic resonance imaging head: no demyelination, fracture deformity,, notes: traumatic subluxation, or compressive myelopathy; Magnetic resonance imaging spinal: no demyelination, fracture deformity, notes: traumatic subluxation, or compressive myelopathy; Magnetic resonance imaging thoracic: no demyelination, fracture deformity, notes: traumatic subluxation, or compressive myelopathy; Mycoplasma test: negative; Nerve conduction studies: 3.0, notes: Unit: mV, Reference: greater than or equal to 4.0, L median-APB, Wrist; 2.8, notes: Unit: mV, Reference: smaller than or equal to 4.0, L median-APB, Elbow; 2.1, notes: Unit: mV, Reference: 76.4; L median-APB, Ulnar wrist; 1.8, notes: Unit: mV, Reference: 84, L median-APB, Ulnar elbow; 5.0, notes: Unit: mV, Reference: greater than or equal to 4.0, R median-APB, Wrist; 4.9, notes: Unit: mV, Reference: greater than or equal to 4.0, R median-APB, Elbow; 11.9, notes: Unit: mV, Reference: greater than or equal to 6.0, L ulnar-ADM, Wrist; 9.3, notes: Unit: mV, Reference: greater than or equal to 6.0, L ulnar-ADM, B elbow; 9.0, notes: Unit: mV, Reference: greater than or equal to 6.0, L ulnar-ADM, A elbow; 11.9, notes: Unit: mV, Reference: greater than or equal to 6.0, R ulnar-ADM, Wrist; 11.2, notes: Unit: mV, Reference: greater than or equal to 6.0, R ulnar-ADM, B elbow; 11.2, notes: Unit: mV, Reference: greater than or equal to 6.0, R ulnar-ADM, A elbow; 11.5, notes: Unit: mV, Reference: greater than or equal to 7.5, L ulnar-FDI, Wrist; 10.7, notes: Unit: mV, Reference: greater than or equal to 7.5, L ulnar-FDI, B elbow; 10.7, notes: Unit: mV, Reference: greater than or equal to 7.5, L ulnar-FDI, A elbow; 13.3, notes: Unit: mV, Reference: greater than or equal to 7.5, R ulnar-FDI, Wrist; 12.2, notes: Unit: mV, Reference: greater than or equal to 7.5, R ulnar-FDI, B elbow; 11.5, notes: Unit: mV, Reference: greater than or equal to 7.5, R ulnar-FDI, A elbow; 130, notes: Unit: mm, Segment: Wrist-Digit II, L median - Digit II (antidromic); 130, notes: Unit: mm, Segment: Wrist-Digit II, R median - Digit II (antidromic); 110, notes: Unit: mm, Segment: Wrist-Digit V, L ulnar - Digit V (antidromic); 110, notes: Unit: mm, Segment: Wrist-Digit V, R ulnar - Digit V (antidromic); 100, notes: Unit: mm, Segment: Forearm-wrist, L radial - anatomical snuffbox (forearm); 100, notes: Unit: mm, Segment: Forearm-wrist, R radial - anatomical snuffbox (Forearm); 80, notes: Unit: mm, Segment: Median palm-wrist, L median, ulnar - transcarpal comparison; 80, notes: Unit: mm, Segment: Ulnar palm-wrist, L median, ulnar - transcarpal comparison; 80, notes: Unit: mm, Segment: Median palm-wrist, R median, ulnar - transcarpal comparison; 80, notes: Unit: mm, Segment: Ulnar palm-wrist, R median, ulnar - transcarpal comparison; 5.0, notes: Unit: ms, L median - APB, Wrist; 5.1, notes: Unit: ms, L median - APB, Elbow; 6.8, notes: Unit: ms, R median - APB, Wrist; 7.2, notes: Unit: ms, R median - APB, Elbow; 6.4, notes: Unit: ms, L ulnar - ADM, Wrist; 6.7, notes: Unit: ms, L ulnar - ADM, B elbow; 6.1, notes: Unit: ms, L ulnar - ADM, A elbow; 6.4, notes: Unit: ms, R ulnar - ADM, Wrist; 6.7, notes: Unit: ms, R ulnar - ADM, B elbow; 6.9, notes: Unit: ms, R ulnar - ADM, A elbow; 5.2, notes: Unit: ms, L ulnar - FDI, Wrist; 5.7, notes: Unit: ms, L ulnar - FDI, B elbow; 5.8, notes: Unit: ms, L ulnar - FDI, A elbow; 5.2, notes: Unit: ms, R ulnar - FDI, Wrist; 5.6, notes: Unit: ms, R ulnar - FDI, B elbow; 5.6, notes: Unit: ms, R ulnar - FDI, A elbow; 4.5, notes: Unit: ms, Reference: smaller than or equal to 4.5, L median-APB, Wrist; 9.6, notes: Unit: ms, Reference: smaller than or equal to 4.5, L median-APB, Elbow; 3.2, notes: Unit: ms, Reference: smaller than or equal to 4.5, L median-APB, Ulnar wrist; 9.4, notes: Unit: ms, Reference: smaller than or equal to 4.5, L median-APB, Ulnar elbow; 4.0, notes: Unit: ms, Reference: smaller than or equal to 4.5, R median-APB, Wrist; 8.5, notes: Unit: ms, Reference: smaller than or equal to 4.5, R median-APB, Elbow; 2.8, notes: Unit: ms, Reference: smaller than or equal to 3.6, L ulnar-ADM, Wrist; 7.0, notes: Unit: ms, Reference: smaller than or equal to 3.6, L ulnar-ADM, 7.0; 9.0, notes: Unit: ms, Reference: smaller than or equal to 3.6, L ulnar-ADM, A elbow; 2.6, notes: Unit: ms, Reference: smaller than or equal to 3.6, R ulnar-ADM, Wrist; 7.1, notes: Unit: ms, Reference: smaller than or equal to 3.6, R ulnar-ADM, B elbow; 9.3, notes: Unit: ms, Reference: smaller than or equal to 3.6, R ulnar-ADM, A elbow; 3.5, notes: Unit: ms, Reference: smaller than or equal to 3.7, L ulnar-FDI, Wrist; 7.8, notes: Unit: ms, Reference: smaller than or equal to 3.7, L ulnar-FDI, B elbow; 9.7, notes: Unit: ms, Reference: smaller than or equal to 3.7, L ulnar-FDI, A elbow; 3.3, notes: Unit: ms, Reference: smaller than or equal to 3.7, R ulnar-FDI, Wrist; 7.8, notes: Unit: ms, Reference: smaller than or equal to 3.7, R ulnar-FDI, B elbow; 9.9, notes: Unit: ms, Reference: smaller than or equal to 3.7, R ulnar-FDI, A elbow; 6.2, notes: Unit:ms, L ulnar - FDI, A elbow; 4.5, notes: Unit:ms, R ulnar - FDI, B elbow; 6.7, notes: Unit:ms, R ulnar-FDI, A elbow; 5.1, notes: Unit:ms, L median -APB, Elbow; 4.5, notes: Unit:ms, R median- APB, Elbow; 4.5, notes: Unit:ms, L ulnar - ADM, B elbow; 6.2, notes: Unit:ms, L ulnar - ADM, A elbow; 4.5, notes: Unit:ms, R ulnar - ADM, B elbow; 6.8, notes: Unit:ms, L ulnar-ADM, A elbow; 4.2, notes: Unit:ms, L ulnar - FDI, B elbow; revealed no significant changes; brachial plexopathy on the left side of the lower, notes: trunk, bilateral median, neuropathies at the wrist, and ulnar sensory neuropathy. Bilateral median sensory nerve action potential (SNAP) amplitudes are diminished, and peak latency is prolonged on the left and normal on the right., Bilateral ulnar sensory nerve action potential (SNAP) amplitudes are diminished, severely on the right; peak latencies are borderline. Bilateral radial sensory nerve action potential (SNAP) amplitudes are borderline, and peak latencies and conduction velocities are normal. Bilateral ulnar compound muscle action potential (CMAP) amplitudes and distal latencies are normal; 7.4, notes: Unit: uV, Reference: greater than or equal to 15.0, L median - Digit II (antidromic), Wrist: Digit II; 7.5, notes: Unit: uV, Reference: greater than or equal to 15.0, R median - Digit II (antidromic), Wrist: Digit II; 6.2, notes: Unit: uV, Reference: greater than or equal to 10.0, L ulnar - Digit V (antidromic), Wrist: Digit V; 1.9, notes: Unit: uV, Reference: greater than or equal to 10.0, R ulnar - Digit V (antidromic), Wrist: Digit V; 20.9, notes: Unit: uV, Reference: greater than or equal to 20.0, L radial - anatomical snuffbox (forearm), Forearm: Wrist; 21.2, notes: Unit: uV, Reference: greater than or equal to 20.0, R radial - anatomical snuffbox (Forearm), Forearm: Wrist; 24.6, notes: Unit: uV, Reference: greater than or equal to 50.0, L median, ulnar - transcarpal comparison, Median palm: Wrist; 8.8, notes: Unit: uV, Reference: greater than or equal to 15.0, L median, ulnar - transcarpal comparison, Ulnar palm: Wrist; 21.9, notes: Unit: uV, Reference: greater than or equal to 50.0, R median, ulnar - transcarpal comparison, Median palm: Wrist; 21.9, notes: Unit: uV, Reference: greater than or equal to 15.0, R median, ulnar - transcarpal comparison, Ulnar palm: Wrist; 3.5, notes: Unit: m/s, Reference: greater than or equal to 3.6, L median - Digit II (antidromic), Wrist: Digit II; 2.8, notes: Unit: m/s, Reference: smaller than or equal to 3.6, R median - Digit II (antidromic), Wrist: Digit II; 2.6, notes: Unit: m/s, Reference: smaller than or equal to 3.1, L ulnar - Digit V (antidromic, Wrist: Digit V; 2.6, notes: Unit: m/s, Reference: smaller than or equal to 3.1, R ulnar - Digit V (antidromic), Wrist: Digit V; 1.8, notes: Unit: m/s, Reference: smaller than or equal to 2.9, L radial - anatomical snuffbox (forearm), Forearm: Wrist; 1.5, notes: Unit: m/s, Reference: smaller than or equal to 2.9, R radial - anatomical snuffbox (Forearm), Forearm: Wrist; 2.3, notes: Unit: m/s, Reference: smaller than or equal to 2.3, L median, ulnar - transcarpal comparison, Median palm: Wrist; 1.4, notes: Unit: m/s, Reference: smaller than or equal to 2.3, L median, ulnar - transcarpal comparison, Ulnar palm: Wrist; 2.1, notes: Unit: m/s, Reference: smaller than or equal to 2.3, R median, ulnar - transcarpal comparison, Median palm: Wrist; 1.4, notes: Unit: m/s, Reference: smaller than or equal to 2.3, R median, ulnar - transcarpal comparison, Ulnar palm: Wrist; 4.4, notes: Unit: m/s, Reference: greater than or equal to 3.6, L median - Digit II (antidromic), Wrist: Digit II; 3.5, notes: Unit: m/s, Reference: smaller than or equal to 3.6, R median - Digit II (antidromic), Wrist: Digit II; 3.2, notes: Unit: m/s, Reference: smaller than or equal to 3.1, L ulnar - Digit V (antidromic), Wrist: Digit V; 3.2, notes: Unit: m/s, Reference: smaller than or equal to 3.1, R ulnar - Digit V (antidromic), Wrist: Digit V; 2.5, notes: Unit: m/s, Reference: smaller than or equal to 2.9, L radial - anatomical snuffbox (forearm), Forearm: Wrist; 2.2, notes: Unit: m/s, Reference: smaller than or equal to 2.9, R radial - anatomical snuffbox (Forearm), Forearm: Wrist; 3.1, notes: Unit: m/s, Reference: smaller than or equal to 2.3, L median, ulnar - transcarpal comparison, Median palm: Wrist; 2.0, notes: Unit: m/s, Reference: smaller than or equal to 2.3, L median, ulnar - transcarpal comparison, Ulnar palm: Wrist; 2.8, notes: Unit: m/s, Reference: smaller than or equal to 2.3, R median, ulnar - transcarpal comparison, Median palm: Wrist; 2.2, notes: Unit: m/s, Reference: smaller than or equal to 2.3, R median, ulnar - transcarpal comparison, Ulnar palm: Wrist; Nerve conduction studies: 100 %, notes: L median - APB, Wrist; 93.2 %, notes: L median-APB , Elbow; 6.4 %, notes: L median-APB , Ulnar wrist; 7.2 %, notes: L median-APB , Ulnar elbow; 100 %, notes: R median-APB , Wrist; 98.1 %, notes: R median-APB , Elbow; 100 %, notes: L ulnar-ADM, Wrist; 93.6 %, notes: L ulnar-ADM, B elbow; 96 %, notes: L ulnar-ADM, A elbow; 100 %, notes: R ulnar-ADM, Wrist; 93.9 %, notes: R ulnar-ADM, Wrist; 99.9 %, notes: R ulnar-ADM, A elbow; 100 %, notes: L ulnar-FDI, Wrist; 93.4 %, notes: L ulnar-FDI, B elbow; 99.3 %, notes: L ulnar-FDI, A elbow; 100 %, notes: R ulnar-FDI, Wrist; 91.9 %, notes: R ulnar-FDI, B elbow; 91.9 %, notes: R ulnar-FDI, A elbow; 37, notes: Unit: m/s, Reference: greater than or equal to 56, segment: Wrist-Digit II; 46, notes: Unit: m/s, Reference: greater than or equal to 56, segment: Wrist-Digit II; 49, notes: Unit: m/s, Reference: greater than or equal to 54, segment: Wrist-Digit V; 43, notes: Unit: m/s, Reference: greater than or equal to 54, segment: Wrist-Digit V; 56, notes: Unit: m/s, Reference: greater than or equal to 49, Forearm: Wrist; 69, notes: Unit: m/s, Reference: greater than or equal to 49, Forearm: Wrist; 35, notes: Unit: m/s, Reference: greater than or equal to 56, Median palm: Wrist; 59, notes: Unit: m/s, Reference: greater than or equal to 56, Ulnar palm: Wrist; 38, notes: Unit: m/s, Reference: greater than or equal to 56, Median palm: Wrist; 59, notes: Unit: m/s ,Reference: greater than or equal to 56 ,Ulnar palm: Wrist; 47, notes: Unit: m/s ,Reference: greater than or equal to 48 ,L median - APB ,Elbow; 52, notes: Unit: m/s, Reference: greater than or equal to 4, R median - APB, Elbow; 55, notes: Unit: m/s, Reference: greater than or equal to 51, L ulnar - ADM, B elbow; 53, notes: Unit: m/s, Reference: greater than or equal to 51, L ulnar - ADM, A elbow; 51, notes: Unit: m/s, Reference: greater than or equal to 51, R ulnar - ADM, B elbow; 49, notes: Unit: m/s, Reference: greater than or equal to 51, R ulnar - ADM, A elbow; 55, notes: Unit: m/s, Reference: greater than or equal to 51, L ulnar - FDI, B elbow; 55, notes: Unit: m/s, Reference: greater than or equal to 51, L ulnar - FDI, A elbow; 51, notes: Unit: m/s, Reference: greater than or equal to 51, R ulnar - FDI, B elbow; 50, notes: Unit: m/s, Reference: greater than or equal to 51, R ulnar - FDI, A elbow; Physical examination: significant for weakness in right-hand, notes: grip and wrist flexion (grade 3). There were no other motor deficits, upper motor, neuron signs, bulbar weakness, or sensory deficits; Rheumatoid factor: negative. Therapeutic measures were taken as a result of neuralgic amyotrophy. Clinical course: the patient presented with nonexertional, constant chest pain for one hour and new onset of bilateral hand weakness for three days. He had no neurological disease or allergies and denied any recent trauma or infection. Three weeks before the onset of the symptoms, the patient received a second dose of the BNT162b2 COVID-19 vaccine, which was administered 21 days after the first dose. Physical examination was significant for weakness in right-hand grip and wrist flexion (Medical Research Council grade 3). There were no other motor deficits, upper motor neuron signs, bulbar weakness, or sensory deficits. Diagnostic workup for the underlying acute coronary syndrome, infection (cytomegalovirus, Epstein-Barr virus, HIV, mycoplasma, Lyme disease), and rheumatological diseases (antinuclear antibody, rheumatoid factor, Sjogren syndrome A (Ro) or Sjogren syndrome B (La), antineutrophil cytoplasmic antibody) were negative. Imaging workup including magnetic resonance imaging (MRI) brain, cervical spine, and thoracic spine done with and without contrast revealed no demyelination, fracture deformity, traumatic subluxation, or compressive myelopathy. Nerve conduction studies showed brachial plexopathy on the left side of the lower trunk, bilateral median neuropathies at the wrist, and ulnar sensory neuropathy. Needle electromyography showed decreased motor unit recruitment in the bilateral first dorsal interosseous and right deltoid, biceps, and triceps muscles. The patient was treated with 40 mg/day of oral prednisone and occupational therapy to maintain range of motion and activities of daily living. He showed significant improvement in pain, with a slight recovery from his weakness. He was then discharged with regular outpatient follow-ups to observe the disease course and taper steroids.  No follow-up attempts are needed; information about lot/batch number cannot be obtained. No further information is expected.; Sender's Comments: As there is limited information in the case provided, the causal association between the Reported event and the suspect drug cannot be excluded. The case will be reassessed once new information is available.   The impact of this report on the benefit/risk profile of the Pfizer drug 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.