Sex: M
Vaccine: COVID19
Symptoms: Blood immunoglobulin G, Blood triglycerides, Computerised tomogram, Computerised tomogram abdomen, Disease recurrence
Clinical narrative: Recurrent acute pancreatitis; Recurrent acute pancreatitis; This is a literature report.  A 46-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE) (Batch/Lot number: unknown) as dose 2, single for COVID-19 immunisation. Relevant medical history included: "upper abdominal pain" (unspecified if ongoing); "nausea" (unspecified if ongoing); "vomiting" (unspecified if ongoing); "hospitalization" (unspecified if ongoing); "acute pancreatitis" (unspecified if ongoing); "2 beers weekly" (unspecified if ongoing). The patient's concomitant medications were not reported. Past drug history included: lisinopril (MANUFACTURER UNKNOWN); hydrochlorothiazide (MANUFACTURER UNKNOWN). Vaccination history included: bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE) (2 days after the first dose of Pfizer-BioNTech COVID-19 vaccine), for COVID-19 immunisation, reactions: "acute pancreatitis".  The following information was reported: PANCREATITIS ACUTE (hospitalization, medically significant), DISEASE RECURRENCE (hospitalization, medically significant), outcome "unknown" and all described as "Recurrent acute pancreatitis".    Clinical course: Introduction: Vaccines are playing a major role in stopping the current deadly SARS CoV 2 Pandemic. mRNA based vaccines were used for the first time on a massive scale. These vaccines were approved by FDA under EUA. Due to hastened clinical trials, certain side effects of these vaccines could become evident in the post marketing phase. Pancreatitis was reported as a side effect to mRNA-based vaccine (1, 2). We present a case of acute recurrent pancreatitis after administration of Pfizer-BioNTech COVID-19 mRNA vaccine.   Case Description/Methods: A 46 yr old male was seen for symptoms of upper abdominal pain, nausea and vomiting, that started 2 days after the first dose of Pfizer-BioNTech COVID-19 vaccine. The symptoms worsened leading to hospitalization with diagnosis of acute pancreatitis. He was taking lisinopril and hydrochlorothiazide. He drinks 2 beers weekly. The lipase was 648 U/L with normal LFTs. CT scan showed uncomplicated acute pancreatitis involving the distal body and tail of the pancreas with normal biliary anatomy. He was discharged after improvement with NPO, IV fluids and analgesics. He was advised to stop alcohol. The lipase was 45 U/L on the day of discharge. He did well until after the second dose of vaccine. He developed similar symptoms of upper abdominal pain about 2 days after the vaccine shot. His pain continued to worsen in a similar fashion as happened after the first dose of vaccine leading to hospitalization. Denied use of alcohol. His lipase was 1483 U/L. CT abdomen showed peripancreatic inflammatory changes consistent with pancreatitis with a 5 cm complex thick-walled pseudocyst or walled off necrosis given the internal debris. IgG4 and triglycerides were normal. Patient was again kept NPO and treated with analgesics and IV fluids. Lisinopril and HCTZ were discontinued. Patient was discharged with amlodipine. His lipase was 233 U/L on the day of discharge.  Discussion: mRNA based COVID-19 vaccine is the most important weapon to stop the current deadly pandemic. Our goal is to make medical community aware of pancreatitis being one of the possible emerging side effects to the vaccine.   The patient underwent the following laboratory tests and procedures: IgG4: normal; triglycerides: normal; computerised tomogram (CT) scan: showed uncomplicated acute pancreatitis involving the distal body and tail of the pancreas with normal biliary anatomy; CT abdomen: showed peripancreatic inflammatory changes consistent with pancreatitis with a 5 cm complex thick-walled pseudocyst or walled off necrosis given the internal debris; lipase: 648 IU/l; 45 IU/l; 233 IU/l; 1483 IU/l; liver function test (LFT): normal. Therapeutic measures were taken as a result of pancreatitis acute.; Sender's Comments: A contributory role of BNT162B2 to the event recurrent acute pancreatitis cannot be fully excluded based on temporal association. Underlying pancreatitis and alcohol use may be contributory. This case will be reassessed if additional information becomes available.  The impact 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-202101671224 same patient, article, drug, and event