Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Alanine aminotransferase increased, Anion gap, Arthralgia, Aspartate aminotransferase increased, Asthenia
Clinical narrative: Fever onset Feb 26 (beginning 20 hrs post vaccine) spiking to 102.5 F on Feb 27 and resolving on March 1. Severe headache, muscle aches and bed-ridden during those days as anticipated. Following weeks continued with severe fatigue, difficulty to think/concentrate (struggled to work remotely at job, but did work). Cognitive processing for my brain was definitely sub-par compared to baseline. 3-4 weeks post vaccine began with pain in joints in hands- began right 5th digit, then spread to all 10 Proximal Interphalangeal (PIP) joints in hands, accompanied by pain and mild swelling of the bilateral axillary node areas.  Increasing whole body weakness until May 5 unable to walk or lift legs off ground. Saw PCP May 6 with labs done 5/6/21 and additional labs ordered from biochemical geneticist 5/7 (including acylcarnitines and organic acid screens). Referred to neuromuscular neurologist (appt. May 26).  Continued until the appointment to be extremely weak, with intermittently unable to lift legs, ptosis of eyelids, and considerable difficulty always to climb stairs in home to bedroom.  Treated primarily with bed rest when not sitting at desk in home office in bedroom.   May 23 the weakness was increasing and moving to proximal large muscles in shoulders also making holding toothbrush difficult and exhausting.  Went to Emergency Department to seek sooner neurological evaluation and ensure not headed into a Guillain-Barre type syndrome.  Physicians suspected that the COVID vaccinations triggered an immune reaction, potentially flaring some unidentified process that showed severe symptoms following prior surgeries and major physiological stress. Labs were started to rule out Myasthenia Gravis (returned negative), and released home. By time saw neuromuscular neurologist on May 26 the degree of muscular weakness was not as severe, although still difficult to walk and thought processing still not normal.  June 11 EMGs, nerve conduction studies, and nerve velocity studies thankfully revealed no evidence of defective neuromuscular junction transmission or evidence of widespread myopathy. The neurologist was unable to determine a definitive cause for the symptoms and recommended continued evaluation with the biochemical geneticist seen previously.  Post EMG/NCS/NVS testing, the physicians  now gave permission to increase to higher doses again of the "possible metabolic/mitochondrial cocktail" (consisting of cofactors in Kreb's (TCA) cycle and Electron transport chain for generating ATP) that been taking since post surgery complications in 2008 when first evaluated by a neuromuscular neurologist.  June 12 -began to double and triple the amount of Ubiquinol (Co-enzyme Q-10) to 100 mg now bid or tid, high doses of Riboflavin and Thiamin (100 mg bid to tid) and Vitamin C 500 mg (bid to tid). These were pushed to doses originally taken to recover post surgery in 2008 after multiple months of difficulty until seen by neurology.  Also added back creatinine monophoshate 5 grams daily.  Strength and symptoms began to slow recover over subsequent weeks allowing normal ambulation at most times beginning in mid-July(although walking distances still limited and difficulty with standing more than 5-10 minutes without recurrence of muscle weakness).  Summary: While symptoms triggered by the Pfizer-BioNTech SARS CoV-2 vaccine may not have specifically caused the discrete bodily reactions (e.g., onset of new symptoms never before experienced) the timing of the neuromuscular weakness and severe fatigue appear to have been triggered within the body by an immune reaction started by the vaccinations.  The PIP joint pain had never been experienced prior.  Also, the blurred vision and severe headaches immediately following the vaccines were of a type not previously experienced.  The most profound symptoms that have significantly impacted regular functioning (including performing ADLs and IADLs) for the next 6 months post COVID vaccination are related to extreme fatigue, muscular weakness, headaches, and difficulty with cognitive processing.  For a person who just completed a doctoral degree December 2020, there has been a striking impact on cognition that seems to be parallel to the levels of overall body and muscular functioning. The VAERS form wasn't completed prior (e.g., closer to the vaccination) since being too exhausted just trying to survive life. Functional disability has existed, although have pressed through and worked remotely from a home office (new job and did not want to take sick time since with a new employer and did not want to risk losing position). Anticipate functional disability will improve over future months and hopefully not result in permanent disability, although cannot predict the future.