Sex: F
Vaccine: COVID19
Symptoms: Bell's palsy, Disease recurrence, Investigation, Neurological examination
Clinical narrative: Another case of Bells palsy recurrence after Pfzer-BioNTech COVID-19 vaccination; Another case of Bells palsy recurrence after Pfzer-BioNTech COVID-19 vaccination; This is a literature report for the following literature source(s).  A 38-year-old female patient received BNT162b2 (BNT162B2), on 29Apr2021 as dose 1, single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history included: "a prior episode of left-sided Bell's Palsy" (unspecified if ongoing), notes: 10 years earlier; "acupuncture" (unspecified if ongoing). The patient's concomitant medications were not reported. Past drug history included: Prednisone for a prior episode of left-sided Bell's Palsy; Antiviral for a prior episode of left-sided Bell's Palsy. The following information was reported: BELL'S PALSY (medically significant), DISEASE RECURRENCE (medically significant) all with onset 04May2021, outcome "recovering" and all described as "Another case of Bells palsy recurrence after Pfzer-BioNTech COVID-19 vaccination". The patient underwent the following laboratory tests and procedures: follow-up exams: revealed a slower improvement in her, notes: symptomatology in comparison to her episode 10 years ago; was unremarkable; Neurological examination: Negative. Therapeutic measures were taken as a result of bell's palsy, disease recurrence.  Clinical course: Introduction- In both the Moderna and Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine clinical trials conducted at 99 centers across the United States, Bell's Palsy was listed as a possible side effect. After reporting a case of Bell's Palsy recurrence in a patient who received the Pfizer-BioNTech COVID-19 vaccine, we encountered another patient with recurrence of Bell's Palsy six days after the administration of the first dose of the Pfizer-BioNTech COVID-19 vaccine. This report intends to add to the growing literature regarding the safety profile of this new vaccine.  Case Presentation The patient is a 38-year-old female who connected with us upon reading our previous report. She had been previously healthy except for a prior episode of left-sided Bell's Palsy around 10 years earlier. The symptoms from her first episode were described as severe with eventual full recovery after receiving a combination of a brief course of prednisone, antiviral medication, and acupuncture. The patient received her first dose of the Pfizer-BioNTech COVID-19 vaccine on April 29th of 2021 and began to experience tongue numbness six days later. The following day, she developed a right facial droop. The rest of her neurological examination was negative and her workup was unremarkable. Her symptoms progressed over the next few days, which prompted treatment with a week-long course of prednisone. Serial follow-up exams revealed a slower improvement in her symptomatology in comparison to her episode 10 years ago. Discussion- This report marks another episode of Bell's Palsy recurrence following administration of the mRNA COVID-19 vaccination that the same practice has encountered this year, suggesting a potential association between the mRNA vaccine and these recurrences. COVID infection as well as mRNA-based vaccines have been associated with many neurological conditions, including Bell's Palsy. Data on recurrent Bell's Palsy are lacking; our previously reported Bell's Palsy recurrence after mRNA-based vaccine remains the only peer reviewed case report in the literature. Some have suggested that type I interferons, which are strongly elicited by mRNA vaccinations, may play a contributory role. Several case reports have hypothesized that a similar phenomenon may be contributing to the development of Bell's Palsy after hepatitis C virus treatment as well as administration of another mRNA vaccine. Additionally, at the molecular level, activation of the p53 upregulated modulator apoptosis (PUMA) and innate immunity signaling module (SARM1) can lead to axonal degeneration. Another study suggested that upregulation of the aquaporin 1 water channel protein can lead to infratemporal facial nerve edema and eventual impingement in the temporal bone canal. Conclusions- With the wide roll-out of mRNA COVID-19 vaccines, population-level surveillance will be required to establish any concrete association between recurrent Bell's palsy and the vaccines. Possible adverse reactions such as the one described here should be diligently reported to help establish a more reliable vaccine safety profile. With this documentation, we hope to help reassure individuals with doubts about vaccination that such occurrences are still very low.  No follow-up attempts are possible.  Follow-up (10Jan2024): This is a literature report for the following literature source entitled: This is a follow-up report based on the receipt of the publication; the case has been updated to include additional information identified in the publication. Updated information included: Reporter, literature information, RMH, labs updated and narrative updated.  No follow-up attempts are possible.; Sender's Comments: Based on temporal association, there is reasonable possibility of causal association between the Reported events Bells Palsy and Disease Recurrence and the suspect drug. 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.