Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: Off label use, Pulmonary function test, Respiratory tract inflammation
Clinical narrative: chest was horribly over expanded/ chest that was hyperinflated; patient had the first dose on 14Feb2021 and the second dose on 01Mar2021; patient had the first dose on 14Feb2021 and the second dose on 01Mar2021; Worse breathlessness/shortness of breath; Vaccine changed the cellular airway phenotype/inflammation in the airway before the vaccine had changes qualitatively or quantitatively; Vaccine changed the cellular airway phenotype/inflammation in the airway before the vaccine had changes qualitatively or quantitatively; Plagued with a cough, some from his upper airway and some from his lower airway; This is a spontaneous report from a contactable physician. A 71-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection), via an unspecified route of administration on 01Mar2021 (Batch/Lot number was not reported), at the age of 71 years old, as single dose for COVID-19 immunisation. Medical history included breathlessness (which has been a bit of an issue for 6-8 months), subclinical airway disease, and inflammation in the airway; all are ongoing. The patient stopped smoking years ago. The patient's concomitant medications were not reported. The patient previously had the first dose of BNT162B2 on 14Feb2021 for COVID-19 Immunisation. The physician stated that he was a lung specialist and had a friend (patient) who got the Pfizer vaccine. The patient had the first dose on 14Feb2021 and the second dose on 01Mar2021. Shortly after the second dose, the patient had breathlessness, which has been a bit of an issue for 6-8 months he hadn't seen him with the pandemic, he got worse breathlessness on Mar2021. Stated that they both got vaccinated and he went to his house and the patient said to let himself in as he (patient) had shortness of breath and can't go up and down the stairs. The physician stated that he (physician) was his student but he was also the patient's lung specialist and he was treating him. The patient was then initially treated with Breo which was a combo drug that was good with airway disease. It was a product from GSK that was an inhaled steroid and long acting. It worked 72-96 hours and he was really trapping a lot of air and feeling it in his back musculature. Stated that the patient stopped taking it and mentioned that the patient was a guy and guys are sort of born stupid and he never called him and found out he was plateauing and not better. The patient was then started on Anoro which was 2 drugs in one an anticholinergic and a long acting sympathicsomatic and he was considerably better. The patient was still plagued with a cough, some from his upper airway and some from his lower airway in Mar2021. The physician said that he had to be careful with inhaled steroids because the patient does not want to weaken his vocal cords. The physician then stated what he thought happened was the vaccine changed the cellular airway phenotype and that happened since the patient was vaccinated with the second dose. Stated that the inflammation in the airway before the vaccine had changes qualitatively or quantitatively or both and what the vaccine does was recruit all sorts of inflammation and sorts and distributes it through the body. The physician was asking to get guidance with regards to pharmacology and even more complicated think beta 2 receptors polymorphism which means unlike him (the physician), who was asthmatic can reach for his rescue inhaler and get better if he needed to and the patient can't do that, he had to be on a category of medication reserved for emphysema or chronic bronchitis which he does not have. Stated he will formulate a question on what was the airway phenotype before the vaccine going on with it, in retrospect brewing for away and some tipping point was reached and something happened with the vaccine, which he felt was excellent in clinical. The physician stated that the immune response in the airway was a large response, stating that there were 1000 cell types and a million chemicals in that "soup". The physician stated that he would like a call next week and talk to a Pfizer pulmonologist and get guidance and a little instruction the patient does not want to damage his airway. Stated 8/10 times the airway issue resolves with Breo and 2/10 times it doesn't. Stated that this situation got worse after vaccinated and paradoxically they got together after 6-8 months to see each other. Stated that the medication was Breo 100 and what was happening was the patient was trapping a lot of air and he measured his total lung volume and his chest was horribly over expanded. Stated that the patient's total lung volume on 18Mar2021 was 160% the predicted and that it was the equivalent of taking the normal lung volume, 4L and putting in another 2.5L and walking around with a chest that was hyperinflated and when the patient reaches to take a breath there was no room. The physician stated he has taken care of him and the patient "plateaued" and he needed to do something. The outcome of cough was not recovered, while outcome of the remaining events was unknown.  No follow up attempts are needed; information about lot/batch number cannot be obtained.