Sex: M
Vaccine: COVID19
Symptoms: Laryngoscopy, Nausea, Physical examination, Tachycardia, Tryptase
Clinical narrative: angioedema; severe uvular swelling with associated nausea, emesis, and dyspnea; severe uvular swelling with associated nausea, emesis, and dyspnea; severe uvular swelling with associated nausea, emesis, and dyspnea; severe uvular swelling with associated nausea, emesis, and dyspnea; hypertensive; tachycardic; This is a literature report for the following literature source(s): A 33 year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) (Batch/Lot number: unknown) as dose 1, single for COVID-19 immunisation. Relevant medical history included: "type I diabetes" (unspecified if ongoing); "eosinophilic esophagitis" (unspecified if ongoing); "peanut allergy" (unspecified if ongoing); "asthma" (unspecified if ongoing). The patient's concomitant medications were not reported. The following information was reported: ANGIOEDEMA (medically significant, life threatening), outcome "recovering", described as "angioedema"; ENLARGED UVULA (medically significant), NAUSEA (medically significant), VOMITING (medically significant), DYSPNOEA (medically significant), outcome "recovering" and all described as "severe uvular swelling with associated nausea, emesis, and dyspnea"; HYPERTENSION (medically significant), outcome "recovering", described as "hypertensive"; TACHYCARDIA (medically significant), outcome "recovering", described as "tachycardic". The events "angioedema", "severe uvular swelling with associated nausea, emesis, and dyspnea", "severe uvular swelling with associated nausea, emesis, and dyspnea", "severe uvular swelling with associated nausea, emesis, and dyspnea", "severe uvular swelling with associated nausea, emesis, and dyspnea", "hypertensive" and "tachycardic" were evaluated at the emergency room visit. The clinical course was reported as follows: The patient received the first dose of his Pfizer-BioNTech COVID-19 vaccine without immediate adverse reactions. About 25 hours later, he woke up with severe uvular swelling with associated nausea, emesis, and dyspnea. He had no prior history of angioedema. He denied tongue or lip swelling, pruritus, or hives. Review of other additional triggers was unrevealing. He self-administered intramuscular (IM) epinephrine (MANUFACTURER UNKNOWN) at home without significant improvement. He presented to the emergency department, where he was found to be hypertensive and tachycardic. Physical exam was notable for drooling and tripoding, and flexible laryngoscopy showed grape-sized uvular swelling. Intubation was deferred due to his ability to protect his airway. He received diphenhydramine (MANUFACTURER UNKNOWN), systemic corticosteroids, IM epinephrine, and remained on an epinephrine drip for several hours. The angioedema gradually improved over 24 hours. Tryptase and C4 levels returned normal. He was advised to defer his second dose of the vaccine due to the severity of his reaction. This case most likely represented delayed angioedema to the COVID-19 vaccine. Other differentials for uvular swelling, such as infection, trauma, and drug exposure were ruled out. The absence of personal or familial history of angioedema made chronic spontaneous angioedema unlikely. Clinicians should be aware of the possibility of delayed angioedema following administration of the COVID-19 vaccine. The patient underwent the following laboratory tests and procedures as aforementioned. Therapeutic measures were taken as a result of angioedema, enlarged uvula, nausea, vomiting, dyspnoea, hypertension, tachycardia.; Sender's Comments: The events of delayed angioedema, enlarged severe uvular swelling with associated nausea and emesis are life-threatening serious and expected with the suspect drug, BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE);however they are most likely due to the delayed angioedema. The event dyspnea, hypertension and tachycardia are serious and unexpected with the suspect drug and are most likely due to the delayed angioedema. This case will be reassessed when further information is provided.