Sex: F
Vaccine: COVID19
Symptoms: Blood thyroid stimulating hormone, Computerised tomogram abdomen, Electrocardiogram, Full blood count, Investigation
Clinical narrative: acute pancreatitis; This is a literature report 2021, vol 13(4); DOI: 10.7759/cureus.14741 entitled Acute Pancreatitis: A Possible Side Effect of COVID-19 Vaccine.  By reporting this case, the goal is to highlight and make the medical literature aware of the possible effects of this BNT162b2 mRNA vaccine. We also want to emphasize the role of healthcare workers in exploring the emerging long-term side effects of this new product. This information may be essential to make timely interventions and create guidelines to protect high-risk individuals. The patient is a 96-year-old female who presented to the emergency department with complaints of progressively worsening epigastric pain for two days. The pain was sharp, 10/10 in intensity, and radiating to the right lower chest. She had some nausea but no vomiting, diarrhea, or fever. The patient also denied any recent sick contacts, diet changes, or use of new medical preparations or herbal products. Her past medical history includes diastolic congestive heart failure, hypertension, and hypothyroidism. Past surgical history was significant for cholecystectomy and appendectomy. Her home medications included amlodipine, aspirin, bumetanide, carvedilol, levothyroxine, and lisinopril, which has been her regimen for the past three years without any recent changes. The patient denied any use of alcohol in the last 10 years. Notably, the patient got the first dose of the BNT162b2 COVID-19 vaccine for COVID-19 immunization at dose 1, single a few days before coming to the hospital. On physical examination, the patient had epigastric abdominal tenderness, but otherwise, the exam and vital signs were within normal limits. Initial lab work including complete blood count (CBC), comprehensive metabolic panel (CMP), urinalysis, lipid panel, thyroid-stimulating hormone (TSH), troponin levels, and electrocardiogram (EKG) were unremarkable. Her lipase level was significantly elevated at 4036 U/L. Computed tomography (CT) scan of the abdomen did not show any acute pathological findings. The patient was diagnosed with acute pancreatitis and monitored overnight with conservative treatment. Remarkably, her pain was already improving on admission and nearly resolved overnight. Lipase levels trended down to 205 U/L. Her diet was gradually advanced to regular. The patient's symptoms resolved, and she was discharged home in stable condition. The brief duration of symptoms and the timing of COVID-19 vaccination administration led to the increased likelihood of the vaccine as a plausible culprit for her acute bout of pancreatitis. Acute pancreatitis, defined as inflammation of the pancreas leading to autodigestive injury to the pancreatic parenchyma, can develop due to multiple causes. Some of the most common factors include gallstones, hypertriglyceridemia, alcohol, and smoking. Toxins or drugs, autoimmune, idiopathic, and procedure-related infections are few other less frequent causes. Autoimmune pancreatitis is usually diagnosed at a much younger age and, in most cases, associated with other autoimmune conditions. In the patient mentioned in this article, all common risk factors were ruled out. Multiple cases of COVID-19-induced pancreatitis have been reported in the literature. Medications have also been linked to acute pancreatitis.  A case of lisinopril-induced pancreatitis has been reported in the past after starting on lisinopril two weeks before presentation. It is unlikely that this could be the cause in our patient as she had been on the medication for many years before developing the episode. The safety of the BNT162b2 vaccine has been investigated in short-term trials with data available for three months, and local reactions were observed predominantly in patients who received the vaccine when compared to the placebo group. Some of the recipients reported severe adverse events between the first dose and the second dose that was given after one month. One of them developed pancreatitis, and none of the placebo recipients had such an event. Although it is difficult to make conclusions about the likelihood of the vaccine being the etiologic factor of pancreatitis, it is essential to continue monitoring for possible under-reported side effects until we have extensive long-term data available in post-marketing surveillance for long-term and rare side effects. Because the vaccine is new, it is reasonable to assume that we have not yet seen many of the potential side effects that may occur in patients who have received it. The main goal to write this case is to make medical literature aware of the possible emerging side effects of the COVID-19 vaccine, one of such side effects self-resolving uncomplicated acute pancreatitis. In conclusion, our patient developed acute pancreatitis several days after receiving the BNT162b2 vaccine and had no other risk factors for the condition. We present this case to make medical literature aware of the possibility that the vaccine may have some side effects that are not yet reported or taken into consideration. The incredible benefits of the vaccine are apparent and not disputed in this article. However, some patients may likely be at risk of developing some unestablished and high-risk side effects, and being aware of these risks will aid in weighing the risks versus benefits when deciding who should be vaccinated.; Sender's Comments: Based on known drug safety profile, there is reasonable possibility of causal association between the acute pancreatitis and the suspect drug BNT126B2.  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.