Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Disease recurrence, Drug ineffective, Post-acute COVID-19 syndrome
Clinical narrative: SARS-CoV-2 infections; SARS-CoV-2 infections; SARS-CoV-2 infections; Long COVID symptoms arose; This is a literature report for the following literature source(s).  A 29-year-old male patient received BNT162b2 (COMIRNATY), in Mar2021 as dose 1, single (Batch/Lot number: unknown), in Apr2021 as dose 2, single (Batch/Lot number: unknown) and in Nov2021 as dose 3 (booster), single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history and concomitant medications were not reported. The following information was reported: DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant) all with onset May2022, outcome "unknown" and all described as "SARS-CoV-2 infections"; DISEASE RECURRENCE (medically significant) with onset Jul2022, outcome "recovered", described as "SARS-CoV-2 infections"; POST-ACUTE COVID-19 SYNDROME (medically significant) with onset 2022, outcome "unknown", described as "Long COVID symptoms arose". Therapeutic measures were taken as a result of post-acute covid-19 syndrome which included nirmatrelvir/ritonavir.  Clinical course: A 29-year-old man had clinically confirmed SARS-CoV-2 infections in May2022 and Jul2022. His symptoms appeared to resolve fully after his first infection. After his second infection, his acute symptoms resolve after three weeks, at which time his Long COVID symptoms arose. His Long COVID symptoms include extreme fatigue, PEM, tachycardia, POTS, persistent headache, brain fog, chest pain and shortness of breath on exertion, and unrefreshing sleep; he met the myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) diagnostic criteria. Since the onset of his Long COVID symptoms, he also developed constipation, chilblains, atopic dermatitis on his face, and paresthesia. His abnormal test results include high cholesterol and prominent Virchow spaces on a brain MRI. Before his initial infection, he had received three doses of the Comirnaty vaccine (Mar2021, Apr2021, and Nov2021). He received an additional dose of the Spikevax vaccine in Oct2022. In May2023, he began a 15-day course of nirmatrelvir/ritonavir outside of the context of an acute COVID-19 infection. Concomitant medications included finasteride, amphetamine/dextroamphetamine salts, bupropion, atenolol, midodrine, Vitamin D3, and famotidine. Approximately six days  into the course, he noticed slight ("~10%") improvement in his fatigue and brain fog. These improvements were sustained and increased to "~20%" by the end of the course. His 15 days on nirmatrelvir/ritonavir also coincided with the longest number of consecutive days (15) without any worsening of symptoms (e.g., a crash). However, two days after the final nirmatrelvir/ritonavir dose, he experienced a PEM crash, which included a sore burning sensation in his arms, poor sleep, headache, fatigue, and brain fog so intense that sitting, moving, and talking was difficult. He returned to his pre-nirmatrelvir/ritonavir Long COVID baseline within five days. He has remained at his pre-nirmatrelvir/ritonavir Long COVID baseline in the subsequent months.; Sender's Comments: Vaccine efficacy varies from person to person and is affected by many factors. The association between the event lack of effect/drug ineffective (CoVID-19, and disease recurrence) with the suspect product BNT162B2 cannot be fully excluded. Based on known disease pathophysiology, the event post-acute COVID-19 syndrome is assessed as not related to the suspect product, and more likely a consequence or complication of the CoVID-19 infection.,Linked Report(s) : US-PFIZER INC-202500004798 Same patient, different dose;