Initial dose received on 10/04/2021. At clinic visit 10/25/2021 for dose #2 of Covid Vaccine, the patient reported that he experienced new onset of headache that started 4-5 days after his first COVID19 Pfizer vaccine dose that only occurred during sexual activity. Reported no headache on 10/25/2021; had no headache in the week before 10/25/2021 and also no sexual activity in the last week before 10/25/2021. Reported the headaches lasted from 1-2 hours to a half day after sexual activity and seemed to gradually subside with lying down.  He had not taken any medications or done any treatments. The headaches have seemed to be about the same with each sexual encounter (not improving or worsening). After the 2nd COVID vaccine dose on 10/25, he reported  he had some body aches and chills for one day, slept more than usual for one day and then felt normal the next day. He reported no known family history of hemorrhagic stroke, aneurysm, or other "brain bleed."  and no prior history of any type of recurrent headache previously. My colleague, contacted the patient via telephone on 10/27/2021 to follow up on the new complaint of headache and after reviewing the symptoms with the patient,  shared the concern that with this uncommon type of new headache, there is a chance that there is an aneurysm with or without subacute intracranial hemorrhage or other intracranial pathology and shared that he not seen any reports of this type of complication from COVID mRNA vaccines.  There have been some rare instances of central venous thrombosis after COVID vaccines, particularly the Janssen option. The Dr.  reviewed by phone that while he is currently symptom-free, he could not say definitively what his risk is from his new headaches and so felt that urgent brain imaging is indicated, and did review the potential complications of undiagnosed/untreated aneurysm or intracranial hemorrhage. A CT Scan of the head was ordered. The patient was advised to abstain from other activity until CT scan of Head results were back and Pt notified of results. Avoid Valsalva maneuver or bearing down. The CT Scan of the head was performed on 10/29/2021 and the result was normal or negative on 10/29/2021; and the patient was notified of the result by the Dr. and also in a follow up telephone call by me on 10/29/2021 as a courtesy.  A letter was written for work restrictions starting 10/29/2021 and the patient was advised to perform nonexceptional and non stressful work for his 12 hour duty shift. A follow up telephone appointment was held 11/03/2021 to reassess how the patient was doing with no further complaints of headache, but the patient had also not had further sexual activity. the patient was given signs and symptoms that would prompt return for evaluation, including red flag symptoms and advised to be evaluated in ED/call 911 if headache escalates or if the worst headache of his life, thunderclap headache, nausea/emesis, chest pain, shortness of breath to be evaluated. The patients denied any associated symptoms of  fever, chills, body aches, cough, shortness of breath, dizziness, syncope, chest pain, shortness of breath, visual changes, nausea or emesis. the patient was advised to monitor/track headaches over the next 4 weeks from 11/03/2021 and to follow up if headaches recur or persist in which case would advise urgent Neurology consult and with Neurology's input will consider ordering a CTA or MRI/MRA of head/vasculature. the patient was returned to normal work and physical activities including other activity, but was advised if he should develop an abrupt or acute headache during  activity to abort the activity and seek immediate evaluation to ED/call 911. Letter written for return to work without restrictions on 11/03/2021. The patient was advised to follow up in 4 weeks as needed, return sooner with concerns/if new symptoms develop.