ACUTE PONTINE STROKE /ISOLATED RIGHT PONTINE LACUNAR INFARCT INVOLVING THE RIGHT FACIAL COLLICULUS, MIMICKING BELLS PALSY; MULTIPLE STENOTIC LESIONS OF INTRACEREBRAL ARTERIES  INDICATIVE OF WIDESPREAD ATHEROSCLEROSIS; MODERATE ANEMIA WITH HEMOGLOBIN OF 7.7; GLUCOSE 284 MG/DL; BLOOD PRESSURE 187/79; This spontaneous report was received from literature: This report concerned a 66 year old female of an unspecified race and ethnicity. The objective of this study was to describe In the race to curb the spread of the coronavirus disease 2019 (COVID-19) pandemic, various vaccines were developed around the world. Data from the Phase 3 ENSEMBLE study [3], a randomized, placebo-controlled, double-blind study, showed 85% protection from severe COVID-19 disease beginning 28 days after vaccination. As a single-dose vaccine with prolonged stability in standard vaccine storage conditions, this vaccine has shown tremendous potential in the fight against COVID-19 and has been rolled out for use across the world. In clinical trials, there was concern regarding two cases of Bell's palsy in vaccine wing trial participants, however, there were two notable cases of Bell's palsy in the placebo wing trial as well. Clinical trial investigators concluded these events were unlikely to be related to the Ad26.COV2.S vaccine The patient's height, and weight were not reported. The patient's concurrent conditions included: ischemic cerebral vascular accident and and without residual deficit, insulin-dependent diabetes mellitus type 2, hypertension, chronic anemia, and depression, encephalomalacia and other pre-existing medical conditions included: The patient denied headache, vision or speech changes, trauma, or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number: unknown, Expiry: unknown, dose were not reported) dose, start therapy date were not reported, 1 total administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. Concomitant medications included meclizine, ondansetron, prednisone, valaciclovir for bells palsy, olmesartan, acetylsalicylic acid, atorvastatin, hydrochlorothiazide, insulin lispro, pravastatin, semaglutide, and venlafaxine.  On an unspecified date, immediately after receiving vaccine the patient presented to emergency department with complaints of nausea, vomiting, constant vertigo/persistent vertigo/ Room-spinning vertigo, and sudden right facial drooping progressively worsening over the past 24 hours, bells palsy, encephalomalacia, ischemic stroke/acute to subacute ischemia, acute pontine stroke /isolated right pontine lacunar infarct involving the right facial colliculus, mimicking bells palsy, multiple stenotic lesions of intracerebral arteries, indicative of widespread atherosclerosis, atherosclerosis and was hospitalized for 3 days and the patient discharged with medication and she was referred for an outpatient follow-up with physical and occupational therapists.  Laboratory data (dates unspecified) included: Activated partial thromboplastin time (NR: 22 - 34) 22.2 sec, Antibody test: negative, Blood pressure: 187/79, Body temperature was normal, Cholesterol (NR: 70 - 200) 199 mg/dL, CT head without contrast was performed in the emergency department for an immediate evaluation of cerebral infarction, CTA head with and without contrast exhibited multiple stenotic lesions of intracerebral arteries, indicative of widespread atherosclerosis DNA antibody HSV PCR was negative, Electrocardiogram reveals normal sinus rhythm, Glucose (NR: 74 - 106) 284 mg/dL, HIV antibody was negative, HIV antigen (p24) test was negative, HbA1C was less than 3.8, Hemoglobin (NR: 12 - 16) 7.7 mg/dL, High density lipoprotein (NR: 40 - 60) 79 mg/dL, Low density lipoprotein (NR: 0 - 130) 108 mg/dL, MRI of the brain without contrast revealed a tiny focus of diffusion restriction in the right pons and cerebellar peduncle with associated T2/fluid-attenuated inversion recovery (FLAIR) hyperintensity consistent with acute to subacute ischemia. Transthoracic echocardiogram (TTE) did not reveal any thrombi or structural heart disease. TTE, with a bubble study, and transesophageal echocardiogram (TEE) were not performed due to the low pretest probability of cardioembolic phenomena. Physical examination Grade V right facial paralysis on the House-Brackmann scale. There was a loss of right forehead wrinkling and an inability to close the right eye and raise the right eyebrow , loss of nasolabial fold, and drooping of the corner of the mouth. No parotid swelling or masses were noted. Sensory and cerebellar exams were unrevealing. Platelet count (NR: 140 - 440) 225 kU/L, Potassium (NR: 3.5 - 5.51) 3.5 mmol/L, Prothrombin time (NR: 9.5 - 12.4) 10.8 sec, Pulse rate was 73 bpm, Sodium (NR: 136 - 145) 137 mmol/L. The authors emphasized that Ipsilateral complete facial paralysis due to isolated pontine lesions can be easily misdiagnosed as Bell's palsy by clinicians due to the rare occurrence of the latter. It is crucial for clinicians to assess risk factors, perform a thorough neurological examination, and choose appropriate diagnostic tests before reaching a conclusion. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the acute pontine stroke /isolated right pontine lacunar infarct involving the right facial colliculus, mimicking bells palsy, multiple stenotic lesions of intracerebral arteries indicative of widespread atherosclerosis, moderate anemia with hemoglobin of 7.7, glucose 284 mg/dl and blood pressure 187/79 was not reported. This report was serious (Hospitalization Caused / Prolonged); Sender's Comments: V0- 20220422828-covid-19 vaccine ad26.cov2.s- Acute pontine stroke /isolated right pontine lacunar infarct involving the right facial colliculus, mimicking bells palsy, Multiple stenotic lesions of intracerebral arteries indicative of widespread atherosclerosis, Moderate anemia with hemoglobin of 7.7, Glucose 284 mg/dl and Blood pressure 187/79. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: Medical history. Therefore, this event(s) is considered not related.