Anion Gap 18 mmol/l; Hematocrit 47.4/ Hematocrit 42.3 (ref 30.1 to 41.0); Hemoglobin 15.9 g/dl (ref 10.6 to 15.4); This is a spontaneous report received from a contactable reporter(s) (Other HCP).  A 54 year-old female patient received bnt162b2 (BNT162B2), intramuscular, administered in deltoid left, administration date 19Feb2021 10:43 (Lot number: EN6203) at the age of 54 years as dose 2, single for covid-19 immunisation. Relevant medical history included: "nicotine dependence", start date: 04Jan2005 (ongoing), notes: 04Jan2005-ongoing; "cough" (unspecified if ongoing); "Congestion" (unspecified if ongoing); "GI Sx" (unspecified if ongoing). Concomitant medication(s) included: MUCINEX taken for cough; SUDAFED [PSEUDOEPHEDRINE HYDROCHLORIDE] taken for nasal congestion; PEPTOBISMOL taken for gastrointestinal disorder. Vaccination history included: Bnt162b2 (Dose: 1st, Date / Time:, Date: 25Jan2021, Time: 1422, Site and Route of injection:~, Anatomical Site of injection: L deltoid, Route of administration: Intramuscular, Batch/Lot number: EN5318), administration date: 25Jan2021, when the patient was 54 years old, for Covid-19 immunization, reaction(s): "mild sinus disease with mucoperiosteal thickening", "neuropathy", "nonspecific demyelinating disease/ nonspecific toxic and/or metabolic demyelinating changes", "hypertensive encephalopathy changes", "numbness rt (right) side of face and numbness rt side hand and foot", "rt eye blurriness", "migraines", "ringing rt ear", "memory loss", "Confusion", "Severe jaw pain", "microangiopathy", "nonspecific vasculopathy/vasculitis", "nonspecific vasculopathy/vasculitis", "calcification of the pineal gland", "vascular variant (venous angioma)". The following information was reported: ANION GAP INCREASED (non-serious), outcome "unknown", described as "Anion Gap 18 mmol/l"; HAEMATOCRIT INCREASED (non-serious), outcome "unknown", described as "Hematocrit 47.4/ Hematocrit 42.3 (ref 30.1 to 41.0)"; HAEMOGLOBIN INCREASED (non-serious), outcome "unknown", described as "Hemoglobin 15.9 g/dl (ref 10.6 to 15.4)". Relevant laboratory tests and procedures are available in the appropriate section.   Additional information: Technique: Sagittal T1 weighted, T2 FLAIR with reformatted images, precontrast and postcontrast FSPGR 3-D with reformatted axial and coronal images; axial T2, FS; DWI, ADC map and SWAN in the axial plane were also performed. Sagittal 72 FLAIR with reformatted axial and coronal images, MRI of the IACS Axial FIESTA T2 and FSPGR 3-D T1( with and without contrast) were obtained through the level of the internal auditory canals. Coronal reconstruction +. There is no brain parenchymal mass effect or midline shift. Nonspecific foci of T2 and flair hyperintensity in the subcortical and periventricular white matter are noted and best seen in the left cerebral hemisphere. Differential considerations includes nonspecific white matter changes in patients with migraine headaches and microangiopathy. Additional differential considerations include nonspecific demyelinating disease (including multiple sclerosis), nonspecific vasculopathy/vasculitis, hypertensive encephalopathy changes, nonspecific toxic and/or metabolic demyelinating changes. No abnormal DWI hyperintensity and corresponding ADC hypo intensity to suggest restricted diffusion. No abnormal brain parenchymal enhancement. SWAN images demonstrates hypo intensity in the basal ganglia. Differential considerations includes mineralization and/or calcification. Hypo intensity in the pineal gland on SWAN images. Differential considerations includes calcification of the pineal gland. The ventricles are midline and without hydrocephalus. The sulci and extra-axial spaces are normal. There are no abnormal extra-axial fluid collections. Intracranial flow voids are noted. A left medial temporal vessel that extends to the left lateral ventricle temporal Hern is noted (series 1400, images 125-128; series 12, images 38-41). Differential considerations includes a vascular variant (venous angioma). Other vascular lesions are not excluded. Mild sinus disease with mucoperiosteal thickening. Questionable slightly prominent CSF around the optic nerves. Meckel's cave appears upper limit normal in size. The internal auditory canals are well visualized, and the visualized the 7th and 8th cranial nerves are normal bilaterally. There is no evidence of an IAC mass. The cochlea and semicircular canals are relatively symmetrical and normal. On 21SepECEIVEDvestibular appears normal. No abnormal fluid collections noted within the visualized portions of the mastoiditis and petrous apex anatomical location. Nonspecific white matter changes. This commonly represents microangiopathy. No brain parenchymal mass effect or midline shift. No abnormal suggest restricted diffusion. signal to No abnormal brain parenchymal enhancement. Recommend clinical and ophthalmology correlation to determine if this is normal for the patient versus of the etiology including mild papilledema and/or increased intracranial pressure. A left medial temporal vessel that extends to the lett lateral ventricle temporal horn. Differential considerations includes a vascular variant (venous angioma) Other vascular lesions are not excluded. Inferior left sphenoid and bilateral maxillary sinus mucoperiosteal thickening. The visualized paranasal sinuses, mastoids, orbits and extracranial soft tissues are unremarkable. The visualized brain parenchyma and CSF spaces are unremarkable. Motion artifact. No acute finding or focal abnormality within the intracranial vasculature. Unremarkable MRA of the head. Mild sinus disease as discussed above and postcontrast FSPGR 3-D with reformatted axial and coronal images; axial FS: DWI, ADC map and SWAN in the axial plane were also performed. SagittalT2FLAIR with reformatted axial and coronal images. MRI of the IACS Axial FIESTA T2 and FSPGR 3-D T1( with and without contrast) were obtained through the level f the internal auditory canals. Coronal reconstruction FINDINGS: There is no brain parenchymal mass effect or midline shift. Nonspecific foci of T2 and flair hyperintensity in the subcortical and tricular white matter are noted and best seen in the left cerebral Differential considerations includes nonspecific white matter changes in patients with migraine headaches and microangiopathy. Additional differential considerations include nonspecific demyelinating disease (including multiple sclerosis), nonspecific vasculopathy/vasculitis, hypertensive encephalopathy changes, nonspecific toxic and/or metabolic demyelinating changes. No abnormal DWI hyperintensity and corresponding ADC hypo intensity to, No abnormal brain parenchymal enhancement. SWAN images demonstrates hypo intensity in the basal ganglia. Differential considerations includes mineralization and/or calcification. Hypo intensity in the pineal gland on SHAN images. Differential considerations includes calcification of the pineal gland. The ventricles are midline and without hydrocephalus. The suici are normal. Intracranial flow voids are noted. A left medial temporal vessel that extends to he left lateral ventricle temporal horn is noted. Differential considerations includes a vascular variant (venous angioma). Other vascular lesions are not excluded. Mild sinus disease with mucoperiosteal thickening The internal auditory canals are well visualized, and the visualized portions of the 7th and 8th cranial nerves are normal bilaterally. There is no evidence of an IAC mass. Questionable slightly prominent CSF around the optic nerves. Meckel's cave appears upper limit normal in size. Recommend clinical and ophthalmology correlation to determine if this is normal for the patient versus of the etiology including mild papilledema and/or increased intracranial pressure. A left medial temporal vessel that extends to the left lateral ventricle temporal horn. Differential considerations includes a vascular variant (venous angioma). Other vascular lesions are not excluded. Mild sinus disease with mucoperiosteal thickening.  The reporter considered the pfizer product had a casual effect to the ad-verse event.  No follow-up attempts are possible. No further information is expected.