key: cord-0861774-cerswpmf
authors: Saxby, Kathryn; Kingsborough, Brett; Young, Daisy; Capone, David
title: MODERNA VACCINE PULMONARY EMBOLISM: ASSOCIATION VS COINCIDENCE
date: 2021-10-31
journal: Chest
DOI: 10.1016/j.chest.2021.07.086
sha: d9fb02bb9f422f72d28417751873440adc761fae
doc_id: 861774
cord_uid: cerswpmf

TOPIC: Biotechnology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Recent case reports have called attention to cerebral venous thrombosis after receiving the Johnson & Johnson vaccine for the novel Coronavirus 2019 (COVID-19), which resulted in the temporary suspension of the single-dose viral vector option. However, as of April 13th, 2020, CDC states that there are no reports of the clotting in the approximately 180 million doses of the Pfizer and Moderna vaccines administered in the United States. Here we present a case of a healthy male who developed pulmonary embolisms after receiving the Moderna vaccine. CASE PRESENTATION: A 55-year-old healthy, physically active male of Ashkenazi Jewish descent presents with multiple bilateral segmental and sub-segmental pulmonary embolisms. Twenty-four hours prior to onset of symptoms, the two-vaccine series of Moderna was completed. The patient was both COVID-19 PCR and COVID-19 IgG antibody negative, but positive for COVID IgM antibody. There was no evidence of deep vein thrombosis. In addition, his hypercoagulable work-up was negative. DISCUSSION: COVID-19 dramatically increases the risk of pulmonary embolism through a proposed mechanism of thrombo-inflammation triggered by viral infection, which originates in the pulmonary vasculature. Initially it was theorized that the etiology of this patient's pulmonary embolisms were an acute COVID-19 infection but two PCR tests from two different laboratories resulted as negative. Increased clotting has not yet been reported in the Pfizer and Moderna mRNA vaccine cohorts. In fact, the preliminary data from the Moderna vaccine trial stated that risk of pulmonary embolism is less than 0.03%, which was lower than the placebo group.It is also unknown if the Moderna vaccine trial included patients of Ashkenazi Jewish descent. It is theorized that as more patients worldwide become vaccinated, major side effects could increase as those patients who were not originally represented in the preliminary studies. CONCLUSIONS: Although the Moderna vaccine has shown to theoretically decrease the risk of clotting by decreasing risk of COVID-19 infection, as more of the world becomes vaccinated, the incidence of side effects could increase, despite preliminary data. REFERENCE #1: Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management [published correction appears in Thromb Res. 2020 Nov 26;:]. Thromb Res. 2020;194:101-115. doi:10.1016/j.thromres.2020.06.029 REFERENCE #2: Oliver SE, Gargano JW, Marin M, Wallace M, Curran KG, Chamberland M, McClung N, Campos-Outcalt D, Morgan RL, Mbaeyi S, Romero JR, Talbot HK, Lee GM, Bell BP, Dooling K. The Advisory Committee on Immunization Practices' Interim Recommendation for Use of Moderna COVID-19 Vaccine - United States, December 2020. MMWR Morb Mortal Wkly Rep. 2021 Jan 1;69(5152):1653-1656. doi: 10.15585/mmwr.mm695152e1. PMID: 33382675. REFERENCE #3: VRBPAC December 17, 2020 Meeting Announcement. U.S. Food and Drug Administration. https://www.fda.gov/advisory-committees/advisory-committee-calendar/vaccines-and-related-biological-products-advisory-committee-december-17-2020-meeting-announcement. Published December 17, 2020. Accessed April 27, 2021. DISCLOSURES: No relevant relationships by David Capone, source=Web Response No relevant relationships by Brett Kingsborough, source=Web Response No relevant relationships by Kathryn Saxby, source=Web Response No relevant relationships by Daisy Young, source=Web Response

CASE PRESENTATION: A 55-year-old healthy, physically active male of Ashkenazi Jewish descent presents with multiple bilateral segmental and sub-segmental pulmonary embolisms. Twenty-four hours prior to onset of symptoms, the two-vaccine series of Moderna was completed. The patient was both COVID-19 PCR and COVID-19 IgG antibody negative, but positive for COVID IgM antibody. There was no evidence of deep vein thrombosis. In addition, his hypercoagulable work-up was negative.

DISCUSSION: COVID-19 dramatically increases the risk of pulmonary embolism through a proposed mechanism of thromboinflammation triggered by viral infection, which originates in the pulmonary vasculature. Initially it was theorized that the etiology of this patient's pulmonary embolisms were an acute COVID-19 infection but two PCR tests from two different laboratories resulted as negative. Increased clotting has not yet been reported in the Pfizer and Moderna mRNA vaccine cohorts. In fact, the preliminary data from the Moderna vaccine trial stated that risk of pulmonary embolism is less than 0.03%, which was lower than the placebo group.It is also unknown if the Moderna vaccine trial included patients of Ashkenazi Jewish descent. It is theorized that as more patients worldwide become vaccinated, major side effects could increase as those patients who were not originally represented in the preliminary studies.

CONCLUSIONS: Although the Moderna vaccine has shown to theoretically decrease the risk of clotting by decreasing risk of COVID-19 infection, as more of the world becomes vaccinated, the incidence of side effects could increase, despite preliminary data.

The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management

The Advisory Committee on Immunization Practices' Interim Recommendation for Use of Moderna COVID-19 Vaccine -United States

REFERENCE #3: VRBPAC December 17, 2020 Meeting Announcement. U.S. Food and Drug Administration