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Venous sinus thrombosis after the first dose of Pfizer BioNTech vaccine
  1. Muhammad Imran Ahmad Qureshi1,
  2. Bilal Azam2,
  3. Muhammad Aamir Waheed3 and
  4. Afsheen Imran4
  1. 1Acute Medicine/GIM, Northampton General Hospital NHS Trust, Northampton, UK
  2. 2Acute Internal Medicine, Northampton General Hospital NHS Trust, Northampton, UK
  3. 3Acute Internal Medicine/GIM, Northampton General Hospital NHS Trust, Northampton, UK
  4. 4General Internal Medicine, Northampton General Hospital NHS Trust, Northampton, UK
  1. Correspondence to Dr Muhammad Imran Ahmad Qureshi; mia.qureshi{at}


mRNA vaccines including Pfizer BioNTech and Moderna have categorically been considered safe when it comes to preventing COVID-19. However, there is still a small associated risk of thromboembolic phenomenon including venous sinus thrombosis with it and our case report highlights one.

We describe a patient who developed severe progressive headache, tinnitus and visual disturbance symptoms post-Pfizer-SARS-CoV-2 vaccination. His medical history included essential tremors, hypertension, type 2 diabetes mellitus, chronic kidney disease stage 3, anxiety, depression and long-term catheterisation. Systemic examination revealed hypotonia, generalised reduced power and central diplopia along with peripheral visual field defect in the left eye. He was extensively investigated, the COVID-19 PCR test was negative and all routine blood tests were in the normal range except a marginally raised D-dimer of 779 ng/mL. CT head was unremarkable. He was also tested for myasthenia gravis; however, acetylcholine receptors antibodies were negative and nerve conduction studies were normal. Subsequent MRI of the brain with venography confirmed venous sinus thrombosis. A 24-hour Holter monitoring test did not reveal any cardiac rate or rhythm abnormality. He was treated with apixaban as per a neurologist’s advice. His clinical condition started to improve and was later discharged from the hospital with an outpatient neurologist clinic follow-up.

  • Venous thromboembolism
  • COVID-19
  • Healthcare improvement and patient safety
  • Vaccination/immunisation
  • Stroke

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  • Contributors MIAQ was involved in the conception and design, interpretation of data, and drafting and revising it critically before final approval. BA helped in data gathering and compiling the evidence. MAW and AI assisted in drafting and revising up critically before final submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.