CASE REPORT: DOUBLE JEOPARDY

Abstract

Introduction

Malaysia’s National COVID-19 Vaccination Programme is currently providing homologous vaccination (1^st and 2^nd doses of the same vaccine).  The prospect of mixing vaccines are said to further boost the immunity provided; however there are no concrete data published yet on their efficacy and possible AEFIs.  We wish to report an AEFI case of status epilepticus in a recipient receiving combination vaccination of PFIZER (COMINARTY) and SINOVAC vaccines.

Case Description:

A 21-year-old female who reportedly received her first dose of PZIFER vaccination weeks ago, came for her “second” dose of vaccination.  In the PPV, she was given a dose of SINOVAC instead.  This has led her to develop a focal seizure on her non-vaccine arm during observation post vaccination.  She was later moved to Emergency Department for further monitoring and subsequently developed status epilepticus refractory to conventional treatment requiring intubation to secure her airway.  Conversely this was not her fault.  On further history patient had multiple history of drug allergies including established allergic reaction to first dose of PFIZER. In view of the first dose allergy reaction, SINOVAC vaccine was chosen as the second dose vaccine based on the existing guideline.

All blood investigation and imaging reveals normal findings including contrast enhance CT scan (CECT) and electroencephalogram (EEG). 

Patient was discharge neurologically intact, with a diagnosis of severe Adverse effect following immunisation. 

Discussion and conclusion

In conclusion, status epilepticus has not been reported as adverse effect following COVID-19 vaccination before. It can be a rare occurrence in homologous vaccination, but it could be one of adverse effect when combining vaccine doses.  Further clinical trial is needed before such “mix and match” vaccines being rolled out.  Nevertheless, clinician should be aware of the possible atypical neurological complications in patients receiving vaccines and to initiate the appropriate treatment.