Concomitant Peripheral and Pulmonary Arterial Thromboembolism 35 Days After SARS-CoV-2 mRNA Vaccine

Although thromboembolism after ChAdOx1 vaccine has been extensively reported, this association was rarely reported after vaccination with BNT162b2. We present the case of an otherwise healthy patient who developed concomitant acute limb ischemia and extensive pulmonary embolism (PE) 35 days after the first dose of BNT162b2 vaccine. Fogarty balloon thrombectomy was performed using open femoral artery exposure, and limb perfusion was restored. Reperfusion strategies were not used for treating PE due to low risk on prognostic assessment. The patient made an uneventful recovery, and she was discharged home on postoperative day 5 on warfarin, and remains symptom-free in a 3-month follow-up. Even though thromboembolic events following BNT162b2 are very rare, concomitant venous and arterial thromboembolism may occur in patients as late as 35 days after vaccination. However, the risk of thromboembolism following BNT162b2 vaccination appears significantly lower compared with severe acute respiratory syndrome-coronavirus-2 infection itself.