The COVID-19 pandemic has already caused more than 3 million deaths worldwide [ 1 ]. An essential method for controlling the pandemic has recently been provided by vaccines—modern genetically engineered preparations designed to trigger the immune response to coronavirus antigen. A few such vaccines have been registered by the FDA and EMA [ 2 5 ]. Their safety and efficacy were assessed on large groups of participants (the combined number of recruits was >130,000). The most common adverse effects were similar in all preparations and included pain at the injection site, fatigue, headache, myalgia, arthralgia, pyrexia and nausea [ 2 5 ]. With the growing number of vaccinated people, more and more adverse effects are being reported, including adverse events not described in medicinal product characteristics. The report we would like to present describes a very rare case of pancreatic injury and suspected acute pancreatitis that occurred shortly after administering the Pfizer BioNTech COVID-19 mRNA vaccine (Comirnaty) to a young and healthy patient.

2. Case

The patient, an MD and a healthcare worker, is a 29-year-old female Caucasian with no history of pancreatitis, concomitant diseases and allergic reactions to drugs or vaccines. She is a healthy woman, breastfeeding mother who did not consume alcohol or drugs. On 8 January 2021, she was administered the first dose of Pfizer BioNTech COVID-19 mRNA vaccine. A few minutes after receiving the vaccine, she reported severe pain at the injection site, radiating to her left hand and neck.

Twelve hours after vaccination, the patient experienced muscle pain, headache, chills and general weakness, which lasted for about 3 h. Twenty hours after vaccination, she woke up in the night because of severe abdominal pain. Despite taking paracetamol (2 × 500 mg, orally), the pain level increased over the next hours and became radiating to the spine. Twenty-eight hours after vaccination, the patient still suffered from severe pain in the upper abdomen, unresponsive to standard oral painkillers. Moreover, fever up to 40 °C occurred. The timeline of adverse effects is presented in Figure 1

The patient went to the hospital, suspecting pancreatitis. Laboratory analyses were carried out the next day after vaccination. Blood morphology was normal ( Table 1 ), except for minor disturbances in neutrophil and lymphocyte percentage, slightly increased mean corpuscular haemoglobin concentration (MCHC) and increased platelet anisocytosis (PDW). Biochemical analysis revealed significantly increased CRP and urine amylase ( Table 2 ). Nasopharyngeal swab for RT-PCR COVID-19 testing taken in Emergency Room was negative. Abdominal ultrasonography was performed, resulting in hyperechoic lesion in the right lobe of the liver, gallbladder not enlarged with normal wall, intrahepatic bile ducts not dilated, pancreas clearly visible in the head and body area not enlarged, homogeneous, without calcification, pancreatic tail obscured by intestinal gases difficult to assess, kidneys of normal and comparable size, without signs of stagnation and calcified deposits, unexpanded spleen. Magnetic resonance imaging of the abdomen was performed and revealed no significant changes, suggesting mild pancreatic injury.

iv and was discharged home (on her demand, despite indications for hospital treatment) with the recommendation of a strict diet (fluids only, 2–3 litres daily), gastro-resistant capsules of pancreatic enzymes (10,000 units orally, three times daily) and proton pump inhibitors (pantoprazole 40 mg orally, two times daily). Biochemical parameters were then assessed two days later ( In the hospital, the patient received paracetamol 1gand was discharged home (on her demand, despite indications for hospital treatment) with the recommendation of a strict diet (fluids only, 2–3 litres daily), gastro-resistant capsules of pancreatic enzymes (10,000 units orally, three times daily) and proton pump inhibitors (pantoprazole 40 mg orally, two times daily). Biochemical parameters were then assessed two days later ( Table 2 ), showing a significant decrease in CRP (still above norm) and urine amylase (normal result). Moreover, slightly elevated total bilirubin was found. The analysis performed eight days later revealed correct CRP and urine amylase values and slightly increased total and direct bilirubin.

Because the patient is an actively working physician, it was concluded that the risk of serious complications after infection with SARS-CoV-2 outweighs the risk of potential mild pancreatic injury. As a result, the patient received a second dose of vaccine on her demand on 5 March 2021. No such severe reaction was observed at that time. The pain at the injection site was felt 2–3 h after vaccination. Twelve hours after receiving the vaccine, muscle and joint pains along with hyperesthesia appeared. Twenty-four hours after vaccination, lymphadenopathy under the left armpit was found, with lymph nodes enlarged to about 2–3 cm. The lymph nodes were painful for about four days.