Published: 2022-03-25

Anaphylaxis for COVID-19 Pfizer-BioNTech mRNA vaccination in a person with previous allergy to the vaccine: a case report

Maktoum bin Abdul Azeez, Sanaulla Sheik, Maha Saif Almesallam


Protection from COVID-19 infection has been a major challenge and priority to protect the health and life of people around the globe. In clinical trials, vaccination has shown to protect people from severe COVID-19 infection and reduce both morbidity and mortality. At the time of writing this article, mRNA-based vaccines were being used as new form of vaccination against the COVID-19 infection. As this is a new method of vaccination, full information about managing cases with allergy to the vaccine was not clearly available. So, any form of allergic response was considered contraindication for the future doses of the mRNA based COVID-19 vaccines. A 35 years old female received 2nd dose COVID-19 mRNA vaccine as per vaccination plan in a healthcare center. She developed features of allergic reaction and anaphylaxis including urticarial rash, intense itching of whole body, tightness in the chest, hypotension, reduced central pulse volume, decreased level of consciousness and grunting.  Immediate anaphylaxis diagnosis with level 1 certainty of Brighton Anaphylaxis scoring and management with Epinephrin, Hydrocortisone and IV fluids was    undertaken. Patient was stabilized and transferred to secondary care for further management. The use of mRNA vaccines for COVID-19 had initial uncertainties about allergic reactions, severity of allergic reactions, the patients for future allergic reaction and dealing with these patients about future vaccine doses. We presented a case with history of previous immediate mild rash to 1st COVID-19 mRNS vaccine dose and subsequent anaphylaxis following 2nd dose of the same mRNS vaccine.  


COVID-19 infection, Pfizer-BioNTech mRNS vaccine, Anaphylaxis, Severe acute respiratory syndrome coronavirus-2

Full Text:



Al Khal A. Ministr of Public Health Press Conference on COVID-19. Ministry of Public Health. 2021. Available at: https://covid19.moph. Accessed on 2021 Mar 16.

CDC. COVID-19 and IPC Overview. 2020 Available at: Accessed on 2021 Apr 22.

Hinton DM. U.S. Department of Health and Human Services. 2021. Available at: media/144412/download. Accessed on 2021 Apr 22.

Anesi J. The advisory Committee on Immunization practices’ updated interim recommendation for allocation of COVID-19 vaccine-United states, December 2020. Am J Transplant. 2021;21(2):897.

Weekes M, Jones NK, Rivett L, Workman C, Ferris M, Collaboration CC et al. Single-dose BNT162b2 vaccine protects against asymptomatic SARS-CoV-2 infection. Authorea. 2021;1-3.

Turner PJ, Ansotegui IJ, Campbell DE, Cardona V, Ebisawa M, El-Gamal Y et al. COVID-19 vaccine-associated anaphylaxis: A statement of the World Allergy Organization Anaphylaxis Committee. World Allergy Organ J. 2021;14(2):100517.

Shimabukuro T, Nair N. Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine. JAMA. 2021;325(8):780-781.

Prior G. Part 10.6: Anaphylaxis. Circulation. 2005;112(24):143-5.

Law B. Safety Platform for Emergency vACcines Guide for 1st Tier AESI Acute Myelitis. 2020. Available at: Accessed on 2021 Apr 22.

McNeil MM, DeStefano F. Vaccine-associated hypersensitivity. J Allergy Clin Immunol. 2018;141(2):463-72.

Shimabukuro TT, Cole M, Su JR. Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US. 2021. JAMA. 2021;2020-1.