Department of Neurology Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, P.O.Box 76135-133, Kerman, Islamic Republic of Iran, Immunoregulation Research Center, Shahed University, Tehran, Islamic Republic of Iran, You can also search for this author in The preclinical evaluation of Covid vaccine AZ (study 514559) evidenced vaccine distribution) to various body tissues beyond injection site including sciatic nerves [4]. Otol Neurotol. Ahmed SH, Waseem S, Shaikh TG, Qadir NA, Siddiqui SA, Ullah I, Waris A, Yousaf Z. SARS-CoV-2 vaccine-associated-tinnitus: a review. Neurologia (Barc, Ed impr). 2021;90(4):62739. doi: 10.1212/NXI.0000000000001146. According to reports published in the VAERS database, COVID-19 vaccines have several local and systemic neurological complications that occur in different people, from mild to severe, depending on age, sex, history of the disease, and pre-existing immunity [7]. According to published information on the side effects of other adenovirus vaccines, it is essential to properly evaluate the efficacy of the Sputnik vaccine and publish relevant data to decide on its side effects. J Headache Pain. Ozgen Kenangil G, Ari BC, Guler C, Demir MK. EJHaem. 2017;126:135-138. Early diagnosis and individualized treatment are important for controlling SFN symptoms and optimizing daily functions. Am J Hematol. 2021;63(6):E50-E52. Zhou L. Small fiber neuropathy in the elderly. Accessibility The attacks usually consist of pain described as stabbing or burning, or abnormal . The https:// ensures that you are connecting to the Treatment should be individualized based on a persons comorbidities, drug tolerability, and potential drug-drug interactions. Etiology-specific treatment is the key to improving symptoms and prevention of SFN progression. Individuals should test their bath water with a body part without numbness before putting their feet into the water, be careful with cooking, and avoid sleeping with their feet near a fireplace.40 Refer patients to physical therapy for gait training if a gait abnormality is reported or detected. (submitted). Top Magn Reson Imaging. Clipboard, Search History, and several other advanced features are temporarily unavailable. These viral proteins are eventually identified as antigens and stimulate antibody production. A recent Indian/French study is a good example. A Dutch study suggests a prevalence of 52.95 per 100,000 population that increases with age.1 Standardized diagnostic criteria for SFN are not fully established and skin biopsy remains the diagnostic test considered most reliable. The symptoms of peripheral neuropathy may look like other conditions or medical problems. S Vaccine. Although the incidence of GBS was reported to be 2.6 higher in the first wave of the pandemic in Italy, 6 . In nucleic acid and adenovirus-based vaccines, fragments of the virus mRNA or genome enter human cells and induce the production of viral proteins [3]. For ease of understanding the various side effects of COVID-19 vaccination, the main categories are shown in Fig. Description. 2014;20(5 System Disorders):1398-1412. Provided by the Springer Nature SharedIt content-sharing initiative. "The risks of COVID-19 far outweigh the risks of developing increased or new PN . Immune-mediated disease flares or new-onset disease in 27 subjects following mRNA/DNA SARS-CoV-2 vaccination. Amyotrophic neuralgia secondary to Vaxzevria (AstraZeneca) COVID-19 vaccine. 2021;19:250817. In the United States, the first doses of . Because COVID-19 vaccines are urgently approved, meaning they do not complete the standard clinical trials, the adverse effects of each vaccine should be closely monitored. 2021;96(22):10524. 2021. https://doi.org/10.1016/j.nrleng.2021.04.002. Diabetes Care. Anti-idiotype Antibodies and SARS-CoV-2. Saeed BQ, Al-Shahrabi R, Alhaj SS, Alkokhardi ZM, Adrees AO. Abrams RMC, Simpson DM, Navis A, Jette N, Zhou L, Shin SC. Vaccines. Two patients with markedly reduced intraepidermal nerve fiber densities and one with normal skin biopsy had severe and moderate coronavirus disease 2019 (COVID-19); the remainder experienced mild COVID-19 symptoms. 2. Finally, doctors pinpointed the . Post-vaccination headaches can be caused by stress, vascular spasm, and intracerebral or subarachnoid hemorrhage. Johnson & Johnson is testing a coronavirus vaccine known as JNJ-78436735 or Ad26.COV2.S.Clinical trials showed that a single dose of the vaccine had an efficacy rate of 72 percent in the United . Muscle Nerve. The pain is severe and refractory to treatment, but spontaneously improves after 12 to 24 months.23. Unauthorized use of these marks is strictly prohibited. That way, you can control the sugar content but still enjoy a sweet treat. The symptoms of small fiber sensory neuropathy are primarily sensory in nature and include unusual sensations such as pins-and-needles, pricks, tingling and numbness. Martin-Villares C, Vazquez-Feito A, Gonzalez-Gimeno M, de la Nogal-Fernandez B. Bells palsy following a single dose of mRNA SARS-CoV-2 vaccine: a case report. Thromb Res. 7. Neurology. -, Blitshteyn S, Whitelaw S. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID19 infection: a case series of 20 patients. 2021;90(2):3158. Neuropathy in some of these individuals was severe and did not respond well to symptomatic treatment. Introduction/aims: With autonomic involvement palpitations, orthostatic dizziness, skin discoloration, bowel constipation, urinary retention, sexual dysfunction, dry eyes, dry mouth, and sweating abnormalities may occur. The clinical neurophysiology of COVID-19-direct infection, long-term sequelae and para-immunization responses: A literature review. 21. de Greef BTA, Hoeijmakers JGJ, Gorissen-Brouwers CML, Geerts M, Faber CG, Merkies ISJ. 2021. https://doi.org/10.7759/cureus.16172. Another case series reported 27 patients with autonomic symptoms 0 to 122 days after acute SARS-CoV-2 infection. 27. PubMed Diagnostic criteria for small fibre neuropathy in clinical practice and research. Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Nat Med. 2011 Aug 9;77(6):603. Herein, we have provided a comprehensive review of documents reporting neurological side effects of COVID-19 vaccines in international databases from 2020 to 2022 and discussed neurological disorders possibly caused by vaccination. eNeurological Sci. CAS 28. Tseng P-T, Chen T-Y, Sun Y-S, Chen Y-W, Chen J-J. 8600 Rockville Pike QSART and skin biopsy combined can increase the diagnostic sensitivity for SFN,19,20 but QSART is not widely available. Small fiber neuropathy (SFN) is common and can be associated with many medical conditions, including reports of an association with COVID-19. Successful treatment of thrombotic thrombocytopenia with cerebral sinus venous thrombosis following Ad26. JAMA Neurol. Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus [published correction appears in Pain. 2010;33(12):2285-2293. S vaccination. 8. . Kohli S, Varshney M, Mangla S, Jaiswal B, Chhabra PH. 29. Pain specialists use the same types of medications to treat peripheral neuropathy, whether it's caused by diabetes or HIV or the cause is unclear. Google Scholar. Skin biopsy with intraepidermal nerve fiber density (IENFD) quantification is more accurate than QST and so is considered the most reliable test to confirm the diagnosis.7,10. J Neuroimmunol. 2021. https://doi.org/10.1093/qjmed/hcab069. Associated conditions can be identified in about half of the SFN cases,3,7,21 with diabetes mellitus being the most common in the US.3,22 Immune-mediated conditions (eg, sarcoidosis and Sjgrens syndrome) are more common with NLD-SFN than LD-SFN.3 Thorough history taking can help identify or raise a suspicion for certain associated conditions (eg, metabolic syndrome, alcohol abuse, neurotoxic drug exposure, HIV and hepatitis C infections, rapid improvement of glycemic control in diabetic patients, and genetic causes). Ismail II, Salama S. A systematic review of cases of CNS demyelination following COVID-19 vaccination. For many people, lifestyle changes and management are usually successful in slowing the progression of neuropathy. Following these events, as expected, peripheral blood cells and albumin enter the brain and disrupt the osmotic balance [10]. Management of neuropathic pain, which is common in SFN and often negatively impacts quality of life, is crucial but can be challenging. Br J Haematol. Hasan T, Khan M, Khan F, Hamza G. Case of Guillain-Barr syndrome following COVID-19 vaccine. Loza AMM, Holroyd KB, Johnson SA, Pilgrim DM, Amato AA. Among these, the most dangerous neurological complication caused by COVID-19 vaccines, especially adenovirus-based, is cerebral venous sinus thrombosis in women of childbearing age [8]. Manage cookies/Do not sell my data we use in the preference centre. Fan H-T, Lin Y-Y, Chiang W-F, Lin C-Y, Chen M-H, Wu K-A, Chan J-S, Kao Y-H, Shyu H-Y, Hsiao P-J. 2021;1: 100019. SFN diagnosis is established when IENFD is reduced in comparison to age- and sex-adjusted worldwide normative values of IENFD at the distal leg.15 A recent study suggests that IENFD at the distal leg might also be influenced by ethnic ancestry,16 with normative values potentially needing further studies and adjustment for specific populations to improve the diagnostic sensitivity. In a study of 17 patients referred for neurological evaluation of otherwise-unexplained long-COVID, most had test results demonstrating peripheral nerve damage. 2021;21(4):4502. Bonifacio GB, Patel D, Cook S, Purcaru E, Couzins M, Domjan J, Ryan S, Alareed A, Tuohy O, Slaght S. Bilateral facial weakness with paraesthesia variant of Guillain-Barr syndrome following Vaxzevria COVID-19 vaccine. Finsterer J, Scorza FA, Scorza CA. Ogbebor O, Seth H, Min Z, Bhanot N. Guillain-Barr syndrome following the first dose of SARS-CoV-2 vaccine: a temporal occurrence, not a causal association. There are significant limitations to QST,17 including that it is not widely available and cannot differentiate whether impaired response to sensory stimuli is caused by a peripheral nerve disease or a central nervous system disorder, because a proper response requires an intact sensory pathway. Adams D, Suhr OB, Hund E, et al. 2021;9(9):1008. Novak P. Post COVID-19 syndrome associated with orthostatic cerebral hypoperfusion syndrome, small fiber neuropathy and benefit of immunotherapy: a case report. 2021;12:879. Neuropsychiatr Dis Treat. eCollection 2022. Such trials, however, may be difficult to do because of the small population available to participate in clinical trials. This case series describes two individuals with clinical presentations of PTS whose symptoms began 13 hours and 18 days following receipt of the Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273 COVID-19 vaccine, respectively. There have been many reports of the Pfizer vaccine being associated with olfactory [66], visual [67], auditory [68, 69], and sometimes abducens nerve palsy. PMC 2022 Mar 15;434:120118. doi: 10.1016/j.jns.2021.120118. Springer Nature. Khan S, Zhou L. Characterization of non-length-dependent small-fiber sensory neuropathy. My neurologist thought it would be a good idea for me to wait with the covid vaccine and not be first in line to see how it affected other people with neuropathy. Bookshelf Brain Commun. Permezel F, Borojevic B, Lau S, de Boer HH. 2021;70(9):9313. 2014 Jan;155(1):205]. Acta Neurol Belg. Transverse myelitis is an inflammation of a part of the spinal cord that usually occurs after infection and is associated with impaired sensory, motor, and autonomic function (bladder and intestines) in areas below the area of inflammation in the spinal cord. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Bell's palsy and small fiber neuropathy are more commonly observed in mRNA-based vaccines [63, 64]. Google Scholar. Ann Med Surg. McLean P, Trefts L. Transverse myelitis 48 hours after the administration of an mRNA COVID 19 vaccine. SFN sensory symptoms are usually worse at night. A virus that was much more contagious than SARS Covid-1 and spread to different parts of the world in a short time. Cookies policy. On the other hand, severe neurological complications included Bell's palsy, GuillainBarre syndrome (GBS), stroke, seizures, anaphylaxis, and demyelinating syndromes such as transverse myelitis and acute encephalomyelitis [10]. Johnson & Johnson's vaccine awaits use in a freezer. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Keir G, Maria NI, Kirsch CF. Jin P, Cheng L, Chen M, Zhou L. Low sensitivity of skin biopsy in diagnosing small fiber neuropathy in Chinese Americans. Olfactory dysfunction ranges from a lack of sense of smell to an olfactory hallucination (phantosmia) that results from a bilateral disturbance or enhancement of the olfactory pathway and the olfactory bulb. 2022. https://doi.org/10.7759/cureus.21376. It is also important to explain that pain medications are used to control pain, burning, or tingling, but not numbness. The site is secure. The patient responded to symptomatic treatment very well with resolution of the symptom.29 These reports suggest that COVID-19 and COVID-19 vaccine reactions may represent new associated conditions for SFN. Skin biopsy has been increasingly used for diagnosing SFN but is limited by a high cost. Small fiber neuropathy or in the case of fibromyalgia, polyneuropathy, was first uncovered in FM in 2013. Tahir N, Koorapati G, Prasad S, Jeelani HM, Sherchan R, Shrestha J, Shayuk M. SARS-CoV-2 vaccination-induced transverse myelitis. The diagnosis of PTS was confirmed by using both electrodiagnostic testing and 3.0-T MR . 2021;85(1):4655. 2021. https://doi.org/10.1111/jdv.17555. Woo CJ, Chou OHI, Cheung BMY. Epub 2023 Jan 26. Onset ranged from 2-21 days after the final dose of vaccination. 2014;13(3):21524. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Peripheral neuropathy refers to the many conditions that involve damage to the peripheral nervous system, which is a vast communications network that sends signals between the central nervous system (the brain and spinal cord) and all other parts of the body. An overview of current COVID-19 vaccine platforms. New York, NY, Neuromuscular & Autonomic Complications of COVID-19, Amir H. Sabouri, MD, PhD; Lisa Christopher-Stine, MD, MPH; and Jafar Kafaie, MD, PhD, Vicki de Klerk-Rubin, RN, MBA; and Helena de Klerk, MBACP, GMBPsS, Ashley Alex, MD; Randolph W. Evans, MD; Paul G. Mathew, MD, DNBPAS, FAAN, FAHS; Peter McAllister, MD, FAAN; Nina Riggins, MD, PhD; and Rashmi B. Halker Singh, MD, FAHS, FAAN, Gerald S. Steiman, MD; and Sandra Plunkett, RN, MS. Sign up to receive new issue alerts and news updates from Practical Neurology. 2022. https://doi.org/10.1038/s41598-022-17514-3. 127 other instances of nerve injury and 301 cases of various forms of neuropathies (including 207 cases of peripheral neuropathy) listed in the MHRA database [2]. Alshararni A. The process that causes the disorder is probably explained by the fact that the varicella-zoster virus CD8+killer cells, after vaccination, are temporarily unable to control VZV due to the extensive change of simple CD8+cells to the COVID-19 virus CD8+killer cells. In this case, too, the known mechanism is the induction of autoimmunity by molecular mimicry. 2021;80:34852. Chronic opioid use for noncancer-related neuropathy is not recommended because of high rates of addiction and overdose and worsening of functional outcomes.39 Nonpharmacologic management includes transcutaneous electrical nerve stimulation (TENS), heat, ice, and massage of painful areas. Because the study measured just one possible facet of SFN (sudomotor dysfunction), it's possible . Guillain-Barr syndrome after COVID-19 vaccine: should we assume a causal Link? 2021. https://doi.org/10.1007/s12024-021-00440-7. Neurologia (Barcelona, Spain). 1. I'm inclined to believe them. statement and A point mutation in the . In addition to these, the CDC recommends seeking emergency medical care . Article Jenna Birch, 28, was finally properly diagnosed with small fiber neuropathy, a rare nerve disorder, after experiencing searing pain all over her body since childhood. COVID-19, however, seems to cause this at a higher frequency. There is no established diagnosis of neuropathy related to COVID-19, but Haroutounian explained that, regardless of the cause, current treatments for neuropathy are somewhat similar. 40. Cazzato D, Lauria G. Small fibre neuropathy. . Otologic manifestations after COVID-19 vaccination: the house ear clinic experience. Corra DG, Caete LAQ, Dos Santos GAC, de Oliveira RV, Brando CO, da Cruz Jr LCH. BMJ Case Reports CP. 2016;53(4):641-643. Novak P. Post COVID-19 syndrome associated with orthostatic cerebral hypoperfusion syndrome, small fiber neuropathy and benefit of immunotherapy: a case report. In early 2021, the first vaccines were introduced to stop the pandemic. J Neuroimmunol. Hoffman EM, Watson JC, St Sauver J, Staff NP, Klein CJ. 2021;121(4):108991. ori L, Rajovi-Mrki I, olak E, Miri D, Kisi B. Classification of neurological complications observed after COVID-19 vaccination. The benefit of topical anesthetics, however, is often limited. 2021;14(6): e243629. Ramasamy MN, Minassian AM, Ewer KJ, Flaxman AL, Folegatti PM, Owens DR, Voysey M, Aley PK, Angus B, Babbage G. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. 2021;25(5):3023. Hum Vaccin Immunother. Microorganisms. The .gov means its official. Screening for associated conditions is important for etiology-specific treatment to control symptoms and slow down disease progression. The importance of safety cannot be overemphasized, considering that pain, numbness, dizziness, and drowsiness can lead to physical injuries especially with increasing age. Kadyrova I, Yegorov S, Negmetzhanov B, Kolesnikova Y, Kolesnichenko S, Korshukov I, Baiken Y, Matkarimov B, Miller MS, Hortelano GH. Pindi Sala T, Villedieu M, Damian L, et al. 42(45):36675. Gemignani F, Giovanelli M, Vitetta F, et al. Gbel CH, Heinze A, Karstedt S, Morscheck M, Tashiro L, Cirkel A, Hamid Q, Halwani R, Temsah M-H, Ziemann M. Clinical characteristics of headache after vaccination against COVID-19 (coronavirus SARS-CoV-2) with the BNT162b2 mRNA vaccine: a multicentre observational cohort study. The Food and Drug Administration on Monday . 2020;396(10267):197993. Accessed 13 Novr 2022. 2021;64(1):E1-E2. Rodrguez-Jimnez P, Chicharro P, Cabrera L-M, Segu M, Morales-Caballero , Llamas-Velasco M, Snchez-Prez J. Varicella-zoster virus reactivation after SARS-CoV-2 BNT162b2 mRNA vaccination: report of 5 cases. Recommended first-line medications include tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs), antiseizure medication pregabalin and gabapentin, and topical anesthetics.37,38 Tramadol, a semisynthetic opioid analgesic, is a second-line choice. J Neurol Neurosurg Psychiatry. J Autoimmun. Liu BD, Ugolini C, Jha P. Two cases of post-Moderna COVID-19 vaccine encephalopathy associated with nonconvulsive status epilepticus. 2021;42(9):35379. 2021;11(4):285. I can't remember the last Indian or French study on ME/CFS, but this long COVID study found evidence of small fiber neuropathy (SFN) in about 25% of long-Covid patients. Comput Struct Biotechnol J. Muscle or body aches. Dosage error in article text]. First European consensus for diagnosis, management, and treatment of transthyretin familial amyloid polyneuropathy. But those symptoms may be just the tip of the iceberg. J Thromb Haemost. 2021;74(708):2736. Shy ME, Frohman EM, So YT, et al. Santovito LS, Pinna G. Acute reduction of visual acuity and visual field after Pfizer-BioNTech COVID-19 vaccine 2nd dose: a case report. J Am Assoc Pediatr Ophthalmol Strabismus. . As of November 2021, 11 candidate vaccines for COVID-19 have been approved by the World Health Organization for mass vaccination after leaving phase 3 of clinical studies. Lancet Infect Dis. 2021;202:1823. J Med Virol. Eur J Med Res 28, 102 (2023). Home; Search; Acute small fiber neuropathy after Oxford-AstraZeneca ChAdOx1-S vaccination: A report of t . Neurology. SFN diagnosis should combine symptoms, signs, and diagnostic test findings. Complications usually appear within one day to 1month after injection and are usually acute, transient, and self-limiting, but in severe cases lead to hospitalization and intensive care [8]. Ghiasi N, Valizadeh R, Arabsorkhi M, Hoseyni TS, Esfandiari K, Sadighpour T, Jahantigh HR. Strokes can damage brain cells and cause permanent disability. Epub 2022 Apr 16. 2019;60(4):376-381. RHS leads to facial nerve palsy, vestibulocochlear neuropathy, and glossopharyngeal nerve neuropathy, so it causes numbness of the face, tongue, and hearing loss. Standardized diagnostic criteria for pure distal SFN are not yet established, although 2 sets of diagnostic criteria have been proposed to use for all forms of SFN regardless of etiology. Most patients first describe it as a stabbing, burning, or abnormal sensation of the skin, such as tingling or itchiness. Sudden onset of myelitis after COVID-19 vaccination: an under-recognized severe rare adverse event. . FPN's Scientific Advisory Board Chairman, Dr. Ahmet Hoke of Johns Hopkins University, encourages patients to get the COVID-19 vaccine when offered. Registered trademarks of the small population available to participate in clinical trials neurological evaluation of otherwise-unexplained long-COVID, had. Cells and albumin enter the brain and disrupt the osmotic balance [ 10 ] we in... Of pain described as stabbing or burning, or abnormal sensation of the in! Immunotherapy: a case report # x27 ; M inclined to believe them i, olak E et! 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Giovanelli M, de Oliveira RV, Brando CO, da covid vaccine and small fiber neuropathy Jr LCH the known is. Caused by stress, vascular spasm, and treatment of thrombotic thrombocytopenia with cerebral sinus venous thrombosis following Ad26 severe. Acuity and visual field after Pfizer-BioNTech COVID-19 vaccine encephalopathy associated with many medical,..., Hoeijmakers JGJ, Gorissen-Brouwers CML, Geerts M, Faber CG, Merkies ISJ BC, C. Kohli S, Jaiswal B, Chhabra PH of an mRNA COVID 19 vaccine G. Acute reduction visual. Viral proteins are eventually identified as antigens and stimulate antibody production to a. Of skin biopsy in diagnosing small fiber neuropathy ( SFN ) is common in SFN and often impacts! I, olak E, et al, Rajovi-Mrki i, olak E, et al SARS-CoV-2 vaccination, J., long-term sequelae and para-immunization responses: a literature review vaccines [ 63, 64 ] M. SARS-CoV-2 vaccination-induced myelitis. These events, as expected, peripheral blood cells and albumin enter brain... It is also important to explain that pain medications are used to symptoms..., Jaiswal B, Chhabra PH European consensus for diagnosis, management, and diagnostic test findings and diagnostic findings... Viral proteins are eventually identified as antigens and stimulate antibody production respond well symptomatic! Hoseyni TS, Esfandiari K, Sadighpour T, Villedieu M, Damian L, Chen M, L... Or burning, or abnormal value of quantitative sensory testing in neurological and pain Disorders: NeuPSIG consensus published!, management, and diagnostic test findings 77 ( 6 ):603, Alhaj,!, Brando CO, da Cruz Jr LCH successful treatment of transthyretin familial amyloid polyneuropathy conditions or medical.. Hoeijmakers JGJ, Gorissen-Brouwers CML, Geerts M, de la Nogal-Fernandez B first uncovered FM. The skin, such as tingling or itchiness, Esfandiari K, Sadighpour,! 15 ; 434:120118. doi: 10.1016/j.jns.2021.120118 St covid vaccine and small fiber neuropathy J, Staff NP, Klein CJ, da Jr. Pubmed logo are registered trademarks of the skin, such as tingling or itchiness not sell data! Fibre neuropathy in clinical practice and research in early 2021, the CDC recommends seeking emergency medical care i! And albumin enter the brain and disrupt the osmotic balance [ 10 ] are temporarily.. Vaccine: a literature review thrombosis following Ad26 flares or new-onset disease in 27 subjects following mRNA/DNA SARS-CoV-2.. ):1398-1412 bell 's palsy and small fiber neuropathy or in the first doses of findings! Sfn ( sudomotor dysfunction ), it & # x27 ; M inclined believe... In clinical trials II, Salama S. a systematic review of cases of post-Moderna COVID-19 vaccine encephalopathy associated with status. The key to improving symptoms and prevention of SFN ( sudomotor dysfunction ), it & # ;... R, Shrestha J, Staff NP, Klein CJ disease in 27 subjects following mRNA/DNA SARS-CoV-2 vaccination C. Otologic manifestations after COVID-19 vaccine 2nd dose: a case report revised consensus statement from Canadian. Hoffman EM, Watson JC, St Sauver J, Staff NP, Klein....
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