Patient Case Strongly Suggests Link Between Pfizer COVID-19 Vaccine and Bell’s Palsy

The patient developed facial paralysis after each dose of the Pfizer-BioNTech vaccine.

The case of a patient who experienced two facial paralysis – one after the first and another after the second dose of the Pfizer-BioNTech COVID-19 vaccine – strongly suggests that Bell’s palsy (paralysis of the facial nerve of unknown cause) is related with the Pfizer-BioNTech vaccine, doctors write in the journal BMJ Case Reports.

They describe the first case reported in the medical literature of two separate unilateral facial nerve palsies, in which the muscles on one side of the face become weak or paralyzed shortly after each dose of a COVID-19 vaccine.

“The occurrence of the episodes immediately after each vaccine dose strongly suggests that Bell’s palsy was attributed to the Pfizer-BioNTech vaccine, although a causal relationship cannot be established,” the authors say.

In the first clinical trials of the three main COVID-19 vaccines approved for use in the UK (Pfizer-BioNTech, Moderna and Oxford/Astra Zeneca), some episodes of unilateral facial nerve palsy were reported, and subsequent case reports have been reported been.

In Phase 3 studies, four cases of facial paralysis of unknown cause (Bell’s palsy) were reported in volunteers who received the Pfizer-BioNTech mRNA vaccine, compared with none in those who received the placebo vaccine, and three cases were reported in volunteers who received the Pfizer-BioNTech mRNA vaccine. Moderna mRNA vaccine compared to one in the placebo group. Three cases of facial nerve palsy were also reported in volunteers who received the Oxford/AstraZeneca vaccine during clinical trials, and there were three cases in volunteers who received the placebo vaccine.

This case report describes a 61-year-old white male with no history of facial nerve palsy who experienced an episode of Bell’s palsy on the right side of his face five hours after receiving his first dose of the Pfizer-BioNTech vaccine, and a more severe episode of Bell’s palsy on the right side of his face. the left side of his face two days after receiving the second dose.

The patient had a high BMI, high blood pressure, high cholesterol and type 2 diabetes. Both doses of the vaccine were administered to the left arm.

The patient went to the emergency department after the first episode, unable to properly close his left eye or move the left side of his forehead and was diagnosed with Bell’s palsy. Routine blood and a CT head scan showed nothing of concern and he was discharged on a course of steroids and the facial nerve paralysis was completely gone.

The patient received the second dose of the Pfizer-BioNTech vaccine six weeks after the first and developed more severe left-sided facial nerve palsy two days later. Symptoms included dribbling, difficulty swallowing and the inability to close his left eye completely. He went to the emergency department, where he was again prescribed a course of steroids. He was also referred to the emergency ENT (Throat-nose-Ear) clinic, who continued the steroids and referred him to ophthalmology.

The authors report that his symptoms have greatly improved and the patient is almost back to normal. “The patient has been advised to discuss future mRNA vaccines with the GP on a case-by-case basis, taking into account the risk versus benefit of having each vaccine,” they say.

Bell’s palsy is believed to be related to inflammation and swelling of the facial nerve due to fluid buildup (edema) caused by a virus. In 2004, the inactivated intranasal flu vaccine was found to significantly increase the risk of Bell’s palsy and it was discontinued. An increased incidence of Bell’s palsy has also been observed following administration of other influenza and meningococcal vaccines, although a causal relationship has not been established.

While most cases of Bell’s palsy resolve spontaneously over time, the symptoms can cause significant temporary disability, affecting facial expression and the ability to eat and drink. Risk factors include diabetes, obesity, hypertension, pregnancy, preeclampsia, and upper respiratory tract disease.