Hello Dr. Been,

I want to share an interesting and distubind stroy about my daugter, age 23. She received the the pfizer vaccine in early March. A week later she came down with covid. I treated her with a  four day course of Ivermectin and her major symptoms mostly resolved after 2 days of treatment. Although I advised her not to get the second dose of vaccine as schduled, she insisted on getting it citing CDC recommendations, mainly because she wanted to say that she was fully vaccinated.  Her reaction to the second dose was intense and lasted about three days. Then, for the next 2 months she never quite felt 100%. I told her that it may take some time to fully recover from covid and if she did not feel better soon we would start a course of steroids and repeat the Ivermectin.  

My wife (who is also a physician) and I also advised her to see her doctor for a complete exam to rule out any other factors contributing to her not feeling 100%. The blood work showed low platelets (105K) and slightly elevated liver enzymes. The blood work was to be repeated in 2 weeks. In the interim she develped headaches. At first we were not concerned because she has migranes but when they did not resolve as usual with summatriptin I became concerned.  Now I am thinking that her platelet count may have been much lower post vaccine/covid since they were only 105K about two months out and she may have a post vaccine  or post covid thrombosis. So I tell her to go back to her physician and ask for additional bloodwork to include D-Dimer, hs-CRP, fibrinogen and ELISA platlet factor 4 antibodies. Her physician did not see the need for it but agreed to do it anyway (althought she did not order the PF4 antibody test because she did not even know what it was.)

At 9:00 PM that evening my wife gets a call from my daughter's physicain saying that she called our daugher and told her to go directly to NYU emergency room (fortunately she lives only 4 blocks away from it)  She said the D-Dimer came back 35,645!!!!!  (her CRP was also very high at 12.45) Needless to say we were concerned about a blood clot and immediately drove down to NYU Langone hospital. Her neurological exam was normal, EKG normal, O2 sat. 98, all good signs. However, the CT scan of the head showed a possible venous sinus thrombosis so an MRI was schdued first thing at 7:00 AM, three hours later. The neurologist on call was talking about starting heparin but I pointed out that this may be a vaccine induced thrombosis and that heparin is contraincated until we know the reult of the ELISA PF4 antibody test. Fortunatly the MRI came back negative but the fact remains that the off the charts elevated D-Dimer may be the result of many micro-thrombi or perivascualr fibrinlysis, and coupled with the high inflammatory state she is still at risk. This is a complicated case becase only the J&J and Astra Zeneca vaccines have been shown in the literature to produce vaccine induced thrombosis/thrombocytopenia. So was it her active covid infection, the vaccine, or a combination of both that let to the thrombocytopenia and sky high D-Dimer?  Who knows. With so many unknowns, it is imperative to use first priciples resoning whan assessing this disease, vacccines and treatments.. Distill everyting down to what we know to be true then reason up from there, constanly weighting the risk/benfits of each decision and never assume anything that is not based in fundamental truths. (You do that VERY, VERY well DrBeen!!!!)   A very scary scenario indeed.