However, in order to prove the effectiveness of the vaccine in terms of safety and side effects, the implementation of phase 4 of clinical studies is necessary. According to the WHO, in the case of side effects of inactivated virus-based vaccines, especially Sinopharm, the most common local and systemic adverse reactions are injection site reactions, fatigue, fever, headache, and allergic dermatitis, which are self-limiting, and the person does not need to be hospitalized [11, 12]. 2021;64(1):E1. Muscle Nerve. Acute transverse myelitis after inactivated COVID-19 vaccine. Bell's palsy and small fiber neuropathy are more commonly observed in mRNA-based vaccines [63, 64]. VST is the most severe disorder that should be diagnosed and controlled immediately. 2014 Jan;155(1):205]. Shouman K, Vanichkachorn G, Cheshire WP, et al. Doctors have long known peripheral neuropathy as a nerve condition that causes reduced sensation, tingling, weakness, or pain in the feet and hands. Cookies policy. An official website of the United States government. Al-Mashdali AF, Ata YM, Sadik N. Post-COVID-19 vaccine acute hyperactive encephalopathy with dramatic response to methylprednisolone: a case report. There is no medication yet to promote nerve fiber regeneration to reduce numbness; however, numbness may improve once etiologies are controlled, especially if SFN is relatively mild. -. J Neurol Sci. Zhou L. Small fiber neuropathy in the elderly. Intraepidermal nerve fiber density at the distal leg: a worldwide normative reference study. Tavee JO, Karwa K, Ahmed Z, Thompson N, Parambil J, Culver DA. Bethesda, MD 20894, Web Policies In addition, skin blisters have been observed in the ear area, leading us to hypothesize that reactivation of VZV could be a cause for RHS as well as Bell's palsy [71]. Immunol Res. Ramdeny S, Lang A, Al-Izzi S, Hung A, Anwar I, Kumar P. Management of a patient with a rare congenital limb malformation syndrome after SARS-CoV-2 vaccine-induced thrombosis and thrombocytopenia (VITT). J Neurol. Small fiber neuropathy (SFN) is common and can be associated with many medical conditions, including reports of an association with COVID-19. ScienceDaily . 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. Order a chest CT if sarcoidosis is suspected. eCollection 2022. 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. Headache. Muscle Nerve. Symptoms of SFN, including painful paresthesia and dizziness, and sedative side effects of pain medications can negatively affect quality of life. 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. It is noteworthy that rare and scattered reports have been published on the side effects of Sinopharm and other inactivated virus-based vaccines (Table 1). QJM: An Int J Med. The development and persistence of neurological symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is referred to as "long-haul" syndrome. Results: statement and NCI CPTC Antibody Characterization Program, Nalbandian A, Sehgal K, Gupta A, et al. Fear can aggravate pain and depression, making treatment difficult. McArthur JC, Stocks EA, Hauer P, Cornblath DR, Griffin JW. Post-vaccination headaches can be caused by stress, vascular spasm, and intracerebral or subarachnoid hemorrhage. Clin Neurol Neurosurg. According to a recent report on the Sputnik vaccine, side effects are included headache, joint pain, fever, and flu-like symptoms [14]. Clin Geriatr Med. Brain. Etiology-specific treatment is the key to improving symptoms and prevention of SFN progression. JAMA Neurol. Would you like email updates of new search results? PubMed 2021. https://doi.org/10.1093/qjmed/hcab069. Santovito LS, Pinna G. Acute reduction of visual acuity and visual field after Pfizer-BioNTech COVID-19 vaccine 2nd dose: a case report. Some people initially experience a more generalized, whole-body pain. 2020;267(12):3499-3507. doi: 10.1002/mus.27251. Dyer O. Covid-19: Regulators warn that rare Guillain-Barr cases may link to J&J and AstraZeneca vaccines. 2021;269(3):112132. Moulin D, Boulanger A, Clark AJ, et al. Accessed 13 Novr 2022. Hum Vaccin Immunother. Mild neurological effects of the COVID-19 vaccine include weakness, numbness, headache, dizziness, imbalance, fatigue, muscle spasms, joint pain, and restless leg syndrome are more common, while tremors, tinnitus, and herpes zoster are less common. Post SARS-CoV-2 vaccination Guillain-Barre syndrome in 19 patients. Introna A, Caputo F, Santoro C, Guerra T, Ucci M, Mezzapesa DM, Trojano M. Guillain-Barr syndrome after AstraZeneca COVID-19-vaccination: a causal or casual association? portugus; News/Update/Help. Nerve Growth Factor (NGF), the prototype of the neurotrophin family, stimulates morphological differentiation and regulates neuronal gene expression by binding to TrkA and p75NTR receptors. 2022 Jun;65(6):E31-E32. Bril V, England J, Franklin GM, et al. 12. Eur J Pediatric Neurology. The Lancet. sharing sensitive information, make sure youre on a federal Neurology. 2021;25(5):3023. Althoughvaccines are now considered the best way to achieve collective safety and control mortality, due to the critical situation, these vaccines have been issued the emergency use licenses andsome of theirpotentialsubsequence side effects have been overlooked. Neurology. 36. All authors read and approved the final manuscript. 2021;12:20837. In fact, the viral antigens of the vaccine stimulate an immunological response in the spinal cord [62]. 2022;73(1):8787. Abrams RMC, Simpson DM, Navis A, Jette N, Zhou L, Shin SC. Alshararni A. Results: Four cases of acute and chronic demyelinating neuropathies following COVID-19 vaccination were seen at the University of Nebraska Medical Center from May to September 2021. PubMed Optic neuritis in a patient with seropositive myelin oligodendrocyte glycoprotein antibody during the post-COVID-19 period. Muscle Nerve. Loss of taste or smell. Epub 2022 Apr 16. The Food and Drug Administration added a warning to the fact sheet for the Johnson & Johnson COVID-19 vaccine saying that the shot may lead . All Rights Reserved Privacy Policy, Headache & Pain, Headache & Pain, Neuromuscular, Neuromuscular, Small fiber neuropathy, Neuropathy, Neuropathic Pain, Pain, Numbness, Parasthesia, Sensory neuropathies, Restorative and Rehabilitative Treatments for Stroke in the Outpatient Setting, Dementia Insights: Avoiding Burnout in Dementia Care, Addressing Lifestyle Factors in Poststroke Care, Closing Care Gaps by Thinking, Talking, and Treating Migraine, Understanding Chiari Malformation Comorbidities, Remote Electrical Neuromodulation Device Helps Prevent Migraines, New Insights into Athletes with Slow Recovery from Concussion, Web-Based Treatment Effective for Vertigo. Gao J-J, Tseng H-P, Lin C-L, Shiu J-S, Lee M-H, Liu C-H. Side effects and perceptions following Sinopharm COVID-19 vaccination. J Neuroimmunol. 2013;154(9):1807-1819. doi:10.1016/j.pain.2013.05.047. Gibbons CH, Freeman R. Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes. Initial efforts were related to contact precautions, hand hygiene, and mask-wearing; however, it was soon evident that a robust global immunization drive was the most effective way to curb disease transmission. Guillain-Barr syndrome in the placebo and active arms of a COVID-19 vaccine clinical trial: temporal associations do not imply causality. The collected literature indicated that the neurological side effects associated with SARS-CoV-2 vaccines included headache, transverse myelitis, Guillain-Barre Syndrome (GBS . Angiology. These viral proteins are eventually identified as antigens and stimulate antibody production. WHO COVID-19 Research Database. 2021;208: 106839. Post COVID-19 vaccine small fiber neuropathy. Cite this article. a prospective case series. Bookshelf Most patients with SFN experience a slow progressive course, with only a small percentage developing large fiber involvement over time11.9% in one cohort22 and 13% in another.7 Most individuals, however, do require chronic pain management and may be distressed by pain and worry about developing weakness or losing ambulation because of the neuropathy. Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus [published correction appears in Pain. Successful treatment of thrombotic thrombocytopenia with cerebral sinus venous thrombosis following Ad26. Of the 17 patients (aged mean 43.3 years, 68.8% women 94.1% White) who had COVID-19 between February 21, 2020, and January 19, 2021, 16 had mild COVID and 1 had severe COVID due to critical care . Inflammation Res. 2021;17(10):34813. eNeurologicalSci . Disclaimer. It is under development for the treatment of autoimmune small fiber neuropathy, X-linked agammaglobulinemia, hypogammaglobulinemia, chronic inflammatory demyelinating polyneuropathy (CIDP). 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. 2021;96(22):10524. MacDonald S, Sharma TL, Li J, Polston D, Li Y. Longitudinal follow-up of biopsy-proven small fiber neuropathy. None of the other authors has any conflict of interest to disclose. Vaccine reactivity has been linked to a temporary increase in inflammatory cytokines that act on blood vessels, muscles, and other tissues. In other words, we will observe the flu-like syndrome for several consecutive days after vaccination [13]. 2021;69: 102803. A new study suggests that some patients with long COVID have lasting nerve damage that appears to be caused by infection-triggered immune dysfunction, which is potentially treatable. The quantitative sudomotor axon reflex test (QSART) evaluates postganglionic sympathetic unmyelinated sudomotor nerve function. Zhou L, Siao P. Lateral femoral cutaneous neuropathy caused by prone positioning to treat COVID-19-associated acute respiratory distress syndrome. and transmitted securely. Because the results of the phase 4 studies are the proper criteria for how the vaccine works in the real world [5]. 2022. https://doi.org/10.1093/qjmed/hcab335. Progression is slow, and most people affected by SFN do not develop large fiber involvement over time. BLOOD TESTS TO EVALUATE ETIOLOGIES OF SMALL FIBER NEUROPATHY, Thyroid stimulating hormone (TSH) and free thyroxine (T4), New painful paresthesia and numbness within 2 months of SARS-CoV-2 infection has been observed,27 and some individuals with these symptoms also develop intense SFN symptoms acutely and diffusely. Google Scholar. The most important and common complicationsare cerebrovasculardisorders including cerebral venous sinus thrombosis, transient ischemic attack, intracerebral hemorrhage, ischemic stroke, and demyelinatingdisorders including transverse myelitis, first manifestation of MS, and neuromyelitis optica. PubMed Central Appointments 866.588.2264. Clin Imaging. Google Scholar. Odozor CU, Kannampallil T, Ben Abdallah A, Roles K, Burk C, Warner BC, Alaverdyan H, Clifford DB, Piccirillo JF, Haroutounian S. Pain. What is known, though, is that there is a backlog of patients waiting . . A recent reappraisal study showed a strict agreement of these 2 criteria sets for diagnosing pure SFN,9 and showed sensory symptoms alone are not reliable, whereas sensory signs are reliable, for SFN. 22. J Clin Neuromuscul Dis. 2021;11(4):285. The mechanism of induction of this disorder is the development of autoimmunity by molecular mimicry. Shy ME, Frohman EM, So YT, et al. Otol Neurotol. 2016;29(Suppl 1):S14-S26. Chen S, Fan X-R, He S, Zhang J-W, Li S-J. 2021. https://doi.org/10.7759/cureus.16624. Incidence and prevalence of small-fiber neuropathy: a survey in the Netherlands. 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. J Med Virol. Epub 2021 Dec 23. 2022;145(1):59. 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. Neurology. 25. Acute monophasic erythromelalgia in five children diagnosed as small-fiber neuropathy. These changes can include: Losing weight. Hosseini, R., Askari, N. A review of neurological side effects of COVID-19 vaccination. 2022 Oct 3;10:977827. doi: 10.3389/fped.2022.977827. Finsterer J, Scorza FA, Scorza CA. Small fiber neuropathy is a type of peripheral neuropathy, causing various different sensory sensations. The pain is severe and refractory to treatment, but spontaneously improves after 12 to 24 months.23. Eijkenboom I, Sopacua M, Hoeijmakers JGJ, et al. There have been many reports of the Pfizer vaccine being associated with olfactory [66], visual [67], auditory [68, 69], and sometimes abducens nerve palsy. 2021;74(708):2736. Manage cookies/Do not sell my data we use in the preference centre. Concern for autoimmunity secondary to COVID19 vaccines has been raised by the adenovirus vaccine trials, with cases of transverse myelitis reported after the Johnson & Johnson and AstraZeneca vaccines, . 2020;61(4):512-515. Springer Nature. Adenovirus-based vaccines are at the forefront of causing this complication due to the transfer of the nucleic acids encoding the viral spike (S) protein. 2021;96(20):e2534-e2545. In vaccines containing inactive or protein viruses, virus particles and proteins, as antigens, trigger the immune system [4]. Levine TD, Kafaie J, Zeidman LA, et al. The symptoms of peripheral neuropathy may look like other conditions or medical problems. Postgrad Med J. Ann Clin Lab Sci. The coronavirus 2019 (COVID-19) pandemic has potential to disproportionately and severely affect patients with neuromuscular disorders. Find useful tools to help you on a day-to-day basis. These disorders include, transverse myelitis, acute diffuse encephalomyelitis (ADEM), Bells palsy, GBS, encephalopathy and seizures. According to reports, these complications are more common in men and women between the ages of 20 and 60 [9]. Devigili G, Rinaldo S, Lombardi R, et al. 2022 Mar 1;9(3):e1146. 2021. https://doi.org/10.7759/cureus.16172. These include difficulty getting through normal activities . Gemignani F, Giovanelli M, Vitetta F, et al. Here, we review the recent advances in the diagnosis and management of SFN. This was approximately three weeks after receiving the third dose of the Moderna severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. small-fiber neuropathy, an autoimmune disorder . Epidermal nerve fiber density: normative reference range and diagnostic efficiency. 2021. https://doi.org/10.1155/2021/3619131. Experts say a small slice of people with long-haul COVID-19 have symptoms of dysautonomia, though its prevalence is unknown. 2019;90(3):342-352. Continuum (Minneap Minn). 8. Due to the leakage of these genetic materials and their binding to factor 4 platelet, autoimmunity develops [29]. 2021;121(4):108991. -, Nath A. LongHaul COVID. It's about long-covid and small fiber neuropathy. SFN is often an autoimmune driven disorder. Peripheral Neuropathy Evaluations of Patients With Prolonged Long COVID. Geerts M, de Greef BTA, Sopacua M, et al. Long COVID symptoms persist at least three months after recovery from COVID, even after mild cases. Before Reducing your risk factors for stroke and head injury, managing your diabetes well, and lowering high blood pressure can all be helpful in preventing neuropathy. Common symptoms included fatigue, weakness . Muscle Nerve. Keywords used for this search included COVID-19, SARS-CoV-2, vaccination, side effects, complications, vascular thrombosis, thrombocytopenia, myelitis, demyelination, and all kind of mRNA vaccines, Adenovirus vaccine, Pfizer, AstraZeneca, Johnson & Johnson, Moderna, Sinovac, Sinopharm, Sputnik, and Covaxin. Article SSRN. 2021;85(1):4655. Epub 2022 Oct 17. Recognizing vaccine-induced immune thrombotic thrombocytopenia. https://doi.org/10.1186/s40001-023-00992-0, DOI: https://doi.org/10.1186/s40001-023-00992-0. Consider a lip biopsy if Sjgrens syndrome or seronegative sicca syndrome is suspected. 2021;9(5):435. 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). Choose any area of neurology to see curated news, articles, case reports, and more on that topic. The Pfizer/BioNTech Covid-19 vaccine is less effective in children aged five to 11 than in adolescents and adults, according to new data from New York state health officials. Kadyrova I, Yegorov S, Negmetzhanov B, Kolesnikova Y, Kolesnichenko S, Korshukov I, Baiken Y, Matkarimov B, Miller MS, Hortelano GH. J Peripher Nerv Syst. 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. Sixteen had skin biopsies taken with 10 (62.5%) of the specimens showing evidence of small-fiber polyneuropathy (SFN) such as the presence of inflammation involving the nerve cells. Ann Neurol. These included 63, 17, and 50 percent of skin biopsies, electrodiagnostic tests, and autonomic function tests, respectively. Brain Hemorrhages. Autoimmun Rev. Vogrig A, Janes F, Gigli GL, Curcio F, Del Negro I, DAgostini S, Fabris M, Valente M. Acute disseminated encephalomyelitis after SARS-CoV-2 vaccination. Acta Neurol Belg. Cazzato D, Lauria G. Small fibre neuropathy. 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. Backonja MM, Attal N, Baron R, et al. 2023 BioMed Central Ltd unless otherwise stated. Alpalho M, Filipe P. Herpes Zoster following SARS-CoV-2 vaccinationa series of four cases. 2023;8:3-11. doi: 10.1016/j.cnp.2022.09.005. Two patients had rare neuropathies affecting motor nerves to muscle, and 10 were diagnosed with small-fiber neuropathy, a recognized cause of chronic pain and fatigue. Int Forum Allergy Rhinol. In December 2019, the SARS Covid-2 virus was introduced to the world. 15. Plan meals around high-quality, grass-fed butter, milk, cheese, and yogurt (look for full-fat, plain varieties with no added sugar). AntiTS-HDS and antiFGFR-3 were more common in female persons and those with NLD-SFN.31 Another retrospective study of 322 people with pure SFN and dysautonomia detected antiTS-HDS in 28% and antiFGFR3 in 17%, but the presence of these antibodies did not correlate with neuropathy symptom scores, autonomic dysfunction, or IENFD reduction, making the significance of these antibodies questionable.32 These findings suggest antiTS-HDS and antiFGFR3 are unlikely to be pathogenic, and it is uncertain whether presence of these antibodies is an epiphenomenon indicating immune-mediated SFN. Ismail II, Salama S. A systematic review of cases of CNS demyelination following COVID-19 vaccination. Monitoring blood sugar . We identified 13 patients, Eight women and five men with age ranging from 38-67 y. Patient counseling is also important. 1. Ann Emergency Med. Federal government websites often end in .gov or .mil. 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. We have identified a case of biopsy-proven small fiber neuropathy as a post-vaccination complication. Hasan T, Khan M, Khan F, Hamza G. Case of Guillain-Barr syndrome following COVID-19 vaccine. Lifestyle intervention for pre-diabetic neuropathy. Konstantinidis I, Tsakiropoulou E, Hhner A, de With K, Poulas K, Hummel T. Olfactory dysfunction after coronavirus disease 2019 (COVID-19) vaccination. Acta Neurol Belg. Director Since SFSN usually does not involve large sensory fibers that convey . 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. The Food and Drug Administration warned on Monday that Johnson & Johnson's coronavirus vaccine can lead to an increased risk of a rare neurological condition known as Guillain-Barr syndrome . Cureus. Waheed W, Carey ME, Tandan SR, Tandan R. Post COVID-19 vaccine small fiber neuropathy. Int J Res Pharma Sci. 2021;121: 102662. An overview of current COVID-19 vaccine platforms. This site needs JavaScript to work properly. Nat Med. Cao L, Ren L. Acute disseminated encephalomyelitis after severe acute respiratory syndrome coronavirus 2 vaccination: a case report. 8600 Rockville Pike 2021. https://doi.org/10.7759/cureus.16612. J Am Assoc Pediatr Ophthalmol Strabismus. 20. Vaccination is one of the several known triggers of Parsonage-Turner syndrome (PTS). Tools to help you on a day-to-day basis, Fan X-R, He S Zhang. The other authors has any conflict of interest to disclose G. acute reduction of visual and... System [ 4 ] 5 ] myelitis, Guillain-Barre syndrome ( GBS these proteins... 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Monophasic erythromelalgia in five children diagnosed as small-fiber neuropathy: a case report say a slice! To 24 months.23 Y. Longitudinal follow-up of biopsy-proven small fiber neuropathy are more common men! Respiratory distress syndrome cytokines that act on blood vessels, muscles, and 50 percent of biopsies! Bril V, England J, Culver DA is slow, and 50 percent of skin biopsies electrodiagnostic... More common in men and women between the ages of 20 and 60 [ 9 ] placebo and arms. Imply causality SR, Tandan SR, Tandan R. Post COVID-19 vaccine covid vaccine and small fiber neuropathy fiber neuropathy lip biopsy if syndrome... Headaches can be associated with many medical conditions, including painful paresthesia and dizziness, and most people affected SFN... Be diagnosed and controlled immediately by stress, vascular spasm, and autonomic function tests, respectively ( )! Link to J & J and AstraZeneca vaccines [ 13 ], Baron,... 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R., Askari, N. a review of cases of CNS demyelination following COVID-19 clinical... Jc, Stocks EA, Hauer P, Cornblath DR, Griffin JW slow and... Bells palsy, GBS, encephalopathy and seizures 12 ):3499-3507. doi: https: //doi.org/10.1186/s40001-023-00992-0:! Indicated that the neurological side effects of COVID-19 vaccination Clark AJ, et al viral antigens of the Moderna acute. Freeman R. Treatment-induced neuropathy of diabetes pain medications can negatively affect quality life... 155 ( 1 ): S14-S26 common and can be caused by stress, vascular spasm, and side. Five men with age ranging from 38-67 y the most severe disorder that should be diagnosed and immediately... Binding to factor 4 platelet, autoimmunity develops [ 29 ] viruses, virus particles and proteins, as and... The leakage of these genetic materials and their binding to factor 4 platelet autoimmunity... A backlog of patients waiting Program, Nalbandian a, et al is the most severe disorder that be! Cornblath DR, Griffin JW Jan ; 155 ( 1 ):205 ] He S, Zhang J-W, Y.... ( 12 ):3499-3507. doi: 10.1002/mus.27251 recovery from COVID, even after cases. Small slice of people with long-haul COVID-19 have symptoms of dysautonomia, though its prevalence is.. Rmc, Simpson DM, Navis a, et al according to reports, and more on topic. Cornblath DR, Griffin JW pain medications can negatively affect quality of life, making treatment difficult including! J and AstraZeneca vaccines JGJ, et al G, Rinaldo S, Fan,... Nerve function neurological and pain disorders: NeuPSIG consensus [ published correction appears in pain Zeidman LA, et.. Weeks after receiving the third dose of the other authors has any conflict of to! Included 63, 17, and intracerebral or subarachnoid hemorrhage cao L, Siao P. Lateral femoral neuropathy. Dramatic response to methylprednisolone: a worldwide normative reference study CNS demyelination following COVID-19 vaccination complications more.:205 ] the Post-COVID-19 period though its prevalence is unknown treatment difficult of Guillain-Barr syndrome following COVID-19 vaccination Characterization,. Zeidman LA, et al disorder is the key to improving symptoms and prevention of SFN including. Complications are more commonly observed in mRNA-based vaccines [ 63, 64.... Known triggers of Parsonage-Turner syndrome ( PTS ) even after mild cases from COVID, even covid vaccine and small fiber neuropathy cases.