SARS-Cov-2 is one of the most complex viruses known to medical science. Patients with COVID-19 present a broad spectrum of clinical manifestations, ranging from asymptomatic infection to lethal outcome. Both the young and the old may have very different clusters of symptoms and responses to medications, including the COVID-19 vaccines.  Each type is associated with how severe of an illness a patient might experience, ranging from asymptomatic to lethal. 

Precision medicine approaches such as whole-exome sequencing can provide insight into the phenotypes, endotypes and underlying mechanisms of the disease. The high cost of cutting-edge approaches, however, keeps these tools out of reach for many research teams. 

In this age of big data and large clinical studies, we should not forget about the value of individual cases. A good case report tells a detailed story. It describes a unique phenotype and offers unique clues to its resolution into an endotype. 

A new systematic review of case reports aims to answer questions about COVID-19 subtypes in octogenarians, nonagenarians, and centenarians and offer possible solutions to organize the knowledge and identify the gaps. 

REFERENCES

Irene S. Gabashvili. The outcomes of COVID-19 vaccination and SARS-CoV-2 infection in octogenarians, nonagenarians, and centenarians. PROSPERO 2022 CRD42022332621 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022332621

Irene S. Gabashvili (2022), “COVID-19 vaccine and SARS-CoV-2 in the oldest old: rapid literature review”, Mendeley Data, v1 http://dx.doi.org/10.17632/6sk33d9z7s.1 https://data.mendeley.com/datasets/6sk33d9z7s/1

May 18, 2022: Long COVID symptoms don't resolve due to subsequent vaccinations A new study from Mount Sinai followed 453 COVID-19 patients with post-acute sequelae of COVID (PASC) 72% of got vaccinated in the following 6 months but this did not resolve anosmia, respiratory symptoms, depression, anxiety, PTSD, or quality of life.

May 16, 2022: Fatal Breakthrough COVID-19 in a Heart Transplant Recipient A 71-year-old male is gdiagnosed with a breakthrough COVID-19 16 days after his second mRNA vaccine dose.

May 13, 2022: Pericardial effusion as a complication of vaccination against COVID-19 Cases following vaccination in adults and fetuses after maternal COVID-19 vaccination

May 12, 2022: Urological Adverse Effects of COVID-19 Vaccination More than 10% of individuals experience deterioration in storage lower urinary tract symptoms after COVID-19 vaccination

May 10, 2022: Fatal autoimmune acquired factor XIII/13 deficiency after COVID-19 vaccination A 78-year-old woman with no personal or family history of abnormal bleeding dies of CNS bleeding induced by her COVID-19 mRNA vaccination.

May 6, 2022: Long Breakthrough COVID Cases of fully vaccinated and boosted individuals developing long COVID after breakthrough infection

May 5, 2022: Fatal Guillain-Barré syndrome after COVID-19 vaccination A fit and healthy 77-year-old woman went from capable of loading firewood to being paralyzed after her 1st dose.

April 30, 2022: Precision medicine for IBD A precision medicine approach discovers hidden genetic connections in Inflammatory Bowel Disease

April 29, 2022: Increased cardiovascular emergencies during vaccine rollout Using a unique dataset from Israel National Emergency Medical Services (EMS) from 2019 to 2021, an increase of over 25% was detected in both cardiac arrest (CA) and acute coronary syndrome (ACS) EMS calls during January–May 2021, compared with the years 2019–2020

April 28, 2022: 15-year-old boy commits suicide after cyberbullying for false rumor of being non-vaccinated A 15-year-old boy enrolled at a prestigious private school had a promising future — that is, until he became a victim of relentless cyberbullying by his classmates.

April 25, 2022: Diabetes after COVID-19 vaccination Diabetes risk rises after COVID and, in some cases, after COVID-19 vaccination.

April 20, 2022: On Cabbage and SELENBP1 Mutations in the gene encoding Selenium Binding Protein were found in multiple individuals with extra-oral halitosis.

April 5, 2022: Fatal outcomes despite 4 COVID-19 vaccine doses COVID-19 vaccines reduce hospitalization and death, but they don't completely eliminate it, not even after four doses.

April 1, 2022: April Fools' 2022 April Fools' Technology jokes can be prophetic or ominous, wishful thinking or a reflection of real concerns.

March 31, 2022: COVID-19 Vaccine Effectiveness during Pregnancy We describe case series for pregnant women and discuss recent findings that pregnant individuals were 90% more likely to have been infected with coronavirus than the same number of people who were not pregnant, despite vaccination.

March 27, 2022: Autoimmune skin conditions in the elderly after vaccination We discuss 29 cases of bullous pemphigoid with a median age 82.

March 21, 2022: Passive Sensors for Health Monitoring Health data can be collected passively enabling continuous data collection and home-based trials.

March 19, 2022: Long COVID and Adverse Effects of Vaccination in incontinentia pigmenti Patients with certain genetics are prone to more severe COVID-19, long COVID and adverse reactions to vaccination.

March 11, 2022: Multisystem Inflammatory Syndrome in Children after SARS-CoV-2 Vaccination Multisystem inflammatory syndrome can follow SARS-CoV-2 infection, but it can be also induced by vaccination without current COVID-19 infection.

March 6, 2022: Hearing Loss after COVID-9 Vaccination In a study of vaccinations in Israel, an association was found between the BNT162b2 mRNA COVID-19 vaccine and Sudden Sensorineural Hearing Loss. Similar case reports from other countries have been published in peer-reviewed journals.

March 3, 2022: Getting Out of Echo Chambers We need critical thinking and cultural intelligence analysis skills to recognize the legitimacy and ongoing necessity of opposing views.

February 28, 2022: Fatal outcomes in elderly patients after COVID-19 vaccination Many elderly individuals whose death was linked to the vaccine had preexisting cardiovascular diseases. Genetic predispositions could be also involved.

February 20, 2022: Acute liver failure after COVID-19 vaccination A healthy 34-year-old health care worker with no history of COVID-19 dies from hepatic infarction a few days after his first dose of ChAdOx1nCov-19 vaccine.

February 16, 2022: Catecholamine-Mediated Stress Cardiomyopathy after COVID-19 Infection & Vaccination An overly exuberant immune response to the vaccine can cause myocardial injury mediated by similar immune mechanisms as described with SARS-COV-2 and multisystem inflammatory syndrome (MIS-C) cytokine storms.

February 15, 2022: Fatal breakthrough infections in solid organ transplant recipients 4 case reports of fatal breakthrough infections among liver and kidney transplant recipients aged 13-69.

February 13, 2022: Fatal COVID-19 breakthroughs in kidney disease patients Brazilian and Scottish studies show that patients with kidney disease do not benefit from existing COVID-19 vaccines.

February 2, 2022: Fatal COVID-19 breakthrough in an 88-year-old male Yet another report about a healthy person (except benigh prostate) who dies despite 2 doses of a COVID-19 vaccine

February 2, 2022: Deaths of elderly individuals wrongly given an extra dose of the vaccine. They were given too many doses too soon - due to insufficient documentation or vaccine passport bureaucrats.

February 1, 2022: Who benefits the least from COVID-19 vaccines? Vaccines help some people more than others.

February 1, 2022: Vaccinated 71-year-old male dies from breakthrough COVID-19 on the 2nd day of symptom onset 71-year-old double-vaccinated overweight male started to feel unwell on the 7th day and died on the 9th day - while sitting in his easy chair shortly before an ambulance arrived.

January 30, 2022: Severe breakthrough COVID-19 in vaccinated patients with multiple sclerosis. Multiple sclerosis patients have a higher risk of breakthrough infection

January 21, 2022: Another case report on fatal breakthrough with brain involvement. Neurological manifestations are common in COVID-19. A sudden-onset reversible cerebral vasoconstriction syndrome (RCVS), possibly caused by a transient dysregulation of cerebral vascular tone, is described in this fatal COVID-19 vaccine breakthrough case.

January 18, 2022: Fatal Anorexia caused by COVID-19 vaccination. A 90-year old woman in stable health receives the first dose of the COVID-19 vaccine, experiences inreased heart rate, develops anorexia and dies 28 weeks later.

January 16, 2022: A fatal case of COVID-19 breakthrough infection in a 61-year old man A 61-year-old man with a history of arterial hypertension (PA 145/95 mmHg) and obesity with a body mass index (BMI) of 37.11 was vaccinated with a double dose of mRNA vaccine, but 4 months after the 2nd dose was diagnosed with COVID-19 and died 15 days after diagnosis despite treatment.

January 13, 2022: Young COVID-19 vaccine breakthrough fatalities Vaccine effectiveness may fail for individuals with particular genetics and we need more studies and more medical case reports to develop personalized preventative and curative approaches.

January 12, 2022: Post-infectious body odor A paper posted today on MedRxiv tells that dogs can easily detect long COVID - and not only acute COVID-19 - in at least half of the cases. Vaccine effectiveness may fail for individuals with particular genetics and we need more studies and more medical case reports to develop personalized preventive and curative approaches.

January 8, 2022: Risk Factors for Severe COVID-19 Outcomes Among Vaccinated Individuals New Morbidity and Mortality Weekly Report (MMWR) emphasizes the usual risk factors for fatal breakthroughs: age 65 or older or at least one of these conditions: diabetes mellitus, immunosuppression, chronic kidney disease, chronic liver disease, chronic neurologic disease, chronic cardiac disease, or chronic pulmonary disease.