Thrombosis post-mRNA-based SARS-CoV-2 vaccination (BNT162b2) – Time to think beyond thrombosis with thrombocytopenia syndrome (TTS)

The COVID-19 pandemic has affected the global socioeconomic and healthcare infrastructure. Vaccines have been the cornerstone in limiting the global spread of the pandemic. However, the mass scale vaccination has resulted in some unanticipated adverse events. Arguably the most serious of these has been the development of widespread thrombosis with viral-vectored vaccines. We present a case of extensive thrombosis associated with the messenger RNA (m-RNA) vaccine. •Association of thrombosis with BNT162b2 is a rare yet pathophysiologically distinct entity from TTS.•Clinicians should be aware of this phenomenon and the treatment options, which do not conform to current recommendations for vaccine-induced TTS.•The BNT162b2 associated thrombosis can be treated with either heparin or non-heparin anticoagulation, e.g., DOACs.