{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T20:13:46Z","timestamp":1762460026582,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/bmj.com\/coronavirus\/usage"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,6,25]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>As with past illnesses, an approach has been taken to vaccinate the population and halt the spread of COVID-19. On 13 April 2021, the US Food and Drug Administration called for a halt in the administration of the Johnson &amp; Johnson (J&amp;J) COVID-19 vaccine due to reports of thrombosis and thrombocytopenia being associated with vaccination. We present the case of a 43-year-old woman with a history of dyslipidaemia, depression, gastro-oesophageal reflux disease and obesity presenting with dyspnoea, headache and light headedness of 3\u2009days\u2019 duration. Ten days prior, she had received the J&amp;J COVID-19 vaccine. She was found to have thrombocytopenia, elevated D-dimers, pulmonary emboli and presented 1\u2009day after discharge with an arterial clot despite being on apixaban. Six other US-based cases of venous thrombotic events are being reviewed at present. Patients should be informed of the possibility of such events to provide informed consent.<\/jats:p>","DOI":"10.1136\/bcr-2021-243975","type":"journal-article","created":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T12:16:04Z","timestamp":1626264964000},"page":"e243975","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":30,"title":["Pulmonary embolism, transient ischaemic attack and thrombocytopenia after the Johnson &amp; Johnson COVID-19 vaccine"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8762-7321","authenticated-orcid":false,"given":"Bilal","family":"Malik","sequence":"first","affiliation":[{"name":"Internal Medicine, McLaren Health Care Corp\/ MSU, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atefeh","family":"Kalantary","sequence":"additional","affiliation":[{"name":"Internal Medicine, McLaren Health Care Corp\/ MSU, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamal","family":"Rikabi","sequence":"additional","affiliation":[{"name":"Internal Medicine, McLaren Health Care Corp\/ MSU, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arvind","family":"Kunadi","sequence":"additional","affiliation":[{"name":"Nephrology\/ Internal Medicine, McLaren Health Care Corp\/ MSU, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,14]]},"reference":[{"key":"2025082723554096000_14.7.e243975.1","unstructured":"Acpinternist.org . Clot concerns with adenovirus COVID-19 vaccines, antibody treatment recommendations and data [Internet], 2021. Available: https:\/\/acpinternist.org\/weekly\/archives\/2021\/04\/20\/1.htm?utm_campaign=FY20-21_NEWS_INTERNIST_DOMESTIC_042021_EML&utm_medium=email&utm_source=Eloqua"},{"key":"2025082723554096000_14.7.e243975.2","unstructured":"Shimabukuro T . ACIP April 14, 2021 Presentation Slides | Immunization Practices | CDC [Internet], 2021. Available: https:\/\/www.cdc.gov\/vaccines\/acip\/meetings\/slides-2021-04.html"},{"key":"2025082723554096000_14.7.e243975.3","unstructured":"Schuchat A , Marks P . Joint CDC and FDA Statement on Johnson & Johnson COVID-19 Vaccine [Internet], 2021. Centers for disease control and prevention. Available: https:\/\/www.cdc.gov\/media\/releases\/2021\/s0413-JJ-vaccine.html"},{"key":"2025082723554096000_14.7.e243975.4","doi-asserted-by":"crossref","first-page":"2202","DOI":"10.1056\/NEJMoa2105385","article-title":"Pathologic antibodies to platelet factor 4 after ChAdOx1 nCoV-19 vaccination","volume":"384","author":"Scully","year":"2021","journal-title":"N Engl J Med"},{"key":"2025082723554096000_14.7.e243975.5","unstructured":"European Medicines Agency . COVID-19 Vaccine Janssen: EMA finds possible link to very rare cases of unusual blood clots with low platelets - European Medicines Agency [Internet], 2021. Available: https:\/\/www.ema.europa.eu\/en\/news\/covid-19-vaccine-janssen-ema-finds-possible-link-very-rare-cases-unusual-blood-clots-low-blood"},{"key":"2025082723554096000_14.7.e243975.6","unstructured":"Johnson & Johnson . Johnson & Johnson COVID-19 Vaccine Roll-out to Resume in Europe Following European Medicines Agency (EMA) Review, EMA Confirms Overall Benefit-Risk Profile Remains Positive [Internet], 2021. Available: https:\/\/www.jnj.com\/johnson-johnson-covid-19-vaccine-roll-out-to-resume-in-europe-following-european-medicines-agency-ema-reviewema-confirms-overall-benefit-risk-profile-remains-positive"},{"key":"2025082723554096000_14.7.e243975.7","unstructured":"Centers for Disease Control and Prevention . CDC Recommends Use of Johnson & Johnson\u2019s Janssen COVID-19 Vaccine Resume [Internet], 2021. Available: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/vaccines\/safety\/JJUpdate.html"},{"key":"2025082723554096000_14.7.e243975.8","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.1056\/NEJMc2105869","article-title":"Thrombotic thrombocytopenia after Ad26.COV2.S vaccination","volume":"384","author":"Muir","year":"2021","journal-title":"New England Journal of Medicine"},{"key":"2025082723554096000_14.7.e243975.9","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1056\/NEJMc2106075","article-title":"Thrombotic Thrombocytopenia after Ad26.COV2.S Vaccination - Response from the Manufacturer","volume":"384","author":"Sadoff","year":"2021","journal-title":"N Engl J Med"},{"key":"2025082723554096000_14.7.e243975.10","article-title":"Vaccine-Induced immune thrombotic thrombocytopenia (VITT): targeting pathomechanisms with Bruton tyrosine kinase inhibitors","author":"von Hundelshausen","year":"2021","journal-title":"Thromb Haemost"},{"key":"2025082723554096000_14.7.e243975.11","unstructured":"et al Bussel J , Connors J , Cines D . Thrombosis with Thrombocytopenia Syndrome [Internet]. Hematology.org, 2021. Available: https:\/\/www.hematology.org\/covid-19\/vaccine-induced-immune-thrombotic-thrombocytopenia"},{"key":"2025082723554096000_14.7.e243975.12","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1056\/NEJMoa2104840","article-title":"Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination","volume":"384","author":"Greinacher","year":"2021","journal-title":"N Engl J Med"},{"key":"2025082723554096000_14.7.e243975.13","doi-asserted-by":"crossref","first-page":"2448","DOI":"10.1001\/jama.2021.7517","article-title":"US case reports of cerebral venous sinus thrombosis with thrombocytopenia after Ad26.COV2.S vaccination, March 2 to April 21, 2021","volume":"325","author":"See","year":"2021","journal-title":"JAMA"},{"key":"2025082723554096000_14.7.e243975.14","doi-asserted-by":"crossref","unstructured":"Oldenburg J , Klamroth R , Langer F . Diagnosis and management of vaccine-related thrombosis following AstraZeneca COVID-19 vaccination: guidance statement from the GTH. 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