text: COVID 19 Disease Womens Predominant Non Heparin Vaccine Induced Thrombotic Thrombocytopenia and Kounis Syndrome A Passepartout Cytokine Storm Interplay Coronavirus disease 2019 COVID 19 and severe acute respiratory syndrome coronavirus 2 SARS CoV 2 constitute one of the deadliest pandemics in modern history demonstrating cardiovascular gastrointestinal hematologic mucocutaneous respiratory neurological renal and testicular manifestations and further complications COVID 19 induced excessive immune response accompanied with uncontrolled release of cytokines culminating in cytokine storm seem to be the common pathogenetic mechanism of these complications The aim of this narrative review is to elucidate the relation between anaphylaxis associated with profound hypotension or hypoxemia with pro inflammatory cytokine release COVID 19 relation with Kounis syndrome and post COVID 19 vaccination correlation with heparin induced thrombocytopenia with thrombosis HITT especially serious cerebral venous sinus thrombosis were also reviewed A current literature search in PubMed Embase and Google databases was performed to reveal the pathophysiology prevalence clinical manifestation correlation and treatment of COVID 19 anaphylaxis with profuse hypotension Kounis acute coronary syndrome and thrombotic events post vaccination The same key immunological pathophysiology mechanisms and cells seem to underlie COVID 19 cardiovascular complications and the anaphylaxis associated Kounis syndrome The myocardial injury in patients with COVID 19 has been attributed to coronary spasm plaque rupture and microthrombi formation hypoxic injury or cytokine storm disposing the same pathophysiology with the three clinical variants of Kounis syndrome COVID 19 interrelated vaccine excipients as polysorbate polyethelene glycol PEG and trometamol constitute potential allergenic substances Better acknowledgement of the pathophysiological mechanisms clinical similarities multiorgan complications of COVID 19 or other viral infections as dengue and human immunodeficiency viruses along with the action of inflammatory cells inducing the Kounis syndrome could identify better immunological approaches for prevention treatment of the COVID 19 pandemic as well as post COVID 19 vaccine adverse reactions 