Age: 46.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Lumbar puncture, Magnetic resonance imaging head, Myasthenia gravis, Sinusitis
Clinical narrative: POSSIBLE OCULAR MYASTHENIA GRAVIS; POSSIBLE FOURTH CRANIAL NERVE PALSY; SINUS INFECTION; ALLERGIC REACTION; SLIGHT DIFFERENCE IN EAR PRESSURES; This spontaneous report received from a patient concerned a 46 year old male. The patient's height, and weight were not reported. The patient's concurrent conditions included marginally high blood pressure, and the patient had no allergies to medications, food, or other products. The patient had no other illnesses at the time of vaccination and up to one month prior, and no prior medical history or neurological history in the family. The patient had no adverse event following any previous vaccine. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805029, expiry: UNKNOWN) dose was not reported, administered on 09-MAR-2021 at 11:00 to left arm for prophylactic vaccination. Concomitant medications included ascorbic acid (Vitamin C), Multivitamins, cod-liver oil, Vitamin D, and lisinopril. On an unspecified date in MAY-2021, the patient had some vision issues/seeing double, but did not think much about it . The patient went to his Primary Care Physician (PCP) for annual physical exam where bloodwork and everything was done and it came back normal except Cholesterol, which was marginally higher. The issue was not causing much discomfort for the patient, and it sort of went away, the best the patient could recall or couldn't recall. On 14-JUN-2021, the patient started having trouble focusing with his eyes again. It was causing him more discomfort than before so he visited his PCP, on 15-JUN-2021.doctor mentioned there was slight difference in ear pressures and maybe it was that. Not totally satisfied with that, the patient visited his Optometrist the next day and he suspected 4th nerve Palsy and asked the patient to make an appointment with the Eye Center with a specialist. The patient went and saw doctor at the eye Centre, On 17-JUN-2021 and he also suspected 4th nerve Palsy. Doctor ordered Magnetic Resonance Imaging (MRI) of the brain and Orbit which the patient completed on 22-JUN-2021 (later to come back normal). As the patient waited for the results that week, his condition was slightly deteriorating whereby he had to close his right eye to walk and go up and down the stairs. Just to rule out any Ear, Nose, And Throat (ENT) issues, the patient went and saw his ENT doctor on 21-JUN-2021. His hearing was normal and he conducted a Computed Tomography (CT) scan of the sinuses and he saw some infection but did not think it was in an area which would have caused any issues with the patient's right eye. The doctor, however, did prescribe antibiotics which the patient had started. The first dose and the patient started having an allergic reaction even though he had taken it before and not had any reaction (the patient had never had any reaction to any medication prior to that in his life). So the doctor changed the antibiotic and the patient started taking the other medication. On 27-JUN-2021, when the patient woke up, he noticed his right eye to be half closed, he thought maybe he had overworked his right eye and it might get better. However, on 28-JUN-2021, when the patient woke up, it had got worse. The patient decided to visit doctor that day itself at the Eye institute. Doctor, after his examination and consulting with another neurologist, said that he suspected Cranial nerve Palsy and possible Myasthenia Gravis. doctor suggested that if the patient wanted answers right away, then check into the Emergency Room (ER). The patient did check himself that same day and the neurologists and the ER doctors immediately admitted him to the hospital and conducted multiple tests. Laboratory data included: Antibody test (NR: not provided) Unknown, Carotid angiogram (Magnetic resonance angiography-MRA) (NR: not provided) Unknown, Chest X-ray (NR: not provided) Unknown, Electromyogram (NR: not provided) Unknown, and Lumbar puncture (NR: not provided) Unknown.  The patient was at the hospital till 03-JUL-2021, and released with medications and possible diagnosis of cranial nerve palsy/Ocular Myasthenia Gravis. The patient was hospitalized for 6 days. The patient was waiting for a call back from the neurologists for a follow-up appointment and further treatment, if any. The patient's symptoms of droopy eyes persist on his right eye, and both his eyes cannot focus together. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from suspected fourth cranial nerve palsy/right eye half closed/vision issues, seeing double/closes right eye to walk and go up and down the stairs, possible ocular myasthenia gravis, sinus infection, slight difference in ear pressures, and allergic reaction. This report was serious (Hospitalization Caused / Prolonged).; Sender's Comments: V0:20210731014-Covid-19 vaccine ad26.cov2.s -Possible ocular myasthenia gravis, IVth nerve paralysis. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).