Age: 81.0
Sex: M
Vaccine: COVID19
Symptoms: IIIrd nerve paralysis, Magnetic resonance imaging head, Pupillary light reflex tests, Red blood cell sedimentation rate, Slit-lamp examination
Clinical narrative: partial oculomotor nerve palsy of the left eye; Exotropia of 3 prism diopters (PD) in the primary position; left hyperopia of 5 PD; Binocular oblique diplopia; Felt dizzy; Ptosis of his left upper eyelid; This literature-non-study case was reported in a literature article and describes the occurrence of IIIRD NERVE PARALYSIS (partial oculomotor nerve palsy of the left eye) in an 81-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.      The patient's past medical history included SARS-CoV-2 infection (symptoms included fever, myalgia, general malaise, and mild respiratory symptoms, as well as lower extremity weakness and gait instability) in September 2020. Concurrent medical conditions included Hypertension, Hypercholesterolemia and Diabetes mellitus loss of control.    On 04-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Feb-2021, the patient experienced DIZZINESS (Felt dizzy) and EYELID PTOSIS (Ptosis of his left upper eyelid). On 08-Feb-2021, the patient experienced DIPLOPIA (Binocular oblique diplopia). On an unknown date, the patient experienced IIIRD NERVE PARALYSIS (partial oculomotor nerve palsy of the left eye) (seriousness criterion medically significant), STRABISMUS (Exotropia of 3 prism diopters (PD) in the primary position) and HYPERMETROPIA (left hyperopia of 5 PD). At the time of the report, IIIRD NERVE PARALYSIS (partial oculomotor nerve palsy of the left eye), DIZZINESS (Felt dizzy), EYELID PTOSIS (Ptosis of his left upper eyelid), STRABISMUS (Exotropia of 3 prism diopters (PD) in the primary position) and HYPERMETROPIA (left hyperopia of 5 PD) outcome was unknown and DIPLOPIA (Binocular oblique diplopia) had resolved.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, C-reactive protein: elevated (High) elevated. In 2021, Magnetic resonance imaging head: ischemia or aneurysmal compression (normal) showed no pathology to explain the patient's complaints; MRA  also done. There were no ischemic changes at the level of the left oculomotor nucleus in the midbrain, nor evidence of a mass effect on the nerve as it entered or left the cavernous sinus. In 2021, Pupillary light reflex tests: pupils were round and equally responsive to light (normal) pupils were round and equally responsive to light, without evidence of an afferent pupillary defect or of anisocoria. In 2021, Red blood cell sedimentation rate: normal (normal) normal. In 2021, Slit-lamp examination: normal bilaterally (normal) normal bilaterally; there were no retinal lesions or any optic nerve swelling. In 2021, Visual acuity tests: 20/40 in the right eye and 20/30 +2 in left eye (Inconclusive) 20/40 in the right eye and 20/30 +2 in left eye; limited adduction and infraduction of  left eye and full motility of right eye.     The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.   For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered IIIRD NERVE PARALYSIS (partial oculomotor nerve palsy of the left eye), DIPLOPIA (Binocular oblique diplopia), DIZZINESS (Felt dizzy), EYELID PTOSIS (Ptosis of his left upper eyelid), STRABISMUS (Exotropia of 3 prism diopters (PD) in the primary position) and HYPERMETROPIA (left hyperopia of 5 PD) to be possibly related.    Concomitant medications were not provided by the reporter.  The patient returned for a follow-up visit on 19-Feb-2021 and had full extraocular motility in both eyes and minimal residual exodeviation in the primary position, indicating a spontaneous near-total resolution of his cranial neuropathy. As SARS-CoV-2 may produce neurological manifestations, it was hypothesize that the oculomotor palsy occurred because of a reactivation of a SARS-CoV2associated, immune-mediated mechanism taking place after the vaccine's administration.  This case that oculomotor nerve palsy may occur as an adverse effect after the administration of the mRNA-1273 vaccine. Its etiology may be the reactivation (or vaccine-induced mimicry) of the immune phenomena that may occur following a SARS-CoV-2 infection. A post vaccination etiology for an oculomotor palsy is a diagnosis of exclusion and should only be considered once other potential etiologies have been ruled out.  No treatment was provided.  Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.   Most recent FOLLOW-UP information incorporated above includes: On 23-Aug-2021: Follow up received by safety 25-Aug-2021 included an email with full text article and does not contain any new information; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.