Age: 32.0
Sex: F
Vaccine: COVID19
Symptoms: Electrocardiogram, Imaging procedure, Lumbar puncture, Magnetic resonance imaging head, Magnetic resonance imaging neck
Clinical narrative: ASA syndrome 2/2 infarct of an anterior spinal artery C5-T1; Spinal cord infarction; This literature-non-study case was reported in a literature article and describes the occurrence of ANTERIOR SPINAL ARTERY SYNDROME (ASA syndrome 2/2 infarct of an anterior spinal artery C5-T1) and SPINAL CORD INFARCTION (Spinal cord infarction) in a 32-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination.   LITERATURE REFERENCE:    The patient's past medical history included Ventriculostomy.    On 30-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-May-2021, the patient experienced ANTERIOR SPINAL ARTERY SYNDROME (ASA syndrome 2/2 infarct of an anterior spinal artery C5-T1) (seriousness criteria hospitalization and medically significant) and SPINAL CORD INFARCTION (Spinal cord infarction) (seriousness criteria hospitalization and medically significant). The patient was hospitalized on sometime in 2021 due to ANTERIOR SPINAL ARTERY SYNDROME and SPINAL CORD INFARCTION. The patient was treated with IMMUNOGLOBULINS NOS (IMMUNOGLOBULIN I.V) (intravenous) for Inflammation, at an unspecified dose and frequency; ASPIRIN [ACETYLSALICYLIC ACID] at an unspecified dose and frequency and ATORVASTATIN at an unspecified dose and frequency. At the time of the report, ANTERIOR SPINAL ARTERY SYNDROME (ASA syndrome 2/2 infarct of an anterior spinal artery C5-T1) and SPINAL CORD INFARCTION (Spinal cord infarction) had not resolved.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Antibody test: (Negative) negative serum NMO Ab. On an unknown date, Coagulation test: Unremarkable; Negative for etiology of the event. On an unknown date, Computerized tomogram spine: Unremarkable. On an unknown date, Echocardiogram: Unremarkable. On an unknown date, Electrocardiogram: showed normal sinus rhythm CT head showed prominent 4th ventricle. On an unknown date, Imaging procedure: consistent with ASA syndrome 2/2 infarct of an anterior spinal artery C5 T1. On an unknown date, Lumbar puncture: showed normal IgG index. On an unknown date, Magnetic resonance imaging head: showed postprocedural changes associated with recent prior left trans frontal ventriculostomy catheter. On an unknown date, Magnetic resonance imaging neck: showed T2 hyperintense lesion extending from C3/4 to T1 with central predominance rostrally, whole cord involvement at C5, and with anterior predominance caudally with extent to the upper thoracic level of T1; shows patchy enhancement. On an unknown date, Magnetic resonance imaging thoracic: showed T2 hyperintense lesion extending from C3/4 to T1 with central predominance rostrally, whole cord involvement at C5, and with anterior predominance caudally with extent to the upper thoracic level of T1; shows patchy enhancement.. On an unknown date, Microbiology test: Unremarkable; Negative for etiology of the event. On an unknown date, Neurological examination: normal except for 1/5 handgrip, 2/5 wrist, and 3/5 triceps bilaterally. Triceps and brachioradialis reflexes were absent bilaterally., unremarkable except of an enlarged 4th ventricle for which she underwent left frontal ventriculostomy; negative for etiology and showed absent pinprick sensations C7 and below. Vibration and proprioception sensations were intact. On an unknown date, Physical examination: showed decreased tone in wrist bilaterally. On an unknown date, Rheumatological examination: (Negative) Negative for etiology of the event.     The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown.   For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   No concomitant medication was reported.  Patient with no significant past medical history, was presented with acute onset of bilateral extremity weakness and numbness that started 2 weeks ago. Patient was awake, alert, and oriented. Patient was treated with IVIG for presumed inflammatory disorder with minimal improvement. Patient underwent a repeat neurological workup at facility due to ongoing symptoms. She was discharged to rehab on aspirin and atorvastatin. Patient had symptoms and imaging consistent with ASA syndrome 2/2 infarct of an anterior spinal artery C5-T1.  Author stated that onset of symptoms were after receiving first dose of mRNA COVID-19 vaccine, however, unclear if the presentation was consistent with post vaccination vaccine ASA syndrome or idiopathic.  This is a literature non-study case concerning a 32-year-old female, with no significant past medical history, presented with acute onset of bilateral extremity weakness and numbness 16 days after the first dose of mRNA-1273 vaccine. She was admitted. Physical examination showed decreased tone in wrist bilaterally. Motor examination was normal except for 1/5 handgrip, 2/5 wrist, and 3/5 triceps bilaterally. Triceps and rachioradialis reflexes were absent bilaterally. Sensory examination showed absent pinprick sensations C7 and below. Vibration and proprioception sensations were intact. Neurological work was unremarkable except of an enlarged 4th ventricle for which she underwent left frontal ventriculostomy. Lumbar puncture showed normal IgG index and negative serum NMO Ab. She was treated with intravenous immunoglobulins for presumed inflammatory disorder with minimal improvement. Patient underwent a repeat neurological workup at our facility due to ongoing symptoms. An electrocardiogram showed normal sinus rhythm, a head computerized tomography showed prominent 4th ventricle, and the spine computerized tomography spine were unremarkable. The magnetic resonance imaging of the brain showed Postprocedural changes associated with recent prior left trans frontal ventriculostomy catheter. The magnetic resonance of the cervical and thoracic spine showed T2 hyperintense lesion extending from C3/4 to T1 with central predominance rostrally, whole cord involvement at C5, and with anterior predominance caudally with extent to the upper thoracic level of T1; shows patchy enhancement. The transthoracic echocardiogram was unremarkable. Infectious and hypercoagulable workup was also unremarkable. She was discharged to rehabilitation on aspirin and atorvastatin. The author assessed that was unclear if the presentation was consistent with post vaccination vaccine Anterior spinal artery syndrome or idiopathic. The benefit-risk relationship of mRNA-1273 is not affected by this report.   Most recent FOLLOW-UP information incorporated above includes: On 28-Nov-2022: Follow up received by safety on 28-NOV-2022 has email with abstract received and contains significant information: Medical history was added, suspect dose information was updated, event information was updated, treatment medication was added, hospitalization details were added, laboratory tests were added On 02-Dec-2022: Live follow-up received by safety on 02-Dec-2022 has email with full text article and contains significant information: Reporter information was updated, citation details were updated; Sender's Comments: This is a literature non-study case concerning a 32-year-old female, with no significant past medical history, presented with acute onset of bilateral extremity weakness and numbness 16 days after the first dose of mRNA-1273 vaccine. She was admitted. Physical examination showed decreased tone in wrist bilaterally. Motor examination was normal except for 1/5 handgrip, 2/5 wrist, and 3/5 triceps bilaterally. Triceps and rachioradialis reflexes were absent bilaterally. Sensory examination showed absent pinprick sensations C7 and below. Vibration and proprioception sensations were intact. Neurological work was unremarkable except of an enlarged 4th ventricle for which she underwent left frontal ventriculostomy. Lumbar puncture showed normal IgG index and negative serum NMO Ab. She was treated with intravenous immunoglobulins for presumed inflammatory disorder with minimal improvement. Patient underwent a repeat neurological workup at our facility due to ongoing symptoms. An electrocardiogram showed normal sinus rhythm, a head computerized tomography showed prominent 4th ventricle, and the spine computerized tomography spine were unremarkable. The magnetic resonance imaging of the brain showed Postprocedural changes associated with recent prior left trans frontal ventriculostomy catheter. The magnetic resonance of the cervical and thoracic spine showed T2 hyperintense lesion extending from C3/4 to T1 with central predominance rostrally, whole cord involvement at C5, and with anterior predominance caudally with extent to the upper thoracic level of T1; shows patchy enhancement. The transthoracic echocardiogram was unremarkable. Infectious and hypercoagulable workup was also unremarkable. She was discharged to rehabilitation on aspirin and atorvastatin. The author assessed that was unclear if the presentation was consistent with postvaccination vaccine Anterior spinal artery syndrome or idiopathic. The benefit-risk relationship of mRNA-1273 is not affected by this report.