Age: 77.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Periodic acid Schiff stain, Rash maculo-papular, Skin erosion, Skin lesion, Skin ulcer
Clinical narrative: right foot between 2nd and 3rd toe one huge blister appeared/blisters are spreading slowly all over the body, to his chest, arms, hips; a few days later some red bumps appeared in his ankle; urticarial phase of bullous pemphigoid/bullous pemphigoid also called blistering disease/The biopsy result is a superficial and mid dermal perivascular dermatitis with frequent eosinophils; This spontaneous case was reported by an other health care professional and describes the occurrence of PEMPHIGOID (urticarial phase of bullous pemphigoid/bullous pemphigoid also called blistering disease/The biopsy result is a superficial and mid dermal perivascular dermatitis with frequent eosinophils) and BLISTER (right foot between 2nd and 3rd toe one huge blister appeared/blisters are spreading slowly all over the body, to his chest, arms, hips) in a 77-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 060A22A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     Family history included Melanoma.    On 22-Jun-2022, the patient received fourth dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Jun-2022,  after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced PEMPHIGOID (urticarial phase of bullous pemphigoid/bullous pemphigoid also called blistering disease/The biopsy result is a superficial and mid dermal perivascular dermatitis with frequent eosinophils) (seriousness criterion medically significant). On an unknown date, the patient experienced BLISTER (right foot between 2nd and 3rd toe one huge blister appeared/blisters are spreading slowly all over the body, to his chest, arms, hips) (seriousness criterion medically significant) and MACULE (a few days later some red bumps appeared in his ankle). The patient was treated with DEXAMETHASONE (DECADRON [DEXAMETHASONE]) for Bullous pemphigoid, at an unspecified dose and frequency; DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for Bullous pemphigoid, at an unspecified dose and frequency; TRIAMCINOLONE ACETONIDE for Bullous pemphigoid, at an unspecified dose and frequency and CLOBETASOL for Bullous pemphigoid, at an unspecified dose and frequency. At the time of the report, PEMPHIGOID (urticarial phase of bullous pemphigoid/bullous pemphigoid also called blistering disease/The biopsy result is a superficial and mid dermal perivascular dermatitis with frequent eosinophils) had not resolved and BLISTER (right foot between 2nd and 3rd toe one huge blister appeared/blisters are spreading slowly all over the body, to his chest, arms, hips) and MACULE (a few days later some red bumps appeared in his ankle) outcome was unknown.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 11-Jul-2022, Biopsy: Result is a superficial and mid dermal perivascular dermatitis with frequent eosinophils..     For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   No concomitant medications were reported. No past medical history was reported, and no medical history related to AE and both Acute and Chronic illnesses at the time of vaccination. Patient was not tested positive for COVID-19 since. No other vaccines given within 1 month prior to Moderna COVID-19 vaccine. No similar events were experienced by the patient in the past.  After the second Moderna Covid-19 vaccine booster dose it was reported that patient had experienced a lesion on the left lower leg and a second Lesion on the left big toe. The lesions were bothersome enough that the Patient went to see the Physician. The patient reports that the lesions looked maculopapular in nature. The patient was sent to a laboratory by the Physician and the lab performed a biopsy of the lesions. The biopsy result is a superficial and mid dermal perivascular dermatitis with frequent eosinophils. The differential diagnosis for the lesion on the patients left leg includes arthropod bite, hypersensitivity dermatitis, drug eruption, and urticarial phase of bullous pemphigoid. PAS-LG Stain for Fungi is pending. On the patients left great big toe the patient reports lichen simplex chronicus with evidence of prior erosion/ulceration. A few of the blisters have resolved after the patients physician treated with Dexamethasone.  After 2nd booster, on 26-Jun-2022 patient started to develop a rash in his left foot with blisters, and on 30-Jun-2022, patient visited a nurse practitioner who diagnosed with bullous pemphigoid also called blistering disease, which is a very rare and bad disease with no cure that can be deadly. After the treatment symptoms got better for a while, but a few days later some red bumps appeared in the ankle and it was more aggressive than before, and in the right foot between 2nd and 3rd toe one huge blister appeared, color was bright orange or yellow, and when patient was punctured the blister, a very bright orange or yellow liquid came out. Company Comment: This spontaneous case concerning a 77-year-old male patient with no relevant medical history, who experienced the unexpected, serious event of Pemphigoid which was medically significant and occurred 8 days after receiving the 2nd booster dose of mRNA-1273 vaccine along with unexpected, serious, Medically Significant event of Blisters which occurred on an unknown date. 4 days after receiving the 2nd booster patient started to develop a rash in his left foot with blisters, and 2 days later the patient visited a nurse practitioner who diagnosed him with bullous pemphigoid. Treatment given was an injection of Benadryl with Decadron and Triamcinolone acetonide cream. Symptoms improved, but a few days later some red bumps appeared in his ankle and was more aggressive than before, and in the right foot between 2nd and 3rd toe one huge blister appeared, color was bright orange or yellow, and when the blister was punctured, a very bright orange or yellow liquid came out. Patient visited a surgeon and biopsy was done on the huge blister in the right foot, but results were not provided. The biopsy site got infected a few days later and treatment given was antibiotics. Patient also visited an internist and was treated with Clobetasol. The patient stated that blisters are spreading slowly all over the body, to his chest, arms, hips. No further information on other laboratories, diagnostics, or other treatments were provided. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.   This case was linked to MOD-2022-613439 (Patient Link).   Most recent FOLLOW-UP information incorporated above includes: On 25-Jul-2022: Live follow up included additional reporters were added and the narrative was updated.; Sender's Comments: This spontaneous case concerning a 77-year-old male patient with no relevant medical history, who experienced the unexpected, serious event of Pemphigoid which was medically significant and occurred 8 days after receiving the 2nd booster dose of mRNA-1273 vaccine along with unexpected, serious, Medically Significant event of Blisters which occurred on an unknown date. 4 days after receiving the 2nd booster patient started to develop a rash in his left foot with blisters, and 2 days later the patient visited a nurse practitioner who diagnosed him with bullous pemphigoid. Treatment given was an injection of Benadryl with Decadron and Triamcinolone acetonide cream. Symptoms improved, but a few days later some red bumps appeared in his ankle and was more aggressive than before, and in the right foot between 2nd and 3rd toe one huge blister appeared, color was bright orange or yellow, and when the blister was punctured, a very bright orange or yellow liquid came out. Patient visited a surgeon and biopsy was done on the huge blister in the right foot, but results were not provided. The biopsy site got infected a few days later and treatment given was antibiotics. Patient also visited an internist and was treated with Clobetasol. The patient stated that blisters are spreading slowly all over the body, to his chest, arms, hips. No further information on other laboratories, diagnostics, or other treatments were provided. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.