Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Arthralgia, Asthenia, Blood test, Gait disturbance, Hypokinesia
Clinical narrative: Neck, legs,and shoulders were painful; Neck, legs,and shoulders were painful; problems in turning over in bed/going up and down stairs and getting in and out of my truck; problems in turning over in walking; Neck, legs,and shoulders were painful; patient don't have a lot of energy which is not normal for the patient; memory doesn't seem as sharp as it was; Did not have the strength in arms and legs that the patient had before the patient took the vaccine; Still has the pain; extreme muscle pain; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (extreme muscle pain), PAIN (Still has the pain), NECK PAIN (Neck, legs,and shoulders were painful), PAIN IN EXTREMITY (Neck, legs,and shoulders were painful) and HYPOKINESIA (problems in turning over in bed/going up and down stairs and getting in and out of my truck) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002C21A and 002C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 02-May-2021 at 11:35 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-May-2021 at 11:35 AM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 03-Jun-2021, the patient experienced MYALGIA (extreme muscle pain). On 16-Jul-2021, the patient experienced PAIN (Still has the pain). In August 2021, the patient experienced ASTHENIA (patient don't have a lot of energy which is not normal for the patient), MEMORY IMPAIRMENT (memory doesn't seem as sharp as it was) and MUSCULAR WEAKNESS (Did not have the strength in arms and legs that the patient had before the patient took the vaccine). On an unknown date, the patient experienced NECK PAIN (Neck, legs,and shoulders were painful), PAIN IN EXTREMITY (Neck, legs,and shoulders were painful), HYPOKINESIA (problems in turning over in bed/going up and down stairs and getting in and out of my truck), GAIT DISTURBANCE (problems in turning over in walking) and ARTHRALGIA (Neck, legs,and shoulders were painful). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) in August 2021 for Adverse event, at a dose of 600 mg three times a day; PREDNISONE for Adverse event, at a dose of 20 mg twice a day; PREDNISONE for Adverse event, at a dose of 20 mg, 1.5 tabs; PREDNISONE for Adverse event, at a dose of 20 mg once a day; PREDNISONE in August 2021 for Adverse event, at a dose of 20 mg, 0.5 tabs and PARACETAMOL (TYLENOL) in August 2021 for Adverse event, at an unspecified dose and frequency. At the time of the report, MYALGIA (extreme muscle pain), PAIN (Still has the pain), NECK PAIN (Neck, legs,and shoulders were painful), PAIN IN EXTREMITY (Neck, legs,and shoulders were painful), HYPOKINESIA (problems in turning over in bed/going up and down stairs and getting in and out of my truck), GAIT DISTURBANCE (problems in turning over in walking), ASTHENIA (patient don't have a lot of energy which is not normal for the patient), MEMORY IMPAIRMENT (memory doesn't seem as sharp as it was), MUSCULAR WEAKNESS (Did not have the strength in arms and legs that the patient had before the patient took the vaccine) and ARTHRALGIA (Neck, legs,and shoulders were painful) was resolving.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood test: high inflammation (High) showed high inflammation (inflammatory markers increased).         The patient had never been diagnosed or tested positive for COVID-19. The patient had none acute illnesses at the time of vaccination and up to one month before. After the second dose the muscle pain returned and was much more severe.  The pain caused problems in turning over in bed, walking, going up and down stairs and getting in and out of my truck.  After the patient was out of bed and got moving around, the patient could function a little better but pain did not go away.   The treatment with ibuprofen seemed to help a little. The worst pain was when the patient tried to bend over to pick something up off the floor.  The patient had to get down on knees and hopefully had something available to aid getting back up.   The physician suggested to take higher doses of Ibuprofen or Advil at least 3 times a day.  It did help with sleeping but still did not alleviate the pain.  Then the physician put the patient on 20 mg Prednisone with Tylenol but it took about 6 hours to start working and lasted 12 hours. Then the patient was put on 40 mg of Prednisone for 3 days then tapered off to 20 mg until all 15 pills were gone.  It was better but the patient still had issues with pain.    The patient was doing good and had no indication of pain, after taking the tapering doses of prednisone in early Aug-2021.   No concomitant medication details was provided.   This case was linked to MOD-2021-259078 (Patient Link).   Most recent FOLLOW-UP information incorporated above includes: On 20-Sep-2021: Significant followup appended - Events added, treatment details updated, added lab data