acute epithelial rejection of living-related conjunctival limbal allograft; This literature-non-study case was reported in a literature article and describes the occurrence of CORNEAL GRAFT REJECTION (acute epithelial rejection of living-related conjunctival limbal allograft) in a 27-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination.   LITERATURE REFERENCE: (Privacy)     The patient's past medical history included Living related conjunctival limbal allograft (Patient undergone LR-CLAL of the right eye 4 years and 7 months previously.). Concurrent medical conditions included Limbal stem cell deficiency (Patient had developed limbal stem-cell deficiency secondary to the use of contact lens.). Concomitant products included MYCOPHENOLATE MOFETIL, PREDNISONE and DIFLUPREDNATE for Corneal graft rejection, TACROLIMUS for an unknown indication.    On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date,  after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced CORNEAL GRAFT REJECTION (acute epithelial rejection of living-related conjunctival limbal allograft) (seriousness criterion medically significant). At the time of the report, CORNEAL GRAFT REJECTION (acute epithelial rejection of living-related conjunctival limbal allograft) had resolved.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Intraocular pressure test: normal (normal) normal. On an unknown date, Ophthalmological examination: normal Patient last examination 1 month before presentation revealed healthy LR-CLAL grafts with quiet conjunctiva, clear corneal epithelium, and stroma and abnormal Examination revealed significant improvement in the epitheliopathy although there remained a faint haze from the previous epithelial rejection line.. On an unknown date, Slit-lamp examination: abnormal Biomicroscopy findings included 1+ conjunctival hyperemia nasally which spared the LR-CLAL grafts. There was an irregular epithelial rejection line temporally which extended superiorly along the limbus with fluorescein instillation revealing late staining. There was no epithelial defect, corneal infiltrate, or edema. The anterior chamber was quiet.. On an unknown date, Visual acuity tests: 20/20 maintained a best-corrected visual acuity of 20/20., 20/20 visual acuity was 20/20 in the right eye and 20/20 Four weeks after the onset of corneal epithelial rejection, the patient's best-corrected visual acuity was 20/20 in the right eye..     The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown.   For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered CORNEAL GRAFT REJECTION (acute epithelial rejection of living-related conjunctival limbal allograft) to be related.    The patient presented with an acute redness and irritation of the right eye 15 days after receiving the first dose of the vaccine. She had no previous history of coronavirus disease 2019. Patient was started on difluprednate every hour in the right eye and oral prednisone  daily for acute epithelial rejection. Over the next week, patient symptoms improved and reported less redness. The examination showed a decrease in the prominence of the epithelial rejection line and the epitheliopathy. The difluprednate was tapered to every 2 hours, and the oral prednisone was decreased to 20 mg daily. The MMF was increased to 1000 mg twice daily. Two weeks later, there was further decrease in the whorl epitheliopathy and the epithelial rejection line continued to fade. The difluprednate was further tapered to 6 times daily, and the prednisone was tapered off over the next 3 weeks  Company comment: This literature non-study case concerns a 27-year-old female patient with history of limbal stem cell deficiency, living-related conjunctival limbal graft, experienced the unexpected serious AESI event, Corneal graft rejection, on an unknown date after first dose of mRNA-1273 received on an unknown date. The patient presented with an acute redness and irritation of the right eye 15 days after receiving the first dose of the vaccine. Patient was started on difluprednate every hour in the right eye and oral prednisone daily for acute epithelial rejection. Over the next week, patient symptoms improved and reported less redness. During the treatment, patient was advised to proceed as scheduled with the second dose of the SARS-CoV-2 vaccine while on increased topical and systemic immunosuppression. The patient did not have any further rejection episodes. The benefit-risk relationship of mRNA-1273 is not affected by this report.    Most recent FOLLOW-UP information incorporated above includes: On 07-Feb-2022: Follow up received by safety on 14-Feb-2022 has Email with (Privacy) received from (Privacy) team and contains significant information. Reporter information,  Literature information, Relevant history, Lab data. Product tab and Event tab were updated.; Sender's Comments: This literature non-study case concerns a 27-year-old female patient with history of limbal stem cell deficiency, living-related conjunctival limbal graft, experienced the unexpected serious AESI event, Corneal graft rejection, on an unknown date after first dose of mRNA-1273 received on an unknown date. The patient presented with an acute redness and irritation of the right eye 15 days after receiving the first dose of the vaccine. Patient was started on difluprednate every hour in the right eye and oral prednisone daily for acute epithelial rejection. Over the next week, patient symptoms improved and reported less redness. During the treatment, patient was advised to proceed as scheduled with the second dose of the SARS-CoV-2 vaccine while on increased topical and systemic immunosuppression. The patient did not have any further rejection episodes. The benefit-risk relationship of mRNA-1273 is not affected by this report.