Third cranial nerve palsy in an 88-year-old man after SARS-CoV-2 mRNA vaccination: change of injection site and type of vaccine resulted in an uneventful second dose with humoral immune response.

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  • Additional Information
    • Source:
      Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 101526291 Publication Model: Electronic Cited Medium: Internet ISSN: 1757-790X (Electronic) Linking ISSN: 1757790X NLM ISO Abbreviation: BMJ Case Rep Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BMJ Pub. Group
    • Subject Terms:
      COVID-19* ; COVID-19 Vaccines*; Aged, 80 and over ; Antibodies, Viral ; BNT162 Vaccine ; Humans ; Immunity, Humoral ; Male ; Oculomotor Nerve ; Paralysis ; RNA, Messenger ; SARS-CoV-2 ; Vaccination/adverse effects
    • Abstract:
      Vaccines for SARS-CoV-2 currently authorised by the European Medicine Agency are effective, safe and well tolerated in practice. Awareness of rare potential vaccine-related adverse effects (AEs) is important to improve their recognition, management and reporting. An 88-year-old man attended the emergency department with incomplete palsy of the right third cranial nerve 3 days after the first administration of Moderna mRNA-1273 SARS-CoV-2 vaccine. Imaging ruled out a vascular accident and a vaccine AE was hypothesised. Two weeks of oral steroids led to the patient's recovery, but without evidence of humoral immune response to vaccine. Thus, full immunisation with a dose of Pfizer mRNA-BNT162b2 SARS-CoV-2 vaccine in a different site was attempted. This was uneventful and followed by a robust antibody response. Empirical change of site and vaccine brand may represent a tailored option to obtain full immune protection in selected patients, after vaccine AEs.
      Competing Interests: Competing interests: None declared.
      (© BMJ Publishing Group Limited 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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    • Contributed Indexing:
      Keywords: COVID-19; cranial nerves; peripheral nerve disease; unwanted effects / adverse reactions; vaccination/immunisation
    • Accession Number:
      0 (Antibodies, Viral)
      0 (COVID-19 Vaccines)
      0 (RNA, Messenger)
      N38TVC63NU (BNT162 Vaccine)
    • Publication Date:
      Date Created: 20220209 Date Completed: 20220210 Latest Revision: 20220223
    • Publication Date:
      20231215
    • Accession Number:
      PMC8830097
    • Accession Number:
      10.1136/bcr-2021-246485
    • Accession Number:
      35135792