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VAERS Report 2157247

Case Report Section

Vaer Report Details

Age: 79 years old

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: 000004a


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-01-21
Date of Onset
3
Number of days (onset date – vaccination date)
3
Adverse Event Description

peripheral paralysis of the vii right cranial nerve and retinal detachment right eye; peripheral paralysis of the vii right cranial nerve and retinal detachment right eye; peripheral paralysis of the vii right cranial nerve and retinal detachment right eye; peripheral paralysis of the vii right cranial nerve and retinal detachment right eye; this case was received via agency (reference number: it-minisal02-841298) on 25-feb-2022 and was forwarded to moderna on 25-feb-2022. this regulatory authority case was reported by a physician and describes the occurrence of facial paralysis (peripheral paralysis of the vii right cranial nerve and retinal detachment right eye), peripheral paralysis (peripheral paralysis of the vii right cranial nerve and retinal detachment right eye), retinal detachment (peripheral paralysis of the vii right cranial nerve and retinal detachment right eye) and bell's palsy (peripheral paralysis of the vii right cranial nerve and retinal detachment right eye) in a 79-year-old male patient who received mrna-1273 (spikevax) (batch no. 000004a) for covid-19 vaccination. no medical history information was reported. on 21-jan-2022, the patient received dose of mrna-1273 (spikevax) (intramuscular) 1 dosage form. on 24-jan-2022, the patient experienced facial paralysis (peripheral paralysis of the vii right cranial nerve and retinal detachment right eye) (seriousness criterion medically significant), peripheral paralysis (peripheral paralysis of the vii right cranial nerve and retinal detachment right eye) (seriousness criterion medically significant), retinal detachment (peripheral paralysis of the vii right cranial nerve and retinal detachment right eye) (seriousness criterion medically significant) and bell's palsy (peripheral paralysis of the vii right cranial nerve and retinal detachment right eye) (seriousness criterion medically significant). at the time of the report, facial paralysis (peripheral paralysis of the vii right cranial nerve and retinal detachment right eye), peripheral paralysis (peripheral paralysis of the vii right cranial nerve and retinal detachment right eye), retinal detachment (peripheral paralysis of the vii right cranial nerve and retinal detachment right eye) and bell's palsy (peripheral paralysis of the vii right cranial nerve and retinal detachment right eye) had not resolved. for mrna-1273 (spikevax) (intramuscular), the reporter did not provide any causality assessments. concomitant medication was not provided. treatment details were not provided. it was reported in sender's comments that on 09/02/2022 - entered anonymously, the report of both the neurological and ophthalmology examination, provided by the reporter. added bell's paralysis in the adverse reaction section, as indicated in the neurological examination report. company comment: this regulatory authority case concerns a 79-year-old male patient with no medical history reported, who experienced the unexpected serious events of peripheral paralysis and retinal detachment and expected serious aesi of facial paralysis and bell's palsy (seriousness criterion medically significant) which occurred 3 days after the third (booster) dose of mrna- 1273 vaccine. the benefit-risk relationship of mrna- 1273 vaccine is not affected by this report. events were assessed as serious by the regulatory authority report.; reporter's comments: performed anticovid19 booster vaccination with moderna vaccine on 21/01/2022, on 24/01/2022 appearance of retinal detachment right eye and peripheral paralysis vii nc right; sender's comments: this regulatory authority case concerns a 79-year-old male patient with no medical history reported, who experienced the unexpected serious events of peripheral paralysis and retinal detachment and expected serious aesi of facial paralysis and bell's palsy (seriousness criterion medically significant) which occurred 3 days after the third (booster) dose of mrna- 1273 vaccine. the benefit-risk relationship of mrna- 1273 vaccine is not affected by this report. events were assessed as serious by the regulatory authority report

Lab Data
na
List of symptoms
retinal detachment facial paralysis bell's palsy peripheral paralysis
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Unknown
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
No
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na