PT  - JOURNAL ARTICLE
AU  - Maria Pia Cicalese
AU  - Francesca Ferrua
AU  - Federica Barzaghi
AU  - Federica Cerri
AU  - Matteo Moro
AU  - Alessandro Aiuti
AU  - Paolo Silvani
TI  - 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
AID  - 10.1136/bcr-2021-246485
DP  - 2022 Feb 01
TA  - BMJ Case Reports
PG  - e246485
VI  - 15
IP  - 2
4099  - http://casereports.bmj.com/content/15/2/e246485.short
4100  - http://casereports.bmj.com/content/15/2/e246485.full
SO  - BMJ Case Reports2022 Feb 01; 15
AB  - 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.