Received Apr 30, 2026
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (MODERNA)) | MODERNA | 2 | — | — |
dissection of the right vertebral artery; acute infarct of the inferior right cerebellar hemisphere in the distribution of the posterior inferior cerebellar artery (PICA); evolving infarct in the right inferior cerebellum in the vicinity of the prior right PICA infarct; This literature-non-study case was reported in a literature article and describes the occurrence of VERTEBROBASILAR ARTERY DISSECTION (dissection of the right vertebral artery), CEREBELLAR INFARCTION (acute infarct of the inferior right cerebellar hemisphere in the distribution of the posterior inferior cerebellar artery (PICA)) and CONDITION AGGRAVATED (evolving infarct in the right inferior cerebellum in the vicinity of the prior right PICA infarct) in a 39-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 prophylaxis. LITERATURE REFERENCE: The patient's past medical history included COVID-19 (mild (diagnosed on antigen testing). Symptoms included moderate to severe cough, sore throat, chills, and myalgias, and were managed in the outpatient setting with antipyretics and phenylephrine. The patient's acute symptomatic phase lasted at least six days, with self-limited episodes of intermittent dizziness that persisted for several months after) in October 2020. Previously administered products included for COVID-19: phenylephrine in 2020. Past adverse reactions to the above products included No adverse effect with phenylephrine. Concurrent medical conditions included Hypertension (longstanding (more than five years)), Non-tobacco user and Abstains from alcohol. Concomitant products included Losartan potassium (Losartan) and Hydrochlorothiazide for Hypertension. In March 2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In 2021, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 06-May-2021, the patient experienced VERTEBROBASILAR ARTERY DISSECTION (dissection of the right vertebral artery) (seriousness criteria hospitalization and medically significant) and CEREBELLAR INFARCTION (acute infarct of the inferior right cerebellar hemisphere in the distribution of the posterior inferior cerebellar artery (PICA)) (seriousness criteria hospitalization and medically significant). On an unknown date, the patient experienced CONDITION AGGRAVATED (evolving infarct in the right inferior cerebellum in the vicinity of the prior right PICA infarct) (seriousness criterion medically significant). The patient was hospitalized from sometime in May 2021 to sometime in May 2021 due to CEREBELLAR INFARCTION and VERTEBROBASILAR ARTERY DISSECTION. The patient was treated with Physical therapy (physical therapy) for Cerebellar infarction and Physical therapy (physical therapy) for Condition aggravated. At the time of the report, VERTEBROBASILAR ARTERY DISSECTION (dissection of the right vertebral artery), CEREBELLAR INFARCTION (acute infarct of the inferior right cerebellar hemisphere in the distribution of the posterior inferior cerebellar artery (PICA)) and CONDITION AGGRAVATED (evolving infarct in the right inferior cerebellum in the vicinity of the prior right PICA infarct) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In October 2020, SARS-CoV-2 test: (Positive) mild case of COVID-19 (diagnosed on antigen testing). On an unknown date, Angiogram: Catheter angiography revealed a lack of contrast passage across the proximal right vertebral artery with backflow across the distal vertebral artery Fluoroscopy obtained on the day of presentation., Computed tomography with angiography of the head and neck identified dissection of the right vertebral artery, noting minimal residual flow from small vessel branches of the right thyrocervical trunk feeding the distal right vertebral vessel. Axial view of a CT angiogram obtained on the day of presentation demonstrating no passage of contrast through the right transverse foramen. The passage of contrast was observed through the left transverse foramen and Repeat CT angiogram of the head was obtained six weeks from presentation and was suggestive of subacute occlusion, revealing proximal occlusion of the right vertebral artery with reconstitution at the level of the mid cervical spine via thyrocervical trunk branches and muscular branches, as well as an evolving infarct in the right inferior cerebellum in the vicinity of the prior right PICA infarct. On an unknown date, Magnetic resonance imaging head: with and without contrast within the same hospitalization, which noted an acute infarct of the inferior right cerebellar hemisphere in the distribution of the posterior inferior cerebellar artery (PICA). Area of ischemia noted roughly 36 hours after initial presentation in the cerebellum on T2-FLAIR MRI imaging. The affected area demonstrating higher intensity signal owing to increased amount of fluid from reactive edema. On an unknown date, Modified Rankin score: modified Rankin score of 0, modified Rankin score of +1 and modified Rankin score of 0. On an unknown date, stroke scale: Stroke scale score of 2. On an unknown date, Neurological examination: on presentation to an outpatient clinic, the neurologic exam was initially unremarkable and Follow-up neurologic exams while inpatient were unremarkable. On an unknown date, Physical examination: cranial nerves 2-12 were intact, gait was normal; sensorium was grossly intact to light touch on the back, trunk, and extremities. Strength was normal and symmetric in all extremities, no hyperreflexia was noted, and coordination was noted to be intact on finger/nose, rapid alternating movements, and heel/shin. On an unknown date, Romberg test: (Negative) Reference range: not available. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. In early 2021, the patient received the first dose of the Moderna Spikevax vaccine series, and in March 2021, he received the second dose without any immediate post-vaccination complications. On 6-May-2021, nine months after infection, and three weeks after receiving the second dose of the vaccine, he developed a sudden onset of dizziness and left lower extremity weakness, which resolved within minutes. This coincided with a mild right-sided headache. He reported another sudden bout of dizziness and left upper (mild motor drift) and lower extremity weakness, which raised concern for a transient ischemic attack. This second bout of symptoms also resolved within minutes. He was referred to the emergency department (ED) for further evaluation. At the ED, computed tomography, catheter angiography was performed. He underwent MRI of the head with and without contrast within the same hospitalization. He was admitted for further workup and observation. Follow-up history was negative for cervical manipulation, recent excessive strain, or head/neck trauma; and he denied use of any steroids, illicit drugs. No autoimmune, thrombophilic, or connective tissue disorder screening was performed. He was discharged without neurologic deficits two days after admission on aspirin 81 mg daily, clopidogrel 75 mg daily, and a high-dose statin. At follow-up with neurointerventional radiology, no intervention on the occluded vessel was recommended, and dual antiplatelet therapy was continued. He subsequently followed up with neurology one month after initial presentation, without recurrence of his prior symptoms. The evolving infarct was later noted to have become symptomatic, with the patient having developed persistent disequilibrium, reportedly waxing and waning, on follow-up with his primary care manager 2.5 months after presentation. These symptoms were mild, having no effect on his ability to carry out activities of daily living or participate in work. On follow-up nine months from initial presentation, the patient was found to be in a normal state of health, his symptoms having resolved after completing a course of physical therapy targeted at improving balance. He completed a six-month course of dual antiplatelet therapy, following which he remained on low-dose aspirin only. His recovery and lack of residual symptoms eventually allowed him to remain on active duty. Author described a patient who developed a right vertebral artery dissection complicated by posterior circulation ischemic stroke following symptomatic COVID-19 infection and subsequent mRNA vaccination. Vertebral artery dissection (VAD) leading to a posterior inferior cerebellar artery (PICA) stroke. While mechanisms had been proposed for COVID-19 and vaccine-mediated endothelial damage and dysfunction, long-term vascular effects had yet to be fully defined. It should be stated that they presented only a temporal association for the purpose of hypothesis-generation. Though no causal conclusions should be drawn from this case, they recommend clinical vigilance in patients presenting with neurologic syndromes following COVID-19 or mRNA vaccination.; Reporter's Comments: Underlying hypertension and medical history of COVID-19 could be risk factors for the case. The benefit-risk relationship of product is not affected by this report.
Abstains from alcohol; Hypertension (longstanding (more than five years)); Non-tobacco user
Medical History/Concurrent Conditions: COVID-19 (mild (diagnosed on antigen testing). Symptoms included moderate to severe cough, sore throat, chills, and myalgias, and were managed in the outpatient setting with antipyretics and phenylephrine. The patient's acute symptomatic phase lasted at least six days, with self-limited episodes of intermittent dizziness that persisted for several months after)
Losartan; Hydrochlorothiazide
Test Name: Catheter angiography; Result Unstructured Data: Catheter angiography revealed a lack of contrast passage across the proximal right vertebral artery with backflow across the distal vertebral artery Fluoroscopy obtained on the day of presentation.; Test Name: computed tomography with angiography; Result Unstructured Data: Computed tomography with angiography of the head and neck identified dissection of the right vertebral artery, noting minimal residual flow from small vessel branches of the right thyrocervical trunk feeding the distal right vertebral vessel. Axial view of a CT angiogram obtained on the day of presentation demonstrating no passage of contrast through the right transverse foramen. The passage of contrast was observed through the left transverse foramen; Test Name: computed tomography with angiography; Result Unstructured Data: Repeat CT angiogram of the head was obtained six weeks from presentation and was suggestive of subacute occlusion, revealing proximal occlusion of the right vertebral artery with reconstitution at the level of the mid cervical spine via thyrocervical trunk branches and muscular branches, as well as an evolving infarct in the right inferior cerebellum in the vicinity of the prior right PICA infarct; Test Name: MRI of the head with and without contrast; Result Unstructured Data: with and without contrast within the same hospitalization, which noted an acute infarct of the inferior right cerebellar hemisphere in the distribution of the posterior inferior cerebellar artery (PICA). Area of ischemia noted roughly 36 hours after initial presentation in the cerebellum on T2-FLAIR MRI imaging. The affected area demonstrating higher intensity signal owing to increased amount of fluid from reactive edema; Test Name: Modified Rankin score; Result Unstructured Data: modified Rankin score of 0; Test Name: Modified Rankin score; Result Unstructured Data: modified Rankin score of +1; Test Name: Modified Rankin score; Result Unstructured Data: modified Rankin score of 0; Test Name: neurologic exam; Result Unstructured Data: on presentation to an outpatient clinic, the neurologic exam was initially unremarkable; Test Name: neurologic exam; Result Unstructured Data: Follow-up neurologic exams while inpatient were unremarkable; Test Name: Stroke Scale (SS); Result Unstructured Data: Stroke Scale (SS) score of 2; Test Name: On exam; Result Unstructured Data: cranial nerves 2-12 were intact, gait was normal; sensorium was grossly intact to light touch on the back, trunk, and extremities. Strength was normal and symmetric in all extremities, no hyperreflexia was noted, and coordination was noted to be intact on finger/nose, rapid alternating movements, and heel/shin; Test Name: Romberg; Test Result: Negative ; Test Date: 202010; Test Name: COVID-19 antigen test; Test Result: Positive