Disclosures: Kevin Huang, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 71-year-old female with 20-year history of controlled seizures experiences breakthrough seizures following the Moderna COVID Vaccine.

Case Description or Program Description: The patient presented to the emergency department with chills and tremors 3 hours after her first dose of the Moderna vaccine. After 2 hours, she was discharged after her tremors abated. 7 hours later, the patient was found altered, feverish, and tachycardic. Workup revealed elevated troponin levels and positive E. coli urine culture. She was treated with antibiotics, but family reported she still experienced ‘atypical seizures’ that subsided after phenobarbital administration. MRI brain, EEG, CT head, and cardiac workup were unremarkable. Her baseline mental status returned 3 days after admission, but she experienced AMS and seizures shortly after discharge, requiring readmission. She was acutely encephalopathic with recurrent rigors, severe fevers, and seizures. Of note, the patient’s last seizure was 20 years ago. EEG showed no recurrent seizures, but revealed infective encephalopathy. Following stabilization and discharge to LTAC, the patient suffered a hip fracture secondary to a fall with subsequent transfer to acute rehab.

Setting: Acute Inpatient Rehab

Assessment/Results: The patient remained confused and agitated throughout her course. Her pain was difficult to control, but mobility and self-care did improve. No further epileptic activity was witnessed during her inpatient stay. Unfortunately, she remained max assist with most tasks requiring substantial care upon discharge.

Discussion (relevance): This case demonstrates a need for retrospective research of the COVID-19 vaccine among patients with epileptic history. Despite being seizure free for 20 years, she experienced adverse reactions following administration of the COVID-19 mRNA vaccine and subsequent devastating sequelae that caused severe deficits in self-care, mobility, and cognition.

Conclusions: The COVID-19 pandemic continues to challenge the safety standards of our current vaccination protocols. This poses a distinct challenge for rehabilitation and indicates a need for further research into adverse effects and contraindications to this vaccine.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/breakthrough-seizures-following-the-mrna-1273-moderna-covid-vaccine-a-case-report/