Altered mental status and pronounced febrile response after second mRNA-1273 (Moderna) COVID-19 vaccine administration in a patient with previously documented COVID-19 infection

Abstract

A 54-year-old man who was previously found to be COVID-19 positive received two doses of mRNA-1273 (Moderna) vaccine 4 weeks apart, as recommended by the manufacturer. He was brought to the emergency department 1 day after second dose of the vaccine with altered mental status, headache and high fever. The patient was hospitalised for 2 days and managed with supportive care. He completely recovered with return of mental status to baseline and resolution of fever.

Psychiatric adverse reactions to COVID-19 vaccines: A rapid review of published case reports

“…In some individuals, this may lead to cytokine storm and NMDA receptor hypofunction with a resultant increase in dopamine; this may trigger a psychotic state ( Grover et al, 2022a ). Other hypothesized causes for psychosis post-vaccination include anti-NMDA encephalitis ( Flannery et al, 2021 , Hilaire et al, 2021 ). Majority of the index cases patients had no prior history of psychiatric illness before receipt of vaccine.…”

“… Takata et al, 2021 42/F Second dose of ChAdOx1 nCoV-19 vaccine (Viral vector vaccine) Altered mental status Few days Alert but disoriented to time, person and place, agitated with labile affect, hallucinations (visual and tactile) 2. Hilaire et al, 2021 54/M Second dose mRNA-1273 vaccine (mRNA vaccine) Altered mental status 1 day Altered mental status, headache and high fever. History of type 2 diabetes mellitus, atrial flutter, hypothyroidism, well-controlled seizure disorder, and a remote history of traumatic brain injury 3.…”

“…There were three reports of altered mental status characterized by disorientation, hallucinations, and labile affect within 0-10 days of vaccination. These presentations were reported after second dose of ChAdOx1 nCoV-19 vaccine( Takata et al, 2021 ), mRNA-1273 COVID-19 vaccine( Hilaire et al, 2021 ), and first dose of AstraZeneca COVID-19 vaccine( Roberts et al, 2021 ), respectively. Two of these described males over 50 years of age ( Hilaire et al, 2021 , Roberts et al, 2021 ) and one described a 22-year-old female ( Takata et al, 2021 ).…”

“…These presentations were reported after second dose of ChAdOx1 nCoV-19 vaccine( Takata et al, 2021 ), mRNA-1273 COVID-19 vaccine( Hilaire et al, 2021 ), and first dose of AstraZeneca COVID-19 vaccine( Roberts et al, 2021 ), respectively. Two of these described males over 50 years of age ( Hilaire et al, 2021 , Roberts et al, 2021 ) and one described a 22-year-old female ( Takata et al, 2021 ). None of them had a previous psychiatric history.…”

Role of Psychosomatic Symptoms in COVID-19 Vaccine Hesitancy

“…Vaccination could also trigger a smaller but similar immune response, potentially leading to the development of neuropsychiatric symptoms [ 37 ]. Case reports have described delirium, psychosis, mania, depression, anxiety, and confusion, among other symptoms, in both psychiatric and non-psychiatric patients [ 29 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ].…”