 The COVID-19 vaccination programme worldwide may reveal new adverse events associated with available vaccines, especially in sub-populations not included in clinical trials, such as patients with autoimmune diseases like multiple sclerosis, MS. A 34-year-old woman with RIMS who received GAM COVID-Vac three months after her last infusion of rachyximab and three days before experiencing a relapse episode presented with severe right hemiplegia and ataxia. Magnetic resonance imaging revealed several new lesions, and she was advised to receive the second dose of GAM COVID-Vac after discontinuation of all steroid taper. The safety of adenovirus-based vaccines in patients with autoimmune diseases requires further investigation, and clinicians should raise awareness among their patients regarding the potentially limited efficacy of COVID-19 vaccination in those treated with anti-CD-20 treatments. After careful risk-benefit assessments, planning a delay, pause in such treatments to create a time window for patients to receive the vaccine and develop anti-SARS-CoV-2 immunity may be recommended. This article was authored by Masoud Etimadafa, Amir Hossein Akavansigari, Nahad Sederhad, and others. We are article.tv, links in the description below.