Compilation of 145 Case Reports of Vaccine Related Myo/Pericarditis & Other Cardiac Injuries
Compilation of 145 Case Reports of Vaccine Related Myo/Pericarditis & Other Cardiac Injuries
Mild & Rare Indeed.....
Compilation of 145 Case Reports of Vaccine Related Myo/Pericarditis & Other Cardiac Injuries
I attempted to collect every myocarditis/pericarditis case report published as of 5/16.
I had to remove 6 for being unrelated which messed up the number scheme, but it would take too much time to go through them all manually, so the #’s formerly used for the removed studies are skipped.
They are organized by date published online, oldest to newest.
A brief primer for laypeople: A case report or case series is a report written by the attending physicians - sometimes with help or input from others - describing the clinical details of a patient they treated. They are exceedingly rare, as doctors don’t have the time to write up lengthy academic papers on a level that is acceptable to submit to a legit medical journal. Also, with the covid vaccines, there is the additional pressure to not make the vaccines look bad in any way or promote “vaccine hesitancy”.
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1: Temporal relation between second dose BNT162b2 mRNA Covid-19 vaccine and cardiac involvement in a patient with previous SARS-COV-2 infection
Author: Ammirati et al
Country: Italy
Date Published Online: 3/31/21
Vaccine: Pfizer
Link: https://www.sciencedirect.com/science/article/pii/S2352906721000622
Case: “An otherwise healthy 56-year-old man presented to the emergency department complaining of acute onset of chest pain 3 days after the second dose of BNT162b2 mRNA COVID-19 vaccine. He did not report fever, systemic symptoms or cutaneous rash after the first and second dose of the vaccine.”
2: COVID-19 mRNA Vaccine-Associated Myocarditis Presenting as STEMI in a 48-Year-Old Male
Author: Dlewati et al
Country: US
Date Published Online: 4/15/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35465413/
Case: “Myocarditis has been recognized as a rare complication of coronavirus disease 2019 (COVID-19) mRNA vaccinations. Young adult and adolescent males < 30 years of age are the most commonly affected group, with decreased incidence with older age. This is a case of a 48-year-old male who presented with chest pain and EKG findings of STEMI shortly after receiving the second dose of the Moderna COVID-19 mRNA vaccine. Emergent left heart catheterization revealed normal coronaries. Subsequently, the patient had rapid resolution of his symptoms and improvement in serum markers. The exact etiology factors to this new and rare phenomenon are yet to be fully understood. This patient did have a history of previous viral myocarditis 7 years ago; however, it remains unclear if this could be a predisposing factor to the development of mRNA vaccine-associated myocarditis.”
3: Acute myocarditis after administration of the BNT162b2 vaccine against COVID-19
Author: Garcia et al
Country: Spain
Date Published Online: 4/27/21
Vaccine: Pfizer
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075838/
Case: “We describe the case of a 39-year-old male physician, with a past medical history of asthma, autoimmune hypothyroidism, chronic atrophic gastritis, an isolated episode of atrial fibrillation, and recurrent spontaneous pneumothorax with left apical lobectomy.”
4: Myocarditis following COVID-19 vaccination
Author: Albert et al
Country: US
Date Published Online: 5/18/21
Vaccine: Moderna
Link: https://www.sciencedirect.com/science/article/pii/S1930043321003289
Case: “We report a case of a 24-year-old man who presented to the hospital with acute substernal chest pain, 4 days after his second COVID-19 Moderna vaccination. Laboratory studies revealed elevated troponins and negative viral serologies. Cardiac magnetic resonance imaging (cMRI) demonstrated edema and delayed gadolinium enhancement of the left ventricle in a midmyocardial and epicardial distribution. The patient was diagnosed with myocarditis following Moderna vaccination. Our case report raises concern that myocarditis is a rare side effect of COVID-19 vaccine. Despite our report, it appears that there is a significantly higher risk of cardiac involvement from COVID-19 infection compared to COVID-19 vaccination.”
5: Myocarditis following COVID-19 mRNA vaccination
Author: Abu Mouch et al
Country: Israel
Date Published Online: 5/28/21
Vaccine: Pfizer
Case: “Five patients presented after the second and one after the first dose of the vaccine. All patients were males with a median age of 23 years. Myocarditis was diagnosed in all patients, there was no evidence of COVID-19 infection. Laboratory assays excluded concomitant infection; autoimmune disorder was considered unlikely. All patients responded to the BNT162b2 vaccine. The clinical course was mild in all six patients.”
6: Acute myocarditis associated with anti-COVID-19 vaccination
Author: Nevet
Country: Israel
Date Published Online: 5/31/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34222133/
Case: “We report on three young male patients, who developed acute myocarditis 2 days after receiving the second dose of the BNT162b2 vaccine. Primary acute myocarditis was not previously reported in association with vaccines that do not include adjuvants. A high index of suspicion should be maintained in order to diagnose and treat patients who develop auto-inflammatory vaccine-related complications in a timely manner. Further research is required in order to explore the significance of this phenomenon and its underlying molecular mechanism.”
8: Transient Cardiac Injury in Adolescents Receiving the BNT162b2 mRNA COVID-19 Vaccine – PubMed
Author: Snapiri et al
Country: Israel
Date Published Online: 6/2/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34077949/
Case: “All patients were males 16-18 years old, of Jewish descent, who presented with chest pain that began 1-3 days following vaccination (mean, 2.1 days). In 6 of the 7 patients, symptoms began following the 2nd dose and in 1 patient following the 1st dose. All cases were mild and none required cardiovascular or respiratory support. The incidence of perimyocarditis during the vaccination period was elevated in comparison to previous years.”
9: Myocarditis After SARS-CoV-2 Vaccination: A Vaccine-Induced Reaction?
Author: D'Angelo et al
Country: Italy
Date Published Online: 6/8/21
Vaccine: Pfizer
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187737/
Case: “Myocarditis has been reported as a possible and rare adverse consequence of different vaccines, and its clinical presentation can range from influenza-like symptoms to acute heart failure. We report a case of a 30-year-old man who presented progressive dyspnea and constrictive retrosternal pain after receiving SARS-CoV-2 vaccine. Cardiac magnetic resonance and laboratory data revealed typical findings of acute myopericarditis.”
10: Myocarditis and Other Cardiovascular Complications of the mRNA-Based COVID-19 Vaccines - PubMed
Author: Vidula et al
Country: US
Date Published Online: 6/10/21
Vaccine: Pfizer, Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34277198/
Case: “Cardiovascular complications following the receipt of mRNA-based (Pfizer-BioNTech and Moderna) coronavirus disease 2019 (COVID-19) vaccines have not yet been described. In this case series, we describe two patients with clinically suspected myocarditis, one patient with stress cardiomyopathy, and two patients with pericarditis after receiving an mRNA-based COVID-19 vaccine. The two patients with clinically suspected myocarditis were otherwise healthy young men who presented with acute substernal chest pressure and/or dyspnea after receiving the second dose of the vaccine and were found to have diffuse ST elevations on electrocardiogram (ECG), elevated cardiac biomarkers and inflammatory markers, and mildly reduced left ventricular (LV) function on echocardiography. Both patients met the modified Lake Louise Criteria for acute myocarditis by cardiac magnetic resonance imaging. We subsequently discuss a case of a 60-year-old woman with known coronary artery disease (CAD) and previously normal LV function, who presented with new exertional symptoms, ECG changes, and apical akinesis following the second dose of the vaccine, and was diagnosed with a stress cardiomyopathy. Finally, we describe two patients with pericarditis who presented with chest pain, elevated inflammatory markers, and pericardial effusions after receiving the vaccine. Overall, this case series describes the first reported cases of myocarditis, stress cardiomyopathy, and pericarditis after receiving an mRNA-based COVID-19 vaccine.”
11: Pericarditis after administration of the BNT162b2 mRNA vaccine against COVID-19 - PMC
Author: Ramírez-García et al
Country: Spain
Date Published Online: 6/12/21
Vaccine: Pfizer
Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8196309/
Case: “Here we report 2 cases of pericarditis after administration of the BNT162b2 vaccine. Both patients have given their consent for the publication of the clinical case and, in addition, these adverse events have been reported to the Spanish System of Pharmacovigilance of Medicines for Human Use.
Case 1 is a 36-year-old man with a history of idiopathic acute pericarditis in 2013, without routine treatment. He went to the emergency room for oppressive chest pain that had lasted for hours, which was unrelated to exertion, increased with deep inspiration and lying down, and improved with sitting. The patient reported similarity of pain with the previous episode of pericarditis. He had no fever and denied recent respiratory infections. He had no history of COVID-19. He had received the second dose of the BioNTech-Pfizer mRNA vaccine 11 days before the onset of symptoms.
Case 2 is an 80-year-old man with a history of paroxysmal atrial fibrillation treated by cryoablation of the pulmonary veins in 2009. He was referred to the emergency room by his primary care physician for pain of 4 days' duration located in the left hemithorax. There was no relationship with the efforts and worsened with deep inspiration. He had no fever and denied recent respiratory infections. He had received the second dose of the BioNTech-Pfizer mRNA vaccine 11 days before the onset of symptoms. He had no history of COVID-19.” [Google Translate from Spanish]
12: COVID-19 mRNA Vaccine and Myocarditis
Author: Singh et al
Country: US
Date Published Online: 6/14/21
Vaccine: Pfizer
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276934/
Case: “We describe the case of a 24-year-old Caucasian man with no past medical history who presented to the Emergency Department (ED) with chest pain which had woken him from sleep. The pain was left-sided, severe, constant, non-radiating, was associated with headache and had started 30 min before arrival in the ED. The patient denied taking any over-the-counter medications for pain relief.
The patient had received his second dose of BNT162b2 (Pfizer-BioNTech COVID-19 vaccine) 3 days before the episode. On the day he received the second dose, he developed subjective fever, chills, fatigue, headache and lower back pain, which resolved over the next 24 hours. The night before presenting to the hospital, he had shoveled snow for about 30 minutes. The next morning, he developed chest pain which prompted him to come to the ED.”
13: A Series of Patients With Myocarditis Following SARS-CoV-2 Vaccination With mRNA-1279 and BNT162b2 – ScienceDirect
Author: Dickey et al
Country: US
Date Published Online: 6/16/21
Vaccine: Pfizer, Moderna
Link: https://www.sciencedirect.com/science/article/pii/S1936878X21004861
Case: “Six previously healthy men (17-37 years of age) with no infectious prodrome developed severe chest pain and elevated troponin I within 2 days-4 days of their second vaccination (Figure 1). Five patients had ST-segment elevation on presentation, with 4 demonstrating no coronary artery obstruction. All patients had negative nasopharyngeal SARS-CoV-2 PCR testing. CMR revealed patchy midmyocardial increased T2 signal with corresponding late gadolinium enhancement consistent with the acute inflammation of myocarditis (Figure 1). Five patients had abnormal left ventricular systolic function. None of the patients developed any other complications, and all were discharged home.”
14: Acute myocarditis following administration of BNT162b2 vaccine
Author: Habib et al
Country: Qatar
Date Published Online: 6/16/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34189042/
Case: “A 37-year-old Filipino man, ex-smoker, drinking alcohol occasionally, was on regular bisoprolol for hypertension, with no history of cardiac disease, presented to the emergency department on 23 April 2021 with a new onset of severe chest pain starting three days after receiving the second dose of BNT162b2 vaccine. The pain was retrosternal, non-radiating, squeezing in nature, with no change to body position or breathing. It was preceded by generalized body aches, fever, chills, and headache for one day, but no other complaints.”
15: Myocarditis After BNT162b2 and mRNA-1273 Vaccination - PMC
Author: Larson et al
Country: US, Italy
Date Published Online: 6/16/21
Vaccine: Pfizer, Moderna
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340725/
Case: “Here, we describe 8 patients who were hospitalized with chest pain and who were diagnosed with myocarditis by laboratory and cardiac magnetic resonance imaging within 2 to 4 days of receiving either the BNT162b2 or mRNA-1273 vaccine (Table). Patients provided written informed consent, and the collection of clinical cases followed local Institutional Review Board requirements. The data that support the findings of this study are available from the corresponding author on reasonable request. Two of the patients (patients 3 and 4) had previously been infected by SARS-CoV-2 without need for hospitalization. All individuals were otherwise healthy males between the ages of 21 and 56 years. All but 1 patient developed symptoms after their second dose. Systemic symptoms began within 24 hours after vaccine administration in 5 out of 8 patients, with chest pain presenting between 48 and 96 hours later. Chest pain was most commonly described as constant, nonpositional, and nonpleuritic (only patient 7 reported pericardial pain), consistent with acute myocarditis mainly without pericardial involvement. Troponin values were elevated in all individuals and appeared to peak the day after admission, whereas no patient had eosinophilia. All patients were tested and were negative for SARS-CoV-2.”
16: Myopericarditis in a previously healthy adolescent male following COVID-19 vaccination: A case report
Author: Mclean & Johnson
Country: US
Date Published Online: 6/16/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34133825/
Case: “We report the case of a previously healthy 16-year-old male who developed myopericarditis following the second dose of his Pfizer-BioNTech COVID-19 vaccine, with no other identified triggers. Adolescents and young adults experiencing chest pain after COVD-19 vaccination should seek emergent medical care, and emergency providers should have a low threshold to consider and evaluate for myopericarditis. More data are needed to better understand the potential association between COVID-19 vaccines and myopericarditis. If a true causal link is identified, the risk must also be viewed in context with the millions of patients who have been safely vaccinated and the known morbidity and mortality from COVID-19 infection. As we see widespread vaccine rollout, it is important that all potential adverse reactions are reported as we continue to monitor for more rare but potentially serious side effects not identified in vaccination trials.”
17: In-Depth Evaluation of a Case of Presumed Myocarditis After the Second Dose of COVID-19 mRNA Vaccine
Author: Muthukumar
Country: US
Date Published Online: 6/16/21
Vaccine: Moderna
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340727/
Case: “A 52-year-old man presented to the emergency department ≈90 min after the onset of substernal chest pain. Three days before presentation, he received his second dose of mRNA-1273 (Moderna) vaccine for coronavirus disease 2019 (COVID-19), and the next day had a severe reaction that he described as being the “worst he had ever felt.” He had subjective high fevers, shaking chills, myalgias, and a headache. These symptoms largely resolved by the third day after vaccination except for a positional headache that was unusual for him. On the morning of hospitalization, he walked 3 to 4 miles and felt fine. Later that day, while in a meeting, he developed persistent midsternal chest discomfort without radiation, prompting him to seek evaluation in a university hospital emergency department. The pain subsided spontaneously after approximately 3 hours. He had no associated dyspnea, palpitations, dizziness, fever, chills, or myalgia.”
18: Myocarditis Temporally Associated With COVID-19 Vaccination
Author: Rosner et al
Country: US
Date Published Online: 6/16/21
Vaccine: Pfizer, Moderna, J&J
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340723/
Case: “We present a case series of 7 patients hospitalized for acute myocarditis-like illness after COVID-19 vaccination, from 2 US medical centers in Falls Church, VA, and Dallas, TX. All were men <40 years of age and of White or Hispanic race/ethnicity (Table). Only 1 patient reported previous history of COVID-19 infection. Six patients received an mRNA vaccine (Moderna or Pfizer/BioNTech), and 1 received the adenovirus vaccine (Johnson and Johnson). All patients presented 3 to 7 days after vaccination with acute onset chest pain and biochemical evidence of myocardial injury, by cTnI ([cardiac troponin I]; Abbott Diagnostics, Lake Forest, IL) (mean peak, 15.77 ng/mL; median peak, 12.01 ng/mL) or elevated high-sensitivity cTnI (Abbott Diagnostics) (peak, 7000 ng/L). All were hemodynamically stable and none had a pericardial friction rub or rash. ECG patterns varied from normal to ST segment elevation. Three patients underwent invasive coronary angiography, and none had evidence of obstructive coronary artery disease. Echocardiograms showed left ventricular ejection fraction ranging from 35% to 62%, with 5 of 7 having some degree of hypokinesis. Patients underwent cardiac magnetic resonance imaging between 3 and 37 days after vaccination, including multiplanar SSFP sequences, short axis T1 and T2 stacks, T1 mapping when available and multiplanar myocardial late gadolinium enhancement. Multifocal subepicardial late gadolinium enhancement was present in 7 of 7 patients and additional midmyocardial late gadolinium enhancement was 4 of 7 patients. There was corresponding myocardial edema in 3 of 7 patients. Two patients who underwent cardiac magnetic resonance imaging >7 days from presentation had no edema, with an additional patient’s T2 images limited by artifact. One patient underwent endomyocardial biopsy without pathological evidence of myocarditis. No patients reported palpitations, and there was no evidence of sustained arrhythmias.”
19: Possible Association Between COVID-19 Vaccine and Myocarditis
Author: Shaw et al
Country: US
Date Published Online: 6/16/21
Vaccine: Pfizer, Moderna
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245050/
Case: “We present cardiac magnetic resonance (CMR) imaging findings in 4 cases of acute myocarditis that were temporally related to the receipt of COVID-19 vaccine and could raise the possibility of being associated with the vaccination (Figures 1, ,2,2, ,3,3, ,4,4, and and5 ).5 ). CMR imaging used a specific institutional imaging protocol (see the following text) to evaluate for the presence of myocardial edema and nonischemic myocardial injury configuring the main criteria according to the updated Lake Louise criteria (1). To our knowledge, this is the largest case series to date with a comprehensive timeline description (Figure 1) and systematic CMR imaging evaluation of this potential adverse reaction to the COVID-19 vaccine. The fact that the 2 patients with prior COVID-19 infection developed symptoms following their first dose, and the 2 patients without prior COVID-19 infection developed symptoms following their second dose, raises interesting possibilities about a potential immune-boosting mechanism after prior immune exposure or priming.”
20: Acute myocarditis after a second dose of the mRNA COVID-19 Vaccine: a report of two cases
Author: Mansour et al
Country: US
Date Published Online: 6/18/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34166884/
Case: “We report two cases of myocarditis, in two young and previously healthy individuals, temporally related to the second dose of the mRNA-COVID-19 vaccine. Both patients developed acute chest pain, changes on electrocardiogram (ECG), and elevated serum troponin within two days of receiving their second dose. Cardiac magnetic resonance (CMR) findings were consistent with acute myocarditis.”
21: Self-limited myocarditis presenting with chest pain and ST segment elevation in adolescents after vaccination with the BNT162b2 mRNA vaccine
Author: Park et al
Country: US
Date Published Online: 6/18/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34180390/
Case: “Two adolescent males presented within 3 days after the first and second dose of the BNT162b2 vaccine with chest pain. Elevated troponin levels, ST segment elevation, and enhancement of the myocardium in cardiac MRI suggested myocarditis. Left ventricular function remained normal, symptoms resolved, and patients were discharged in 4 days. BNT162b2 vaccine may be associated with self-limited myocarditis in youth.”
22: Myocarditis Associated with mRNA COVID-19 Vaccination | Radiology
Author: Starekova et al
Country: US
Date Published Online: 6/20/21
Vaccine: Pfizer, Moderna
Link: https://pubs.rsna.org/doi/10.1148/radiol.2021211430
Case: “In this retrospective institutional review board–approved and Health Insurance Portability and Accountability Act–compliant study, cardiac MRI examinations performed at our institution between January 1 and May 25, 2021, were reviewed for MRI findings of myocarditis and pericarditis. Subsequently, electronic health records were reviewed, and all patients who received COVID-19 vaccine preceding cardiac MRI were included (consecutive sample). Informed consent was waived per institutional review board protocol. Patients with a history of prior COVID-19 were excluded.”
“Five patients (4:1 male:female; age range, 17–38 years) were identified who had abnormal MRI findings and were vaccinated against COVID-19 prior to MRI. Cardiac troponin levels and electrocardiogram findings were abnormal in all patients. All patients were hospitalized due to acute onset of chest pain with diagnosis of acute myocarditis.
Patients 1–3 received their second dose of BNT162b2 vaccine 2 days, 3 days, and 2 days, respectively, before onset of chest pain. Patients 4 and 5 both received their second dose of mRNA-1273 at 3 days before onset of chest pain. In all patients, MRI showed myocarditis-like findings including nonischemic pattern of late gadolinium enhancement, corresponding signal abnormalities on T2-weighted images, and pericardial enhancement (Table, Figure). Diagnostic considerations included pulmonary embolus or acute coronary event with additional imaging-based testing (Table). Ipsilateral axillary lymphadenopathy to the vaccination site was identified in four patients. COVID-19 testing at the time of diagnosis (and history of prior COVID-19) were negative. No respiratory symptoms, prodrome, or skin rash were present prior to vaccination. Furthermore, medical history did not reveal any preexisting cardiac disease in these patients.”
23: Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination
Author: Kim HW et al
Country: US
Date Published Online: 6/29/21
Vaccine: Pfizer, Moderna
Link: https://jamanetwork.com/journals/jamacardiology/article-abstract/2781602
Case: “In this study of 7 patients with acute myocarditis, 4 occurred within 5 days of COVID-19 vaccination between February 1 and April 30, 2021. All 4 patients had received the second dose of a messenger RNA (mRNA) vaccine, presented with severe chest pain, had biomarker evidence of myocardial injury, were hospitalized, and had cardiac magnetic resonance imaging findings typical of myocarditis.”
24: Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military - PubMed
Author: Montgomery et al
Country: US
Date Published Online: 6/29/21
Vaccine: Pfizer, Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34185045/
Case: “A total of 23 male patients (22 currently serving in the military and 1 retiree; median [range] age, 25 [20-51] years) presented with acute onset of marked chest pain within 4 days after receipt of an mRNA COVID-19 vaccine. All military members were previously healthy with a high level of fitness. Seven received the BNT162b2-mRNA vaccine and 16 received the mRNA-1273 vaccine. A total of 20 patients had symptom onset following the second dose of an appropriately spaced 2-dose series. All patients had significantly elevated cardiac troponin levels. Among 8 patients who underwent cardiac magnetic resonance imaging within the acute phase of illness, all had findings consistent with the clinical diagnosis of myocarditis. Additional testing did not identify other etiologies for myocarditis, including acute COVID-19 and other infections, ischemic injury, or underlying autoimmune conditions. All patients received brief supportive care and were recovered or recovering at the time of this report.”
25: Myocarditis after BNT162b2 vaccination in a healthy male - PubMed
Author: Watkins et al
Country: US
Date Published Online: 6/29/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34229940/
Case: “In this article, we present a case of a 20-year-old male with no prior medical history who presented to the emergency department (ED) with chest pain. He had received the BNT162b2 vaccine two days prior to his presentation to the ED. The patient had an elevated troponin at 89 ng/L which increased on repeat examination. His electrocardiogram showed diffuse concave ST segment elevations and a later MRI confirmed the diagnosis of myocarditis. Based on these findings, the patient was diagnosed with myocarditis. The patient had a previous infection with SARS-CoV-2 approximately two months prior to the onset of his symptoms, but since he had fully recovered before the time of his presentation to the ED, it is unlikely that the infection caused the myocarditis. To our knowledge, this is the first published case of myocarditis following BNT162b3 vaccination.”
26: A spectrum of cardiac manifestations post Pfizer-BioNTech COVID-19 vaccination
Author: Lee E et al
Country: Singapore
Date Published Online: 6/30/21
Vaccine: Pfizer
Link: https://academic.oup.com/qjmed/article/114/9/661/6311674
Case: “In this case series, we describe three previously asymptomatic patients who presented with cardiac-related manifestations shortly after receiving the Pfizer-BioNTech COVID-19 vaccine.”
27: Acute myocarditis after the second dose of SARS-CoV-2 Vaccine: Serendipity or atypical causal relationship?
Author: Cereda et al
Country: Italy
Date Published Online: 7/1/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34236331/
Case: “A 21-year-old male health worker with no previous medical or cardiac history was admitted to the emergency room with fever and cardiac-sounding chest pain. Electrocardiogram showed diffuse concave-upward ST-segment elevation and troponin elevation (troponin I: 6.53 ng/mL, C-reactive protein: 2.4 mg/dL) (Fig. 1a and 1b). He had been administered the second dose of the Pfizer mRNABNT162b2 Comirnaty® SARS-CoV-2 vaccine (the EU Brand Name for Pfizer & BioNTech’s COVID-19 Vaccine, Developed by Brand Institute) 30 hours earlier.”
28: Acute Myocardial Injury Following COVID-19 Vaccination: A Case Report and Review of Current Evidence from Vaccine Adverse Events Reporting System Database.
Author: Deb et al
Country: US
Date Published Online: 7/3/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34219532/
Case: “COVID-19 vaccination related adverse events is an evolving field. Here we present a case of acute myocardial injury that developed as a result of an acute immune response following the second dose of COVID-19 vaccination (Moderna) in a 67-year-old man who presented in acute congestive heart failure. His clinical course improved over 3 days. Review of the Vaccine Adverse Events Reporting System (VAERS) in the Centers for Disease Control and Prevention websites identified 37 vaccine recipients who developed myocarditis as an adverse event following COVID-19 vaccination. With the mass expansion of COVID-19 vaccine administration, physicians need to be vigilant about the possibility of new adverse events.”
29: Myopericarditis After the Pfizer Messenger Ribonucleic Acid Coronavirus Disease Vaccine in Adolescents - PMC
Author: Schauer et al
Country: US
Date Published Online: 7/3/21
Vaccine: Pfizer
Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8253718/
Case: “We describe 13 patients aged 12-17 years who presented with chest pain within 1 week after their second dose of the Pfizer vaccine and were found to have elevated serum troponin levels and evidence of myopericarditis.”
30: Myocarditis-induced Sudden Death after BNT162b2 mRNA COVID-19 Vaccination in Korea: Case Report Focusing on Histopathological Findings – PMC
Author: Choi et al
Country: Korea
Date Published Online: 7/10/21
Vaccine: Pfizer
Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8524235/
Case: “We present autopsy findings of a 22-year-old man who developed chest pain 5 days after the first dose of the BNT162b2 mRNA vaccine and died 7 hours later. Histological examination of the heart revealed isolated atrial myocarditis, with neutrophil and histiocyte predominance. Immunohistochemical C4d staining revealed scattered single-cell necrosis of myocytes which was not accompanied by inflammatory infiltrates. Extensive contraction band necrosis was observed in the atria and ventricles. There was no evidence of microthrombosis or infection in the heart and other organs. The primary cause of death was determined to be myocarditis, causally-associated with the BNT162b2 vaccine.”
31: COVID-19 vaccine-induced myocarditis: Case report with literature review
Author: Nassar et al
Country: US
Date Published Online: 7/10/21
Vaccine: J&J
Link: https://pubmed.ncbi.nlm.nih.gov/34293552/
Case: “A 70-year-old Caucasian female with a history of multiple sclerosis presented to the hospital after two days of receiving the Janssen COVID-19 vaccine. The patient developed dyspnea at home and eventually required an ambulance for hospital transfer.”
32: Acute Myocardial Infarction Within 24 Hours After COVID-19 Vaccination - American Journal of Cardiology
Author: Sung et al
Country: US
Date Published Online: 7/13/21
Vaccine: Moderna
Link: https://www.ajconline.org/article/S0002-9149(21)00631-7/fulltext
Case: “In conclusion, we report 2 cases of acute myocardial infarction with onset <24 hours after the first dose of a COVID-19 vaccine in patients presenting with shoulder pain.”
“In the first case, the patient experienced gradual onset of left shoulder pain within 1 day after her first dose of COVID-19 vaccine (mRNA-1273) that later progressed to left-sided chest pain. She initially attributed her symptoms to the vaccine. She presented to the emergency department (ED) approximately two hours after chest pain (Table 1).”
“The patient in the second case presented with 4 days of chest and shoulder pain. Symptoms started the night after he had his first dose of COVID-19 vaccine (mRNA-1273). He woke up from sleep with sharp, intense chest pain that radiated to the jaw. Symptoms slightly improved but remained for 4 more days, and he finally presented to an outside hospital. He also reported injection site pain from the vaccination but was otherwise asymptomatic.”
33: Acute Myocarditis Following mRNA-1273 SARS-CoV-2 Vaccination
Author: Williams et al
Country: Canada
Date Published Online: 7/13/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34308326/
Case: “Myocarditis has been described previously as a rare side effect of both influenza and smallpox vaccines. In this report, we present a case of acute perimyocarditis in a young, healthy man after vaccination with the mRNA-1273 severe acute respiratory syndrome coronavirus -2 (SARS-CoV-2; Moderna) vaccine. He presented with chest pain and decompensated heart failure 3 days after administration of his second dose, and his symptoms resolved by 9 days post-inoculation. This case highlights a rare but potentially serious side effect of this mRNA vaccine that primary care physicians and cardiologists should be aware of in order to identify and appropriately manage these patients.”
34: Unusual Presentation of Acute Perimyocarditis Following SARS-COV-2 mRNA-1237 Moderna Vaccination
Author: Khogali & Abdelrahman
Country: Qatar
Date Published Online: 7/23/21
Vaccine: Moderna
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381757/
Case: “In this report, we present an unusual case of acute perimyocarditis and pericardial effusion 10 days following the second dose of Moderna COVID-19 vaccination in Qatar. At the time of presentation, the patient presented with non-specific symptoms of headache, diarrhea, vomiting, lethargy and dehydration. COVID-19 polymerase chain reaction (PCR) was negative. Once admitted to the emergency department, she started to deteriorate with very low blood pressure readings reaching 40/33 mmHg which was treated with aggressive fluid resuscitation. After 5.5 liters of intravenous fluids, echocardiography and electrocardiogram (ECG) were performed. Findings were consistent with pericardial effusion, signs of impending cardiac tamponade and acute perimyocarditis. Cardiac biomarkers including troponin T and pro-brain natriuretic peptide (BNP) were elevated. Hospital course was complicated with cardiac arrest, acute kidney injury, disseminated intravascular coagulation (DIC) and hemodynamic instability. Eventually, the patient recovered after a three-week hospital stay and was discharged on non-steroidal anti-inflammatory medication (NSAIDs). This case report highlights the hospital course and outcome linking the second dose of Moderna vaccination and the development of perimyocarditis.”
35: Myocarditis and pericarditis after vaccination for COVID-19
Author: Hudson et al
Country: US
Date Published Online: 7/26/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34337595/
Case: “Two previously healthy males presented to the emergency [room] with signs of pericarditis/myocarditis after being vaccinated with an mRNA vaccine for COVID‐19.”
“[Case 1:] A previously healthy 24‐year‐old male presented to the emergency department with worsening myalgias and fevers, chills, nausea, vomiting, and 24 hours of worsening midline, substernal burning that was worse when lying flat. These symptoms began 3 days after receiving his second Pfizer COVID‐19 vaccination.”
“A previously healthy 22‐year‐old male presented to the ED with 3 days of worsening chills, low‐grade fevers, and chest pain. He states that the morning of presentation, his pain intensified and was described as pressure in the center‐left chest without any radiation. He noticed his symptoms started ≈12 hours after his second Pfizer vaccination. He denied any other associated symptoms.”
36: Perimyocarditis in Adolescents After Pfizer-BioNTech COVID-19 Vaccine | Journal of the Pediatric Infectious Diseases Society | Oxford Academic
Author: Tano et al
Country: US
Date Published Online: 7/28/21
Vaccine: Pfizer
Link: https://academic.oup.com/jpids/article/10/10/962/6329543
Case: “We describe clinical characteristics of 8 adolescents who presented over the course of 36 days to Nicklaus Children’s Hospital with perimyocarditis within 4 days of receiving a dose of BNT162b2 vaccine.”
“Patient 1: A 17-year-old male with a past medical history of vitiligo presented to the emergency department (ED) with retrosternal pressure-like chest pain. He denied shortness of breath, fever, vomiting, rhinorrhea, abdominal pain, or diarrhea. The patient tested positive for SARS-CoV-2 10 months before. He received the second dose of the BNT162b2 vaccine 4 days before presentation.”
“Patient 2: A 16-year-old male with no past medical history presented to the ED with left-sided chest pain and intermittent palpitations for approximately 1 day. He denied fever, shortness of breath, or recent illness. There was no history of SARS-CoV-2 infection. Patient had received the second dose of BNT162b2 vaccine 3 days prior to presentation.”
(See the study for the other 6)
37: Occurrence of acute infarct-like myocarditis following COVID-19 vaccination: just an accidental co-incidence or rather vaccination-associated autoimmune myocarditis?
Author: Chamling et al
Country: Germany
Date Published Online: 7/31/21
Vaccine: Pfizer, AstraZeneca
Link: https://pubmed.ncbi.nlm.nih.gov/34333695/
Case: “We would like to present the findings of three different patients that presented to our hospital until mid of June 2021 and showed unusual serious adverse cardiovascular events of infarct-like myocarditis (in the absence of CAD), possibly linked to preceding COVID-19 vaccination. CMR imaging revealed some interesting patterns of myocardial damage suggestive of “autoimmune” myocarditis that show some minor differences to the well-known CMR pattern of “viral” myocarditis.”
38: Acute myocarditis following Comirnaty vaccination in a healthy man with previous SARS-CoV-2 infection - PubMed
Author: Patrignani et al
Country: Italy
Date Published Online: 8/2/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34367386/
Case: “In this article, we present a 56 year-old man with no prior medical history, whit the exception of a mild Covid-19 infection 4 months earlier, who experienced an episode of acute epigastric pain, profuse sweating, tachycardia, hypotension 4 days after the first dose of BNT162b2 vaccine. “
39: Acute myocarditis after SARS-CoV-2 vaccination in a 24-year-old man - ScienceDirect
Author: Cimaglia et al
Country: Italy
Date Published Online: 8/3/21
Vaccine: Pfizer
Link: https://www.sciencedirect.com/science/article/pii/S0870255121003243?via%3Dihub
Case: “A 24-year old male nurse presented to the emergency department complaining of chest pain with onset 24 hours earlier. He reported no past medical history and no cardiovascular risk factors apart from e-cigarette smoking. He received the second dose of COVID-19 mRNA BNT162b2 vaccine 60 hours before the onset of chest pain […]. The chest pain was exacerbated by deep breathing and the supine position. It radiated to the back and the left arm and was responsive to non-steroidal anti-inflammatory drugs.
40: Myocarditis Following COVID-19 Vaccination
Author: Isaak et al
Country: Germany
Date Published Online: 8/3/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34342500/
Case: “A healthy 15-year-old boy received his second vaccination dose (BNT162b2-mRNA SARS-CoV2, Biontech/Pfizer) and the following day he developed fever, myalgia, and intermittent tachycardia.”
“Cardiac MRI at 1.5 T showed a normal left ventricular size, normal left ventricular ejection fraction and a small pericardial effusion. T2-weighted short TI inversion recovery sequences displayed focal myocardial edema involving the lateral wall, most emphasized in the basal inferolateral segment (Figure). Corresponding subepicardial enhancement was detected by late gadolinium enhancement imaging indicating inflammatory necrosis (Figure). Quantitative myocardial mapping parameters were elevated confirming the qualitatively assessed findings (Figure). The 2018 Lake Louise criteria for the diagnosis of an acute myocarditis were fulfilled (1, 2). Furthermore, vaccine-induced unilateral axillary lymphadenopathy was also observed. Due to the close temporal relation between the mRNA SARS-CoV-2 vaccination and the onset of symptoms (one day), vaccine-induced hypersensitivity myocarditis was clinical diagnosis. The patient was discharged in stable condition after 7 days of hospitalization.”
41: Perimyocarditis following first dose of the mRNA-1273 SARS-CoV-2 (Moderna) vaccine in a healthy young male: a case report
Author: Hasnie et al
Country: US
Date Published Online: 8/4/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34348657/
Case: “A 22-year-old Caucasian male presented to our hospital center complaining of pleuritic chest pain. Six months prior he had a mild case of COVID-19, but was otherwise healthy. He had received his first dose of the Moderna vaccine three days prior to developing symptoms. Laboratory analysis revealed a markedly elevated troponin and multiple imaging modalities during his hospitalization found evidence of wall motion abnormalities consistent with a diagnosis of perimyocarditis. He was started on aspirin and colchicine with marked improvement of his symptoms prior to discharge.”
42: Case report: acute myocarditis following the second dose of mRNA-1273 SARS-CoV-2 vaccine - PubMed
Author: Tailor et al
Country: US
Date Published Online: 8/4/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34514306/
Case: “A 44-year-old man presented with chest pain and ST-segment elevation 4 days after receiving the second dose of mRNA-1273 SARS-CoV-2 Vaccine. Emergent coronary angiogram showed minimal coronary artery disease. Cardiac magnetic resonance imaging confirmed acute myocarditis. Diagnosis of vaccine-associated myocarditis was made given the temporal relationship and supportive treatment initiated. Follow-up at 1 month confirmed complete symptomatic recovery and echocardiogram demonstrated normalization of cardiac function.”
43: Myocarditis following mRNA vaccination against SARS-CoV-2, a case series - PubMed
Author: King et al
Country: US
Date Published Online: 8/9/21
Vaccine: Pfizer, Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34396358/
Case: “Four patients, ages 20 to 30, presented with myocarditis characterized by chest pain, elevations in troponin-I and C-reactive protein, and negative viral serologies two to four days following mRNA vaccine administration. One had a cardiac MRI showing delayed gadolinium enhancement in a subpericardial pattern. All experienced symptom resolution by the following day, and the two who have returned for follow-up had normal troponin-I and CRP values.”
44: Acute Perimyocarditis Following First Dose of mRNA Vaccine Against COVID-19 - PMC
Author: Vollman et al
Country: Germany
Date Published Online: 8/9/21
Vaccine: Pfizer
Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8422910/
Case: “A 28-year-old man was admitted to hospital with left-sided chest pain 9 days after BioNTech/Pfizer vaccination. Fatigue and fever had occurred 5 days before admission. ST-segment elevations on ECG and blood test results (troponin T 1.30 ng/ml, reference ≤ 0.03; CRP 10.2 mg/dL, ≤ 0.5) pointed to acute perimyocarditis. This was confirmed by cardiac magnetic resonance imaging, which showed slightly reduced left ventricular pump function, myocardial edema (Figure a), and subepicardial late gadolinium enhancement (Figure b). Comprehensive diagnostic workup found no evidence of infectious or rheumatological causation. SARS-CoV-2 infection was ruled out by PCR testing and the absence of antibodies to the nucleocapsid protein. However, the presence of antibodies to the spike protein (6.62 U/mL, <0.80) indicated an early immune response caused by the vaccine. After 4 days and ibuprofen treatment, the patient was discharged from the hospital free of symptoms.”
45: Association of Myocarditis With BNT162b2 Messenger RNA COVID-19 Vaccine in a Case Series of Children | Cardiology | JAMA Cardiology | JAMA Network
Author: Dionne et al
Country: US
Date Published Online: 8/10/21
Vaccine: Pfizer
Link: https://jamanetwork.com/journals/jamacardiology/fullarticle/2783052
Case: “In this case series of 15 children who were hospitalized with myocarditis after receipt of the BNT162b2 messenger RNA COVID-19 vaccine for 1 to 5 days, boys were most often affected after the second vaccine dose, 3 patients had ventricular systolic dysfunction, and 12 patients had late gadolinium enhancement on cardiac magnetic resonance imaging. There was no mortality, and all but 1 patient had normal echocardiogram results on follow-up 1 to 13 days after discharge.”
46: Cardiac Imaging of Acute Myocarditis Following COVID-19 mRNA Vaccination - PubMed
Author: Kim IC et al
Country: Korea
Date Published Online: 8/16/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34402228/
Case: “In Korea, we present a 24-year-old male with acute myocarditis following COVID-19 vaccination (BNT162b2). His chest pain developed the day after vaccination and cardiac biomarkers were elevated. Echocardiography showed minimal pericardial effusion but normal myocardial contractility. Electrocardiography revealed diffuse ST elevation in lead II, and V2-5. Cardiac magnetic resonance images showed the high signal intensity of T2- short tau inversion recovery image, the high value of T2 mapping sequence, and late gadolinium enhancement in basal inferior and inferolateral wall. It was presumed that COVID-19 mRNA vaccination was probably responsible for acute myocarditis. Clinical course of the patient was favorable and he was discharged without any adverse event.”
47: Post-mRNA COVID-19 Vaccination Myocarditis
Author: Matta et al
Country: US
Date Published Online: 8/16/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34527626/
Case: “A new trend of myocarditis among young adults who received mRNA vaccines for COVID-19 is emerging. We present the case of a young adult who presented with chest pain 3 days after the second dose of Pfizer-BioNTech COVID-19 vaccine. He had elevated troponin I and C-reactive protein levels at the time of admission. Electrocardiogram (ECG) and echocardiogram findings were unremarkable. The patient improved with conservative management and was discharged home the next day.”
48: Temporal association between the COVID-19 Ad26.COV2.S vaccine and acute myocarditis: A case report and literature review - ScienceDirect
Author: Sulemankhil et al
Country: US
Date Published Online: 8/16/21
Vaccine: J&J
Link: https://www.sciencedirect.com/science/article/pii/S1553838921005789
Case: “A previously healthy 33-year-old male presented to the emergency department with acute onset substernal chest pain. Two days prior, he had received the Janssen Ad26.COV2·S vaccine. Initially he noted myalgias and chills which resolved 24 h following vaccination. This was followed by a constant, retrosternal, non-radiating, non-exertional chest pain. The pain was not positional, pleuritic, nor exertional. His past medical history was significant for asthma and obstructive sleep apnea but no known cardiac history.”
49: Fulminant myocarditis and systemic hyperinflammation temporally associated with BNT162b2 mRNA COVID-19 vaccination in two patients - PubMed
Author: Abbate et al
Country: US
Date Published Online: 8/18/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34416319/
Case: “We herein report two cases of fulminant myocarditis following BNT162b2 mRNA Covid-19 vaccination associated with systemic hyperinflammatory syndrome and refractory shock requiring support with veno-arterial extracorporeal membrane oxygenation.”
50: Myocarditis after Covid-19 mRNA Vaccination | NEJM
Author: Verma et al
Country: US
Date Published Online: 8/18/21
Vaccine: Pfizer, Moderna
Link: https://www.nejm.org/doi/full/10.1056/NEJMc2109975
Case: “Here, we report two cases of histologically confirmed myocarditis after Covid-19 mRNA vaccination.
Patient 1, a 45-year-old woman without a viral prodrome, presented with dyspnea and dizziness 10 days after BNT162b2 vaccination (first dose).”
“ An endomyocardial biopsy specimen showed an inflammatory infiltrate predominantly composed of T-cells and macrophages, admixed with eosinophils, B cells, and plasma cells (Figure 1A and Figs. S2 through S4). She received inotropic support, intravenous diuretics, methylprednisolone (1 g daily for 3 days), and, eventually, guideline-directed medical therapy for heart failure (lisinopril, spironolactone, and metoprolol succinate). Seven days after presentation, her ejection fraction was 60%, and she was discharged home.”
“Patient 2, a 42-year-old man, presented with dyspnea and chest pain 2 weeks after mRNA-1273 vaccination (second dose). He did not report a viral prodrome, and a PCR test was negative for SARS-CoV-2 (Table S1). He had tachycardia and a fever, and his electrocardiogram showed diffuse ST-segment elevation (Fig. S1). A transthoracic echocardiogram showed global biventricular dysfunction (ejection fraction, 15%), normal ventricular dimensions, and left ventricular hypertrophy. Coronary angiography revealed no coronary artery disease. Cardiogenic shock developed in the patient, and he died 3 days after presentation. An autopsy revealed biventricular myocarditis (Figure 1B and Figs. S5 and S6). An inflammatory infiltrate admixed with macrophages, T-cells, eosinophils, and B cells was observed, a finding similar to that in Patient 1.
In these two adult cases of histologically confirmed, fulminant myocarditis that had developed within 2 weeks after Covid-19 vaccination, a direct causal relationship cannot be definitively established because we did not perform testing for viral genomes or autoantibodies in the tissue specimens. However, no other causes were identified by PCR assay or serologic examination.”
51: Acute myocarditis associated with the Pfizer/BioNTech vaccine
Author: Shumkova et al
Country: Bulgaria
Date Published Online: 8/23/21
Vaccine: Pfizer
Link: https://journals.viamedica.pl/kardiologia_polska/article/view/85495
Case: “A 23-year-old man without any medical history presented in the Emergency Department with fever, shortness of breath, and progressive chest pain exacerbated by deep inspiration and supine position. The symptoms started one day after receiving the second dose of the Pfizer/BioNTech vaccine. After the first dose, he did not have any side effects. He had not been infected with SARS-CoV-2 before.”
52: Myocarditis Associated With COVID-19 Vaccination | Circulation: Cardiovascular Imaging
Author: Viskin et al
Country: Israel
Date Published Online: 8/25/21
Vaccine: Pfizer
Link: https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.121.013236
Case: “Shortly thereafter, during February to April 2021, a cluster of 8 patients acutely presented to our local emergency department with suspected myocarditis after receiving the second dose of the BioNTech COVID-19 (Pfizer) vaccine.”
“All cases involved young (age 20–34 years) patients, all but one of male gender. Acute COVID-19 infection was excluded based on normal chest X-rays, negative swabs for COVID-19 polymerase chain reaction and negative anti-COVID-19-N antibodies but positive COVID-19-S antibodies (reflecting recent vaccination). All but one case had full viral and bacterial workup to exclude alternative causes of myocarditis.”
“All 8 patients had an uneventful course after the first COVID-19 vaccination. However, within 3 to 7 days following the second vaccination, they developed angina-type chest pain and malaise, severe enough to prompt hospitalization.”
53: Symptomatic Acute Myocarditis in 7 Adolescents After Pfizer-BioNTech COVID-19 Vaccination - PubMed
Author: Marshall et al
Country: US
Date Published Online: 9/1/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34088762/
Case: “We report 7 cases of acute myocarditis or myopericarditis in healthy male adolescents who presented with chest pain all within 4 days after the second dose of Pfizer-BioNTech COVID-19 vaccination. Five patients had fever around the time of presentation. Acute COVID-19 was ruled out in all 7 cases on the basis of negative severe acute respiratory syndrome coronavirus 2 real-time reverse transcription polymerase chain reaction test results of specimens obtained by using nasopharyngeal swabs. None of the patients met criteria for multisystem inflammatory syndrome in children. Six of the 7 patients had negative severe acute respiratory syndrome coronavirus 2 nucleocapsid antibody assay results, suggesting no previous infection. All patients had an elevated troponin. Cardiac MRI revealed late gadolinium enhancement characteristic of myocarditis. All 7 patients resolved their symptoms rapidly.”
54: Myocarditis following COVID-19 vaccination - A case series
Author: Levin et al
Country: Israel
Date Published Online: 9/4/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34535317/
Case: “We surveyed all hospitalized military personnel in the Israeli Defense Forces during the period of the COVID-19 vaccination operation (12/28/2021-3/7/2021) for diagnosed myocarditis. We identified 7 cases of myocarditis with symptoms starting in the first week after the second dose of COVID-19 Pfizer-BioNTech vaccine. One case of myocarditis diagnosed 10 days after the second dose of the vaccine was not included. These 8 cases comprise of all events of myocarditis diagnosed in military personnel during this time period. All patients were young and generally healthy. All had mild disease with no sequalae.”
55: Biopsy-proven lymphocytic myocarditis following first mRNA COVID-19 vaccination in a 40-year-old male: case report - PMC
Author: Ehrlich et al
Country: Germany
Date Published Online: 9/6/21
Vaccine: Pfizer
Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8419377/
Case: “We report a 40-year-old, previously healthy man who was admitted to our emergency unit by his family doctor because of fever (till 39 °C), headache, chest pain and shortness of breath. Six days ago, he got the first dose of the mRNA COVID-19 vaccine Comirnaty® (BioNTech/Pfizer). Two days after vaccination, he developed fever and headache and another 2 days later, he suffered from resting dyspnea and angina pectoris.”
“A cardiac MRI study was carried out post-inpatient on day eight after admission. Cine images confirmed a normalized left ventricular ejection fraction (69%) without regional wall motion abnormalities. However, it revealed increased left ventricular wall thickness with a septal thickness of 16 mm at maximum and a persistent myocardial inflammation throughout the left ventricle: myocardial hyper-intensities on T2w images indicating myocardial edema were detected in the left ventricle, primarily in the basal and mid inferoseptal and anterolateral segments as well as in the apical lateral segment. Diffuse late gadolinium enhancement was noted in the basal and mid anteroseptal and inferoseptal segments as well as in the apical septal segment. Focal enhancement was mainly seen in the basal and mid anterolateral segments, in the apical lateral segment as well as in the apical cap. Approximately 90% of the total left ventricular mass was affected. There was no increased pericardial enhancement. Likewise, no pericardial effusion was evident (Fig. 4). A follow-up cardiac MRI study will be scheduled three months after hospital discharge.”
56: Lymphohistocytic myocarditis after Ad26.COV2.S viral vector COVID-19 vaccination
Author: Ujueta et al
Country: US
Date Published Online: 9/7/21
Vaccine: J&J
Link: https://pubmed.ncbi.nlm.nih.gov/34514078/
Case: “A 62-year-old Caucasian female visiting from Uruguay presented to the emergency department complaining of progressive body aches, weakness and worsening fatigue approximately 4 days after administration of the Ad26.COV2.S (Janssen Johnson & Johnson®) viral vector COVID-19 vaccine.”
“The autopsy was performed 9-hours postmortem. […] Microscopic view of the myocardial biopsy showing scattered positive CD3 immunostaining supporting T cell infiltration (Fig. 1b). Multiple immunohistochemistry staining like CD163 supports the diagnosis of lymphohistiocytic myocarditis with sparse eosinophils (Supplementary Fig. 2).”
“This case suggests a potential relationship between the viral vector COVID-19 vaccine and the patient’s lymphohistiocytic myocarditis resulting in severe biventricular cardiomyopathy and death. Although there have been no previous reports of cardiac involvement with the viral vector vaccine, the timing of the event and the lack of other identifiable etiologies suggest a relationship.”
57: Cardiovascular magnetic resonance findings in young adult patients with acute myocarditis following mRNA COVID-19 vaccination: a case series - PMC
Author: Patel Y et al
Country: US
Date Published Online: 9/9/21
Vaccine: Pfizer, Moderna
Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8425992/
Case: “This case series includes 5 young males who were diagnosed with myocarditis or myopericarditis within 72 h after receiving a dose of either the Pfizer or Moderna mRNA-based COVID-19 vaccine.”
58: A Late Presentation of COVID-19 Vaccine-Induced Myocarditis
Author: Gautam et al
Country: US
Date Published Online: 9/11/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34660088/
Case: “We report a case of an elderly man who presented with acute-onset chest pain after three months of receiving the second dose of the mRNA vaccine. He was found to have acute myocarditis on cardiac magnetic resonance imaging (CMRI), which was attributed to exposure to the COVID-19 vaccine in the absence of any other risk factors. Our patient demonstrated quick resolution of symptoms and was discharged within 72 hours.”
59: Takotsubo syndrome after receiving the COVID-19 vaccine
Author: Fearon et al
Country: US
Date Published Online: 9/14/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34539938/
Case: “This case demonstrates the development of takotsubo syndrome (TTS) after administration of the COVID-19 vaccine. A 73-year-old woman with recently diagnosed myocardial infarction with no obstructive coronary atherosclerosis (MINOCA) presented with typical chest pain starting less than a day after receiving the Moderna vaccine. She had troponin elevations and new ST-segment abnormalities. Transthoracic echocardiogram (TTE) findings were consistent with mid-ventricular TTS. Treatment included diuretics, beta-blockers, and angiotensin receptor blockers. Prior to discharge, repeat imaging showed improvement in systolic function. This case presents a post-menopausal woman with a recent diagnosis of MINOCA who developed TTS shortly after receiving the COVID-19 vaccine. Risk factors including sex, age, MINOCA, anxiety about the vaccine, and possibly the vaccine itself may have all contributed to the TTS presentation. TTS may occur after COVID-19 vaccination, and appreciation of this potential rare association is important for evaluating vaccine safety and optimizing patient outcomes.”
60: Acute myocarditis after COVID-19 vaccination with mRNA-1273 in a patient with former SARS-CoV-2 infection
Author: Nguyen et al
Country: Germany
Date Published Online: 9/18/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34536056/
Case: “We describe a case of a 20-year-old healthy man developing chest pain and classical symptoms of vaccine reactogenicity 12 h after receiving the first dose of mRNA-1273 (Moderna). Cardiac troponin T was increased, and subepicardial inflammation and focal contractile dysfunction were detected by cardiac magnetic resonance imaging and echocardiography. We confirmed the diagnosis of acute myocarditis by endomyocardial biopsy demonstrating significant infiltration of monocytes and T lymphocytes. Although we detected IgG against nucleocapsid protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) indicating prior infection, the patient repeatedly tested negative for SARS-CoV-2 and had been asymptomatic for several months. Furthermore, viral genome analysis of endomyocardial biopsy samples was negative for SARS-CoV-2 and other potential cardiotropic viruses. These findings and the strong temporal relation between the vaccination and the symptom onset imply a potential side effect of mRNA-1273.”
61: Acute Myopericarditis after COVID-19 Vaccine in Teenagers - PubMed
Author: Ambati et al
Country: US
Date Published Online: 9/20/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34589238/
Case: “Case Summaries. The first case is a young adolescent who presented with chest pain after receiving his second dose of coronavirus disease 19 vaccination with no other symptoms. His troponin was found to be 40 ng/mL. He had a normal echocardiogram and chest CT angiogram. His troponins trended down with symptomatic pain management after 3 days. The second case is another adolescent who presented with fever, fatigue, headache, and chest pain 3 days after receiving his second dose of coronavirus vaccine. His troponin was elevated to 5 ng/mL, electrocardiogram with ST segment elevations, and mildly decreased systolic function on echocardiogram. His troponins and electrocardiogram were normalized in 3 days at the time of his discharge.”
62: STEMI Mimic: Focal Myocarditis in an Adolescent Patient After mRNA COVID-19 Vaccine
Author: Azir et al
Country: US
Date Published Online: 9/27/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34756746/
Case: “This case report describes a 17-year-old male patient who developed focal myocarditis mimicking an ST-segment elevation myocardial infarction (STEMI) 3 days after administration of an mRNA COVID-19 vaccine. Why Should an Emergency Physician Be Aware of This? Myocarditis is a rare complication in adolescents receiving mRNA COVID-19 vaccines. Focal myocarditis may demonstrate localizing electrocardiographic changes consistent with a STEMI. Overall, complications of the mRNA COVID-19 vaccines are extremely rare. The vaccine continues to be recommended by public health experts, as the benefits of vaccinations greatly outweigh the rare side effects.”
63: Acute Myocardial Infarction and Myocarditis following COVID-19 Vaccination - PubMed
Author: Aye et al
Country: Singapore
Date Published Online: 9/30/21
Vaccine: Pfizer, Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34586408/
Case: “Consecutive patients admitted in a tertiary hospital in Singapore between 1 January 2021 and 31 March 2021, with onset of cardiac manifestations within 14 days following COVID-19 vaccination were studied.”
“Thirty patients were included in the study cohort, with 29 diagnosed with AMI (14 ST-segment elevation and 15 non-ST-segment elevation MI) and 1 with myocarditis. Median hospital stay was 4.5 days (IQR 4.0–6.2). Five patients developed heart failure, two had cardiogenic shock, three intubated, and one had cardiovascular-related mortality.”
65: A Case of Acute Pericarditis After COVID-19 Vaccination
Author: Sonaglioni et al
Country: Italy
Date Published Online: 10/1/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35387019/
Case: “Herein we describe the case of a middle-aged healthy women who developed symptoms and signs of acute pericarditis 7-10 days after the second dose of Pfizer-BioNTech COVID-19 vaccination. Although a direct effect cannot be stated, it is important to report a potential adverse vaccine reaction effect that could be associated with the expression of SARS-CoV-2 spike protein induced from the mRNA of the vaccine.”
66: MODERNA mRNA-1273 vaccine-associated myopericarditis in a patient with a subclinical autoimmune predisposition
Author: Badshah et al
Country: US
Date Published Online: 10/2/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34868402/
Case: “We present a rare case of myopericarditis developing one day after the injection of the second dose of the MODERNA mRNA-1273 vaccine (Cambridge, MA, USA). The patient complained of typical positional chest pain with initial laboratory results significant for elevated troponin, erythrocyte sedimentation rate, and C-reactive protein. […] Based on clinical, laboratory, and cMRI findings, a diagnosis of acute myopericarditis was made and the patient was treated with colchicine and ibuprofen with prompt resolution of symptoms. Vaccine-associated myopericarditis is rare, however, there have been reports of myocarditis developing after smallpox vaccination.”
67: Biventricular systolic dysfunction in acute myocarditis after SARS-CoV-2 mRNA-1273 vaccination
Author: Maki et al
Country: Japan
Date Published Online: 10/3/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34601566/
Case: “A 20-year-old woman with a history of Kawasaki disease developed fever (up to 37.5°C) 14 days after her second dose of mRNA-1273 SARS-CoV-2 vaccination (Moderna). Another 2 days later, she presented to the hospital with chest pain and dyspnoea. Chest X-ray showed significant enlargement of the heart (Panel A); electrocardiography showed sinus tachycardia with ST-segment elevation in leads II and V1–4 (Panel B); echocardiography demonstrated global hypokinesis with a very small pericardial effusion; and her cardiac troponin I, creatinine kinase, and C-reactive protein levels were elevated at 8801.8 ng/L, 576 U/L, and 1.07 mg/dL, respectively.”
68: A Case Report for Myopericarditis after BNT162b2 COVID-19 mRNA Vaccination in a Korean Young Male - PubMed
Author: Kim et al
Country: Korea
Date Published Online: 10/11/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34636504/
Case: “We report the case of a 29-year-old male who was diagnosed with myopericarditis after his second dose of Pfizer-BioNTech COVID-19 vaccine. This patient is the second recognized case of Pfizer-BioNTech COVID-19 vaccine induced myopericarditis in Korea and the first to have recovered from it. He originally presented with chest discomfort and exertional chest pain. Lab tests revealed elevated cardiac marker levels and echocardiographic findings displayed minimal pericardial effusion, prompting diagnosis as myopericarditis. We decided on two weeks of outpatient treatment with non-steroidal anti-inflammatory drugs (NSAIDs) due to the patient's mild symptoms and his occupation in the military. When this proved insufficient, we shifted to combination therapy with low dose corticosteroids and NSAIDs. After two weeks of treatment, the patient's symptoms and pericardial effusion had improved, and he was recovered completely 37 days after the onset.”
69: Acute Myocarditis Following the Administration of the Second BNT162b2 COVID-19 Vaccine Dose
Author: Miqdad et al
Country: Saudi Arabia
Date Published Online: 10/18/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34804729/
Case: “However, we report the case of an 18-year-old male who developed acute central crushing chest pain four days following administration of the second dose of the BNT162b2 COVID-19 vaccine. After extensive cardiac workup, including coronary arteries diagnostic angiography, myocarditis was suspected and confirmed by a cardiac MRI. Fortunately, the patient's clinical condition gradually improved in the form of clinical symptoms and laboratory findings. He was discharged after one week of stay in hospital with regular follow-up in the cardiac clinic.”
70: Myocarditis in the Setting of Recent COVID-19 Vaccination - PubMed
Author: Onderko et al
Country: US
Date Published Online: 10/19/21
Vaccine: Pfizer, Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34712497/
Case: “We report three patients who presented with chest pain after receiving either the BNT162b2 Pfizer/BioNTech or mRNA-1273 Moderna/NIH vaccine. Clinical presentation, biomarker, and cardiac MRI supported myocarditis. It is imperative that potential side effects of COVID-19 vaccine are reported to improve our knowledge about COVID-19 and mRNA vaccines.”
71: Acute Myocarditis after COVID-19 vaccination: A case report - ScienceDirect
Author: Schmitt et al
Country: France
Date Published Online: 10/19/21
Vaccine: Pfizer
Link: https://www.sciencedirect.com/science/article/pii/S0248866321007098
Case: “A 19-year-old man, presenting with troponin-positive acute chest pain, was referred to our department. He had received the Pfizer-BioNTech COVID-19 vaccine three days prior to his admission. The diagnosis of acute myocarditis was confirmed by cardiovascular magnetic resonance imaging. Patient hemodynamic status remained stable during hospitalization. The left ventricular ejection fraction was preserved during hospital stay and at one-month follow-up. We found no evidence for another infectious or autoimmune etiology.”
72: A case report: symptomatic pericarditis post-COVID-19 vaccination - PubMed
Author: Ashaari et al
Country: UK
Date Published Online: 10/26/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34693198/
Case: “A patient presented with typical symptoms of pericarditis and related electrocardiogram and echocardiogram changes, 7 days post receiving the first dose of COVID-19 vaccine. No other causes were identified from series of investigations. Patient had good symptomatic relief with non-steroidal anti-inflammatory medication.”
73: Myocarditis Following a COVID-19 Messenger RNA Vaccination: A Japanese Case Series - PubMed
Author: Murakami et al
Country: Japan
Date Published Online: 10/27/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34693198/
Case: “We herein report two Japanese cases with suspected vaccine-related myocarditis. A 27-year-old man was admitted with chest pain 4 days after the second vaccination. An electrocardiogram (ECG) did not reveal any significant abnormalities. The second patient, a 37-year-old man, was admitted with chest pain 9 days after the first vaccination. His ECG exhibited ST-elevation in multiple leads. In both cases, cardiac magnetic resonance imaging findings were consistent with myocarditis. They recovered with symptomatic relief within a few days. These cases suggest that the benefit of COVID-19 vaccination exceeds the risk of vaccine-related myocarditis.”
74: A case series of acute pericarditis following COVID-19 vaccination in the context of recent reports from Europe and the United States - PMC
Author: Lazaros et al
Country: Greece
Date Published Online: 10/29/21
Vaccine: Pfizer, Moderna, AstraZeneca
Link: https://pubmed.ncbi.nlm.nih.gov/34840235/
Case: “All consecutive cases of AP between January and July 2021 temporally associated with COVID-19 vaccination that presented to our hospital, a referral center for the diagnosis and treatment of pericardial diseases from an urban area of approximately 3 million inhabitants, were recorded. In total, 9 consecutive events of AP in 8 patients following COVID-19 vaccination were recorded and reported to our national Medicines and Healthcare Products Regulatory Agency. The diagnosis of AP was based on the criteria proposed by the 2015 European Society of Cardiology (ESC) guidelines for the diagnosis and management of pericardial diseases [1]. All patients had negative RT-PCR for SARS-CoV-2. Alternative etiologies underlying pericarditis were excluded upon meticulous diagnostic work up [1].”
75: Case Report: Acute Fulminant Myocarditis and Cardiogenic Shock After Messenger RNA Coronavirus Disease 2019 Vaccination Requiring Extracorporeal Cardiopulmonary Resuscitation - PubMed
Author: Lim et al
Country: Korea
Date Published Online: 10/29/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34778411/
Case: “According to the reports so far, myocarditis related to mRNA COVID-19 vaccination is rare and usually associated with a benign clinical course without intensive care or any sequelae of fulminant myocarditis. Here, we report a case of acute fulminant myocarditis and cardiogenic shock after the mRNA COVID-19 vaccination, requiring extracorporeal cardiopulmonary resuscitation. Clinicians should keep in mind the possibility of progression to fulminant myocarditis in patients who presented with suggestive symptoms or signs of myocarditis after the COVID-19 vaccination.”
76: A case of myocarditis in a 60-year-old man 48 h after mRNA vaccination against SARS-CoV2
Author: Habedank et al
Country: Germany
Date Published Online: 11/3/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34731321/
Case: “Against this background, we report on a 60-year-old man with normal body mass index (189 cm, 84 kg) and empty cardiovascular anamnesis despite a WHO degree I arterial hypertension. On July 1st, 2021, he received his 2nd dose of mRNA-vaccine (mRNA-1273, Moderna), and developed a typical vaccination reaction with 39 °C fever and dizziness. About 24 h after vaccination, he had palpitations and after 36 h, he fainted and lost consciousness for some seconds. […] A cardiac magnet resonance imaging (CMRI) was performed next day (80 h after vaccination) and showed a focal edema of anterolateral medial wall in the T2 sequences (Fig. 1a) and a corresponding subepicardial late enhancement in the short axis and four-chamber view (Fig. 1b, c), both consistent with the diagnosis of a myocarditis. The patient remained free of symptoms, the troponin declined to the normal range and he was discharged at day 5. The echocardiography a week and a month later remained normal, so that we presume a complete recovery.”
77: Myocarditis Following Coronavirus Disease 2019 mRNA Vaccine: A Case Series and Incidence Rate Determination | Clinical Infectious Diseases | Oxford Academic
Author: Perez et al
Country: US
Date Published Online: 11/3/21
Vaccine: Pfizer, Moderna
Link: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab926/6420408
Case: “A total of 21 individuals were identified as having a clinical diagnosis of myocarditis via the Mayo Clinic COVID-19 Vaccine Registry after receiving at least 1 dose of a COVID-19 mRNA vaccine on or before 13 May 2021; records were screened by 2 physicians (M. D. S. and A. Y. J.). However, only 7 individuals had new onset myocarditis following vaccination. The remaining 14 patients were excluded since they did not have evidence of COVID-19 vaccine–related myocarditis; however, the diagnosis was used during a post-immunization clinical encounter due to a prior history of myocarditis.”
78: Myocarditis Following mRNA COVID-19 Vaccine - PubMed
Author: Visclosky et al
Country: US
Date Published Online: 11/4/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34731877/
Case: “A 15-year-old male adolescent with no significant medical history presented with a chief complaint of chest pain. Three days prior to presentation, he received his second dose of the Pfizer-BioNTech COVID-19 vaccine. The following day, he experienced a mild headache and a low-grade subjective fever. These resolved quickly, and he was feeling well until early on the morning of presentation when he was awakened by an aching, substernal chest pain. The pain was exacerbated with deep inspirations. It was not reproducible with palpation, it did not radiate, and it was not positional. His review of systems was otherwise negative, including cough, chest pressure, shortness of breath, lower extremity edema, palpitations, or lightheadedness. When the pain did not improve throughout the day, the patient and his family sought emergency care.”
78: Myocarditis Following mRNA COVID-19 Vaccine - PubMed
Author: Schauer et al
Country: US
Date Published Online: 3/25/22
Vaccine: Pfizer
Link: https://www.jpeds.com/article/S0022-3476(22)00282-7/fulltext
Case: “This case review includes patients younger than 18 years of age presenting to Seattle Children's Hospital with chest pain and elevated serum troponin level from April 1, 2021, to January 7, 2022, within 1 week of receiving the second dose of the Pfizer COVID-19 mRNA vaccine.”
“A total of 35 patients with the diagnosis of myopericarditis associated with Pfizer COVID-19 mRNA vaccine were followed at our institution. Twelve patients were excluded, as they never had cardiac MRI scans due to delayed presentation after initial symptoms resolved or admission to other centers. Six patients were excluded, as they did not have a follow up cardiac MRI, either because they followed up out of state or a study is still pending. One patient was excluded, as initial cardiac MRI was performed 3 weeks after presentation. Sixteen patients who had both acute-phase and follow-up cardiac MRIs available for review comprised the final cohort.”
80: Young Male With Myocarditis Following mRNA-1273 Vaccination Against Coronavirus Disease-2019 (COVID-19)
Author: Kaneta et al
Country: Japan
Date Published Online: 11/6/21
Vaccine: Moderna
Link: https://www.jstage.jst.go.jp/article/circj/advpub//advpub_CJ-21-0818/_article
Case: “A 25-year-old man with no past medical or allergic history, developed a fever after receiving the second vaccination. On the 3rd day, he was admitted to hospital with chest pain. The ECG on admission showed ST elevation in the inferior and lateral leads (Figure A), and blood tests showed elevation of myocardial enzymes, which peaked 12h after the onset of symptoms (creatine kinase (CK) 604U/I, CK-MB 47ng/mL and troponin T 0.725ng/mL). Transthoracic echocardiography showed inferolateral hypokinesia (Figure B), coronary angiography showed no significant stenosis, and left ventriculography showed posterolateral hypokinesia (Figure C, Supplementary Movie). Cardiac magnetic resonance (CMR) showed regional increase of T2 signal intensity and late gadolinium enhancement (LGE) of the posterolateral wall (Figure D), findings that met the updated Lake Louise criteria.1 His ECG and echocardiographic findings normalized over several days, and the chest pain spontaneously improved without treatment during hospitalization. The patient was discharged on the 9th day after admission. The stable clinical course and CMR findings were consistent with previous reports in other countries.”
81: 68Ga-DOTATOC digital-PET imaging of inflammatory cell infiltrates in myocarditis following COVID-19 vaccination - PMC
Author: Boursier et al
Country: France
Date Published Online: 11/8/21
Vaccine: Pfizer, Moderna
Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8572651/
Case: “Acute myocarditis was recently reported after mRNA COVID-19 vaccination. Here we present images from two male (18 and 21 years old) patients that were recorded with a digital-PET/CT system (Vereos, Philips) 1 h after the injection of 2 MBq/kg of 68 Ga-DOTATOC, as part of an ongoing clinical study (NCT03347760 on ClinicalTrials.gov). Both patients experienced myocarditis 2 to 3 days after the second dose of an mRNA COVID-19 vaccine (Moderna and Pfizer, respectively) and fulfilled the cardiovascular magnetic resonance 2018 Lake Louise criteria for myocarditis, associated with increased plasma troponin (peak troponin: 771 ng/L and 10 830 ng/L) but normal plasma fibrinogen. Plasma C-reactive protein was increased in the 21-year-old patient (41 mg/L).
The DOTATOC-PET images, recorded at 1 to 3 days from peak troponin, showed an increase in myocardial uptake relative to blood activity, predominantly in the lateral and inferior walls (red arrows) and which are even better depicted on the gated-PET cine-loops in the online supplement. Myocardial/blood SUVmax ratio was > 2.2 in both cases and, thus, higher than what we commonly observe in non-myocarditis patients. This likely reflects a myocardial infiltrate of inflammatory cells overexpressing somatostatin receptors (lymphocytes, macrophages, activated monocytes) [1–4], presumably within specific antigenic sites.”
82: Myocarditis following COVID-19 mRNA vaccination
Author: Parmar et al
Country: US
Date Published Online: 11/15/21
Vaccine: Pfizer, J&J
Link: https://pubmed.ncbi.nlm.nih.gov/35256821/
Case: “We report a case series of four subjects with an acute myocarditis-like illness following mRNA COVID-19 vaccination who were hospitalized at our hospital in Lubbock, Texas. Three patients were young men who presented with acute chest pain after the second dose of the mRNA-1273 vaccine. Another patient was a 53-year-old white woman who presented with acute left arm pain 3 days after the first dose of the mRNA-1273 vaccine. She was later found to have acute decompensated heart failure, and endomyocardial biopsy revealed eosinophilic injury-mediated myocarditis.”
83: Myocarditis Post Moderna Vaccination: Review of Criteria for Diagnosis
Author: McCullough et al
Country: US
Date Published Online: 11/16/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34956759/
Case: “We present a 23-year-old male who is typical of a patient presenting with myocarditis post-COVID-19 mRNA-1273 Moderna vaccination (young males, onset several days after second dose of the mRNA vaccine, and excellent short term complete recovery). Follow-up at 128 days revealed no residual sequelae in our patient. Although a definitive diagnosis of myocarditis requires an endomyocardial biopsy (EMB), diagnosis is usually made clinically and with imaging in most clinical settings unless part of an approved research protocol or if indicated clinically. We recommend active surveillance and reporting for myocarditis post mRNA vaccination and even consider reporting those with symptom onset beyond 90 days.”
84: Perimyocarditis Following COVID-19 Vaccination - PubMed
Author: Tinoco et al
Country: Portugal
Date Published Online: 11/24/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34866957/
Case: “A 39-year-old male was admitted in the emergency room with chest pain. He had been given the second dose of Pfizer-BioNTech COVID-19 vaccine 3 days before. The patient denied taking any other medication beyond the usual. He didn't feel sick in the previous days/weeks. Laboratory studies revealed elevated serum levels of troponin and C-reactive protein. An autoantibody screen and a serologic panel to detect common viruses were negative. A cardiac MRI showed myocardial edema/inflammation and confirmed the diagnosis of perimyocarditis which was considered to be a consequence of COVID-19 vaccination.”
85: Multimodality imaging and histopathology in a young man presenting with fulminant lymphocytic myocarditis and cardiogenic shock after mRNA-1273 vaccination - PubMed
Author: Kadwalwala et al
Country: US
Date Published Online: 11/30/21
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/34848416/
Case: “A 38-year-old man presented with several days of chest pain and shortness of breath 8 days after receiving the first dose of an mRNA-1273 vaccine. The patient was found to have new left ventricular ejection fraction of 10% in the setting of hypotension and cardiogenic shock requiring mechanical support with an axial flow catheter pump. The presentation was concerning for acute fulminant myocarditis secondary to an inflammatory response from the recent mRNA-1273 vaccine. The patient was treated with pulse dose steroids for 3 days, ultimately leading to haemodynamic recovery and removal of mechanical circulatory support. Endomyocardial biopsy was performed and showed focal lymphocytic interstitial infiltrate with myocyte damage consistent with lymphocytic myocarditis. The patient had improvement of cardiac function which was seen on serial imaging.”
86: Myocarditis associated with COVID‑19 vaccination in three male teenagers - Polish Archives of Internal Medicine
Author: Łaźniak-Pfajfer et al
Country: Poland
Date Published Online: 12/1/21
Vaccine: Pfizer
Link: https://www.mp.pl/paim/issue/article/16160/
Case: “Three previously healthy males (17 years old) were admitted to our hospital due to a sudden chest pain. The symptom occurred shortly (1–10 days) after vaccination with BNT162b2 vaccine (Supplementary material, Table S1).”
“However, late gadolinium enhancement (LGE) showed a myocarditis-like pattern in all patients (Figure 1B and 1C). One of the patients exhibited pericardial effusion with pericardial enhancement on the LGE sequences (Figure 1D).”
“Based on the clinical presentation, a diagnosis of myocarditis associated with COVID-19 vaccination was made. Bed rest and thromboprophylaxis with enoxaparin were ordered. A complete resolution of the symptoms and troponin level normalization were observed within a few days, and all the patients were discharged home.”
87: Postvaccination Multisystem Inflammatory Syndrome in Adult with No Evidence of Prior SARS-CoV-2 Infection
Author: Choi YK et al
Country: Korea
Date Published Online: 12/1/21
Vaccine: AstraZeneca
Link: https://pubmed.ncbi.nlm.nih.gov/34852213/
Case: “Ten days after receiving the first dose of coronavirus disease vaccine, a 22-year-old woman in South Korea experienced myocarditis, myopathy, pericarditis, and gastroenteritis; rash subsequently developed. There was no evidence of prior infection with severe acute respiratory syndrome coronavirus 2. The diagnosis was multisystem inflammatory syndrome resulting from coronavirus disease vaccination.”
88: Acute myocarditis associated with COVID-19 vaccination: A case report – PMC
Author: Nagasaka et al
Country: Japan
Date Published Online: 12/3/21
Vaccine: Pfizer
Link: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8639400/
Case: “A 23-year-old man with no previous history of cardiovascular disease or any significant medical history presented to the emergency room with fever and chest pain without respiratory symptoms for 3 days after the second dose of a COVID-19 vaccine (Pfizer-BioNTech BNT16B2b2 mRNA vaccine).”
“Additionally, cardiac magnetic resonance imaging (MRI) showed late gadolinium enhancement, predominantly sub-epicardial and mid-myocardial enhancement, mainly in the inferolateral walls, typical of acute myocarditis (Fig. 2C). These findings are suggestive of myocardial edema and pericardial inflammation, and were compatible with acute myocarditis [5]. He was treated with a nonsteroidal anti-inflammatory drug after admission. On the second day of hospitalization, his troponin I and creatine kinase levels in blood (CK-MB) were elevated [troponin I, 8,699 pg/mL; CK-MB, 13.7 U/L (normal value: ≤10 U/L)]. On day 5, echocardiography showed normalization of wall motion, and the laboratory findings had almost normalized to: troponin I, 174 pg/mL; CK-MB, 2.2 U/L; and C-reactive protein, 0.61 mg/dL. His symptoms had also simultaneously abated, and his troponin levels and echocardiogram had returned to almost normal. He was eventually discharged on day 7 of his hospital stay.”
89: Lessons of the month 3: Haemophagocytic lymphohistiocytosis following COVID-19 vaccination (ChAdOx1 nCoV-19)
Author: Cory et al
Country: UK
Date Published Online: 12/4/21
Vaccine: AstraZeneca
Link: https://pubmed.ncbi.nlm.nih.gov/34862234/
Case: “A 36-year-old woman presented to hospital 9 days after receiving her first dose of the ChAdOx1 nCoV-19 vaccine with fever, myalgia and a sore throat. She was previously fit and well with no prior vaccine reactions.
There was no clinical response to initial treatment with intravenous (IV) antibiotics. Microbiology tests including for COVID-19 were negative. At day 5, she developed pleuritic pain and a pericardial rub. Echocardiography and subsequent cardiac magnetic resonance imaging showed evidence of constrictive pericarditis. Computed tomography revealed gross hepatomegaly and moderate splenomegaly. Blood tests showed raised inflammatory markers, deranged clotting, low platelets and a marked hyperferritinaemia.
A presumptive diagnosis of a multi-system inflammatory disorder secondary to recent COVID-19 vaccination was made and high-dose IV methylprednisolone initiated. Following a high ‘H score’ of 70%–80% a diagnosis of secondary haemophagocytic lymphohistiocytosis (HLH) was made. She was treated with IV immunoglobulin with subsequent clinical response.
HLH is a rare syndrome of acute and rapidly progressive systemic inflammation characterised by cytopenias, excessive cytokine production and hyperferritinaemia. The adult form has multiple triggers, including recent vaccination. This case prompts awareness among clinicians of HLH as a rare complication of COVID-19 vaccination but should not discourage individuals from vaccination.”
90: Chest Pain with New Abnormal Electrocardiogram Development after Injection of COVID-19 Vaccine Manufactured by Moderna
Author: Takase et al
Country: Japan
Date Published Online: 12/7/21
Vaccine: AstraZeneca
Link: https://www.jstage.jst.go.jp/article/internalmedicine/advpub//advpub_8711-21/_article
Case: “We herein report a young woman with chest pain and abnormal electrocardiogram (ECG) changes after receipt of a COVID-19 vaccine manufactured by Moderna. A 19-year-old woman (158 cm, 63 kg) visited our outpatient clinic because of recurrent chest pain with a low-grade fever (37.6 °C) 26 days after receiving her second COVID-19 vaccination. The chest pain lasted for over six hours. She had first complained of a fever (37.6 °C) with chest pain 1 week after receiving her second vaccination and visited another clinic.”
“According to the proposed Bozkurt’s criteria (5), probable acute myocarditis due to COVID-19 vaccination was diagnosed. Since myocarditis can be fatal and most reported COVID-19 vaccination related myocarditis cases have been seen in men (2-4), myocarditis due to COVID-19 vaccination in women is likely to be overlooked. Chest symptoms after COVID-19 vaccination in women should therefore be carefully monitored. Further epidemiological research on the cardiac side effects of COVID-19 vaccination in women seems necessary.”
91: First Report of Acute Myocarditis Post-Pfizer-BioNTech COVID-19 Vaccination in the Kingdom of Bahrain
Author: Chachar et al
Country: Bahrain
Date Published Online: 12/9/21
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35028213/
Case: “A previously healthy 24-year-old Saudi male patient developed chest pain five days after receiving the first dose of the Pfizer-BioNTech (BNT162b2) vaccine. There was no history of viral infection, recent or distant, and no known exposure to confirmed COVID-19 patients.”
“Cardiac MRI demonstrated subepicardial gadolinium enhancement in the basal to mid-lateral and inferolateral walls (non-ischemic pattern) suggestive of myocarditis. The patient was discharged two days after being diagnosed with myocarditis on perindopril 2.5 mg OD and bisoprolol 2.5 mg OD. He reported being asymptomatic, good functional class, and able to exercise normally after a four-week follow-up through phone consultation owing to hospital COVID-19 protocols (Figure (Figure22).”
92: Cardiogenic shock revealing myocarditis after mRNA vaccination against covid-19: Case report and brief review for the first case in Morocco - ScienceDirect
Author: Mimouni et al
Country: Morocco
Date Published Online: 12/30/21
Vaccine: Pfizer, Moderna
Link: https://www.sciencedirect.com/science/article/pii/S2049080121011602
Case: “We report the case of a 14-year-old teenager admitted to the emergency department for a cardiogenic shock, the patient mentioned that he had an anti-COVID 19 vaccination 10 days before his admission. First, the vasoactive drugs had stabilized the patient; the troponins came back highly favorable but later confirmed myocarditis by magnetic resonance imaging. In this sense an etiological analysis was made and it came back without any particularities, leaving us relating the myocarditis to the vaccination.”
93: Kounis syndrome associated with BNT162b2 mRNA COVID-19 vaccine presenting as ST-elevation acute myocardial infarction
Author: Şancı et al
Country: Turkey
Date Published Online: 1/1/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35191390/
Case: “We present the case of a 22-year-old woman with no known co-morbid diseases who had previous egg and tomato allergy and no known prior drug allergies. The patient presented to our emergency department with complaints of “palpitations” and “uneasiness of the chest” after her first dose of COVID-19 vaccine (BNT162b2, Pfizer–BioNTech). Complaints started approximately after 15 minutes of vaccination.”
94: First Identified Case of Fatal Fulminant Necrotizing Eosinophilic Myocarditis Following the Initial Dose of the Pfizer-BioNTech mRNA COVID-19 Vaccine (BNT162b2, Comirnaty): an Extremely Rare Idiosyncratic Hypersensitivity Reaction
Author: Ameratunga et al
Country: NZ
Date Published Online: 1/3/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/34978002/
Case: “The clinical and pathological observations from a case of fatal fulminant necrotising myocarditis in a 57-year-old woman, following the first dose of the Pfizer-BioNTech vaccine, are described. Other causes have been discounted with reasonable certainty.”
“A previously well 57-year-old woman received the first Pfizer-BioNTech vaccine in July 2021. The following day she experienced increasing lethargy and had to leave work early because of worsening fatigue. She had one episode of breathlessness and complained of a stiff neck as well as upper limb pain. She had a sore throat but pointed to her sternum. During the remainder of the day, she became increasingly unwell. The following day she consulted her primary care physician with a sore throat, back pain, fatigue and an episode of haematuria, which had occurred the previous night. She had difficulty getting out of the car and experienced a fall at the family physician’s surgery. She did not complain of palpitations.”
“Autopsy Findings: […] Histological examination of the heart sections showed fulminant necrotizing eosinophilic myocarditis (Fig. 1, bottom left and bottom right). There were multifocal aggregates of lymphoid cells, histiocytes and abundant eosinophils with focal myocyte necrosis in the free walls of both ventricles, inter-ventricular septum and around the conduction system (sino-atrial and atrio-ventricular nodes). No parasitic organisms or giant cells were identified. The eosinophilic infiltrate would make autoimmune myocarditis less likely. There was no evidence of eosinophils in other organs or eosinophilic vasculitis. Histological examination of the left pleural space mass showed a thymoma, WHO subtype AB.”
95: COVID-19 mRNA Vaccine-Associated Myocarditis
Author: Kyaw et al
Country: US
Date Published Online: 1/7/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35154981/
Case: “A healthy 24-year-old male presented to the emergency department with complaints of non-radiating mid-sternal chest pain and pressure. He noticed his symptoms started six hours after he received the second dose of Pfizer COVID vaccine. Laboratory tests revealed elevated cardiac troponin I-CtNI levels. Computed tomography angiography of the chest did not show evidence of pulmonary embolism. Given his presentation of acute chest pain associated with elevated troponin levels, a coronary angiogram was performed which revealed normal coronary arteries. He was subsequently treated for acute peri-myocarditis with colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), and beta-blockers for tachycardia and the prevention of arrhythmia. Although rare, clinicians should be aware of the risk for myocarditis and pericarditis, which should be considered in individuals presenting with chest pain within a week after vaccination, especially in the younger population. Although the long-term risk in these patients is uncertain, early diagnosis and treatment are key to minimizing complications.”
96: Acute myocarditis after receiving first dose of BNT162b2 mRNA vaccine
Author: Wu et al
Country: US
Date Published Online: 1/7/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35018202/
Case: “A 40-year-old man with history of prior coronavirus disease 2019 (COVID-19) infection developed pleuritic chest pain 3 days after receiving the first dose of the BNT162b2 mRNA vaccine. Echocardiography results were significant for mild dysfunction and left ventricular hypertrophy. Cardiac magnetic resonance imaging showed myocardial edema as well as delayed enhancement in the inferior wall of the basal left ventricular myocardium, suggestive of acute myocarditis. This case describes the work-up, diagnosis, risk-stratification, and management of acute myocarditis post BNT162b2 mRNA vaccine.”
97: Fulminant myocarditis following coronavirus disease 2019 vaccination: a case report
Author: Agdamag et al
Country: US
Date Published Online: 1/10/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35088026/
Case: “An 80-year-old female with no significant cardiac history presented with cardiogenic shock and biopsy-proven fulminant myocarditis within 12 days of receiving the BNT162b2 COVID-19 vaccine. She required temporary mechanical circulatory support, inotropic agents, and high-dose steroids for stabilization and management. Ultimately, her cardiac function recovered, and she was discharged in stable condition after 2 weeks of hospitalization. A repeat cardiac MRI 3 months after her initial presentation demonstrated stable biventricular function and continued improvement in myocardial inflammation.”
99: Effusive-constrictive pericarditis after the second dose of BNT162b2 vaccine (Comirnaty): a case report
Author: Viani et al
Country: Italy
Date Published Online: 1/12/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35233481/
Case: “A 59-year-old Caucasian man with a history of type 2 diabetes mellitus accessed the emergency department reporting sharp stabbing pain to the right hemithorax, worsened by inbreathing and supine position, and aggravating exertional dyspnoea. The symptoms occurred about 5 days after the second dose of the BNT162b2 (Comirnaty) vaccine. Medical history was negative for SARS-CoV2 infection.”
“Cardiac magnetic resonance imaging showed pericardial thickening and oedema (Figure 5A and B), with intense late gadolinium enhancement of the pericardial layers (Figure 5C); a very mild pericardial effusion was detected (Video 2). Cine images showed septal bounce (Video 2) and inspiratory flattening of the inter-ventricular septum (Video 3), indicating ventricular interdependence and pericardial constriction.”
“On the basis of the close temporal relation with the second shot of BNT162b2 vaccine, we hypothesized that the pericarditis might have been an adverse reaction to the drug, with a sub-acute evolution.”
100: A Case of Acute Viral Pericarditis Complicated With Pericardial Effusion Induced by Third Dose of COVID Vaccination
Author: Zaki et al
Country: Qatar
Date Published Online: 1/13/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35165640/
Case: “To date, no reports have been made in the literature regarding the onset of acute viral pericarditis after vaccination with the Pfizer BNT162b2 vaccine. But on the other hand, pericarditis is reported to occur in rare instances of COVID-19 infection, and this may be attributed to the pro-inflammatory effects of the spike protein. In this article, we describe the case of an elderly male patient with a known case of hypothyroidism who presented to our emergency department with fever, chills, and dry cough for ten days after the third dose of the Pfizer-BioNTech COVID-19 vaccine. Although we cannot mention a direct effect, it is essential to note a potential adverse reaction to vaccine administration following the expression of SARS-CoV-2 spike protein-induced from the vaccine's mRNA.”
“The patient was discharged after a clinically improved hospital stay for a few days with referral to cardiology clinic as a case of viral pericarditis post-covid vaccination.”
101: Atrial fibrillation as a precursor of mRNA-1273 SARS-CoV-2 vaccine-induced pericarditis
Author: Scheuermeyer et al
Country: Canada
Date Published Online: 1/17/22
Vaccine: Moderna
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761835/
Case: “A healthy 49-year-old male without prescription medications presented to the emergency department with 30 min of palpitations. He had mild dull non-positional, non-radiating chest discomfort but was not short of breath and had no fever. Eight days previously, he had received his second mRNA-1273 (Moderna) SARS CoV-2 vaccination.”
“Computed tomography confirmed a pericardial effusion but no other pathology. The admitting cardiologist reported a friction rub, and along with his characteristic pain, the new effusion, the elevated C-reactive protein, the timing of his symptoms, as well as the lack of any other inciting traumatic, procedural, infectious, or inflammatory cause, he was diagnosed with pericarditis related to mRNA-1273 SARS CoV-2 vaccination. He was admitted overnight, and the cardiology team halted anticoagulation, initiated non-steroidal anti-inflammatories, and discharged him uneventfully the next morning. At two weeks, he had mild dyspnea and a follow-up echocardiogram demonstrated a much smaller effusion. At 6- and 12-week follow-ups, he was symptom-free.”
102: Cardiac Adverse Reactions With COVID-19 Vaccinations
Author: De Jesus et al
Country: US
Date Published Online: 1/18/22
Vaccine: Pfizer, Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35198284/
Case: “Case 1: A healthy 28-year-old male presented to the hospital with midsternal chest pain that started suddenly, radiated to the left arm, worsened with deep inspiration and lying flat, and improved with sitting upright. The patient reported associated headaches, fever, hemoptysis, and unilateral leg swelling. […] Based on his characteristic chest pain and ECG changes, the diagnosis of acute pericarditis was made. He was started on colchicine and ibuprofen. Notably, he had received the second dose of the Moderna COVID-19 vaccine 10 days prior to presentation. Given the absence of obvious etiology, it was thought that his presentation might have been due to an adverse effect of the vaccine. His symptoms as well as ECG changes resolved within one month.”
“Case 2: An 18-year-old male presented with subjective fevers, myalgias, and substernal chest pain radiating down the left arm. The pain was noted to improve when standing and was unrelated to exertional activity. […] He received the second dose of the Pfizer-BioNTech COVID-19 vaccine five days prior to the onset of his symptoms. He was diagnosed with suspected COVID-19 vaccine-related myopericarditis given his complaint of positional chest pain, ECG changes consistent with pericarditis, and elevated troponin I. He was prescribed colchicine and lisinopril. Repeat TTE one month later revealed no change in his LVEF.”
103: Novel case of takotsubo cardiomyopathy following COVID-19 vaccination
Author: Stewart et al
Country: UK
Date Published Online: 1/18/22
Vaccine: AstraZeneca
Link: https://pubmed.ncbi.nlm.nih.gov/35042734/
Case: “We present an unusual case of takotsubo cardiomyopathy (TTC) following administration of the second dose of the DNA ChadOX1 nCOV-19 (AZD122) vaccination. This woman in her early 50s presented to the emergency department 8 days following her vaccine with central chest pain. Initial investigations revealed a raised troponin and evolving T wave inversion on ECG. Acute coronary syndrome management was commenced. Further investigations revealed non-obstructive coronary arteries on coronary angiography and imaging revealed hypokinesia of the anterior and anterior-septal walls in the apex and midcavity level, myocardial oedema and no infarction, all in keeping with TTC. Given the large-scale roll out of vaccinations during the COVID-19 pandemic better understanding of potential adverse events is essential. This is the first case report of TTC following a second dose of the DNA ChadOX1 nCOV-19 (AZD122) vaccination.”
104: Case Report: Cytomegalovirus Reactivation and Pericarditis Following ChAdOx1 nCoV-19 Vaccination Against SARS-CoV-2
Author: Plüß et al
Country: Germany
Date Published Online: 1/18/22
Vaccine: AstraZeneca
Link: https://pubmed.ncbi.nlm.nih.gov/35116025/
Case: “A 67-year-old Caucasian female with a past medical history of atrial fibrillation, hypertension, obesity, degenerative knee joint disease, and no documented history of COVID-19 received a first dose of ChAdOx1 nCoV-19 vaccination. The patient had no allergies, no history of immune deficiency, no recent infectious disease, and denied illicit drug use. Two weeks after vaccination, the patient suffered from fever, weakness and arthralgia of the knees, hips and shoulders (Figure 1A). After additional 3 weeks, the patient was admitted to a community hospital with stable vital parameters and normal physical examination (Figure 1A). Computed tomography (CT) scans of the chest and abdomen revealed reactive mediastinal lymphadenopathy and hepatic steatosis.”
“Cardiac magnetic resonance imaging (MRI) confirmed diagnosis of pericarditis with circumferential thickening and contrast enhancement of the entire pericardium at late gadolinium enhancement (LGE, Figure 1C) (13, 14). Based on these imaging findings, heart involvement with viral pericarditis was suspected. EBV serology was compatible with past infection (anti-EBV-VCA-IgG: positive, anti-EBV-IgM: negative), confirmed by PCR with no detectable EBV-DNA. However, serology of CMV was compatible with active CMV infection (anti-CMV-IgG: >250 IU/mL, anti-CMV-IgM: positive), confirmed by PCR with detectable CMV viremia (415 IU/mL).”
“In summary, we here present the clinical course of a patient with CMV reactivation and pericarditis in temporal association with ChAdOx1 nCoV-19 vaccination against SARS-CoV-2.”
106: COVID-19 mRNA Vaccination Mimicking Heart Attack in a Healthy 56-Year-Old Physician
Author: Xinias et al
Country: Greece
Date Published Online: 1/27/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35200439/
Case: “We report our experience regarding a 56-year-old physician who developed severe symptoms mimicking a heart attack a few days after receiving the second dose of the new mRNA vaccine of Pfizer-BioNTech for COVID-19 protection. The patient is a healthy individual with no comorbidities and a normal clinical and laboratory profile. Five days after receiving the second dose on his left shoulder, he manifested sudden, severe pain on the whole left arm which lasted for about one hour, gradually intensifying and migrating to the chest and presenting as severe angina or heart attack. All work-up, however, was negative, with no evidence of ischemic heart attack or myocarditis. Severe acute symptoms lasted for about 20 h and completely resolved after 36 h.”
107: Acute myocarditis following COVID-19 mRNA vaccination: a paediatric case
Author: Giray & Epçaçan
Country: Turkey
Date Published Online: 2/2/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35105392/
Case: “In this case, a previously healthy, 17-year-old adolescent with myocarditis after BNT162b2 mRNA vaccination was reported. He was admitted to the hospital with severe chest pain, changes in electrocardiography, and elevation in serum troponin level after fourth day of receiving first dose of vaccine. There was no coronary arterial disease in coronary angiogram. A diagnosis of vaccine-induced myocarditis was made, and supportive treatment was initiated.”
108: Prominent J Waves and Ventricular Fibrillation Caused by Myocarditis and Pericarditis After BNT162b2 mRNA COVID-19 Vaccination
Author: Uesako et al
Country: Japan
Date Published Online: 2/9/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35151782/
Case: “A previously healthy 26-year-old man was brought to the emergency department following an out-of-hospital cardiac arrest. He had received a first dose of the BNT162b2 mRNA coronavirus disease vaccine 5 days previously and had developed fatigue and headache the following day. On the day of admission, he had lost consciousness while eating. On arrival of the emergency medical services, the electrocardiogram (ECG) showed VF. Two defibrillations, epinephrine, and cardiopulmonary resuscitation successfully converted the rhythm to sinus rhythm. He had no history of illicit drug use and no family history of sudden death.”
“Cardiac magnetic resonance imaging (MRI) displayed late gadolinium enhancement (LGE) of the epicardial side of the inferior and lateral walls, indicating the presence of myocarditis and pericarditis (Fig. 2 A,B). An endomyocardial biopsy of the septal side of the right ventricle performed on day 8 showed myocardial fibrosis on histology, suggestive of subacute myocarditis (Fig. 2C,D). Immunohistochemistry revealed CD68-positive histiocyte and CD3-positive lymphocyte infiltrates, with histiocyte predominance (Fig. 2E,F).”
“Because his cardiac event occurred 5 days after the vaccination with no other triggers identified, we suspected that the myocarditis and pericarditis that had led to J-wave syndrome and consequent VF was an adverse effect of the BNT162b2 vaccine. We reported it to the Japanese Pharmaceuticals and Medical Devices Agency.”
109: Acute Myopericarditis After First Dose of mRNA-1273 SARS-CoV-2 Vaccine in a Young Adult
Author: Fadah et al
Country: US
Date Published Online: 2/11/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35308760/
Case: “This case report describes the presentation of an otherwise healthy 18-year-old male who experienced retrosternal chest pain after receiving a first dose of the mRNA-1273 vaccine. The patient had a negative polymerase chain reaction (PCR) test for COVID-19 infection. An electrocardiogram revealed diffuse ST elevation and PR segment depression, with increased inflammatory markers consistent with pericarditis. Elevation of troponin (16 ng/mL), evidence of borderline reduced ejection fraction (50-55%), and global left ventricular hypokinesis were suggestive of myopericarditis. Infectious and autoimmune studies were negative. The patient was treated mainly with non-steroidal anti-inflammatory drugs and colchicine, which resulted in a significant improvement of clinical symptoms.”
110: Cardiac magnetic resonance findings in acute myocarditis after mRNA COVID-19 vaccination
Author: Sano et al
Country: Japan
Date Published Online: 2/11/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35169401/
Case: “We report the case of a 20-year-old previously healthy man who presented with fever and chest pain 2 days after the second dose of mRNA-1273 vaccine. Electrocardiogram and laboratory studies showed extensive ST-segment elevation accompanied by elevated cardiac biomarkers. Cardiac magnetic resonance (CMR) revealed late gadolinium enhancement (LGE) characteristics of myocarditis. The patient rapidly improved with conservative management and was discharged on hospital day 6. As an advantage over previous reports, we performed a 1-month follow-up CMR. It showed improvement in myocardial edema but persistence of LGE which may indicate irreversible fibrosis. CMR may be useful not only for diagnosis but also for prognostic evaluation of myocarditis after COVID-19 mRNA vaccination.”
111: Acute Pericarditis Post mRNA-1273 COVID Vaccine Booster
Author: Singh A et al
Country: US
Date Published Online: 2/12/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35308666/
Case: “A 69-year-old female with a history of morbid obesity, hypertension, diabetes, gout disease, and chronic kidney disease stage 3b with an EGFR of 30.2 mL/min/1.73 m2 presented to the hospital with a three-day history of worsening chest pain. It was a crushing chest pain that radiated to the base of her neck. The pain was aggravated when she lay flat. Of note, the patient had received her second dose of Moderna COVID-19 vaccine one day before symptoms onset.”
“The TTE revealed a small pericardial effusion without any obvious pericardial inflammation (Figure (Figure2).2). Therefore, the patient was diagnosed with pericarditis secondary to COVID vaccine administration. Infectious etiologies were low on the differentials as the patient remained afebrile with a normal white blood count and was negative for two sets of blood cultures. Also, autoimmune etiologies were low on the differential as the patient tested negative for antinuclear antibodies (ANA), anti-double-stranded antibodies (anti-dsDNA), and anti-neutrophilic cytoplasmic antibodies (PANCA).”
112: Biopsy-Proven Fulminant Myocarditis Requiring Mechanical Circulatory Support Following COVID-19 mRNA Vaccination
Author: Kazama et al
Country: Japan
Date Published Online: 2/13/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35187464/
Case: “A 48-year-old woman suffered from cardiogenic shock with fulminant myocarditis following the second dose of COVID-19 vaccine (mRNA-1273). Venoarterial extracorporeal membrane oxygenation and Impella support were essential in achieving hemodynamic stability. Endomyocardial biopsy revealed lymphocytic infiltration with predominant immunostaining for CD8- and CD68-positive cells. The left ventricular ejection fraction improved significantly after treatment with mechanical circulatory support. Myocarditis following COVID-19 mRNA vaccination may also occur in middle-aged women; it may be fulminant and require mechanical circulatory support. Although our results suggest the involvement of cytotoxic T lymphocytes and macrophages, further investigation is needed before these can be established as pathogenetic mechanisms.”
113: Autopsy Histopathologic Cardiac Findings in Two Adolescents Following the Second COVID-19 Vaccine Dose | Archives of Pathology & Laboratory Medicine
Author: Gill et al
Country: US
Date Published Online: 2/14/22
Vaccine: Pfizer
Case: “Objective: To examine the autopsy microscopic cardiac findings in adolescent deaths that occurred shortly following administration of the second Pfizer-BioNTech COVID-19 dose to determine if the “myocarditis” described in these instances has the typical histopathology of myocarditis.
Design: Clinical and autopsy investigation of two teenage boys who died shortly following administration of the second Pfizer-BioNTech COVID-19 dose.
Results: The microscopic examination revealed features resembling a catecholamine-induced injury, not typical myocarditis pathology.
Conclusions: The myocardial injury seen in these post-vaccine hearts is different from typical myocarditis and has an appearance most closely resembling a catecholamine-mediated stress (toxic) cardiomyopathy. Understanding that these instances are different from typical myocarditis and that cytokine storm has a known feedback loop with catecholamines may help guide screening and therapy.”
114: Transient Myopericarditis Following Vaccination for COVID-19
Author: Gill J et al
Country: US
Date Published Online: 2/16/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35317093/
Case: “A 44-year-old male presented with left-sided chest pain radiating to the left arm associated with shortness of breath. He had received his second dose of the mRNA-1273 vaccine 4 days before symptom onset. His chest pain began 2 days postvaccination; it was initially mild but progressively became severe.”
“As coronary angiography was nonconclusive cardiac magnetic resonance imaging (MRI) was obtained (Fig. 2), which was consistent with acute myopericarditis, fulfilling the updated Lake Louise criteria.”
115: COVID-19 Vaccine-Induced Multisystem Inflammatory Syndrome With Polyserositis Detected by FDG PET/CT
Author: Lee SJ et al
Country: Korea
Date Published Online: 2/16/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35175945/
Case: “In this case, a 65-year-old man with BNT162b2 mRNA COVID-19 vaccination underwent 18F-FDG PET/CT to evaluate prolonged fever and elevated serum C-reactive protein. PET/CT showed hypermetabolic infiltration in the pericardium and peritoneum suggesting immune-mediated pericarditis and peritonitis. After administration of high-dose corticosteroids, the patient's symptom resolved. This case suggests that multisystem inflammatory syndrome and polyserositis can be induced by the COVID-19 vaccine.”
116: American Journal of Case Reports | Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of Pfizer-BioNTech BNT162b2 mRNA COVID-19 Vaccine: A Case Report - Article abstract #934399
Author: Al-Rasbi et al
Country: Oman
Date Published Online: 2/17/22
Vaccine: Pfizer
Link: https://www.amjcaserep.com/reprintOrder/index/idArt/934399
Case: “A 37-year-old man presented to the Emergency Department (ED) with a 3-day history of back pain and a 1-day history of left upper limb swelling with paresthesia and shortness of breath, 12-days after receiving the first dose of Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine. He was diagnosed with severe myositis complicated with rhabdomyolysis and non-oliguric acute kidney injury, thrombocytopenia, myocarditis with pulmonary edema, and pulmonary hemorrhage. Screens for potential toxic, infectious, paraneoplastic, and autoimmune disorders were unremarkable. The patient was treated with a 5-day course of intravenous methylprednisolone and intravenous immunoglobulin, with a good response. He was hospitalized for 16 days and discharged home on a tapering dose of oral prednisolone for 6 weeks.”
117: Myocarditis Secondary to COVID-19 mRNA Vaccine: A Case Report
Author: Mohammed et al
Country: US
Date Published Online: 2/17/22
Vaccine: Pfizer, Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35371688/
Case: “A previously healthy 19-year-old male presented to the Emergency Department for generalized chest pain of 2 days duration. He reported intermittent sharp diffuse pain, 7/10 in intensity, it started when he was asleep. The pain was worse when he lies flat associated with sweats. The patient denied any cough, fever, or shortness of breath, any recent illness, or knowing any sick person having COVID-19. He reported receiving the first dose of COVID-19 vaccine 2 weeks prior to his presentation.”
“We present a case of a young male adolescent with a clinical diagnosis of mild myocarditis without an infectious etiology following COVID-19 vaccination likely representing a rare adverse event to the vaccine.”
118: Increased Interleukin 18-Dependent Immune Responses Are Associated With Myopericarditis After COVID-19 mRNA Vaccination
Author: Won et al
Country: US
Date Published Online: 2/18/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35251049/
Case: “Here, we report a case of myopericarditis following the first dose of the mRNA-1273 COVID-19 vaccine in a young man who had a history of mild COVID-19 three months before vaccination. The patient presented with chest pain, elevated troponin I level, and electrocardiogram abnormality. His endomyocardial biopsy revealed diffuse CD68+ cell infiltration. We characterized the immune profile of the patient using multiplex cytokine assay and flow cytometry analysis. Sex-matched vaccinated individuals and healthy individuals were used as controls. IL-18 and IL-27, Th1-type cytokines, were highly increased in the patient with COVID-19 vaccine-related myopericarditis compared with vaccinated controls who experienced no cardiac complications. In the patient, circulating NK cells and T cells showed an activated phenotype and mRNA profile, and monocytes expressed increased levels of IL-18 and its upstream NLRP3 inflammasome. We found that recombinant IL-18 administration into mice caused mild cardiac dysfunction and activation of NK cells and T cells in the hearts, similar to the findings in the patient with myopericarditis after COVID-19 mRNA vaccination. Collectively, myopericarditis following COVID-19 mRNA vaccination may be associated with increased IL-18-mediated immune responses and cardiotoxicity.”
119: Acute myocarditis after a third dose of the BNT162b2 COVID-19 vaccine
Author: Fosch et al
Country: Spain
Date Published Online: 2/21/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35277352/
Case: “We describe the clinical case of a 24-year-old man with Crohn's disease, receiving treatment with adalimumab, which was discontinued on his own account 4 months before hospital admission. He had been vaccinated with the complete regimen (2 doses) of BNT162b2 while off treatment with adalimumab. At the second dose, he noted self-limited chest pain, with no other clinical signs or symptoms.
At 24 hours after receiving the third dose of BNT162b2, the patient experienced pericardial chest pain and a low-grade fever of 37.6 °c.On emergency room admission, the electrocardiogram showed sinus rhythm at 71 bpm and a diffuse, concave ST-segment elevation consistent with acute pericarditis (figure 1 ).”
“Based on these findings, a diagnosis was established of acute myocarditis predominantly affecting the lateral LV wall.”
120: A case of myocarditis following ChAdOx1 nCov-19 vaccination
Author: Kerkhove et al
Country: Belgium
Date Published Online: 2/22/22
Vaccine: AstraZeneca
Link: https://pubmed.ncbi.nlm.nih.gov/35189775/
Case: “A 50-year-old male presented at the emergency department with shortness of breath, general malaise and fever, 5 days after receiving a second dose of the ChAdOx1 vaccine. Biochemical analysis revealed elevated serum CRP and troponin levels. Two weeks after initial presentation, a cardiac MRI showed belated contrast capitation in the left ventricle, confirming the diagnosis of myocarditis.”
121: Myocarditis following mRNA COVID-19 vaccination: call for endomyocardial biopsy
Author: Kiblboeck et al (Cases)
Country: Austria
Date Published Online: 2/23/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35194974/
Case: “Case 1: An 18‐year‐old male patient was admitted because of chest pain and fever (37.9°C) 3 days after his first dose of BNT162b2 mRNA COVID‐19 vaccination. Two days prior to the vaccination, the patient had self‐limiting acute diarrhea. […] Echocardiography demonstrated severely reduced left ventricular ejection fraction (EF 33%) and myocardial oedema with patchy intramural late gadolinium enhancement (LGE) was described on cardiac magnetic resonance imaging (MRI) (Figure 1). Transradial left ventricular (LV) EMB revealed lymphocytic myocarditis (CD3 + T‐lymphocytes 50/mm2, CD68 + macrophages >100/mm2) (Figure 2).”
“Case 2: A 22‐year‐old male patient, presented with chest pain and fatigue with an onset 1 day after his second dose of BNT162b2 mRNA COVID‐19 vaccination. Baseline hs‐troponin I levels were markedly elevated (peak 38 735 ng/L). Cardiac MRI demonstrated typical signs of an acute myocarditis with moderately reduced EF (EF 40%) with myocardial oedema and patchy intramural and pericardial LGE (Figure 1). LV EMB revealed mild interstitial fibrosis without evidence of lymphocytic or eosinophilic myocarditis (Figure 2). In the myocardium HHV6B and in the EDTA blood, HHV7 DNA was detected by (RT‐)PCR. The patient recovered on heart failure therapy, NSAID, and colchicine within 1 month.”
“Case 3: A 38‐year‐old male patient was admitted because of fatigue and chest pain 4 days after his second mRNA BNT162b2 COVID‐19 vaccination. The patient had received an immune checkpoint inhibitor therapy (ipilimumab and nivolumab) for malignant melanoma 7 days before symptom onset. Laboratory tests revealed elevated C‐reactive protein and hs‐troponin T levels (peak 1104 ng/L). Cardiac MRI showed a mildly reduced EF with 48% and myocardial oedema with patchy intramural to subepicardial LGE (Figure 1). Acute lymphocytic myocarditis with elevated CD3 + positive T‐lymphocytes (30/mm2) and CD68 + macrophages (34 cells/mm2) was diagnosed by LV EMB (Figure 2). No nucleic acids of pathogens described above were found by (RT‐)PCR in the myocardium. Medical heart failure therapy and an immunosuppressive therapy (prednisolone) was initiated. The patient recovered well, and EF normalized at follow‐up after 1 month.”
122: FDG PET/MRI of Acute Myocarditis After mRNA COVID-19 Vaccination
Author: Lee & Kong
Country: Korea
Date Published Online: 2/28/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35234199/
Case: “A 22-year-old man visited the emergency department with chest pain. He had received a second dose of the coronavirus disease 2019 (COVID-19) mRNA (Moderna) vaccine 5 days prior. 18F-FDG PET/MR revealed a focal FDG uptake and late gadolinium enhancement on the basal posterolateral wall of the left ventricle. Myocarditis after a COVID-19 vaccination has been reported predominantly after the second dose of mRNA vaccines in young men. This was a case of acute focal myocarditis after a COVID-19 mRNA vaccination, which was well-visualized by FDG PET/MRI.”
123: A Case Series of Myocarditis Following Third (Booster) Dose of COVID-19 Vaccination: Magnetic Resonance Imaging Study
Author: Shiyovich et al
Country: Israel
Date Published Online: 3/4/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35310989/
Case: “The CMR imaging was performed after a median of 34 ± 15 days (range 8-47 days) following the 3rd vaccination. One of the patients underwent CMR during the acute phase, while the rest over a month following the acute episode. The CMR findings are presented in Table 1. CMR images of all the patients are presented in Figure 1. The mean left ventricular ejection fraction was 61 ± 7% (range 53-71%), regional wall motion abnormalities were present in one of the patients only. Global T1 values were increased in one (25%) of the patients, while focal values were increased in 3 (75%) of the patients. Global T2 values were increased in one (25%) of the patients, while focal values were increased in all of the patients (100%). Global ECV was increased in 3 (75%) of the patients, while focal ECV was increased in all the patients (100%). LGE was present in all the patients; thus, all of the patients met the Updated Lake Louise Criteria. Mean LGE% was 4 ± 3% (range 1-9%), and the inferolateral segment was the most common location (3/4 patients). LGE patterns were as follows: epicardial 2 patients, mid-wall 1 patient, mid-wall and epicardial 1 patient. LGE in the pericardium was present in 2 of the 4 patients, and pericardial effusion was present in 2 of the 4 patients, circular in both. The diameter of pericardial effusion was 4 and 5 mm in the two latter patients.”
125: Acute Myocarditis in a Patient Following mRNA-1273 SARS-CoV-2 Vaccination
Author: Kawakami et al
Country: Japan
Date Published Online: 3/5/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35249920/
Case: “We herein report a case of acute myocarditis possibly related to the second dose of an mRNA-coronavirus disease 2019 vaccine in a 45-year-old woman with no remarkable medical history. She had a fever for one week following the second dose of the mRNA-1273 severe acute respiratory syndrome coronavirus 2 vaccine. One week later, she presented with chest pain and electrocardiogram changes. Her serum troponin levels were elevated upon admission. Echocardiography showed segmental wall motion abnormalities of the apex, apical portion of the anterior and inferior walls. The findings of cardiac magnetic resonance imaging were consistent with acute myocarditis.”
126: Case Report: Two Case Reports of Acute Myopericarditis After mRNA COVID-19 Vaccine
Author: Sciaccaluga et al
Country: Italy
Date Published Online: 3/7/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35321100/
Case: “We report two cases of myopericarditis after the second dose of the mRNA-1273 COVID-19 vaccine, from the same batch of vaccines, administered on the same day. Two young males, 20-years old and 21-years old, with no past medical history, experienced fever (38 and 40°C, respectively) on the same day of the second dose of mRNA-1273 COVID-19 vaccine and chest pain, exacerbated with breathing, 3 days later, for which they were admitted to the emergency department. […] Due to the clinical presentation and the elevation of high-sensitivity troponin, a complete transthoracic echocardiographic exam was performed. In the first case, transthoracic echocardiography showed no pericardial effusion, a mild inferolateral wall thickness (12 mm) with normal biventricular function, absence of wall motion abnormalities and no significant heart valve disease. The echocardiographic examination of the 21-year-old patient showed a minimal pericardial effusion (2 mm) with hyperreflective pericardial layers, normal biventricular function and no significant heart valve disease. Due to the temporal correlation between the symptom onset and the second dose vaccine, the hypothesized diagnosis was acute myopericarditis as an adverse reaction to the mRNA-1273 COVID-19 vaccine. Therefore, on the day after hospital admission, both patients underwent cardiac magnetic resonance (CMR), which confirmed the diagnosis of acute myopericarditis, with evidence of myocardial oedema and late gadolinium enhancement (LGE) with subepicardial pattern (Figure 2A). In particular, in the 20-year old patient, myocardial oedema was found in the middle inferolateral wall, whereas LGE involved the subepicardial region of the lateral wall, inferior basal wall, and anterior apical septum, with left ventricular ejection fraction (LVEF) = 55%. The CMR of the 21-year-old patient revealed myocardial oedema in the mid-basal lateral wall and LGE in the subepicardial region of the basal inferolateral wall and mid-basal lateral wall with LVEF 52% (Figure 2B). The disease course was benign in both patients, and only one patient presented rare ventricular arrhythmias on the admission day (isolated ventricular ectopic beats, 3 couplets and 1 triplet).”
127: Case Report: Disappearance of Late Gadolinium Enhancement and Full Functional Recovery in a Young Patient With SARS-CoV-2 Vaccine-Related Myocarditis
Author: Korosoglou et al
Country: Germany
Date Published Online: 3/8/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35345490/
Case: “Acute myocarditis was recently demonstrated in previously healthy young male patients after receipt of mRNA SARS-CoV-2 vaccines. Herein, we report on a 21-year-old man who presented with acute fatigue, myalgia, and chest pain 2 days after his second SARS-CoV-2 vaccination with BNT162b2. Cardiac magnetic resonance (CMR) showed acute myocarditis, with mildly impaired LV-function and abundant subepicardial late gadolinium enhancement (LGE). Control CMR after 3 months showed full functional recovery and complete disappearance of LGE.”
128: Lymphohistiocytic Myocarditis Possibly Due to Moderna mRNA-1273 Vaccine
Author: Chow & Lai
Country: Canada
Date Published Online: 3/14/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35285858/
Case: “We describe a case of a previously healthy 45-year-old woman who had palpitations, exercise intolerance, and syncope 1 week after her first mRNA-1273 vaccine dose. Laboratory tests and cardiac imaging were compatible with myocarditis. Given her unusual clinical presentation, an endomyocardial biopsy was performed to exclude other potential etiologies.”
“The endomyocardial biopsy specimen showed patchy endocardial and intramyocardial lymphohistiocytic infiltrates with scattered eosinophils and focal myocyte injury. CD3 and CD68 immunostains confirmed the lymphocytic and histiocytic nature of the infiltrate, respectively. A focal histiocytic collection suggestive of an ill-defined granuloma was present. The histologic and immunohistochemical findings of a lymphohistiocytic myocarditis were highly suggestive of a postvaccination hypersensitivity reaction.”
129: COVID-19-Vaccination-Induced Myocarditis in Teenagers: Case Series with Further Follow-Up
Author: Puchalski et al
Country: Poland
Date Published Online: 3/15/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35329143/
Case: “We retrospectively analysed a group of 5 teenagers aged from 15 to 17 years with obesity/overweight (BMI ranging from 24.8 to 30) who presented typical myocarditis symptoms following the first or second dose (3 and 2 patients, respectively) of the COVID-19 vaccine. In the whole study group, a significant increase in troponin serum concentration was observed (1674-37,279.6 ng/L) with a further quick reduction within 3-4 days. In all patients, ST segments elevation or depression with repolarisation time abnormalities in electrocardiography were noticed. Chest X-ray results were within normal limits. Echocardiography showed normal left ventricular diameter (47-56.2 mm) with ejection fraction between 61-72%. All patients were diagnosed with myocarditis based on cardiac magnetic resonance (CMR) imaging. During further hospitalisation, swift clinical improvement was notable. Follow-up in the whole study group was obtained after 106-134 days from initial CMR, revealing no myocarditis symptoms, proper troponin level, and no ECG or echocardiographic abnormalities. At the same time, persistent myocardium injury features were detected in the whole study group, including ongoing myocarditis. COVID-19-vaccine-induced myocarditis seems to be a mild disease with fast clinical recovery, but the complete resolution of the inflammatory process may last over 3 months. Further follow-up and investigation for assessing subsequent implications and long-term COVID-19-vaccine-induced myocarditis is required.”
130: Hypersensitivity Myocarditis after COVID-19 mRNA Vaccination
Author: Frustaci et al
Country: Italy
Date Published Online: 3/16/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35329986/
Case: “Routine hematochemical screening, ECG, Holter monitoring, 2D echocardiogram cardiac magnetic resonance (CMR) and invasive cardiac studies (cardiac catheterization, selective coronary angiography, left ventriculography and left ventricular endomyocardial biopsy) are reported from three patients (39F-pt1, 78M-pt2, 52M-pt3) with severe compromise of conduction tissue (junctional rhythm and syncope, pt1) or cardiac function compromise (LVEF ≤ 35%, pt2 and pt3) after COVID-19 mRNA (BNT162b2).”
“Histology showed in all three patients extensive myocardial infiltration of degranulated eosinophils and elevation of serum cationic protein directly responsible for cardiomyocyte damage. These findings demonstrate myocarditis hypersensitivity to some component of the vaccine (spike protein?) acting as a hapten to some macromolecules of cardiomyocytes. Steroid administration (prednisone, 1 mg/kg die for 3 days, followed by 0.33 mg/kg for 4 weeks) was followed by complete recovery of cardiac contractility in pt2 and pt3.”
131: Ventricular tachycardia from myocarditis following COVID-19 vaccination with tozinameran (BNT162b2, Pfizer-BioNTech)
Author: Lin et al
Country: Singapore
Date Published Online: 3/19/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35306680/
Case: “A 26‐year‐old Chinese male with no significant past medical history presented to his primary care physician, with a 1‐day history of epigastric discomfort and general malaise. Prior to this, he had completed his COVID‐19 vaccination with the tozinameran mRNA vaccine, receiving his first and second doses 22 days apart. He had refrained from exercise for a week after his second dose, only returning to his usual running after that. He was able to complete his usual 8 km jogging route on 14 days after his second dose but was only able to manage 4 km on 2 days after that, limited by fatigue. He saw his primary care physician 18 days after his second dose for nonspecific symptoms. At his primary care clinic, he was found to be tachycardic at 170 bpm and was promptly referred to the emergency department.”
“However, left ventricular ejection fraction (LVEF) was reduced at 37% and moderate right ventricular dysfunction was seen. A cardiovascular magnetic resonance imaging (CMR) scan was performed 2 days after his VT episode. This documented subepicardial late gadolinium enhancement (LGE) at the LV apex extending to the inferior and lateral left ventricular wall (Figure 3). There was also focal limited LGE of the mid RV inferior wall with associated hypokinesia and myocardial edema. This CMR, which was done 2 days after his initial TTE, showed significant recovery of LVEF to 66%, with right ventricular ejection fraction quantified at 47% (mildly reduced) (Figure 3).”
“He was given a final diagnosis of myocarditis complicated by VT, secondary to COVID‐19 vaccination with tozinameran. During his 5‐day index admission, he remained hemodynamically stable with no further recurrence of VT. He was discharged with low‐dose beta blocker bisoprolol at 1.25 mg daily.
However, he presented again 8 days after his discharge, due to recurrent palpitations. He was found to have frequent nonsustained ventricular VT on telemetry monitoring and received an implantable cardiac defibrillator. During the defibrillation implantation procedure, endomyocardial biopsy was performed for the patient at the same setting. Histology of the myocardial tissue revealed focal hypertrophy of cardiomyocytes, with interstitial fibrosis. Immunohistochemistry with CD3 showed isolated T lymphoid cells while CD163 highlighted scattered histiocytes. This was consistent with recent/resolved myocarditis.
To our knowledge, this is the first case of myocarditis related to COVID‐19 mRNA vaccination that has presented with VT.”
132: Fulminant Giant Cell Myocarditis following Heterologous Vaccination of ChAdOx1 nCoV-19 and Pfizer-BioNTech COVID-19
Author: Kang et al
Country: Korea
Date Published Online: 3/20/22
Vaccine: Pfizer, AstraZeneca
Link: https://pubmed.ncbi.nlm.nih.gov/35334625/
Case: “A 48-year-old female patient underwent a heart transplantation for acute fulminant myocarditis, following heterologous vaccination with the ChAdOx1 nCoV-19 and Pfizer-BioNTech COVID-19. She had no history of severe acute respiratory syndrome coronavirus-2 infection. She did not exhibit clinical signs or have laboratory findings of concomitant infection before or after vaccination. Heart transplantation was performed because her heart failed to recover with venoarterial extracorporeal oxygenation support. Organ autopsy revealed giant cell myocarditis, possibly related to the vaccines. Clinicians may have to consider the possibility of the development of giant cell myocarditis, especially in patients with rapidly deteriorating cardiac function and myocarditis symptoms after COVID-19 vaccination.”
133: A Case of Systemic Capillary Leak Syndrome with Severe Cardiac Dysfunction after mRNA Vaccination for COVID-19
Author: Araki et al
Country: Japan
Date Published Online: 3/24/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35345835/
Case: “A 53-year-old woman with no significant medical history developed cardiogenic shock four days after receiving the second dose of the COVID-19 mRNA vaccine (BNT162b2, Pfizer/BioNtech). The patient required extracorporeal membrane oxygenation and an Impella device. Based on significant hemoconcentration, decreased plasma protein levels, and pathological findings in myocardial specimens, the patient was diagnosed with vaccination-induced fulminant systemic capillary leak syndrome (SCLS) with severe cardiac dysfunction. This Case highlights that SCLS can occur after COVID-19 mRNA vaccination and may be associated with cardiac dysfunction.”
134: Myocarditis Following the Second Dose of COVID-19 Vaccination in a Japanese Adolescent
Author: Yamamoto et al
Country: Japan
Date Published Online: 3/25/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35475062/
Case: “A 13-year-old male adolescent presented with chest pain after the second dose of the BNT162b2 vaccination. Electrocardiography, echocardiography, cardiac magnetic resonance imaging, and blood examinations were consistent with myocarditis. He was treated conservatively because his symptoms were relatively mild. In Japan, it is expected that the chances of diagnosing vaccine-related myocarditis will increase as more children are getting vaccinated.”
135: A Case of Heart Transplantation for Fulminant Myocarditis After ChAdOx1 nCoV-19 Vaccination
Author: Kim SH et al
Country: Korea
Date Published Online: 3/29/22
Vaccine: AstraZeneca
Link: https://pubmed.ncbi.nlm.nih.gov/35380028/
Case: “Herein, we describe clinical records of a 63-year woman with fulminant myocarditis following ChAdOx1 nCoV-19 vaccination that was salvaged by heart transplantation. She complained chest pain, nausea, vomiting, and fever after the second vaccination. After the heart transplantation, the patient died due to necrotizing pneumonia on the 54th day of onset. Fulminant myocarditis is very rare after ChAdOx1 nCoV-19 vaccination but can be fatal.”
136: Fulminant myocarditis in a patient with a lung adenocarcinoma after the third dose of modern COVID-19 vaccine. A case report and literature review
Author: Terán Brage et al
Country: Spain
Date Published Online: 3/31/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35378738/
Case: “Case report 62-year-old woman diagnosed in September 2019 of lung adenocarcinoma stage IV with bilateral lung and lymph node involvement, carrier of an EGFR mutation (Ex19Del) on treatment with osimertinib. She attended emergency department for fever and hypotension 24 h after administration of the third dose of Moderna® COVID-19 vaccine in the context of acute myocarditis with evidence of severe left ventricular (LV) dysfunction in cardiogenic shock. She required vasoactive support, non-invasive mechanical ventilation, corticotherapy, immunoglobulins and subsequent ventricular support with Impella, with improvement of the clinical picture after 3 days. Cardiac magnetic resonance imaging (MRI) showed evidence of global myocardial oedema compatible with acute myocarditis. Coronary CT showed a lesion in the anterior descending coronary artery requiring revascularization. A few days later, she presented febrile symptoms with isolation of Staphylococcus aureus in the central line catheter and antibiotherapy with cloxacillin was started, with subsequent resolution of the infectious symptoms. Conclusion This is an exceptional and controversial case of fulminant myocarditis probably related to the Modern COVID-19 vaccine in a patient diagnosed with metastatic lung adenocarcinoma on treatment with osimertinib. An increasing number of cases of myocarditis and pericarditis have been reported following vaccination with COVID-19 mRNA vaccines. In addition, retrospective data have shown an increased risk of QT prolongation and heart failure in patients treated with tyrosine kinase inhibitors. Hence, the need for close monitoring of cardiac function during treatment of these patients. Future studies will be necessary to evaluate unknown adverse reactions of these vaccines and their possible interaction with other antineoplastic drugs.”
137: A case of myopericarditis following administration of the Pfizer COVID-19 vaccine
Author: Morton et al
Country: US
Date Published Online: 4/6/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35529098/
Case: “We discuss a 16-year-old male who presented to the emergency department with chest pain 48 hours after receiving his second dose of the Pfizer COVID-19 vaccine. His laboratory and electrocardiogram findings were consistent with acute myopericarditis and work-up did not reveal an obvious etiology. After starting anti-inflammatory therapies, the patient's symptoms and laboratory markers improved and the patient was discharged from the hospital expected to make a full recovery.”
138: A case of myocarditis and isolated hypopotassemia after Biontech-Pfizer vaccine for Covid-19
Author: Ceylan et al
Country: Turkey
Date Published Online: 4/11/22
Vaccine: Pfizer
Link: https://www.cureus.com/articles/86711-symptomatic-myocarditis-post-covid-19-vaccination
Case: “57-year-old female patient has been on sertraline 50 mg/day and venlafaxine 37.5 mg/day for Major Depressive Disorder for the last ten years. She received the second shot of Biontech-Pfizer vaccine 39 days after the first shot. Two days after the second shot of Biontech-Pfizer vaccine for Covid-19, she experienced vertigo and fell on the floor. She visited her psychiatrist four days after the vaccine with symptoms of extreme fatigue. She went through a detailed physical and neurological examination, but there was no pathological sign. All the biochemical parameters, including liver and kidney function tests and troponin T levels (Troponin T hs: 0.003 mg/ml), were in the normal range except the following: potassium: 2.6 mmol/L (3.5–5.1), CRP: 25.7 mg/L ( 0–6), CK-MB: 41.3 U/L (0–25). These tests were repeated three days later, and all the parameters (CK-MB: 16.0 U/L, potassium: 3.8 mmol/L) except CRP (28.1) returned to normal levels. She received 2.172 g potassium citrate and 2.00 g potassium bicarbonate orally for 3 days after which the potassium level increased to 3.8 mmol/L. Cardiology examination confirmed a diagnosis of myocarditis. She received no treatment for the myocarditis. Echocardiography revealed mild left ventricular diastolic dysfunction. The cardiac stress test was regular. Her symptoms resolved completely in ten days.”
139: Symptomatic Myocarditis Post COVID-19 Vaccination
Author: Patel et al
Country: US
Date Published Online: 4/11/22
Vaccine: Pfizer, J&J
Link: https://www.cureus.com/articles/86711-symptomatic-myocarditis-post-covid-19-vaccination
Case: “Patient 1: An 18-year-old male presented with acute onset chest pain and shortness of breath. Chest pain was constant, 7/10, substernal, non-radiating, positional, and pleuritic in nature. The pain was exacerbated by lying down, and alleviated by sitting up, leaning forward, and Tylenol. He had experienced fever, cough, myalgias, dizziness, headaches, nausea, and diarrhea one day prior to presentation. Patient had received his second dose of the mRNA-1273 (Moderna) COVID-19 vaccine a day prior to the onset of symptoms. He denied any adverse events following the first dose of vaccination.”
“He also underwent a cardiac MRI (Figure 2), which showed findings consistent with myopericarditis per Lake Louise criteria. Pericardial enhancement adjacent to the right ventricle (RV) free wall and the lateral LV wall was noted. There was a subepicardial pattern of myocardial fibrosis and focal elevations in the myocardial T1 and extracellular volume (ECV) without any definite myocardial edema on T2 mapping. No myocardial infarction was seen on late gadolinium enhancement imaging.”
“Patient 2: A 29-year-old male presented with acute onset chest pain, shortness of breath, palpitations, and nausea. He reported cleaning his pool and inhaling chlorine gas, immediately after which the patient experienced chest tightness. Chest pain was reported as constant, 8/10, midsternal, pleuritic, positional in nature, pressure-like, with radiation to bilateral arms. Pain was exacerbated by lying down and alleviated by sitting up, leaning forward, and Tylenol. The patient was in good health otherwise and denied any illicit substance use prior to arrival. He reported receiving the Ad26.COV2.S (Johnson & Johnson) COVID-19 vaccine one week prior to initiation of symptoms. The patient denied any adverse events immediately following vaccination.”
“He also underwent a cardiac MRI (Figure 4) which showed findings consistent with myocarditis per Lake Louise criteria. A subepicardial pattern of myocardial fibrosis was seen on late gadolinium enhancement imaging in multiple wall segments, involving 26% of the myocardial mass. There were numerous wall segments with elevated myocardial T2 values on parametric mapping. There were markedly elevated myocardial ECV values. A small pericardial effusion was also seen.”
140: COVID Vaccine-Associated Myocarditis in Adolescent Siblings: Does It Run in the Family?
Author: Moosman et al
Country: NZ
Date Published Online: 4/14/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35455360/
Case: “Patient 1 is a 14-year-old male who presented to his general practitioner with acute-onset left-sided chest pain three days after receiving the second dose of the Pfizer–BioNTech COVID-19 vaccine. The patient was previously healthy with no comorbid conditions and no significant family history of cardiac disease.”
“Cardiac MRI 5 days following vaccination confirmed active myocarditis by Lake Louise criteria, including myocardial oedema on T2-weighted imaging and non-ischemic myocardial injury on late gadolinium-enhanced imaging [13]. These changes were focal, involving the inferior basal third of the left ventricle and the posterior obtuse marginal surface (Figure 2A).”
“Patient 2 is a 12-year-old male with no previous medical history or comorbid conditions and is the younger sibling of patient 1 (details in Table 1). Patient 2 presented one week following his brother’s admission with acute left-sided chest pain that developed 48 h after receiving the second dose of the Pfizer–BioNTech COVID-19 vaccine.”
“Cardiac MRI 5 days following vaccination was similar to that of the older sibling. There was a large region of full-thickness myocardial oedema in the inferior and posterior obtuse marginal surfaces of the heart. Late gadolinium-enhanced imaging confirmed the presence of non-ischemic myocardial injury in these regions (Figure 2B).”
141: Myocarditis following COVID-19 mRNA (mRNA-1273) vaccination
Author: Chellapandian et al
Country: Qatar
Date Published Online: 4/18/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35449778/
Case: “A 22‐year‐old male patient presented to the emergency department with complaints of chest pain and generalized body pain. He described his chest pain as a central chest pain without any radiation and had been on and off for the last 2 days. There was no accompanying sweating, shortness of breath, or palpitation. This previously healthy patient did not have any risk factor for coronary artery disease. He claimed that he had his second dose of Covid vaccine 2 days before his complaints started. […] On the cardiac MRI examination, normal biventricular volume and functions were observed. Basal inferolateral myocardial edema supporting myocarditis, myocardial hyperemia, and myocardial scar were observed (Figures 1, ,2, ,3, and and 4).”
142: Intermittent complete heart block with ventricular standstill after Pfizer COVID-19 booster vaccination: A case report
Author: Kimball et al
Country: US
Date Published Online: 4/20/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35475120/
Case: “A 57‐year‐old male with a past medical history of hypertension on valsartan and recent COVID‐19 booster vaccination presented to the emergency department (ED) by ambulance for evaluation of syncope. The patient had received his third dose of the Pfizer‐BioNtech COVID‐19 vaccine the previous day. He subsequently experienced multiple syncopal events for which 911 was called. During emergency medical services transport, the patient had another syncopal episode with reported asystole on the cardiac monitor; this episode resolved spontaneously and cardiopulmonary resuscitation (CPR) was not performed.”
“Shortly after being attached to the cardiac monitor, the patient lost consciousness and went into complete heart block with ventricular standstill with loss of pulses (Figure 2). CPR was initiated; however, before completion of the first round of compressions the patient regained consciousness with return of spontaneous circulation and normal sinus rhythm. The decision was made to intubate the patient for airway protection. While being prepared for intubation, the patient again developed complete heart block with ventricular standstill. CPR was restarted and the patient was given 1 mg of intravenous epinephrine.”
“Given the patient's recurrent episodes of complete heart block with ventricular standstill, the decision was made to place a transvenous pacemaker (TVP) for sustained pacing.”
“Cardiac magnetic resonance imaging (MRI) was more illuminating with evidence of global left ventricular inflammation and late gadolinium enhancement of the basal septum consistent with myocarditis. This diagnosis was confirmed by endomyocardial biopsy that demonstrated lymphocytic myocarditis with negative immunohistochemical staining for amyloid and viral etiologies including parvovirus, adenovirus, herpes simplex virus, and cytomegalovirus.”
143: A Case of Myocarditis Presenting With a Hyperechoic Nodule After the First Dose of COVID-19 mRNA Vaccine
Author: Park & You
Country: Korea
Date Published Online: 4/20/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35470603/
Case: “A 17-year-old boy visited the emergency room complaining of chest pain that first occurred the night before. He described the pain as pressure on the middle of the chest and mild on a numerical rating scale of 2. […] He had received the first dose of the BNT162b2 COVID-19 vaccine 18 days prior to the onset of chest pain. No discomfort was noted during inoculation.”
“Additionally, cardiac magnetic resonance imaging (MRI) was performed to differentiate between focal myocardial infarction and myocarditis. We use a 3.0 Tesla MRI machine (Siemens). The MRI showed late gadolinium enhancement in the mid-base septum and apex lateral wall (Fig. 3). The T1 and T2 weighted images were normal, and there was no evidence of edema. Based on the results, acute multifocal myocarditis was diagnosed.6”
144: Myocarditis after BNT162b2 and mRNA-1273 COVID-19 vaccination: A report of 7 cases
Author: Ahmed
Country: Iraq, Syria
Date Published Online: 4/21/22
Vaccine: Pfizer, Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35466745/
Case: “A total of seven patients with myocarditis were identified between March 7, 2021 and March 3, 2022. All seven patients were males and hemodynamically stable. The median age was 24.5 years, ranging from 16 to 36 years. It summarizes the demographic and clinical characteristics of the seven cases and is shown in (Table 1 ). The most common symptoms were chest pain, and fatigue. Everyone in the group had received the second dose of a messenger RNA (mRNA) vaccine between one and four days before being admitted to the hospital (5 received BNT162b2 [Pfizer-BioNTech] and 2 received mRNA-1273 [Moderna]). All seven patients had negative results for COVID-19 and respiratory virus polymerase chain reaction (PCR) tests. The electrocardiograms of all seven patients were abnormal, and their troponin levels were elevated. A chest radiograph revealed that none of them had acute pulmonary disease. According to the findings, left ventricular ejection fraction ranged from 45% to 65% on echocardiograms. All seven patients were treated with colchicine and NSAIDs. The average length of stay in the hospital was 2.4 days, and all the patients' symptoms had resolved by the time they were discharged.”
145: Acute Fulminant Myocarditis After ChAdOx1 nCoV-19 Vaccine: A Case Report and Literature Review
Author: Wu CT et al
Country: Taiwan
Date Published Online: 4/21/22
Vaccine: AstraZeneca
Link: https://pubmed.ncbi.nlm.nih.gov/35466745/
Case: “A previously healthy 44-year-old Taiwanese female hairdresser (153 cm, 63 kg), without any documented systemic disease, received first dose of ChAdOx1 nCoV-19 vaccine (AstraZeneca) on August 6, 2021. […] She started to feel persistent stabbing chest pain and breathless approximately 48 h after vaccination. Because the symptoms progressed, she visited the emergency department at another hospital on August 11. […] She had nausea, vomiting, and abdominal distension after admission. Hypotension developed on August 12, and echocardiography showed poor left ventricular function. Norepinephrine was infused, and she was transferred to our intensive care unit for further management on August 13.”
“Chest X-way revealed acute pulmonary edema, and echocardiography showed left ventricular diameter 47/39 mm, left ventricular ejection fraction (LVEF) about 35%, and small amount of pericardial effusion.”
“Cardiac MRI on August 19 showed global LV hypokinesia with LVEF 41.6% and markedly increased LV T1 and T2 signal values (Figure 2). Late Gadolinium enhancement (LGE) images depict the patchy enhancements sparsely distributed in the mid-layer and subepicardium, and subendocardial enhancement in the antero-septal subendocardium of LV mid-cavity. On August 23, her LVEF was 45% by echocardiography and ECG showed evolutionary changes including higher QRS voltage and diffuse T wave inversion (Figure 1C). She was discharged on August 24 with colchicine, losartan, ivabradine, and spironolactone. She had mild dyspnea on exertion and tingling chest pain at discharge, and the symptoms gradually disappeared after discharge. Her latest echocardiography on January 17 2022 showed normal LV diameter (45/31 mm), LVEF 60%, and no pericardial effusion. ECG showed normal sinus rhythm without ST-T changes (Supplementary Figure 3). There was a complete recovery of her fulminant perimyocarditis.”
146: A 17-year-old male with acute myocarditis following mRNA-1273 vaccination in Japan
Author: Iwamuro et al
Country: Japan
Date Published Online: 4/25/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35466745/
Case: “A 17-year-old healthy male developed arthralgia and a fever of 38 °C on the day of the second dose of the mRNA-1273 severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) vaccine (Moderna). He presented to a clinic 3 days after vaccination with sharp substernal severe chest pain. […] We diagnosed acute myocarditis due to mRNA-1273 vaccination based on his background, clinical course, ECG, and echocardiography.”
“CMR was performed 4 days after vaccination to clarify the myocardial damage (Fig. 2 ). Cine imaging showed normal left ventricular size, wall thickness, and contraction without pericardial effusion. T2-weighted imaging revealed increased bright signal intensity in the apical anterior wall, which indicated myocardial edema (Fig. 2A). Late gadolinium enhancement CMR imaging showed focal late enhancement in the same lesion with non-ischemic regional distribution, which indicated myocarditis (Fig. 2B). Using the 2018 Lake Louise criteria [3], these findings were consistent with a diagnosis of acute myocarditis.
After 2 days in hospital, his fever had subsided and his TnT and CRP had normalized. He was discharged without complications.
At the outpatient checkup one month later, his ECG findings, TnT, CRP, and NTproBNP were normalized, and exercise tolerance was maintained with AT-VO2 of 113% in the cardiopulmonary exercise stress test.”
147: Acute Myocarditis Following Vaccination With the First Dose of the mRNA-1273 Vaccine
Author: Olagunju et al
Country: US
Date Published Online: 4/25/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35466745/
Case: “We describe a case of acute myocarditis in a 19-year-old male 2 days after the initial dose of the COVID-19 mRNA-1273 vaccine. He presented with chest pain radiating to his left arm and bilateral shoulders. COVID, influenza, coxsackie, respiratory syncytial virus polymerase chain reaction (PCR) tests were negative. Electrocardiogram revealed diffuse ST-segment elevation. Initial Troponin was 15.7 ng/mL. A coronary angiogram revealed patent coronary arteries and no wall motion abnormality. A transthoracic echocardiogram showed diffuse hypokinesis with an ejection fraction of 49%. Cardiac magnetic resonance scan was aborted after 2 attempts due to severe claustrophobia. His chest pain resolved following initiation of aspirin, tylenol, colchicine, lisinopril, and metoprolol.”
148: Post Covıd-19 Vaccınatıon Inflammatory Syndrome: A Case Report
Author: Durucan et l
Country: Turkey
Date Published Online: 5/12/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35556127/
Case: “A previously healthy 24-year-old male patient was referred to our clinic with bilateral lower extremity pain and dark urine, which developed two weeks after receiving the second dose of BNT162b2 vaccine against SARS-CoV-2. Laboratory tests indicated rhabdomyolysis. Lower extremity magnetic resonance imaging was compatible with myositis. Myositis-related antibodies were negative. Biopsy taken from gastrocnemius muscle revealed muscle necrosis and striking expression of major histocompatibility complex class I antigen. He was successfully treated, and his complaints resolved. One week later at follow-up, he reported new-onset exertional dyspnea with palpitations. ST-segment depressions were spotted on electrocardiography. Troponin T was found elevated as 0.595 ng/mL (normal <0.014 ng/mL). Echocardiography showed hypokinetic left ventricle with ejection fraction of 40%, and pericardial effusion of 2mm. An appropriate treatment plan was formulated for the diagnosis of myocarditis, eventually the patient recovered within ten days. BNT162b2 mRNA vaccine was felt to cause the aforementioned condition since no other etiology could be identified. Although it is known that BNT162b2 may induce myocarditis, myositis concomitant myocarditis appears to be a very rare adverse effect of this vaccine.”
149: Case Report: Transient Increase of CMR T1 Mapping Indices in a Patient With COVID-19 mRNA Vaccine Induced Acute Myocarditis
Author: Ansari et al
Country: Germany
Date Published Online: 5/16/22
Vaccine: Moderna
Link: https://pubmed.ncbi.nlm.nih.gov/35571183/
Case: “A 23-year-old male presented in the emergency department with complaints of chest pain radiating to the left arm following vaccination with the second dose of COVID-19 mRNA-1273 vaccine (Moderna). Patient's history revealed an incidence of myocarditis in the past. CMR showed a mid-range left ventricular ejection fraction (38%) and subepicardial late gadolinium enhancement (LGE) in the inferolateral and apical myocardial segments with diffuse elevation of native T1 mapping relaxation times in all myocardial segments. The patient was admitted briefly in the intensive care unit and after a favorable clinical course was discharged from the hospital in stable condition. A follow-up CMR after 3 months revealed normalization of LVEF (57%) and native T1- times in most segments. Scarred myocardium reflecting chronic myocarditis continued to show elevated T1 times.”
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Added Studies:
150: Long QT interval and syncope after a single dose of COVID-19 vaccination: a case report
Author: Azdaki & Farzad
Country: Iran
Date Published Online: 9/30/21
Vaccine: AstraZeneca
Link: https://pubmed.ncbi.nlm.nih.gov/35571183/
Case: We report a case of a 70-year-old man who presented to the hospital for some syncope, 3 days after his first COVID-19 AstraZeneca Vaccination. Initial electrocardiogram (ECG) showed a long QT interval (QTc = 600 milliseconds). Laboratory tests revealed elevated troponin and lack of evidence of viral infection. Further investigations revealed the vaccine-induced myocarditis and arrhythmias linked to it. Within one week of magnesium treatment, the QT interval was completely corrected, and the patient discharged with no typical syncope attacks. This case like the previous reported one confirms that myocarditis is a complication of COVID-19 vaccine, but implies its clinical manifestations may be varied and even may happen after the single dose of vaccination.
151: Complete AV Block in Vaccinated COVID-19 Patient
Author: Lee K et al
Country: US
Date Published Online: 3/30/22
Vaccine: Pfizer
Link: https://pubmed.ncbi.nlm.nih.gov/35371571/
Case: An 84 year-old male with history of coronary artery disease, hypertension, and hyperlipidemia presented to an outside urgent care with prodromal symptoms. The patient had received the second Pfizer vaccine three months prior. This presentation, he was found to be COVID-19 positive as well as bradycardic with a complete AV block. He was transferred to a tertiary center for further evaluation and management. However, after transfer, the patient refused further invasive cardiac interventions and after medical therapy was discharged home in complete AV block.
WOW. A lot of work. THANK YOU!!!
Well done! 👏👏👏