Since it was first detected, novel coronavirus disease rapidly spread, striking over 4 million people worldwide. 1 While adults with COVID-19 demonstrate a range of disease severity with 20% of infected adults being critically ill and an estimated fatality rate as high as 2%, children mostly suffer from a mild disease, only minority presenting with respiratory distress syndrome or multi-organ failure. [2][3][4] However, the role of infected children in spreading the virus to their older relatives and caregivers is yet to be determined.Many countries struggle to stave off the spreading of COVID-19 by using different strategies. In many countries, including Israel, authorities instructed the public to stay at home and to avoid visiting local clinics and hospitals as much as possible while using more telemedicine-based practice. 5 However, emergent medical situations continue to appear alongside the current outbreak and their diagnosis should still be made promptly. Delayed diagnosis and treatment of those common paediatric conditions may lead to significant morbidity that may overweigh the harm caused by COVID-19 infection.Appendicitis is the most common abdominal surgical emergency in paediatric population. 6 Early diagnosis of appendicitis

Background: Vaccines are paramount in the effort to end the coronavirus disease 2019 global epidemic. BNT162b2 is approved for the vaccination of adolescents over 16 years of age. Systemic adverse events were scarce though the pretested cohort of this age group was relatively small. The aim of the current study is to raise awareness for potential adverse reactions. Methods: This is a case series of patients diagnosed with perimyocarditis following vaccination. Patients were compiled from 3 pediatric medical centers in Israel through a network of pediatricians and data regarding those cases was collected. In addition, incidence of perimyocarditis during the vaccination period was compared with previous years. Results: 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. Conclusions: This case series describes a time association between coronavirus disease 2019 vaccine and perimyocarditis in adolescents. All cases were mild, although only long-term follow-up can reveal the true impact of this cardiac injury. While it seems that the incidence of perimyocarditis during the vaccination campaign period is increased, a more comprehensive data collection on a wider scale should be done. We hope this report will serve as a reminder to report events and allow for analysis of potential adverse reactions.

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