Clinical Presentation and Outcomes of Myocarditis Post mRNA Vaccination: A Meta-Analysis and Systematic Review

Abstract

Background: Myocarditis is being increasingly reported as a potential complication of both Pfizer-BioNTech and Moderna vaccines for COVID-19. One thousand five hundred and twenty-two cases were reported as of September 02, 2021, as per CDC’s (Centers for Disease Control) vaccine adverse event reporting system. Most of the published data is available in the form of case reports and series. There is a need to compile the demographic data, clinical features, and outcomes in these patients. Methods: A systematic search was conducted in PubMed, Embase, Web of science, and google scholar for published literature between January 01, 2020, and July 17, 2021. Individual data of 69 patients were pooled from 25 qualifying case reports and case series. Results: The median age of onset was 21 years. 92.7% of the patients were male. 76.8% of patients received the Pfizer-BioNTech vaccine, and 23.2% received the Moderna vaccine. 88.5% developed symptoms after the second dose. Patients were admitted to the hospital a median of three days post-vaccination. All the patients had chest pain and elevated troponin. The myocarditis was confirmed on cardiac MRI in 87% of the patients. Most of the patients had late gadolinium enhancement on MRI. The median length of stay was four days. All the reported patients recovered and were discharged. Conclusion: Post-mRNA vaccination myocarditis is seen predominantly in young males within a few days after their second dose of vaccination. The pathophysiology of myocarditis is not well known. The prognosis is good as all the reported patients recovered. The presence of late gadolinium enhancement on cardiac MRI indicated myocardial necrosis/fibrosis and further studies are needed to establish the long-term prognosis of the condition.

A Rare Case of Myocarditis After the First Dose of Moderna Vaccine in a Patient With Two Previous COVID-19 Infections

“…Similar cases have been reported with a majority of them occurring after the second dose of vaccination [ 6 ]. However, only a few cases have been observed following the first dose of the Moderna vaccine with or without previous COVID-19 infections [ 7 , 8 ].…”

PQQ Supplementation and SARS-CoV-2 Spike Protein-Induced Heart Inflammation

“…SARS-CoV-2 spike protein-induced inflammations have been shown in many works 2 - 15 with attribution in some cases to the spike protein produced by the vaccines by itself rather than the virus. 6 - 9 , 11 - 15 …”

“…Mostly unexplored in the literature is the specific opportunity to develop COVID-19-like symptoms following vaccinations which create the SARS-CoV-2 spike protein, which starts to be covered consistently in the literature. 6 - 9 , 11 - 15 …”

“…The present study aimed to understand if supplementation with pyrroloquinoline quinone (PQQ) 1 may have positive effects to reduce the heart inflammation associated with the administration of COVID-19 mRNA vaccines, which have been claimed to produce COVID-19-like symptoms in some patients, at different degrees of severity. SARS-CoV-2 spike protein-induced inflammations have been shown in many works [2][3][4][5][6][7][8][9][10][11][12][13][14][15] with attribution in some cases to the spike protein produced by the vaccines by itself rather than the virus. [6][7][8][9][11][12][13][14][15] There is no doubt that oxidative and inflammatory conditions may originate from the administration of the COVID-19 vaccines.…”

Peptide Nanoarray Scaffold Vaccine for SARS-COV-2 and Its Variants of Concerns

“…These issues put the immunocompromised vaccine recipients at even greater risk and further hinder vaccine development 29 . Additionally, a certain percentage of current vaccine recipients experience cardiovascular complications such as in ammation and myocarditis 30,31 . With these limitations in mind, we aim to develop a novel vaccinology approach such as a modular epitope vaccine as a proof-of-concept against SARS-CoV-2.…”