Myocarditis Occurring After Immunization With mRNA-Based COVID-19 Vaccines

Abstract

Two reports in the current issue of JAMA Cardiology describe cases of acute myocarditis that occurred among persons who received the BNT162b2-mRNA (Pfizer-BioNTech) or mRNA-1273 (Moderna) messenger RNA (mRNA)-based COVID-19 vaccines authorized for use in the US. 1,2 During the clinical evaluations of these patients, alternative etiologies for myocarditis were not detected.The first report describes 4 cases of myocarditis with symptom onset 1 to 5 days after receipt of a second dose of mRNA-based COVID-19 vaccine (2 receiving the BNT162b2-mRNA vaccine and 2 receiving the mRNA-1273 vaccine) who were evaluated in a single tertiar y care medical center (Duke University Medical Center) that attempted to define its c atchment population. 1 Three cases occurred in men aged 23 to 36 years and the fourth in a 70-year-old woman; details about the medical history of the fourth patient were not provided, but she received coronary angiography during her evaluation and no atherosclerosis was found. All presented with severe acute chest pain, had abnormal electrocardiogram results, and had evidence of myocardial injury demonstrated by elevated troponin levels. Cardiac magnetic resonance imaging was performed in these 4 patients on days 3 through 5 after vaccine receipt, and the findings were consistent with acute myocarditis as defined by recent expert consensus guidelines. 3 The second, larger case report comes from the US Military Health System and describes 23 individuals with acute myocarditis who presented within 4 days after mRNA-based COVID-19 vaccination. 2 All patients were male, 22 of 23 were on active duty, and the median (range) age was 25 (20-51) years; 20 cases occurred after receipt of a second dose of an mRNAbased COVID-19 vaccine. Clinical presentations and laboratory findings were similar to those described in the smaller case series 1 ; 8 of 23 patients in this series received cardiac magnetic resonance imaging, and all 8 demonstrated findings again consistent with acute myocarditis. 2 A separate case report published by Marshall et al 4 provides additional context in a younger population. They report 7 US male adolescents aged 14 to 19 years who presented with myocarditis or myopericarditis within 4 days after receipt of a second dose of the BNT162b2-mRNA COVID-19 vaccine. 4 These adolescents were found to have elevated troponin levels, abnormal electrocardiogram results, and findings on cardiac magnetic resonance imaging consistent with acute myocarditis.

Every rose has its thorns — acute myocarditis following COVID-19 vaccination

“…Acute myocarditis following vaccination is a rare but serious complication, which has until now been recognized as associated almost exclusively with smallpox and influenza immunization [2]. Myocarditis in the course of COVID-19 infection was previously described [3,4]; however, only recently have the first cases of acute myocarditis following administration of the mRNA-based anti-COVID-19 vaccines (Pfizer-BioNTech and Moderna) been reported [2,5]. This complication typically occurs in young adult males within 4 days after administration of the second dose of the COVID-19 vaccine [2,5].…”

Cardiogenic Shock Due to Acute Myocarditis Following AZD1222 Vaccine Administration: a Case Report

“…Several cases of myocarditis have been reported in the period shortly after a Covid-19 vaccination but were deemed to have a different underlying cause. [6,7] In our case, all the tests performed in search of an infectious or immune-mediated cause proved negative, and serological testing demonstrated a typical pattern of SARS-CoV-2 immunization.…”

The coronavirus disease 2019 (COVID-19) pandemic—Looking back and looking forward

“…However, ongoing surveillance has suggested that COVID vaccines may be associated with thrombosis with thrombocytopenic syndrome (TTS) [39][40][41] or myocarditis. 42,43 These adverse events have varied by the specific vaccine administered. However, the benefits of vaccination clearly remain greater than rare serious side effects.…”