Symptomatic acute myocarditis in seven adolescents after Pfizer-BioNTech COVID-19 vaccination
Coronavirus disease 2019 (COVID-19) vaccination trials included a limited number of children , so rare but important adverse events may not have been detected in this population.
We report seven cases of acute myocarditis or myopericarditis in healthy male adolescents who presented with chest pain within four days after the second dose of the Pfizer-BioNTech COVID-19 vaccine.
Five patients had fever at the time of presentation. Acute COVID19 was ruled out in all 7 cases based on negative real-time reverse transcription-polymerase chain reaction (PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from nasopharyngeal swab samples. .
None of the patients met the criteria for multisystem inflammatory syndrome in children (MIS-C).
Six of the 7 patients had negative SARSCoV-2 nucleocapsid antibody assays, suggesting no prior infection.
All patients had elevated troponin .
Cardiac magnetic resonance imaging ( MRI) revealed late gadolinium enhancement characteristic of myocarditis.
All 7 patients resolved their symptoms quickly.
Three patients were treated only with nonsteroidal anti-inflammatory drugs (NSAIDs) and 4 received intravenous immunoglobulin (IVIG) and corticosteroids.
A causal relationship between vaccine administration and myocarditis has not been established. Continued monitoring and reporting to the Food and Drug Administration (FDA) Vaccine Adverse Event Reporting System (VAERS) is strongly recommended.
Myocarditis and myopericarditis after COVID-19 vaccination appear rare. As of May 23, 2021, the Centers for Disease Control and Prevention (CDC) reported that 1,560,652 people under the age of 18 had completed a two-dose series of the COVID-19 vaccine. Of these, 652,758 adolescents received their second dose more than fourteen days ago.
Currently, the PfizerBioNTech COVID-19 vaccine is the only COVID-19 vaccine authorized for children under 18 years of age in the US. We urge physicians and healthcare providers to consider myocarditis in the evaluation of adolescents and young adults who develop chest pain after COVID-19 vaccination.
All cases of myocarditis in patients with recent COVID-19 vaccination should be reported immediately.
