Symptomatic Acute Myocarditis in 7 Adolescents Following Pfizer-BioNTech COVID-19 Vaccination

 Mayme Marshall, MD, Ian D. Ferguson, MD, Paul Lewis, MD, MPH, Preeti Jaggi, MD, Christina Gagliardo, MD, James Steward Collins, MD, Robin Shaughnessy, MD, Rachel Caron, BA, Cristina Fuss, MD, Kathleen Jo E. Corbin, MD, MHS, Leonard Emuren, MBBS, PhD, Erin Faherty, MD, E. Kevin Hall, MD, Cecilia Di Pentima, MD, MPH, Matthew E. Oste, MD, MPH, Elijah Paintsil, MD, Saira Siddiqui, MD, Donna M. Timchak, MD, Judith A. Guzman-Cottrill, DO 

DOI: 10.1542/peds.2021-052478

PDF: https://pediatrics.aappublications.org/content/pediatrics/early/2021/06/02/peds.2021-052478.full-text.pdf

Abstract 

Trials of coronavirus disease 2019 (COVID-19) vaccination included limited numbers of children so may not have detected rare but important adverse events in this population. We report seven cases of acute myocarditis or myopericarditis in healthy male adolescents who presented with chest pain all within four days after the second dose of Pfizer-BioNTech COVID-19 vaccination. Five patients had fever around the time of presentation. Acute COVID19 was ruled out in all 7 cases based on negative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time reverse transcription polymerase chain reaction (PCR) tests of specimens obtained using nasopharyngeal swabs. None of the patients met 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 an elevated troponin. Cardiac magnetic resonance imaging (MRI) revealed late gadolinium enhancement characteristic of myocarditis. All 7 patients resolved their symptoms rapidly. Three patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs) only and 4 received intravenous immune globulin (IVIG) and corticosteroids. This report provides a summary of each adolescent’s clinical course and evaluation. No causal relationship between vaccine administration and myocarditis has been established. Continued monitoring and reporting to the Food and Drug Administration (FDA) Vaccine Adverse Event Reporting System (VAERS) is strongly recommended.

https://pediatrics.aappublications.org/content/pediatrics/early/2021/06/02/peds.2021-052478.full.pdf