Age: 45.0
Sex: M
Vaccine: COVID19
Symptoms: Echocardiogram, Electrocardiogram, Inflammatory marker test, Influenza like illness, Lethargy
Clinical narrative: This literature-non-study case was reported in a literature article and describes the occurrence of STRESS CARDIOMYOPATHY (Takotsubo Cardiomyopathy) in a 45-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 prophylaxis. The occurrence of additional non-serious events is detailed below.  LITERATURE REFERENCE: Unusual case of takotsubo cardiomyopathy secondary to COVID-19 vaccine. Concurrent medical conditions included Non-smoker. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced STRESS CARDIOMYOPATHY (Takotsubo Cardiomyopathy) (seriousness criterion hospitalization), INFLUENZA LIKE ILLNESS (Flu-like symptoms of fever), MYALGIA (myalgia) and LETHARGY (lethargy). At the time of the report, STRESS CARDIOMYOPATHY (Takotsubo Cardiomyopathy) had resolved and INFLUENZA LIKE ILLNESS (Flu-like symptoms of fever), MYALGIA (myalgia) and LETHARGY (lethargy) outcome was unknown. Related. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Angiocardiogram: Revealed no coronary stenosis. On an unknown date, Angiogram pulmonary: (Negative) Negative for pulmonary embolism. On an unknown date, Blood pressure measurement: 150/80. On an unknown date, Brain natriuretic peptide: 200 pg/ml. On an unknown date, Catheterisation cardiac: Did not show any stenosis, acute coronary syndrome was ruled out. On an unknown date, Echocardiogram: Showed reduced left ventricular ejection fraction of 25-30% with akinesis of the mid to distal anterior, anteroseptal, anterolateral, inferolateral, inferoseptal, and inferior walls. ST-segment elevation myocardial infarction (STEMI) alert and the patient was brought urgently to the cath. lab and Repeat transthoracic echo four days later showed recovery of the ejection fraction without segmental wall motion abnormalities (4 days after hospitalization). On an unknown date, Electrocardiogram: showed ST-segment elevation in the anterior leads. and showed normal sinus rhythm without ST-segment elevation (Before discharge). On an unknown date, Inflammatory marker test: (Negative) Negative. Pericarditis and myopericarditis were unlikely. On an unknown date, Troponin I: 1700 ng/dL. On an unknown date, Ultrasound scan: showed left ventricular wall motion abnormality. On an unknown date, Vital signs measurement: Normal limits. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered STRESS CARDIOMYOPATHY (Takotsubo Cardiomyopathy), INFLUENZA LIKE ILLNESS (Flu-like symptoms of fever), MYALGIA (myalgia) and LETHARGY (lethargy) to be related. No concomitant and treatment medications were reported. Patient did not had known past medical history, presented with substernal chest discomfort while having dinner. The pain radiated to his jaw lasting approximately 2 hours. He never had this kind of pain before. Pain was described as a constant, severe stabbing pain that was progressively getting worse. Exertion exacerbated the pain. The pain was not pleuritic in nature. No family history of any heart attack or stroke. He received his second dose of COVID-19 (Moderna) vaccine three days before coming to the hospital. He had had flu-like symptoms of fever, myalgia, and lethargy after his first dose. He was anxious to have similar symptoms after the second dose. The patient symptoms improved significantly during his hospitalization. The patient was stable to be discharged home. there were no signs of pericardial effusion on the transthoracic echo. Patient met all seven diagnostic criteria that were put forth by the local Society of Cardiology, for diagnosis of Takotsubo cardiomyopathy. Company comment: This literature-non-study case concerns an adult male patient aged 45 years with no relevant medical history reported, who experienced the unexpected serious(hospitalization) AESI of Stress cardiomyopathy (reported as Takotsubo Cardiomyopathy) three days after second dose of mRNA-1273 vaccine. Patient presented with substernal chest discomfort radiating to jaw, non-pleuritic, worsened on exertion. Patient was anxious about symptoms following vaccination as he had experienced fever, myalgia, and lethargy after his first dose. On admission, blood pressure was 150/80 and rest of the vitals within normal limits. His labs were significant for high sensitivity troponin of 1700 ng/dl and brain natriuretic peptide (BNP) of 200 pg/ml. EKG showed ST-segment elevation in the anterior leads. 2D Echo done showed left ventricular wall motion abnormality. A formal limited STAT transthoracic echo showed a reduced left ventricle. Company Comment: This literature-non-study case concerns an adult male patient aged 45 years with no relevant medical history reported, who experienced the unexpected serious(hospitalization) AESI of Stress cardiomyopathy (reported as Takotsubo Cardiomyopathy) three days after second dose of mRNA-1273 vaccine. Patient presented with substernal chest discomfort radiating to jaw, non-pleuritic, worsened on exertion. Patient was anxious about symptoms following vaccination as he had experienced fever, myalgia, and lethargy after his first dose. On admission, blood pressure was 150/80 and rest of the vitals within normal limits. His labs were significant for high sensitivity troponin of 1700 ng/dl and brain natriuretic peptide (BNP) of 200 pg/ml. EKG showed ST-segment elevation in the anterior leads. 2D Echo done showed left ventricular wall motion abnormality. A formal limited STAT transthoracic echo showed a reduced left ventricular ejection fraction of 25-30% with akinesis of the mid to distal anterior, anteroseptal, anterolateral, inferolateral, inferoseptal and inferior walls. Urgent coronary angiography done revealed no coronary stenosis ruling out Acute coronary syndrome. Computed tomography angiography (CTA)was negative for pulmonary embolism. Inflammation markers were negative with no pericardial effusion on echo which ruled out Pericarditis and Myopericarditis. The patient's symptoms improved significantly during his hospitalization. Repeat transthoracic echo four days later showed recovery of the ejection fraction without segmental wall motion abnormalities. EKG done before the patient's discharge showed normal sinus rhythm without ST-segment elevation. The pathophysiology behind vaccination-induced TCM is poorly understood but appears to be multifactorial. The etiology is most likely a combination of increased release of catecholamines or increased myocardial sensitization to them. The patient was stable to be discharged home. The benefit-risk relationship of mRNA-1273 is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 12-Sep-2022: Live Follow up received by safety on 15-Sep-2022 has email with FTA and article propagated contains significant information: Citation details were added, current condition was added, suspect dose details was added, laboratory tests was added. Sender's Comments: This literature-non-study case concerns an adult male patient aged 45 years with no relevant medical history reported, who experienced the unexpected serious(hospitalization) AESI of Stress cardiomyopathy (reported as Takotsubo Cardiomyopathy) three days after second dose of mRNA-1273 vaccine. Patient presented with substernal chest discomfort radiating to jaw, non-pleuritic, worsened on exertion. Patient was anxious about symptoms following vaccination as he had experienced fever, myalgia, and lethargy after his first dose. On admission, blood pressure was 150/80 and rest of the vitals within normal limits. His labs were significant for high sensitivity troponin of 1700 ng/dl and brain natriuretic peptide (BNP) of 200 pg/ml. EKG showed ST-segment elevation in the anterior leads. 2D Echo done showed left ventricular wall motion abnormality. A formal limited STAT transthoracic echo showed a reduced left ventricular ejection fraction of 25-30% with akinesis of the mid to distal anterior, anteroseptal, anterolateral, inferolateral, inferoseptal and inferior walls. Urgent coronary angiography done revealed no coronary stenosis ruling out Acute coronary syndrome. Computed tomography angiography (CTA) was negative for pulmonary embolism. Inflammation markers were negative with no pericardial effusion on echo which ruled out Pericarditis and Myopericarditis. The patient's symptoms improved significantly during his hospitalization. Repeat transthoracic echo four days later showed recovery of the ejection fraction without segmental wall motion abnormalities. EKG done before the patient's discharge showed normal sinus rhythm without ST-segment elevation. The pathophysiology behind vaccination-induced TCM is poorly understood but appears to be multifactorial. The etiology is most likely a combination of increased release of catecholamines or increased myocardial sensitization to them. The patient was stable to be discharged home. The benefit-risk relationship of mRNA-1273 is not affected by this report.