Sex: F
Vaccine: COVID19
Symptoms: Electrocardiogram QT prolonged, Heart rate, Magnetic resonance imaging heart, Myocarditis, Respiratory viral panel
Clinical narrative: This is a literature report for the following literature source:  A 23 year-old female patient received BNT162b2 (Batch/Lot number: unknown) as dose 2, single for COVID-19 immunisation. The patient's relevant medical history and concomitant medications were not reported. Vaccination history included: COVID-19 vaccine (dose 1, manufacturer unknown), for COVID-19 immunisation. The following information was reported: MYOCARDITIS (medically significant), ELECTROCARDIOGRAM QT PROLONGED (medically significant), outcome "recovering" and all described as "Sars-Cov-2 Vaccine Induced Myocarditis With Severe QT Prolongation". The event "sars-cov-2 vaccine induced myocarditis with severe qt prolongation" and "sars-cov-2 vaccine induced myocarditis with severe qt prolongation" was evaluated at the physician office visit. Therapeutic measures were taken as a result of myocarditis, electrocardiogram qt prolonged.  Publication (including laboratory tests and procedures): Background: Myocarditis after receiving the Sars-CoV-2 vaccine is rare with a wide variety of clinical presentations. Authors describe abnormalities on diagnostic workup and approach to a patient with myocarditis. Case: 23-year-old healthy female presented with acute chest pain and dyspnea 10 days after her second dose of the BNT162b2 (Pfizer) vaccine. High sensitivity troponin peaked at 1323 ng/L. A viral polymerase chain reaction panel was negative. Initial EKG showed sinus rhythm with heart rate 62 bpm with non-specific ST changes and QTc 452 ms. Repeat EKG 3 hours later showed QTC 545 ms. Coronary CT angiogram was normal. Echocardiogram showed an ejection fraction of 50% with no other abnormalities. Cardiac MRI was consistent with myocarditis. Symptoms resolved after several days of supportive care, however, QTc prolongation worsened to 644 ms with normal electrolytes and in the absence of QT prolonging agents. Repeat EKG 1 month later revealed QTc of 448 ms. Decision-making: Given progressively lengthening QTc in setting of MRI confirmed myocarditis the dilemma was whether steroids were needed. No significant arrhythmias were detected, and her chest pain resolved, therefore supportive care was chosen. She was instructed to avoid all QT prolonging agents and to limit physical activity. Conclusion: Myocarditis after Sars-CoV-2 vaccination is rare. Management has not been defined. Authors present a case of myocarditis induced QTc prolongation with near normalization of QTc with supportive treatment. No follow-up attempts are possible; information about lot/batch number cannot be obtained. Sender's Comments: Based on the current available information and the plausible drug-event temporal association, a possible contributory role of the suspect product BNT162B2 to the development of the reported events Myocarditis With Severe QT Prolongation Cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate