Sex: M
Vaccine: COVID19
Symptoms: Epstein-Barr virus test, Fibrin D dimer, Myocarditis, Parvovirus B19 test, Respiratory viral panel
Clinical narrative: perimyocarditis within 4 days of receiving a dose of BNT162b2 vaccine.; This is a literature report. This author reported similar events for eight patients. This is the fifth of eight reports.  The authors describe clinical characteristics of 8 adolescents who presented over the course of 36 days to (Hospital) with perimyocarditis within 4 days of receiving a dose of BNT162b2 vaccine. A 16-year-old male with no past medical history presented to the ED with intermittent retrosternal chest pressure over 2 days. He denied fever, shortness of breath, or recent illness. He had received his second dose of the BNT162b2 vaccine 1 day before symptom onset. Post-vaccination symptoms included mild body aches and headache. Family history was positive for vitiligo in the patient's mother. Troponin-I was elevated at 1.92 ng/mL, and the peak level obtained was 2.42 ng/mL. ECG demonstrated ST-segment elevation. Chest X-ray was negative. TTE showed no structural abnormalities and qualitatively normal LVSF. He had no recurrence of chest pain while admitted. Patient recovered with no medical intervention. Infectious workup was negative, including RPP, adenovirus plasma PCR, CMV antibodies, enterovirus plasma PCR, EBV titers, and Parvovirus B19 antibodies. Additional workup showed SARS-CoV-2 nucleocapsid IgG-negative. Body mass index (kg/m2) 30.8, Past medical history (PMH) No PMH, History of prior COVID-19 infection No, Days between vaccine and symptom onset 1, Length of stay (hours) 34, Laboratories: White blood cell count (Ref: 5-10) 10, Peak troponin-I (Ref: 0.00-0.08 ng/mL) 2.42, Discharge troponin-I (Ref: 0.00-0.08 ng/mL) 0.81, CKMB (creatine kinase myocardial band, Ref:0-3.5ng/mL) N/A, CPK (creatine phosphokinase, Ref: 33-145 IU/L) N/A, d-dimer (Ref: 0.27-0.41 mmg/mL) 0.52, COVID-19 testing: SARS-CoV-2 PCR Negative, SARS-CoV-2 spike IgM Positive, SARS-CoV-2 nucleocapsid IgG Negative, EKG electrocardiogram; findings Diffuse ST-segment elevation, Imaging: Chest radiograph (cardiopulmonary findings) Negative, Left ventricular ejection fraction on ECHO echocardiogram; 60, Pericardial effusion present No, Cardiac MRI (magnetic resonance imaging) not performed, Left ventricular ejection fraction on MRI, Myocardial edema on MRI (yes/no), Late gadolinium enhancement on MRI (yes/no), Treatment: No IVIG (intravenous immunoglobulin), No Scheduled NSAIDs (nonsteroidal anti-inflammatory drugs).  Herein described is the first case series from a single institution of 8 adolescent males with a diagnosis of perimyocarditis in the setting of recent BNT162b2 vaccination with no other identifiable cause. Pediatricians should consider myocarditis in the differential diagnosis of patients presenting with chest pain after receiving the BNT162b2 vaccine and be aware of the clinical implications and the need to report this potential adverse event. Currently, the association between perimyocarditis and the BNT162b2 vaccine is unproven but recent reports suggest there may be causality. This case series raises additional questions regarding appropriate recommendations for COVID-19 vaccination in adolescents with a prior history of perimyocarditis, of SARS CoV-2 infection (clinically or by serology), and of multisystem inflammatory syndrome associated with SARS-CoV-2 (MISC). It also poses the issue of whether patients who experience perimyocarditis post-BNT162b2 vaccine should receive booster SARS-CoV-2 vaccines in the future.   No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender's Comments: A contributory role of BNT162B2 to the event perimyocarditis cannot be excluded based on the plausible temporal relationship, product safety profile and lack of reported alternative explanation at this time. This case will be reassessed if additional information becomes available.  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.,Linked Report(s) : US-PFIZER INC-202101133568 Same article/drug/event; different patient