Sex: M
Vaccine: COVID19
Symptoms: Red blood cell sedimentation rate, Respiratory syncytial virus test, SARS-CoV-2 test, Troponin T, Ventricular internal diameter
Clinical narrative: acute myocarditis; This is a literature report. This author reported four reports for different patients with different events. This is first of four reports.  A 19-year-old male student with no significant past medical history presented to our hospital with acute substernal chest pressure and shortness of breath four days after receiving the second dose of the Pfizer-BioNTech vaccine. On presentation, he was afebrile, with a heart rate of 71 beats per minute (bpm), and blood pressure of 145/95 mmHg. Physical exam was unremarkable. His electrocardiogram (ECG) was notable for diffuse ST elevations, and laboratory studies demonstrated evidence of myocardial injury and elevated inflammatory markers (This patient was 19-year-old Male. Cardiac Biomarkers: Troponin T: 1.37 ng/mL (reference range: less than 0.03 ng/mL). Inflammatory Markers: CRP: 1.8 mg/dL (reference range: Less than 0.80 mg/dL); ESR: 26 mm/hour (reference range: less than 20 mm/hour). Transthoracic Echocardiogram: LVEF: 47%; LVIDd: 4.7 cm; Normal RV size and function; No valvular disease. Cardiac MRI: LVEF: 56%; LVEDVi: 84 mL/m 2; RVEF: 54%; RVEDVi: 86 mL/m2; Subepicardial LGE involving the basal to mid lateral wall, with corresponding elevated native T1 and T2 values. Coronary angiography: No coronary artery disease or anomalies). There was no evidence of coronary artery disease (CAD) on coronary angiography, and echocardiography showed a mildly reduced left ventricular (LV) ejection fraction (EF) of 47% with no regional wall motion abnormalities. Cardiac magnetic resonance imaging (CMR) identified mild hypokinesis of the basal to mid lateral wall, with corresponding elevated native T1 values (1070-1160 ms; reference range: 950-1050 ms), elevated T2 values (57-59 ms; reference range: 40-50 ms), and subepicardial delayed enhancement in the lateral wall. Based on the clinical presentation and updated Lake Louise Criteria for myocardial inflammation by CMR, the patient was diagnosed with acute myocarditis. Subsequent viral studies were negative for human immunodeficiency virus (HIV), influenza, respiratory syncytial virus (RSV), and SARS-CoV-2. The patient's chest pain resolved, and he was discharged on lisinopril and metoprolol succinate. We report the first case series of patients with myocarditis, stress cardiomyopathy, and pericarditis after receiving the mRNA-based COVID-19 vaccines. While we cannot definitively prove association of the vaccines with these adverse events, we believe reporting these complications may enable further monitoring and investigation. However, it is crucial to emphasize that these findings are rare while SARS-CoV-2 infection is associated with a much higher incidence of cardiovascular complications.  No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender's Comments: As there is limited information in the case provided, the causal association between the event myocarditis and the suspect drug BNT162B2 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.,Linked Report(s) : US-PFIZER INC-202101525198 Same article/drug and different patient/event.;US-PFIZER INC-202101525200 Same article/drug and different patient/event.;US-PFIZER INC-202101525199 Same article/drug and different patient/event.