Sex: M
Vaccine: COVID19
Symptoms: Angiocardiogram, C-reactive protein, Ejection fraction, Electrocardiogram, Investigation
Clinical narrative: Myocarditis; This is a literature report.  A 28-year-old male with a medical history significant for obesity presented with chest pain and lateral ST elevation myocardial infarction by electrocardiogram. He was taken to the catheterization laboratory, and coronary angiogram showed no luminal irregularities. On interview, he reported receiving his second dose of COVID-19 vaccine (NT162b2 Pfizer/BioNTech) three days prior to presentation. After receiving the vaccine, he experienced fatigue, chills, and myalgias that resolved the day before presentation. Labs were significant for Troponin T peak of 1.42 ng/ml, C-reactive protein (CRP) peak of 68.6mg/l (reference < 8:0mg/l), and Erythrocyte Sedimentation Rate (ESR) of 19mm/h (reference < 15 mm/h). He underwent cardiac MRI which showed a left ventricular ejection fraction of 56% and evidence of myocarditis with myocardial edema demonstrated on T2 mapping and myocardial injury with focal LGE in the basal inferior, mid to distal lateral/inferolateral walls. He also did not undergo endomyocardial biopsy, and COVID-19 PCR was negative. During his hospital stay, he was monitored on telemetry without any arrhythmias observed. He was discharged on low-dose beta blocker and activity restriction with plan for continued outpatient follow-up. Authors describe three cases of myocarditis in young, healthy patients following COVID-19 vaccine administration. The temporal timing of the cases correlates with similar reports in literature of myocarditis occurring 12-96 hours following immunization with an mRNA COVID-19 vaccine. These cases demonstrate a similar temporal relationship, increasing the likelihood of causality. This safety signal was not clinically apparent in the early vaccine experience, raising the possibility that the association is purely coincidental as viruses responsible for myocarditis follow a seasonal distribution. All three patients were ruled out for COVID-19 infection using the Centers for Disease Control and Prevention- (CDC-) approved gold standard test: polymerase chain reaction (PCR). Previous reports had demonstrated an association between COVID-19 infection and myocarditis. Routine antigen or antibody testing is not part of the clinical work flow, and some have questioned the utility of antibody testing in the post vaccination cohort. Conclusion: There have been early reports of a presumed link between COVID-19 vaccination and subsequent development of myocarditis, but no causative link has been established. The cases add to others where a temporal relationship between vaccination and myocarditis has been described. Ultimately, further exploration of this clinical phenomenon is warranted.  No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender's Comments: Based on the information provided in the narrative, a causal association between the suspect drug and the event cannot be completely 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-202101619992 Same article/ drug/event and different patient