Age: 19.0
Sex: M
Vaccine: COVID19
Symptoms: Echocardiogram, Ejection fraction, Electrocardiogram, Full blood count, Influenza virus test
Clinical narrative: Acute Myocarditis; This literature-non-study case was reported in a literature article and describes the occurrence of MYOCARDITIS (Acute Myocarditis) in a 19-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination.   Concurrent medical conditions included Childhood asthma and Marijuana use (Patient admitted to occasional marijuana use).    On an unknown date, the patient received first dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On an unknown date, the patient experienced MYOCARDITIS (Acute Myocarditis) (seriousness criteria hospitalization and medically significant). The patient was hospitalized for 2 days due to MYOCARDITIS. The patient was treated with ACETYLSALICYLIC ACID (ASPIRIN (E.C.)) for Myopericarditis, at an unspecified dose and frequency; PARACETAMOL (TYLENOL) for Myopericarditis, at an unspecified dose and frequency; COLCHICINE for Myopericarditis, at an unspecified dose and frequency; LISINOPRIL for Myopericarditis, at an unspecified dose and frequency; METOPROLOL for Myopericarditis, at an unspecified dose and frequency; METOPROLOL (intravenous) for Myopericarditis, at a dose of multiple dose; LORAZEPAM (ATIVAN) for Acute myocarditis, at a dose of multiple dose and DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL A) for Acute myocarditis, at a dose of multiple dose. At the time of the report, MYOCARDITIS (Acute Myocarditis) was resolving. Related    DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Cardiac ventriculogram: unremarkable for takotsubo cardiomyopathy The left heart ventriculography was unremarkable for Takotsubo cardiomyopathy. On an unknown date, Catheterisation cardiac: patent coronary arteries Owing to concerns for ST-segment myocardial infarction, patient emergently underwent cardiac catheterization which revealed patent coronary arteries. On an unknown date, Chest X-ray: unremarkable Chest X-ray was unremarkable, without evidence of pulmonary infiltrate, and normal cardiac border.. On an unknown date, Coxsackie virus test: negative (Negative) coxsackie PCR test negative. On an unknown date, Drug screen: positive (Positive) Urine drug screen was positive for marijuana. On an unknown date, Echocardiogram: mild diffuse hypokinesis transthoracic echocardiogram was obtained which showed mild diffuse hypokinesis. On an unknown date, Ejection fraction: 49% left ventricular ejection fraction of 49%. On an unknown date, Electrocardiogram: significant for diffuse st-segment Electrocardiogram  was significant for diffuse ST-segment elevation. and normal sinus rhythm Repeat EKG showed normal sinus rhythm, with interval decreased magnitude of ST-segment elevations. On an unknown date, Full blood count: normal (normal) Complete blood count was within normal limits. On an unknown date, Influenza virus test: negative (Negative) influenza PCR test negative. On an unknown date, Magnetic resonance imaging heart: unsuccessful Two attempts were made to obtain a cardiac magnetic resonance imaging scan to confirm the diagnosis and characterize the extent of acute myopericarditis. However, these were unsuccessful due to significant claustrophobia, despite multiple doses of Benadryl, Ativan, and intravenous metoprolol. On an unknown date, Metabolic function test: normal (normal) Complete blood count and comprehensive metabolic panel were within normal limits and normal limits (normal) comprehensive metabolic panel was within normal limits. On an unknown date, Respiratory syncytial virus test: negative (Negative) RSV PCR test negative. On an unknown date, SARS-CoV-2 test: negative (Negative) COVID PCR test negative. On an unknown date, Troponin: 15.7 ng/ml Initial troponin was significantly elevated at 15.7 ng/mL and up trended to 24.8 ng/mL., 24.8 ng/ml Initial troponin was significantly elevated at 15.7 ng/mL and up trended to 24.8 ng/mL. and 17.2 ng/ml. Repeat troponin on hospitalization Day 2 had down trended to 17.2 ng/mL.. On an unknown date, Vital signs measurement: 105 beats per minute vital signs were remarkable for sinus tachycardia of 105 beats per minute..     The action taken with mRNA-1273 (Spikevax) (Unknown) was unknown.   For mRNA-1273 (Spikevax) (Unknown), the reporter considered MYOCARDITIS (Acute Myocarditis) to be related.    Patient  presented to the emergency department with a 1-day history of chest pain. The pain was described as a severe pin-like sensation, radiating to the left arm and bilateral shoulders. Pain improved with laying down. He denied any prior similar episodes. He further denied any recent viral illnesses, fever, or cough. He further denied any gastric symptoms including nausea or vomiting.  He appeared anxious but denied shortness of breath. He had no family or personal history of heart disease and denied alcohol, tobacco, or other illicit drug use.  After all laboratory tests were performed, they were concerned about acute myopericarditis.  Two attempts were made to obtain a cardiac magnetic resonance imaging scan to confirm the diagnosis and characterize the extent of acute myopericarditis. However, these were unsuccessful due to significant claustrophobia   Author stated that other differential diagnoses that were considered include coronary vasospasm, sarcoidosis, giant cell myocarditis, and autoimmune causes such as systemic lupus erythematosus and Takayasu arteritis. However, patient's presentation was not typical for any of these. In addition, patient did not have any physical exam and echocardiographic findings of autoimmune diseases; and his symptoms resolved without the use of immunosuppressive medications. Furthermore, in coronary vasospasm, chest pain usually occurs at rest, the ST changes on ECG are transient and normalize with the resolution of chest pain.  Company Comment: This literature non-study case concerns a 19 year old male patient with relevant medical history of childhood  asthma and Marijuana use (Patient admitted to occasional marijuana use), who experienced Serious ( Medically significant , unHospitalization ) expected, AESI event of myocarditis which occurred two days post vaccination with the 1st dose of mRNA-1273 vaccine. This patient  presented to the emergency department with a 1-day history of chest pain,  described as a severe pin-like sensation, radiating to the left arm and bilateral shoulders. Pain improved with laying down. AT the ER  vital signs were remarkable for sinus tachycardia of 105 beats per minute. Initial troponin was significantly high elevated at 15.7 ng/mL and up trended to 24.8 ng/mL. CBCand comprehensive metabolic panelwere within normal limits. Urine drug screen was positive for marijuana. COVID, influenza, coxsackie, and RSV PCR tests were all negative. Chest X-ray was unremarkable, without evidence of pulmonary infiltrate, and normal cardiac border ECG was significant for diffuse ST-segment elevation (Figure 2). Owing to concerns for ST-segment myocardial infarction, he underwent cardiac catheterization. Results  revealed patent coronary arteries. The left heart ventriculography was unremarkable for Takotsubo cardiomyopathy.  A transthoracic echocardiogram was obtained which showed mild diffuse hypokinesis and left ventricular ejection fraction of 49% . Treatment given were; aspirin, tylenol, and colchicine.  Repeat troponin on hospitalization There was a downt trending in the Troponin  levels on day 2 and repeat EKG showed normal sinus rhythm, with interval decreased magnitude of ST-segment elevations and he was started on  low-dose lisinopril and metoprolol. An cardiac MRI was attempted twice in order to confirm the diagnosis and characterize the extent  of acute myopericarditis  however it was not done due to the significant claustrophobia despite the multiple dose of Benadryl  , Atvan and IV metoprolol. On the day 2 of the hospitalization this patient was discharged to continue a 1-month course of colchicine, a  slow taper of aspirin, as well as lisinopril and metoprolol . Outcome of the event was reported as resolving. The reported use of Marijuana of this patient  may be considered as a confounder for the event. Events was reported as related by the reporter. The benefit -risk relationship of mRNA -1273 ( Moderna Covid 19 Vaccine) is not affected by this report.   Most recent FOLLOW-UP information incorporated above includes: On 05-May-2022: Follow-up received by safety on 05-May-2022 with email containing full text article contains significant information: Literature citation, Medical history, Laboratory tests, product details and event details updated.; Sender's Comments: This literature non-study case concerns a 19 year old male patient with relevant medical history of childhood  asthma and Marijuana use (Patient admitted to occasional marijuana use), who experienced Serious ( Medically significant , unHospitalization ) expected, AESI event of myocarditis which occurred two days post vaccination with the 1st dose of mRNA-1273 vaccine. This patient  presented to the emergency department with a 1-day history of chest pain,  described as a severe pin-like sensation, radiating to the left arm and bilateral shoulders. Pain improved with laying down. AT the ER  vital signs were remarkable for sinus tachycardia of 105 beats per minute. Initial troponin was significantly high elevated at 15.7 ng/mL and up trended to 24.8 ng/mL. CBCand comprehensive metabolic panelwere within normal limits. Urine drug screen was positive for marijuana. COVID, influenza, coxsackie, and RSV PCR tests were all negative. Chest X-ray was unremarkable, without evidence of pulmonary infiltrate, and normal cardiac border ECG was significant for diffuse ST-segment elevation (Figure 2). Owing to concerns for ST-segment myocardial infarction, he underwent cardiac catheterization. Results  revealed patent coronary arteries. The left heart ventriculography was unremarkable for Takotsubo cardiomyopathy.  A transthoracic echocardiogram was obtained which showed mild diffuse hypokinesis and left ventricular ejection fraction of 49% . Treatment given were; aspirin, tylenol, and colchicine.  Repeat troponin on hospitalization There was a downt trending in the Troponin  levels on day 2 and repeat EKG showed normal sinus rhythm, with interval decreased magnitude of ST-segment elevations and he was started on  low-dose lisinopril and metoprolol. An cardiac MRI was attempted twice in order to confirm the diagnosis and characterize the extent  of acute myopericarditis  however it was not done due to the significant claustrophobia despite the multiple dose of Benadryl  , Atvan and IV metoprolol. On the day 2 of the hospitalization this patient was discharged to continue a 1-month course of colchicine, a  slow taper of aspirin, as well as lisinopril and metoprolol . Outcome of the event was reported as resolving. The reported use of Marijuana of this patient  may be considered as a confounder for the event. Events was reported as related by the reporter. The benefit -risk relationship of mRNA -1273 ( Moderna Covid 19 Vaccine) is not affected by this report.