Sex: M
Vaccine: COVID19
Symptoms: Enterovirus test, Epstein-Barr virus test, Fibrin D dimer, Haemodynamic test, Magnetic resonance imaging heart
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 fourth 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 15-year-old male with Marfan syndrome and aortic root dilation presented to the ED with sudden onset of retrosternal chest pain, fatigue, and abdominal pain for 1 day. He denied fever, shortness of breath, or recent illness. The patient had a history of SARS-CoV-2 infection in January 2021 with mild symptoms. He had received the first dose of the BNT162b2 vaccine 3 days prior to admission. In the ED, his troponin was 7.2 ng/ mL and ECG demonstrated normal sinus rhythm with no other changes. Chest X-ray was normal. The peak troponin level was 11.8 ng/mL. Pain resolved while he was still in ED. The patient was asymptomatic at the time of admission. TTE showed patent foramen ovale, mild mitral valve prolapses with mild-to-moderate mitral regurgitation, mild aortic root dilation (unchanged), and qualitatively low normal LVSF. Cardiac MRI (magnetic resonance imaging) was significant for focal edema at the basal inferolateral segments, normal biventricular size and global systolic function, and stable aortic root dilation. The patient had 12- and 8-beat runs of irregular polymorphic ventricular tachycardia. The runs occurred within 1 minute of each other, and the patient was asymptomatic at the time. He remained hemodynamically stable. Infectious workup was negative, including adenovirus plasma PCR, CMV antibodies, enterovirus plasma PCR, EBV titers, Leptospira IgM, Parvovirus B19 PCR, and RPP (Respiratory viral panel). Body mass index (kg/m2) 16.8, Past medical history (PMH) Marfan syndrome, History of prior COVID-19 infection: Yes, Days between vaccine and symptom onset 2, Length of stay (hours) 71, Laboratories: White blood cell count (Ref: 5-10) 6.6, Peak troponin-I (Ref: 0.00-0.08 ng/mL) 11.80, Discharge troponin-I (Ref: 0.00-0.08 ng/mL) 0.28, CKMB (creatine kinase myocardial band, Ref:0-3.5ng/mL) N/A, CPK (creatine phosphokinase Ref: 33-145 IU/L) 312, d-dimer (Ref: 0.27-0.41 mmg/mL) less than 0.19, COVID-19 testing: SARS-CoV-2 PCR Negative, SARS-CoV-2 spike IgM Negative, SARS-CoV-2 nucleocapsid IgG Negative, EKG (electrocardiogram): EKG findings Normal sinus Rhythm, Imaging: Chest radiograph (cardiopulmonary findings) Negative, Left ventricular ejection fraction on ECHO (echocardiogram) 57, Pericardial effusion present No, Cardiac MRI performed Yes, Left ventricular ejection fraction on MRI 61, Myocardial edema on MRI (yes/no) Yes, Late gadolinium enhancement on MRI (yes/no) Yes, treatment: no intravenous immunoglobulin; 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) : PFIZER INC-202101133568 Same article/drug/event; different patient