Sex: M
Vaccine: COVID19, COVID19
Symptoms: Investigation, Laboratory test, Myocarditis, Parvovirus B19 test negative, Pericardial effusion
Clinical narrative: perimyocarditis/presented to the emergency department (ED) with retrosternal pressure-like chest pain; This is a literature report. The full publication has been requested. This author reported similar events for eight patients. This is the first of eight reports.  A 17-year-old (also reported as 17.6-year-old) male with a past medical history of vitiligo presented to the emergency department (ED) with retrosternal pressure-like chest pain. He denied shortness of breath, fever, vomiting, rhinorrhea, abdominal pain, or diarrhea. The patient tested positive for SARS-CoV-2 10 months before. He received the second dose of the BNT162b2 vaccine 4 days before presentation. Chest X-ray was negative, and electrocardiogram (ECG) demonstrated normal sinus rhythm with ST-segment depressions in V1 and V2. There were no ST-segment elevations or PR-segment depressions. Initial laboratories were unremarkable aside from elevated creatine phosphokinase-MB (CPK-MB) level of 13 ng/mL and troponin level of 3.34 ng/mL. The peak troponin was 4.85 ng/mL. The patient was transferred to our hospital. Transthoracic echocardiogram (TTE) showed no structural abnormalities, qualitatively low normal left ventricular systolic function (LVSF), and no pericardial effusion. Patient was managed with ibuprofen with no recurrence of pain. Patient had a negative respiratory pathogen panel (RPP), adenovirus plasma PCR, cytomegalovirus (CMV) antibodies, enterovirus plasma PCR, Epstein-Barr virus (EBV) titers, and Parvovirus B19 antibodies. SARS-CoV-2 nucleocapsid immunoglobulin G (IgG) was positive.   Demographic and clinical characteristics: Body mass index (kg/m2) 24.2. Past medical history (PMH) Vitiligo. History of prior COVID-19 infection: Yes. BNT162b2 vaccine dose 2. Days between vaccine and symptom onset 4. Length of stay (hours) 48. Laboratories: White blood cell count (Ref: 5-10) 7.2; Peak troponin-I (Ref: 0.00-0.08 ng/mL) 4.85; Discharge troponin-I (Ref: 0.00-0.08 ng/mL) 3.15; CKMB (Ref:0-3.5ng/mL) 13; CPK (Ref: 33-145 IU/L) 317; D-dimer (Ref: 0.27-0.41 ug/mL) 0.2 . COVID-19 testing: SARS-CoV-2 PCR Negative; SARS-CoV-2 spike IgM Negative; SARS-CoV-2 nucleocapsid IgG Positive; EKG findings Abnormal T waves, ST-segment depression.  Imaging Chest radiograph (cardiopulmonary findings) Negative; Left ventricular ejection fraction on ECHO 56; Pericardial effusion present No; Cardiac MRI performed No;IVIG (intravenous immunoglobulin) No; Scheduled NSAIDs (nonsteroidal anti-inflammatory drugs) Yes.  DISCUSSION 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.  No follow-up attempts are needed, information about batch number cannot be obtained.; 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-202101137122 Same article/ drug/ event and Different patient.;US-PFIZER INC-202101137432 Same article/drug/event; different patient;US-PFIZER INC-202101137891 Same article/drug/event; different patient;US-PFIZER INC-202101138007 Same article/drug/event; different patient;US-PFIZER INC-202101137593 Same article/drug/event; different patient;US-PFIZER INC-202101136924 Same article/ drug/ event and Different patient.;US-PFIZER INC-202101138774 Same article/drug/event; different patient