Myocarditis and pericarditis in association with COVID-19 mRNA-vaccination: cases from a regional pharmacovigilance centre

Abstract

In this article we summarize suspected adverse events following immunization (AEFI) of pericarditis, myocarditis and perimyocarditis that were reported by our regional pharmacovigilance centre after COVID-19 mRNA-vaccination and discuss their association with these vaccines. Seventeen cases were reported between March and July 2021. Of these, nine had perimyocarditis, five myocarditis and three pericarditis. Twelve patients were male (71%). The median age was 38 years (range 17-88). The most commonly observed presenting symptom was acute chest pain (65%). While 47% of the patients were previously healthy, 53% had at least one pre-existing comorbidity, with hypertension being the most prevalent (24%). The European Society of Cardiology diagnostic criteria for the reported AEFIs were fulfilled in twelve cases (71%). The AEFIs occurred after the first vaccine dose in six cases (35%), after the second vaccine dose in ten cases (59%) and after both doses in one case (6%). The median latency of all AEFIs taken together was 14 days (range 1-28) after the first vaccination and 3 days (range 1-17) after the second one. All patients except one were hospitalized (94%) with a median length of stay of 7.5 days (range 3-13). The majority of patients (n = 11, 65%) did not experience any complications, and 13 (77%) of the patients had recovered or were recovering at the time of discharge. In 16 of the 17 cases (94%), the association between the AEFI and mRNA-vaccination was considered possible by the pharmacovigilance centre.

Figure 1.. Number of cases of suspected drug- or vaccine-induced myocarditis, perimyocarditis and pericarditis reported to the RPVC from 2012 until July 2021.

Blue bars and blue lettering indicate the number of myocarditis and perimyocarditis cases, green bars and green lettering indicated the number of pericarditis cases.

Figure 2.. Short-axis (upper line) and long-axis (lower line) CMR images of a young patient with acute myocarditis.

In the first two columns, cine-SSFP images are shown in diastole and systole and suggest absence of any wall motion abnormality. In the next column, T2-weighted edema images demonstrate the presence of patchy focal edema in the sub-epicardium of the inferolateral wall (red arrows). In the last column, T1-weighted LGE images demonstrate presence of sub-epicardially distributed LGE (red arrows) which is typical for acute myocarditis.