Acute cardiac side effects after COVID-19 mRNA vaccination: a case series

Noemi F Freise; Milena Kivel; Olaf Grebe; Christian Meyer; Bahram Wafaisade; Matthias Peiper; Tobias Zeus; Jan Schmidt; Judith Neuwahl; Danny Jazmati; Tom Luedde; Edwin Bölke; Torsten Feldt; Björn Erik Ole Jensen; Johannes Bode; Verena Keitel; Jan Haussmann; Balint Tamaskovics; Wilfried Budach; Johannes C Fischer; Wolfram Trudo Knoefel; Marion Schneider; Peter Arne Gerber; Alessia Pedoto; Dieter Häussinger; Martijn van Griensven; Amir Rezazadeh; Yechan Flaig; Julian Kirchner; Gerald Antoch; Hubert Schelzig; Christiane Matuschek

doi:10.1186/s40001-022-00695-y

Acute cardiac side effects after COVID-19 mRNA vaccination: a case series

Noemi F Freise, Milena Kivel, Olaf Grebe, Christian Meyer, Bahram Wafaisade, Matthias Peiper, Tobias Zeus, Jan Schmidt, Judith Neuwahl, Danny Jazmati, Tom Luedde, Edwin Bölke^*, Torsten Feldt, Björn Erik Ole Jensen, Johannes Bode, Verena Keitel, Jan Haussmann, Balint Tamaskovics, Wilfried Budach, Johannes C FischerWolfram Trudo Knoefel, Marion Schneider, Peter Arne Gerber, Alessia Pedoto, Dieter Häussinger, Martijn van Griensven, Amir Rezazadeh, Yechan Flaig, Julian Kirchner, Gerald Antoch, Hubert Schelzig, Christiane Matuschek

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Vaccination against SARS-CoV-2 has been the main tool to contain the pandemic. The rush development of the 3 vaccines and their expedited approval have led to inoculation of millions of patients around the world, leading to a containment of the disease. Despite continuous viral mutations and the identification of weaker variants, the severity of the infections has been mild, with many patients being either asymptomatic or recovering at home. Currently the focus has shifted from the host of organ damage related to the infection to potential side effects of the vaccine. Myocarditis has been reported as one of the potential side effects from the mRNA vaccine, affecting young healthy individuals. Up to September 30, 2021, 1.243 cases of myocarditis after vaccination with BNT162b2 Comirnaty© were registered in young adults by the Paul-Ehrlich-Institute in Germany alone. The exact pathophysiology and the risk factors for myocarditis following vaccination remain unclear. We present a case series of eight patients with cardiac symptom shortly after SARS-CoV-2 mRNA vaccination (BNT162b6, Biontech, Comirnaty© or mRNA-1237 Moderna, Spikevax©).

PATIENTS AND METHODS: Eight patients between 13 and 56 years of age, vaccinated with either BNT162b2 or mRNA-1273 mRNA vaccine between January and August 2021 developed cardiac side effects shortly after either their first or second dose of the vaccine. Clinical data were retrieved from the clinical information system and analyzed. To support diagnosis of myocarditis or pericarditis, cardiac magnetic resonance imaging (MRI) was performed shortly after the onset of symptoms, with further investigations in severe cases. Symptoms were defined as dyspnea, chest pain and cardiac arrhythmia as determined by electrocardiography.

RESULTS: Eight patients (5 males and 3 females) developed cardiac symptoms compatible with myocarditis, according to the CDC criteria, shortly after SARS-CoV-2 mRNA vaccination. Three patients (2 males, 1 female) required hospitalization due to severe chest pain and elevated troponin levels. All patients recovered fully within 7 days from the symptom onset.

CONCLUSIONS: Our data suggest that cardiac adverse events such as myocarditis or pericarditis shortly after SARS-CoV-2 mRNA vaccination are rare but possible and occur particularly in male patients.

Original language	English
Article number	80
Number of pages	8
Journal	European Journal of Medical Research
Volume	27
Issue number	1
DOIs	https://doi.org/10.1186/s40001-022-00695-y
Publication status	Published - 2 Jun 2022

Keywords

Adolescent
Adult
BNT162 Vaccine/adverse effects
COVID-19/prevention & control
Chest Pain
Female
Humans
Male
Middle Aged
Myocarditis/chemically induced
Pericarditis/chemically induced
SARS-CoV-2/genetics
Vaccination/adverse effects
Vaccines, Synthetic/adverse effects
Young Adult
mRNA Vaccines/adverse effects
Inflammation
COVID-19
Myocarditis
ACUTE MYOCARDITIS
mRNA vaccine

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Cite this

Freise, N. F., Kivel, M., Grebe, O., Meyer, C., Wafaisade, B., Peiper, M., Zeus, T., Schmidt, J., Neuwahl, J., Jazmati, D., Luedde, T., Bölke, E., Feldt, T., Jensen, B. E. O., Bode, J., Keitel, V., Haussmann, J., Tamaskovics, B., Budach, W., ... Matuschek, C. (2022). Acute cardiac side effects after COVID-19 mRNA vaccination: a case series. European Journal of Medical Research, 27(1), Article 80. https://doi.org/10.1186/s40001-022-00695-y

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title = "Acute cardiac side effects after COVID-19 mRNA vaccination: a case series",

abstract = "BACKGROUND: Vaccination against SARS-CoV-2 has been the main tool to contain the pandemic. The rush development of the 3 vaccines and their expedited approval have led to inoculation of millions of patients around the world, leading to a containment of the disease. Despite continuous viral mutations and the identification of weaker variants, the severity of the infections has been mild, with many patients being either asymptomatic or recovering at home. Currently the focus has shifted from the host of organ damage related to the infection to potential side effects of the vaccine. Myocarditis has been reported as one of the potential side effects from the mRNA vaccine, affecting young healthy individuals. Up to September 30, 2021, 1.243 cases of myocarditis after vaccination with BNT162b2 Comirnaty{\textcopyright} were registered in young adults by the Paul-Ehrlich-Institute in Germany alone. The exact pathophysiology and the risk factors for myocarditis following vaccination remain unclear. We present a case series of eight patients with cardiac symptom shortly after SARS-CoV-2 mRNA vaccination (BNT162b6, Biontech, Comirnaty{\textcopyright} or mRNA-1237 Moderna, Spikevax{\textcopyright}).PATIENTS AND METHODS: Eight patients between 13 and 56 years of age, vaccinated with either BNT162b2 or mRNA-1273 mRNA vaccine between January and August 2021 developed cardiac side effects shortly after either their first or second dose of the vaccine. Clinical data were retrieved from the clinical information system and analyzed. To support diagnosis of myocarditis or pericarditis, cardiac magnetic resonance imaging (MRI) was performed shortly after the onset of symptoms, with further investigations in severe cases. Symptoms were defined as dyspnea, chest pain and cardiac arrhythmia as determined by electrocardiography.RESULTS: Eight patients (5 males and 3 females) developed cardiac symptoms compatible with myocarditis, according to the CDC criteria, shortly after SARS-CoV-2 mRNA vaccination. Three patients (2 males, 1 female) required hospitalization due to severe chest pain and elevated troponin levels. All patients recovered fully within 7 days from the symptom onset.CONCLUSIONS: Our data suggest that cardiac adverse events such as myocarditis or pericarditis shortly after SARS-CoV-2 mRNA vaccination are rare but possible and occur particularly in male patients.",

keywords = "Adolescent, Adult, BNT162 Vaccine/adverse effects, COVID-19/prevention & control, Chest Pain, Female, Humans, Male, Middle Aged, Myocarditis/chemically induced, Pericarditis/chemically induced, SARS-CoV-2/genetics, Vaccination/adverse effects, Vaccines, Synthetic/adverse effects, Young Adult, mRNA Vaccines/adverse effects, Inflammation, COVID-19, Myocarditis, ACUTE MYOCARDITIS, mRNA vaccine",

author = "Freise, {Noemi F} and Milena Kivel and Olaf Grebe and Christian Meyer and Bahram Wafaisade and Matthias Peiper and Tobias Zeus and Jan Schmidt and Judith Neuwahl and Danny Jazmati and Tom Luedde and Edwin B{\"o}lke and Torsten Feldt and Jensen, {Bj{\"o}rn Erik Ole} and Johannes Bode and Verena Keitel and Jan Haussmann and Balint Tamaskovics and Wilfried Budach and Fischer, {Johannes C} and Knoefel, {Wolfram Trudo} and Marion Schneider and Gerber, {Peter Arne} and Alessia Pedoto and Dieter H{\"a}ussinger and {van Griensven}, Martijn and Amir Rezazadeh and Yechan Flaig and Julian Kirchner and Gerald Antoch and Hubert Schelzig and Christiane Matuschek",

note = "{\textcopyright} 2022. The Author(s).",

year = "2022",

month = jun,

day = "2",

doi = "10.1186/s40001-022-00695-y",

language = "English",

volume = "27",

journal = "European Journal of Medical Research",

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Freise, NF, Kivel, M, Grebe, O, Meyer, C, Wafaisade, B, Peiper, M, Zeus, T, Schmidt, J, Neuwahl, J, Jazmati, D, Luedde, T, Bölke, E, Feldt, T, Jensen, BEO, Bode, J, Keitel, V, Haussmann, J, Tamaskovics, B, Budach, W, Fischer, JC, Knoefel, WT, Schneider, M, Gerber, PA, Pedoto, A, Häussinger, D, van Griensven, M, Rezazadeh, A, Flaig, Y, Kirchner, J, Antoch, G, Schelzig, H & Matuschek, C 2022, 'Acute cardiac side effects after COVID-19 mRNA vaccination: a case series', European Journal of Medical Research, vol. 27, no. 1, 80. https://doi.org/10.1186/s40001-022-00695-y

TY - JOUR

T1 - Acute cardiac side effects after COVID-19 mRNA vaccination

T2 - a case series

AU - Freise, Noemi F

AU - Kivel, Milena

AU - Grebe, Olaf

AU - Meyer, Christian

AU - Wafaisade, Bahram

AU - Peiper, Matthias

AU - Zeus, Tobias

AU - Schmidt, Jan

AU - Neuwahl, Judith

AU - Jazmati, Danny

AU - Luedde, Tom

AU - Bölke, Edwin

AU - Feldt, Torsten

AU - Jensen, Björn Erik Ole

AU - Bode, Johannes

AU - Keitel, Verena

AU - Haussmann, Jan

AU - Tamaskovics, Balint

AU - Budach, Wilfried

AU - Fischer, Johannes C

AU - Knoefel, Wolfram Trudo

AU - Schneider, Marion

AU - Gerber, Peter Arne

AU - Pedoto, Alessia

AU - Häussinger, Dieter

AU - van Griensven, Martijn

AU - Rezazadeh, Amir

AU - Flaig, Yechan

AU - Kirchner, Julian

AU - Antoch, Gerald

AU - Schelzig, Hubert

AU - Matuschek, Christiane

PY - 2022/6/2

Y1 - 2022/6/2

N2 - BACKGROUND: Vaccination against SARS-CoV-2 has been the main tool to contain the pandemic. The rush development of the 3 vaccines and their expedited approval have led to inoculation of millions of patients around the world, leading to a containment of the disease. Despite continuous viral mutations and the identification of weaker variants, the severity of the infections has been mild, with many patients being either asymptomatic or recovering at home. Currently the focus has shifted from the host of organ damage related to the infection to potential side effects of the vaccine. Myocarditis has been reported as one of the potential side effects from the mRNA vaccine, affecting young healthy individuals. Up to September 30, 2021, 1.243 cases of myocarditis after vaccination with BNT162b2 Comirnaty© were registered in young adults by the Paul-Ehrlich-Institute in Germany alone. The exact pathophysiology and the risk factors for myocarditis following vaccination remain unclear. We present a case series of eight patients with cardiac symptom shortly after SARS-CoV-2 mRNA vaccination (BNT162b6, Biontech, Comirnaty© or mRNA-1237 Moderna, Spikevax©).PATIENTS AND METHODS: Eight patients between 13 and 56 years of age, vaccinated with either BNT162b2 or mRNA-1273 mRNA vaccine between January and August 2021 developed cardiac side effects shortly after either their first or second dose of the vaccine. Clinical data were retrieved from the clinical information system and analyzed. To support diagnosis of myocarditis or pericarditis, cardiac magnetic resonance imaging (MRI) was performed shortly after the onset of symptoms, with further investigations in severe cases. Symptoms were defined as dyspnea, chest pain and cardiac arrhythmia as determined by electrocardiography.RESULTS: Eight patients (5 males and 3 females) developed cardiac symptoms compatible with myocarditis, according to the CDC criteria, shortly after SARS-CoV-2 mRNA vaccination. Three patients (2 males, 1 female) required hospitalization due to severe chest pain and elevated troponin levels. All patients recovered fully within 7 days from the symptom onset.CONCLUSIONS: Our data suggest that cardiac adverse events such as myocarditis or pericarditis shortly after SARS-CoV-2 mRNA vaccination are rare but possible and occur particularly in male patients.

AB - BACKGROUND: Vaccination against SARS-CoV-2 has been the main tool to contain the pandemic. The rush development of the 3 vaccines and their expedited approval have led to inoculation of millions of patients around the world, leading to a containment of the disease. Despite continuous viral mutations and the identification of weaker variants, the severity of the infections has been mild, with many patients being either asymptomatic or recovering at home. Currently the focus has shifted from the host of organ damage related to the infection to potential side effects of the vaccine. Myocarditis has been reported as one of the potential side effects from the mRNA vaccine, affecting young healthy individuals. Up to September 30, 2021, 1.243 cases of myocarditis after vaccination with BNT162b2 Comirnaty© were registered in young adults by the Paul-Ehrlich-Institute in Germany alone. The exact pathophysiology and the risk factors for myocarditis following vaccination remain unclear. We present a case series of eight patients with cardiac symptom shortly after SARS-CoV-2 mRNA vaccination (BNT162b6, Biontech, Comirnaty© or mRNA-1237 Moderna, Spikevax©).PATIENTS AND METHODS: Eight patients between 13 and 56 years of age, vaccinated with either BNT162b2 or mRNA-1273 mRNA vaccine between January and August 2021 developed cardiac side effects shortly after either their first or second dose of the vaccine. Clinical data were retrieved from the clinical information system and analyzed. To support diagnosis of myocarditis or pericarditis, cardiac magnetic resonance imaging (MRI) was performed shortly after the onset of symptoms, with further investigations in severe cases. Symptoms were defined as dyspnea, chest pain and cardiac arrhythmia as determined by electrocardiography.RESULTS: Eight patients (5 males and 3 females) developed cardiac symptoms compatible with myocarditis, according to the CDC criteria, shortly after SARS-CoV-2 mRNA vaccination. Three patients (2 males, 1 female) required hospitalization due to severe chest pain and elevated troponin levels. All patients recovered fully within 7 days from the symptom onset.CONCLUSIONS: Our data suggest that cardiac adverse events such as myocarditis or pericarditis shortly after SARS-CoV-2 mRNA vaccination are rare but possible and occur particularly in male patients.

KW - Adolescent

KW - Adult

KW - BNT162 Vaccine/adverse effects

KW - COVID-19/prevention & control

KW - Chest Pain

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocarditis/chemically induced

KW - Pericarditis/chemically induced

KW - SARS-CoV-2/genetics

KW - Vaccination/adverse effects

KW - Vaccines, Synthetic/adverse effects

KW - Young Adult

KW - mRNA Vaccines/adverse effects

KW - Inflammation

KW - COVID-19

KW - Myocarditis

KW - ACUTE MYOCARDITIS

KW - mRNA vaccine

U2 - 10.1186/s40001-022-00695-y

DO - 10.1186/s40001-022-00695-y

M3 - Article

C2 - 35655235

SN - 0949-2321

VL - 27

JO - European Journal of Medical Research

JF - European Journal of Medical Research

IS - 1

M1 - 80

ER -