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Vaccination

Myocarditis and Pericarditis After Vaccination for COVID-19

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA

Published Online: August 4, 2021

Research Letter

Article Information and Disclosures

George A. Diaz, MD¹;

Guilford T. Parsons, MD, MS²;

Sara K. Gering, BS, BSN³;

Audrey R. Meier, MPH⁴;

Ian V. Hutchinson, PhD, DSc⁵;

Ari Robicsek, MD²

Author Affiliations

¹Section of Infectious Diseases, Providence Regional Medical Center Everett, Everett, Washington
²Providence Research Network, Renton, Washington
³Medical Intensive Care Unit, Providence Regional Medical Center Everett, Everett, Washington
⁴Department of Infection Prevention and Control, Providence Regional Medical Center Everett, Everett, Washington
⁵Office of Clinical Research, Providence Health and Services, Southern California Region, Los Angeles

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Brief Report

Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination

Han W. Kim, MD; Elizabeth R. Jenista, PhD; David C. Wendell, PhD; Clerio F. Azevedo, MD; Michael J. Campbell, MD; Stephen N. Darty, BS; Michele A. Parker, MS; Raymond J. Kim, MD
Brief Report

Association of Myocarditis With BNT162b2 Vaccination in Children

Audrey Dionne, MD; Francesca Sperotto, MD; Stephanie Chamberlain; Annette L. Baker, MSN, CPNP; Andrew J. Powell, MD; Ashwin Prakash, MD; Daniel A. Castellanos, MD; Susan F. Saleeb, MD; Sarah D. de Ferranti, MD, MPH; Jane W. Newburger, MD, MPH; Kevin G. Friedman, MD
Original Investigation

Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021

Matthew E. Oster, MD, MPH; David K. Shay, MD, MPH; John R. Su, MD, PhD, MPH; Julianne Gee, MPH; C. Buddy Creech, MD, MPH; Karen R. Broder, MD; Kathryn Edwards, MD; Jonathan H. Soslow, MD, MSCI; Jeffrey M. Dendy, MD; Elizabeth Schlaudecker, MD, MPH; Sean M. Lang, MD; Elizabeth D. Barnett, MD; Frederick L. Ruberg, MD; Michael J. Smith, MD, MSCE; M. Jay Campbell, MD, MHA; Renato D. Lopes, MD, PhD, MHS; Laurence S. Sperling, MD; Jane A. Baumblatt, MD; Deborah L. Thompson, MD, MSPH; Paige L. Marquez, MSPH; Penelope Strid, MPH; Jared Woo, MPH; River Pugsley, PhD, MPH; Sarah Reagan-Steiner, MD, MPH; Frank DeStefano, MD, MPH; Tom T. Shimabukuro, MD, MPH, MBA
Research Letter

Myocarditis Following a Third BNT162b2 Vaccination Dose in Military Recruits in Israel

Limor Friedensohn, MD; Dan Levin, MD; Maggie Fadlon-Derai, MHA; Liron Gershovitz, MD; Noam Fink, MD; Elon Glassberg, MD; Barak Gordon, MD

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Rare cases of cardiac inflammation following SARS-CoV-2 vaccination have been reported.¹^- 4 We reviewed the clinical records of vaccine recipients to identify cases of postvaccination myocarditis or pericarditis.

Forty hospitals in Washington, Oregon, Montana, and Los Angeles County, California, that were part of the Providence health care system and used the same electronic medical record (EMR) were included. All patients with documented COVID-19 vaccinations administered inside the system or recorded in state registries at any time through May 25, 2021, were identified. Vaccinated patients who subsequently had emergency department or inpatient encounters with diagnoses of myocarditis, myopericarditis, or pericarditis were ascertained from EMRs (see eTables 1 and 2 in the Supplement for exclusions and definitions).

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Article Information

Corresponding Author: George A. Diaz, MD, Providence Regional Medical Center Everett, 1700 13th St, Ste B3-018, Everett, WA 98201 (george.diaz@providence.org).

Accepted for Publication: July 26, 2021.

Published Online: August 4, 2021. doi:10.1001/jama.2021.13443

Author Contributions: Dr Robicsek had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Diaz, Robicsek.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Diaz, Parsons, Meier, Hutchinson, Robicsek.

Critical revision of the manuscript for important intellectual content: Diaz, Gering, Hutchinson, Robicsek.

Statistical analysis: Diaz, Meier, Robicsek.

Administrative, technical, or material support: Parsons, Gering, Robicsek.

Supervision: Robicsek.

Conflict of Interest Disclosures: Dr Diaz reported receipt of clinical trial research support from Gilead Sciences, Regeneron, Roche, Boehringer Ingelheim, and Edesa Biotech and scientific advisory board membership for Safeology. No other disclosures were reported.

Additional Contributions: We acknowledge the patients included in this study and the caregiver teams across the Providence organization.

References

Montgomery J , Ryan M , Engler R , et al. Myocarditis following immunization with mRNA COVID-19 vaccines in members of the US military. JAMA Cardiol. Published online June 29, 2021. doi:10.1001/jamacardio.2021.2833 PubMed Google Scholar

Kim HW , Jenista ER , Wendell DC , et al. Patients with acute myocarditis following mRNA COVID-19 vaccination. JAMA Cardiol. Published online June 29, 2021. doi:10.1001/jamacardio.2021.2828 PubMed Google Scholar

Bautista García J , Peña Ortega P , Bonilla Fernández JA , et al. Acute myocarditis after administration of the BNT162b2 vaccine against COVID-19. Rev Esp Cardiol (Engl Ed). Published online April 27, 2021. doi:10.1016/j.recesp.2021.03.009 PubMed Google Scholar

Rosner CM , Genovese L , Tehrani BN , et al. Myocarditis temporally associated with COVID-19 vaccination. Circulation. Published online June 16, 2021. doi:10.1161/CIRCULATIONAHA.121.055891 PubMed Google Scholar

Su JR , McNeil MM , Welsh KJ , et al. Myopericarditis after vaccination, Vaccine Adverse Event Reporting System (VAERS), 1990-2018. Vaccine. 2021;39(5):839-845. doi:10.1016/j.vaccine.2020.12.046 PubMed Google Scholar Crossref

Wallace M , Oliver S . COVID-19 mRNA vaccines in adolescents and young adults: benefit-risk discussion. Slide 28. Published June 23, 2021. Accessed July 7, 2021. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-06/05-COVID-Wallace-508.pdf

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.