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Myocarditis and Pericarditis After Vaccination for COVID-19

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

Rare cases of cardiac inflammation following SARS-CoV-2 vaccination have been reported.14 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
1.
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.2021.2833PubMedGoogle Scholar
2.
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.2021.2828PubMedGoogle Scholar
3.
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.2021.03.009PubMedGoogle Scholar
4.
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.121.055891PubMedGoogle Scholar
5.
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.2020.12.046PubMedGoogle ScholarCrossref
6.
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
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