Covid-19-vaccine-pfizer-biontech

Author Information

An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

In a case series, 7 men [aged 18-24 years] were described, who developed myocarditis following COVID-19-Vaccine-Pfizer-BioNTech for prevention of COVID-19 infection [routes and dosages not stated].

Case 1: The 20-year-old man presented to the emergency department with chest pain radiating to right arm, fatigue, headache, abdominal pain and perspiration. On day prior to presentation, he had received second dose of COVID-19-Vaccine-Pfizer-BioNTech [Pfizer-BioNTech]. He had a significant history of attention deficit and hyperactivity disorder. Upon presentation, a laboratory examination was performed which showed elevated levels of troponin-I (22000 ng/L), creatine phosphokinase (337 IU/L) and c-reactive protein (58.54 mg/L). Subsequent ECG showed ST elevation, leads I, AVL, V1-6, PR elevation on AVR. Echocardiography showed hypokinesis of the apex. left ventricle (LV) ejection fraction was 45%. Cardiac spectral CT scan revealed sub epicardial focal enhancement of the lateral wall and septum of the inferior wall, No pericardial or pleural effusion. Based on the symptoms and clinical investigation, he was diagnosed with myocarditis secondary to COVID-19-Vaccine-Pfizer-BioNTech. As corrective measures, he received bisoprolol and ramipril. After 4 days, he was discharged with normal LV function.

Case 2: The 19-year-old man presented to the emergency department with chest pain, abdominal pain and fatigue. On day prior to presentation, he had received second dose of COVID-19-Vaccine-Pfizer-BioNTech [Pfizer-BioNTech]. He had a significant history of celiac disease. Upon presentation, a laboratory examination was performed which showed elevated levels of troponin-I (15000 ng/L), c-reactive protein (9 mg/L) and LDH (643U/L). Subsequent ECG showed ST elevation, inferior leads, reciprocal depression on leads I and AVL. Echocardiography and chest x-ray showed normal results. Cardiac CT scan revealed late adherence through the lateral wall, the inferior basal wall, the apex and middle part of the septum. Based on the symptoms and clinical investigation, he was diagnosed with myocarditis secondary to COVID-19-Vaccine-Pfizer-BioNTech. As corrective measures, he received bisoprolol and ramipril. Following the corrective measures, his symptoms resolved and troponin levels decreased. After 4 days, he was discharged from the hospital.

Case 3: The 19-year-old man presented to the emergency department with fatigue, throat pain and dizziness. On day prior to presentation, he had received second dose of COVID-19-Vaccine-Pfizer-BioNTech [Pfizer-BioNTech]. He had a significant history of allergic asthma. Upon presentation, a laboratory examination was performed which showed elevated levels of troponin-I (15527 ng/L) and c-reactive protein (44 mg/L). Subsequent ECG showed normal sinus rhythm. Additionally, chest x-ray and echocardiography also showed normal results. However, 24 hour ECG Holter showed a relatively short QTc (0.33 msec), few premature ventricular contractions with no significant events. Based on the symptoms and clinical investigation, he was diagnosed with myocarditis secondary to COVID-19-Vaccine-Pfizer-BioNTech. As corrective measures, he received bisoprolol and ramipril. Following the corrective measures, his symptoms resolved. After 4 days, he was discharge from the hospital. Two weeks after discharge, a cardiac MRI was performed which showed left ventricle (LV) ejection fraction of 51% and late subepicardial and mesocardiac enhancement of 5% of LV walls.

Case 4: The 22-year-old man presented to the emergency department with chest pain radiating to the left arm and fatigue. Five days prior to presentation, he had received second dose of COVID-19-Vaccine-Pfizer-BioNTech [Pfizer-BioNTech]. Upon presentation, a laboratory examination was performed which showed elevated levels of troponin-I (60000 ng/L), creatine phosphokinase (358 IU/L) and C-reactive protein (7 mg/L). Subsequent ECG showed ST elevation I, II, III, AVF, V3-6 leads. Echocardiography showed normal left ventricle (LV) function, minimal pericardial effusion. Based on the symptoms and clinical investigation, he was diagnosed with myocarditis secondary to COVID-19-Vaccine-Pfizer-BioNTech. As corrective measures, he received colchicine and ibuprofen. After 4 days, he was discharge from the hospital. Four days after discharge, troponin levels were within normal limits. After 1 month from discharge, his echocardiography showed normal LV function.

Case 5: The 24-year-old man presented to the emergency department with squeezing chest pain and dyspnoea. Two days prior to presentation, he had received second dose of COVID-19-Vaccine-Pfizer-BioNTech [Pfizer-BioNTech]. Upon presentation, a laboratory examination was performed which showed elevated levels of troponin-T (409 ng/L), creatine phosphokinase (381 IU/L) and C-reactive protein (58.1 mg/L). Subsequent ECG showed diffuse ST segment elevation in septal and lateral leads, and PR segment depressions in inferior leads. Echocardiography and chest x-ray showed normal results. Cardiac MRI showed myocardial oedema and late gadolinium enhancement were noted in the basal left ventricle (LV) and subepicardial myocardium. Based on the symptoms and clinical investigation, he was diagnosed with myocarditis secondary to COVID-19-Vaccine-Pfizer-BioNTech. As corrective measures, he received colchicine and ibuprofen. On the next day, he was discharged from the hospital with clinical improvement in the symptoms.

Case 6: The 21-year-old man presented to the emergency department with squeezing chest pain radiating to the back, fever and malaise. Five days prior to presentation, he had received second dose of COVID-19-Vaccine-Pfizer-BioNTech [Pfizer-BioNTech]. Upon presentation, a laboratory examination was performed which showed elevated levels of troponin-T (2300 ng/L) and c-reactive protein (120 mg/L). Subsequent ECG showed sinus tachycardia and findings consistent with left ventricle (LV) hypertrophy. Echocardiography showed moderate global LV dysfunction, LV ejection fraction (EF) of 38-42%, and normal right ventricle (RV) size and function. Cardiac MRI showed dilated LV (60mm), mild to moderate systolic dysfunction (EF:42%), normal RV size with mild systolic dysfunction (EF:44%). Late gadolinium enhancement in the subepicardial and midmyocardium, along the lateral wall, infero-basal wall and mid- and basal septum involving 8% of myocardial mass. Enhancement was evident diffusely in the peri card. Based on the symptoms and clinical investigation, he was diagnosed with myocarditis secondary to COVID-19-Vaccine-Pfizer-BioNTech. As corrective measures, he received colchicine and bisoprolol. After 2 days, he was discharged from the hospital. ECG and Troponin levels taken after discharge were normal.

Case 7: The 18-year-old man presented to the emergency department with stabbing chest pain aggravated by lying down, myalgia, headache and malaise. Two days prior to presentation, he had received second dose of COVID-19-Vaccine-Pfizer-BioNTech [Pfizer-BioNTech]. Upon presentation, a laboratory examination was performed which showed elevated levels of troponin-T (33 ng/L) and c-reactive protein (4 mg/L). Subsequent ECG showed diffuse ST segment elevation associated with ST segment depression in AVR and PR segment depression. His echocardiography was normal left ventricle (LV) and right ventricle (RV) function. Based on the symptoms and clinical investigation, he was diagnosed with myocarditis secondary to COVID-19-Vaccine-Pfizer-BioNTech. As corrective measures, he received colchicine. Following the corrective measures, troponin level decreased and his symptoms resolved. After 5 days, he was discharge from the hospital.