3 pediatric centers in Israel, 7 cases of perimyocarditis following COVID-19 mRNA technology based Pfizer vaccination in children 16–18 years of age; all patients were Jewish & presented with chest

by Paul Alexander

pain that began 1–3 days following vaccination (mean, 2.1 days). In 6 of the 7 patients, symptoms began following the 2nd dose and in 1 patient following the 1st dose.




‘Here, we describe a single representative case from Schneider medical center, following a table summarizing information of all cases: A 16-year-old male presented to the emergency room with exertional chest pain and cough that started on the day of admission, 2 days following inoculation with a second dose of the BNT162b2 vaccine. Due to the protocol implemented in the educational institution he was attending, he underwent routine sequential COVID-19 polymerase chain reaction (PCR) tests in the weeks before his admission, all were negative. Upon arrival to the emergency room, vital signs and physical examination were normal. Chest radiograph did not demonstrate any pathologic findings. ECG revealed normal sinus rhythm, right ventricular conduction delay, ST-segment elevation in leads I, II, augmented vector foot and in V4–V6 and ST depression in leads V1 and augmented vector right (Fig. 1). Laboratory testing revealed 8900 white blood cells/microliter, hemoglobin level of 13.2 g/dL, platelet level of 120,000 cells/microliter, C-reactive protein level of 3.3 mg/dL, maximal troponin level of 3130 nanogram/L (normal range<14 ng/dL), N-terminal pro-brain natriuretic peptide of 631 picograms/mL (normal range <125 pg/mL), fibrinogen level of 571 mg/dL (normal range, 200–530 mg/dL) and D-dimer of 855 nanogram/mL (normal range <500 ng/mL). Biochemistry and coagulation studies were within the normal limits. Echocardiography demonstrated normal right ventricular and pulmonary artery pressures, near-normal ventricular function (left ventricular fractional shortening of 28%), no pericardial effusion. The patient was admitted to the pediatric intensive care unit with a presumed diagnosis of myocarditis and was treated with ibuprofen. An extensive laboratory investigation was performed including cultures and serologies for prevalent pathogens (ie, viruses, typical and atypical bacteria associated with perimyocarditis) as well as a rheumatologic panel, although no specific etiology was found. Throughout his hospitalization, he was hemodynamically stable and did not require inotropic support. During his 6 days of hospitalization, he gradually began to show clinical, laboratory and echocardiographic improvement. Subsequent echocardiography was found normal with fractional shortening of 38%. Troponin level upon discharge plummeted to 53 nanogram/L. Three weeks post discharge, he was asymptomatic and had a normal ECG and echocardiogram.’

‘All patients were males 16–18 years old, of Jewish descent, who presented with chest pain that began 1–3 days following vaccination (mean, 2.1 days). In 6 of the 7 patients, symptoms began following the 2nd dose and in 1 patient following the 1st dose. All cases were mild and none required cardiovascular or respiratory support. The incidence of perimyocarditis during the vaccination period was elevated in comparison to previous years.’

‘Myocarditis and pericarditis incidence during the inoculation campaign compared with previous years: Data collected from all 3 medical centers during the time period between January 1, 2021, and February 28, 2021, revealed a total of 10 children 16–18 years of age diagnosed with pericarditis and myocarditis, 8 of them following the COVID-19 vaccination (7 are described above and a single case was excluded due to inadequate documentation). During the same time period in previous years, a lower incidence of perimyocarditis was reported in this age group, with only 2 cases in 2018 and 2020 and 4 cases in 2019.’