COVID-19 Myocarditis Advisory for Healthcare Providers

Reminder to Report COVID Vaccine-Associated Myocarditis and Pericarditis

Posted July 22, 2021. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.


Since April 2021, increased cases of myocarditis and pericarditis have been reported in the United States after mRNA COVID-19 vaccination (Pfizer-BioNTech and Moderna), particularly in adolescents and young adults. There has not been a similar reporting pattern observed after receipt of the Janssen COVID-19 Vaccine (Johnson & Johnson). In most cases, patients who presented for medical care have responded well to medications and rest resulting in prompt improvement of symptoms.

Reported cases have occurred predominantly in males aged 16 years and older. Onset was typically within several days after mRNA COVID-19 vaccination, and cases have occurred more often after the second dose than the first dose. CDC and its partners are investigating these reports of myocarditis and pericarditis following mRNA COVID-19 vaccination.

Recommendations for Clinicians

  • CDC continues to recommend COVID-19 vaccination for everyone 12 years of age and older given the greater risk of other serious complications related to COVID-19 illness, such as hospitalization, multisystem inflammatory syndrome in children (MIS-C), long term health problems, hospitalization, or death.
  • Please report any patients with pericarditis or myocarditis following vaccination:
    • To VAERS
    • AND to the Spokane Regional Health District by faxing the report to 509-324-3623.
  • Consider myocarditis and pericarditis in adolescents or young adults with acute chest pain, shortness of breath, or palpitations. In this younger population, coronary events are less likely to be a source of these symptoms.
  • Ask about prior COVID-19 vaccination if you identify these symptoms, as well as other medical, travel, and social history.
  • For initial evaluation, consider an ECG, troponin level, and inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate. In the setting of normal ECG, troponin, and inflammatory markers, myocarditis or pericarditis are unlikely.
  • For suspected cases, consider consultation with cardiology for assistance with cardiac evaluation and management. Evaluation and management may vary depending on patient age, clinical presentation, potential causes, or provider preference.
  • For follow-up of patients with myocarditis, consult the new guidance from the American Heart Association.
  • It is important to rule out other potential causes of myocarditis and pericarditis. Consider consultation with infectious disease and/or rheumatology to assist in this evaluation.
    • Where available, evaluate for potential etiologies of myocarditis and pericarditis, particularly acute COVID-19 infection (e.g., PCR testing), prior SARS-CoV-2 infection (e.g., detection of SARS-CoV-2 nucleocapsid antibodies), and other viral etiologies (e.g., enterovirus PCR and comprehensive respiratory viral pathogen testing).

For more information

Resources

Centers for Disease Control and Prevention (2021, May 28). Clinical considerations: Myocarditis and pericarditis after receipt of mRNA COVID-19 Vaccines among adolescents and young adults.