BCHHS Public Health Provider Alert: Rare reports of myocarditis following COVID-19 vaccination

May 26, 2021

Reports of myocarditis occurring after COVID-19 vaccination

  •          In recent weeks, there have been rare reports of myocarditis occurring after COVID-19 vaccination with Moderna or Pfizer vaccines in the United States and Europe. 
  •          The CDC is aware of these reports and has been closely monitoring myocarditis/pericarditis in multiple safety systems, including the Vaccine Adverse Event Reporting System (VAERS)  and the Vaccine Safety Datalink (VSD). 
    •    To date, there has not been a safety signal identified in either VAERS or VSD. 
    •    Rates of myocarditis reports in the window following COVID-19 vaccination have not differed from expected baseline rates. 
  •          CDC will continue to evaluate reports of myocarditis/pericarditis occurring after COVID-19 vaccination and will share more information as it becomes available.  
  •          CDC’s Advisory Committee on Immunization Practices' COVID-19 Vaccine Safety Technical (VaST) work group has reviewed post-authorization COVID-19 vaccine safety data on a weekly basis since the start of the United States’ vaccination program. 
  •          Myocarditis is the inflammation of the heart muscle and pericarditis is the inflammation of the lining outside the heart. In both cases, the body's immune system is causing inflammation in response to an infection or some other trigger.  While myocarditis can be serious, it is frequently mild and self-limited. Symptoms can include abnormal heart rhythms, shortness of breath, or chest pain. Both myocarditis and pericarditis have been reported as complications in patients with COVID-19.   
  •          While these reports are being further investigated, health care providers should do the following:  
    •    Consider a diagnosis of myocarditis or pericarditis in any evaluation of chest pain following COVID-19 or COVID-19 vaccination.  
    •    Inquire about recent COVID-19 or COVID-19 vaccination in any patient presenting with symptoms consistent with myocarditis or pericarditis.  
      •   Clinical features of myocarditis and pericarditis include chest pain or pressure, shortness of breath, electrocardiogram (EKG) changes and elevated cardiac biomarkers.  
      •   Elicit a detailed history including vaccination status and potential exposures to COVID-19. Patients should be tested for COVID-19 infection using a molecular (PCR) test.  
    •    Report cases of myocarditis or pericarditis within two weeks of any COVID-19 vaccination to the U.S. Vaccine Adverse Events Reporting System (VAERS): https://vaers.hhs.gov/reportevent.html 
      •   It is recommended that the evaluating (not administering) provider report the incident to VAERS so appropriate clinical details can be reported accurately. 
  •          The CDC continues to recommend COVID-19 vaccination for people 12 years and older.   

Coadministration of COVID-19 vaccine and other vaccines

I also want to reiterate something from an email I sent out last week, as it has come to our attention that there are some providers in NC who are unaware of this important update to the CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States:

  •          COVID-19 vaccines may now be administered with other vaccines without regard to timing. This includes simultaneous administration of COVID-19 vaccines and other vaccines on the same day, as well as coadministration within 14 days.
    •    If multiple vaccines are administered at a single visit, administer each injection in a different injection site.
      •   For adolescents and adults, the deltoid muscle can be used for more than one intramuscular injection.
      •   Separate injection sites by 1 inch or more, if possible.
      •   Administer the COVID-19 vaccines and vaccines that may be more likely to cause a local reaction (e.g., tetanus-toxoid-containing and adjuvanted vaccines) in different limbs, if possible.