jamanetwork.com
Open in
urlscan Pro
40.76.153.40
Public Scan
Submitted URL: https://lnkd.in/djdXEjkf
Effective URL: https://jamanetwork.com/journals/jama/fullarticle/2788346
Submission: On January 27 via manual from US — Scanned from DE
Effective URL: https://jamanetwork.com/journals/jama/fullarticle/2788346
Submission: On January 27 via manual from US — Scanned from DE
Form analysis 2 forms found in the DOM
POST ./2788346
<form method="post" action="./2788346" id="webform" class="m0" novalidate="novalidate">
<div class="aspNetHidden">
<input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="IgGNnsolTG9GeJx/hqhWC92dQdDA5azduJbGhQKCTFwvKVYyWyt9wOwkt3pqjCv07rGjKU4ok1i3iVPGwkefdSwY/7M=">
</div>
<div class="aspNetHidden">
<input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="2173C2F0">
<input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION"
value="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">
</div>
<input id="hdnSiteID" type="hidden" value="3">
<input id="hdnDomain" type="hidden" value=".jamanetwork.com">
<section class="master-header">
<script type="text/javascript">
var App = App || {};
App.LoginUserInfo = {
isInstLoggedIn: [0],
currentSessionId: 'rg3mov4mydsw3jmeifa4xfok'
};
</script>
<input name="ctl00$ctl00$BodyContent$Header$hfGlobalSearchSiteURL" type="hidden" id="hfGlobalSearchSiteURL" value="https://jamanetwork.com/">
<input name="ctl00$ctl00$BodyContent$Header$hfAppIsPaidUser" type="hidden" id="hfAppIsPaidUser" value="false">
<input name="ctl00$ctl00$BodyContent$Header$hfAppIsMember" type="hidden" id="hfAppIsMember" value="false">
<input name="ctl00$ctl00$BodyContent$Header$hfAppSubscribedTo" type="hidden" id="hfAppSubscribedTo">
<input name="ctl00$ctl00$BodyContent$Header$hfAppIsIndividual" type="hidden" id="hfAppIsIndividual" value="false">
<input name="ctl00$ctl00$BodyContent$Header$hfAppHasAccess" type="hidden" id="hfAppHasAccess" value="false">
<input name="ctl00$ctl00$BodyContent$Header$hfAppIsReferredFromGoogle" type="hidden" id="hfAppIsReferredFromGoogle" value="False">
<input name="ctl00$ctl00$BodyContent$Header$hfSolrAutoSuggestMinimumCharactersLength" type="hidden" id="hfSolrAutoSuggestMinimumCharactersLength" value="2">
<input name="ctl00$ctl00$BodyContent$Header$hfSolrJournalName" type="hidden" id="hfSolrJournalName" value="JAMA">
<input name="ctl00$ctl00$BodyContent$Header$hfSolrJournalID" type="hidden" id="hfSolrJournalID" value="J67">
<input name="ctl00$ctl00$BodyContent$Header$hfAppIsLucy" type="hidden" id="hfAppIsLucy" value="false">
<div class="header-wrap">
<header class="header">
<div class="network-bar">
<a class="jama-network" href="/" title="JAMA Network Home">
<img alt="JAMA Network Home" class="title-image" width="443" height="52" src="//cdn.jamanetwork.com/UI/app/svg/Jama_Network_Logo.svg">
</a>
</div>
<a class="nav-toggler" href="#nav">
<div class="nav-toggler-indicator">
<span class="indicator-stroke"></span>
<span class="indicator-stroke"></span>
<span class="indicator-stroke"></span>
<span class="indicator-stroke"></span>
</div>
<div class="nav-toggler-site">
<span id="BodyContent_Header_siteFullNamenav" class="nav-toggler-microsite"><span class="network">JAMA</span></span>
</div>
</a>
<nav id="nav" class="nav hide">
<div class="nav-journal-level sb-nav-journal-level">
<a href="https://jamanetwork.com/journals/jama" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_0" class="home">Home</a><a href="https://jamanetwork.com/journals/jama/newonline" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_1" class="new-online">New Online</a><a href="https://jamanetwork.com/journals/jama/currentissue" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_2" class="current-issue">Current Issue</a><a href="https://jamanetwork.com/journals/jama/pages/for-authors" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_3" class="for-authors">For Authors</a>
</div>
<div class="nav-journals">
<div class="widget-SelfServeContent widget-instance-HamburgerPublicationMenu">
<div class="self-serve">
<style type="text/css">
.nav-journals {
margin-bottom: 1em;
}
.nav-heading {
color: #B9B9B9;
text-transform: uppercase;
font-size: 1.5em;
padding: .7em .75em;
border-top: 1px solid #242424;
border-bottom: 1px solid #242424;
font-weight: 400;
margin: 0 0 .5em 0;
}
a.no-bullet {}
a.no-bullet:before {
content: none !important;
}
</style>
<h2 class="nav-heading">Podcasts</h2>
<a href="/journals/jama/pages/jama-clinical-reviews">Clinical Reviews</a>
<a href="/journals/jama/pages/jama-editors-summary">Editors' Summary</a>
<a href="/journals/jama/pages/jama-medical-news">Medical News</a>
<a href="/journals/jama/pages/jama-author-interviews">Author Interviews</a>
<a href="https://sites.jamanetwork.com/audio" class="no-bullet">More</a>
<h2 class="nav-heading">Publications</h2>
<a href="/journals/jama" class="theme-jama">JAMA</a>
<a href="/journals/jamanetworkopen" class="theme-jama-network-open">JAMA Network Open</a>
<a href="/journals/jamacardiology" class="theme-jama-cardiology">JAMA Cardiology</a>
<a href="/journals/jamadermatology" class="theme-jama-dermatology">JAMA Dermatology</a>
<a href="/journals/jama-health-forum" class="theme-jama-health-forum">JAMA Health Forum</a>
<a href="/journals/jamainternalmedicine" class="theme-jama-internal-medicine">JAMA Internal Medicine</a>
<a href="/journals/jamaneurology" class="theme-jama-neurology">JAMA Neurology</a>
<a href="/journals/jamaoncology" class="theme-jama-oncology">JAMA Oncology</a>
<a href="/journals/jamaophthalmology" class="theme-jama-ophthalmology">JAMA Ophthalmology </a>
<a href="/journals/jamaotolaryngology" class="theme-jama-otolaryngology-head-neck-surgery">JAMA Otolaryngology–Head & Neck Surgery</a>
<a href="/journals/jamapediatrics" class="theme-jama-pediatrics">JAMA Pediatrics</a>
<a href="/journals/jamapsychiatry" class="theme-jama-psychiatry">JAMA Psychiatry</a>
<a href="/journals/jamasurgery" class="theme-jama-surgery">JAMA Surgery</a>
<a href="/journals/archneurpsyc" class="theme-archives-of-neurology-psychiatry-1919-1959-">Archives of Neurology & Psychiatry (1919-1959)</a>
</div>
</div>
</div>
<div class="nav-network-other">
<a href="https://edhub.ama-assn.org/jn-learning" id="BodyContent_Header_rptOtherResources_aItemResourceList_0" class="is-b link-jn-learning-cme" target="_blank">JN Learning / CME</a><a href="https://store.jamanetwork.com/index.aspx?productcode=64" id="BodyContent_Header_rptOtherResources_aItemResourceList_1" class="is-b link-subscribe" target="_blank">Subscribe</a><a href="https://jamanetwork.com/pages/apps" id="BodyContent_Header_rptOtherResources_aItemResourceList_2" class="is-b link-apps">Apps</a><a href="https://careers.jamanetwork.com/" id="BodyContent_Header_rptOtherResources_aItemResourceList_3" class="is-b link-jobs" target="_blank">Jobs</a><a href="https://jamanetwork.com/pages/institutions-and-librarians" id="BodyContent_Header_rptOtherResources_aItemResourceList_4" class="is-b link-institutions-librarians">Institutions / Librarians</a><a href="https://jamanetwork.com/pages/reprints-and-permissions" id="BodyContent_Header_rptOtherResources_aItemResourceList_5" class="is-b link-reprints-permissions" rel="nofollow">Reprints & Permissions</a>
</div>
<div class="white text-xxs">
<div class="p05 ml4 mr3 mb1 mt10 flex hamburger-menu-legal">
<a href="/pages/conditions-of-use" class="p0" rel="nofollow">Terms of Use</a>
<span class="pl1 pr1">| </span>
<a href="/pages/privacy-policy" class="p0" rel="nofollow">Privacy Policy</a>
<span class="pl1 pr1">| </span>
<a href="/pages/accessibility-statement" class="p0" rel="nofollow">Accessibility Statement</a>
</div>
<div class="ta-c">
<span class="pb1">2022 American Medical Association. All Rights Reserved</span>
</div>
</div>
</nav>
<a class="toolbar-search-trigger is-b" data-mobile-tog-target=".site-search"></a>
<div id="site-search" role="search" class="site-search">
<div class="site-search-bar">
<div role="search">
<div class="cs-select cs-skin-border" tabindex="0"><span class="cs-placeholder is-a">Search All</span>
<div class="cs-options">
<ul>
<li role="options" data-option="" data-value="J*" aria-label="Search All" name="Search All" value="J*"><span>Search All</span></li>
<li role="options" data-option="" data-value="3" aria-label="JAMA" name="JAMA" value="3"><span>JAMA</span></li>
<li role="options" data-option="" data-value="214" aria-label="JAMA Network Open" name="JAMA Network Open" value="214"><span>JAMA Network Open</span></li>
<li role="options" data-option="" data-value="192" aria-label="JAMA Cardiology" name="JAMA Cardiology" value="192"><span>JAMA Cardiology</span></li>
<li role="options" data-option="" data-value="12" aria-label="JAMA Dermatology" name="JAMA Dermatology" value="12"><span>JAMA Dermatology</span></li>
<li role="options" data-option="" data-value="261" aria-label="JAMA Forum Archive" name="JAMA Forum Archive" value="261"><span>JAMA Forum Archive</span></li>
<li role="options" data-option="" data-value="193" aria-label="JAMA Health Forum" name="JAMA Health Forum" value="193"><span>JAMA Health Forum</span></li>
<li role="options" data-option="" data-value="15" aria-label="JAMA Internal Medicine" name="JAMA Internal Medicine" value="15"><span>JAMA Internal Medicine</span></li>
<li role="options" data-option="" data-value="16" aria-label="JAMA Neurology" name="JAMA Neurology" value="16"><span>JAMA Neurology</span></li>
<li role="options" data-option="" data-value="159" aria-label="JAMA Oncology" name="JAMA Oncology" value="159"><span>JAMA Oncology</span></li>
<li role="options" data-option="" data-value="17" aria-label="JAMA Ophthalmology" name="JAMA Ophthalmology" value="17"><span>JAMA Ophthalmology</span></li>
<li role="options" data-option="" data-value="18" aria-label="JAMA Otolaryngology–Head & Neck Surgery" name="JAMA Otolaryngology–Head & Neck Surgery" value="18"><span>JAMA Otolaryngology–Head & Neck Surgery</span></li>
<li role="options" data-option="" data-value="19" aria-label="JAMA Pediatrics" name="JAMA Pediatrics" value="19"><span>JAMA Pediatrics</span></li>
<li role="options" data-option="" data-value="14" aria-label="JAMA Psychiatry" name="JAMA Psychiatry" value="14"><span>JAMA Psychiatry</span></li>
<li role="options" data-option="" data-value="20" aria-label="JAMA Surgery" name="JAMA Surgery" value="20"><span>JAMA Surgery</span></li>
<li role="options" data-option="" data-value="23" aria-label="Archives of Neurology & Psychiatry" name="Archives of Neurology & Psychiatry" value="23"><span>Archives of Neurology & Psychiatry</span></li>
</ul>
</div><select name="ctl00$ctl00$BodyContent$Header$ddlForSearch" id="BodyContent_Header_ddlForSearch" class="cs-select cs-skin-border" title="Search Site Selector" role="options" aria-labelledby="searchLabel">
<option value="J*">Search All</option>
<option value="3">JAMA</option>
<option value="214">JAMA Network Open</option>
<option value="192">JAMA Cardiology</option>
<option value="12">JAMA Dermatology</option>
<option value="261">JAMA Forum Archive</option>
<option value="193">JAMA Health Forum</option>
<option value="15">JAMA Internal Medicine</option>
<option value="16">JAMA Neurology</option>
<option value="159">JAMA Oncology</option>
<option value="17">JAMA Ophthalmology</option>
<option value="18">JAMA Otolaryngology–Head & Neck Surgery</option>
<option value="19">JAMA Pediatrics</option>
<option value="14">JAMA Psychiatry</option>
<option value="20">JAMA Surgery</option>
<option value="23">Archives of Neurology & Psychiatry</option>
</select>
</div>
</div>
<div class="search-input-container">
<input type="search" name="textbox" autocomplete="off" role="textbox" id="search-term" aria-labelledby="searchLabel" class="search-term at-microsite-search-term" placeholder="Enter Search Term" maxlength="255" title="Enter Search Term">
<ul id="umbrellaSiteAutoCompleteResults" class="term-list hidden"></ul>
<label style="display:none" for="umbrellaSiteSearchInputHint" id="searchLabel">Input Search Term</label>
<input class="searchTerm search-input" name="textbox" role="textbox" type="text" id="umbrellaSiteSearchInputHint" aria-labelledby="searchLabel" title="Input Search Term" autocomplete="off">
</div>
<!-- /.search-input-container -->
<a name="button" role="button" class="search-button is-b" alt="search button" href="javascript:;"></a>
</div>
</div>
<div id="BodyContent_Header_GlobalSignIn_auth" class="auth">
<a class="auth--trigger is-b is-a" href="javascript:;">
<span id="BodyContent_Header_GlobalSignIn_spnUserFullName" class="user-full-name">Sign In</span>
</a>
<div class="auth--dropdown js-signIn-dropdown hide">
<div class="auth--option auth--ind">
<div id="BodyContent_Header_GlobalSignIn_divUserFullName" class="auth--ind-user"></div>
<div id="BodyContent_Header_GlobalSignIn_divIndSignIn" class="auth--ind-auth">
<div class="auth--title">Individual Sign In</div>
<a href="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2788346" id="BodyContent_Header_GlobalSignIn_oauthSignInLink" rel="nofollow" class="auth--ind-sign-in">Sign in</a><a href="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2788346" id="BodyContent_Header_GlobalSignIn_oauthSignUpLink" rel="nofollow" class="auth--ind-create">Create an Account</a>
</div>
</div>
<div id="BodyContent_Header_GlobalSignIn_divInstSignIn" class="auth--option auth--inst">
<div class="auth--inst-auth">
<div class="auth--title">Access through your institution</div>
<a href="/signinshibboleth?returnUrl=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2788346" id="BodyContent_Header_GlobalSignIn_institutionSignIn" rel="nofollow" class="auth--shib">Sign In</a>
</div>
</div>
<div id="BodyContent_Header_GlobalSignIn_divPurchaseOptions" class="auth--option auth--purchase">
<div class="auth--title">Purchase Options:</div>
<a id="BodyContent_Header_GlobalSignIn_lnkSubscribeJournal" class="auth--subscribe" rel="nofollow" href="https://store.jamanetwork.com/index.aspx?productcode=64">Subscribe to the JAMA journal</a>
</div>
</div>
</div>
</header>
</div>
<div class="editors-choice-header">
</div>
<div id="BodyContent_Header_divAds" class="header-ad-wrap sb-background-primary-dark">
<div class="leader-ad desktop-only">
</div>
</div>
<!-- /.header-ad-wrap -->
</section>
<section class="master-main">
<div class="social-share hide" data-share-journal="JAMA_current" data-share-title="Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021"></div>
<div class="widget-UserContentAccessWrite widget-instance-AMA_LocalStorage_Article">
<div class="SCM-SharedWidgets-LocalStorage-UserContentAccessWrite" data-values="{"id":"2788346","type":"Article","date":"1/27/2022 4:46:18 PM"}"></div>
</div>
<div class="widget-ArticleToggleView widget-instance-AMA_ArticleToggleView">
<div class="widget-ArticleFullView widget-instance-AMA_ArticleFullView">
<script>
(function() {
var bodyElem = document.querySelector('body');
var className = 'split-screen';
if (bodyElem.classList) {
bodyElem.classList.add(className);
} else {
el.className += ' ' + className;
}
})();
</script>
<div id="resources-panel" class="resources-panel">
<span class="hide tagmanagervalue" data-attribute="articleTemplate" data-value="splitscreen" data-type="string"></span>
<div class="tab-nav is_stuck" style="position: fixed; top: 100px; width: 799px;">
<a class="tab-nav-trigger tab-nav-full-text tablet-down" href="#full-text-tab">
<i class="icon-full_text"><span class="sr-t">full text icon</span></i>
<div class="tab-nav-tab-name">Full Text</div>
</a>
<a class="tab-nav-trigger tab-nav-contents target-tab-active" href="#contents-tab">
<i class="icon-contents"><span class="sr-t">contents icon</span></i>
<div class="tab-nav-tab-name">Contents</div>
</a>
<a class="tab-nav-trigger tab-nav-figure-table" href="#figure-table-tab">
<i class="icon-figures"><span class="sr-t">figure icon</span></i>
<div class="tab-nav-tab-name">Figures / <br> Tables</div>
</a>
<a class="tab-nav-trigger tab-nav-multimedia tab-no-content" href="#multimedia-tab" style="display: none!important">
<i class="icon-multimedia"><span class="sr-t">multimedia icon</span></i>
<div class="tab-nav-tab-name">Multimedia</div>
</a>
<a class="tab-nav-trigger tab-nav-supplemental" href="#supplemental-tab">
<i class="icon-attach"><span class="sr-t">attach icon</span></i>
<div class="tab-nav-tab-name">Supplemental <br> Content</div>
</a>
<a class="tab-nav-trigger tab-nav-references" href="#references-tab">
<i class="icon-references"><span class="sr-t">references icon</span></i>
<div class="tab-nav-tab-name">References</div>
</a>
<a class="tab-nav-trigger tab-nav-related" href="#related-tab">
<i class="icon-related"><span class="sr-t">related icon</span></i>
<div class="tab-nav-tab-name">Related</div>
</a>
<a class="tab-nav-trigger tab-nav-comments tab-no-content" href="#comments-tab" style="display: none!important">
<i class="icon-user-comments"><span class="sr-t">comments icon</span></i>
<div class="tab-nav-tab-name">Comments</div>
</a>
</div>
<div style="position: relative; width: 799px; height: 92px; display: block; vertical-align: baseline; float: none;"></div>
<div class="resource-tabs">
<div id="contents-tab" class="resource-tab contents-tab tab-active">
<div class="contents-tab-contents">
<a id="pdf-link" class="toolbar-tool toolbar-pdf al-link pdfaccess" data-article-id="2788346" data-article-url="/ama/content_public/journal/jama/938849/jama_oster_2022_oi_210145_1643049434.03827.pdf" data-ajax-url="/Content/CheckPdfAccess"><span class="toolbar-pdf-text"><span class="toolbar-link-text-extra">Download </span><span class="toolbar-link-text">PDF</span></span>
</a>
<div class="widget-ArticleJumpLinks widget-instance-AMA_ArticleJumpLinks_Widget">
<a href="#top" class="section-jump-link contents-tab-jump-link top-of-article" data-tab-toggle=".tab-nav-full-text">Top of Article</a>
<ul class="section-jump-links bullet ml2 pl1">
<li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#248198253" data-tab-toggle=".tab-nav-full-text">Key Points</a></li>
<li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#248198254" data-tab-toggle=".tab-nav-full-text">Abstract</a></li>
<li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#248198259" data-tab-toggle=".tab-nav-full-text">Introduction</a></li>
<li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#248198263" data-tab-toggle=".tab-nav-full-text">Methods</a></li>
<li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#248198277" data-tab-toggle=".tab-nav-full-text">Results</a></li>
<li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#248198292" data-tab-toggle=".tab-nav-full-text">Discussion</a></li>
<li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#248198303" data-tab-toggle=".tab-nav-full-text">Conclusions</a></li>
<li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#248198305" data-tab-toggle=".tab-nav-full-text">Article Information</a></li>
<li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#248198306" data-tab-toggle=".tab-nav-full-text">References</a></li>
</ul>
</div>
<div class="widget-SelfServeContent widget-instance-AMA_Contents_Tab_SelfServe">
</div>
</div>
<div class="contents-tab-ad">
<div id="split-screen-contab">
<div id="ad-article-contents-sky" class="ad-article-contents-sky advertisement ad-text" data-slot="50" data-google-query-id="CMen9vaw0vUCFdr5dwody7UIeQ">
<div id="google_ads_iframe_/6479/ama.jama/scholarly_1__container__" style="border: 0pt none;"><iframe id="google_ads_iframe_/6479/ama.jama/scholarly_1" title="3rd party ad content"
name="google_ads_iframe_/6479/ama.jama/scholarly_1" width="160" height="600" scrolling="no" marginwidth="0" marginheight="0" frameborder="0" role="region" aria-label="Advertisement" tabindex="0" srcdoc=""
data-google-container-id="2" style="border: 0px; vertical-align: bottom;" data-load-complete="true"></iframe></div>
</div>
</div>
</div>
</div>
<div id="figure-table-tab" class="resource-tab figure-table-tab need-jobs-ad">
<div class="widget-ArticleFiguresAndTables widget-instance-AMA_Article_Figures_Tab">
<div class="figure-table-wrapper thm-bd-top">
<div class="figure-label">Figure 1. Cases of Myocarditis After mRNA-Based COVID-19 Vaccination by Age at Onset of Myocarditis</div><a id="joi210145f1" class="figure-table-anchor"> </a>
<div class="figure-table-links right">
<a class="view-large figure-table-link is-b desktop-only" path-from-xml="joi210145f1" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145f1_1643049434.36887.png?Expires=1646325914&Signature=dJiVGTifuNrRoQMM~Z1s0M9jg-zsUhxsJoXVbNv8wU87VrcFsqkyP-pFYhIDK7zi-8gBnvGFM6LeXRrcxfYNFj3onmNGQMtaVAPxANolOrgTkMY15EnPOU4lf-kU0UhaLT1fcGHTYON0YssTmfOAMzPrhCTqhJ3B-Ollf8CODtWHKAo-dn7LyuTKkVHMjQ4sXQ6DK4lXlofZvsefLrX94hiouIHkD4yFJeEo0WgRIUFUtXjqWynQOAEInGgCJ-6DoXhSI6FUTzU3d~MUAeKdTDSzNVF40dLcafqg6kcsE0jGXPx8HxpdhRpKdw~aPC7A50OimubTbVUXdRHQiCQ27Q__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b" path-from-xml="joi210145f1" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145f1_1643049434.36887.png?Expires=1646325914&Signature=dJiVGTifuNrRoQMM~Z1s0M9jg-zsUhxsJoXVbNv8wU87VrcFsqkyP-pFYhIDK7zi-8gBnvGFM6LeXRrcxfYNFj3onmNGQMtaVAPxANolOrgTkMY15EnPOU4lf-kU0UhaLT1fcGHTYON0YssTmfOAMzPrhCTqhJ3B-Ollf8CODtWHKAo-dn7LyuTKkVHMjQ4sXQ6DK4lXlofZvsefLrX94hiouIHkD4yFJeEo0WgRIUFUtXjqWynQOAEInGgCJ-6DoXhSI6FUTzU3d~MUAeKdTDSzNVF40dLcafqg6kcsE0jGXPx8HxpdhRpKdw~aPC7A50OimubTbVUXdRHQiCQ27Q__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=248198282&ar=2788346&imagename=&siteId=3" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b at300b" rel="nofollow" title="Twitter" href="#"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b at300b" rel="nofollow" title="Facebook" href="#"><span class="share-text"> </span></a>
</div>
<div class="figure-table cf cb">
<div class="figure-table-image">
<a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145f1_1643049434.36887.png?Expires=1646325914&Signature=dJiVGTifuNrRoQMM~Z1s0M9jg-zsUhxsJoXVbNv8wU87VrcFsqkyP-pFYhIDK7zi-8gBnvGFM6LeXRrcxfYNFj3onmNGQMtaVAPxANolOrgTkMY15EnPOU4lf-kU0UhaLT1fcGHTYON0YssTmfOAMzPrhCTqhJ3B-Ollf8CODtWHKAo-dn7LyuTKkVHMjQ4sXQ6DK4lXlofZvsefLrX94hiouIHkD4yFJeEo0WgRIUFUtXjqWynQOAEInGgCJ-6DoXhSI6FUTzU3d~MUAeKdTDSzNVF40dLcafqg6kcsE0jGXPx8HxpdhRpKdw~aPC7A50OimubTbVUXdRHQiCQ27Q__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="joi210145f1" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/m_joi210145f1_1643049434.36887.png?Expires=1646325914&Signature=t0TdGwnvYJeDSdzTspVArDo-n6VBY6AZHrXPk2lBC94iYDcBDpoUydT7k0sIEjhnFmXLohOY~CktzjPheFOHGNiMrTA1~xD6gjx7BfSvkmBHfB0F8C2JTRAD906NAjMXbQA3EisilaGVyNq2fgc-nhUy4Q~jmbTNJhbnEsvTCcHzclFX1jgkUpuOZEMFGITLQc5nX1kT2S015ZUhOz8YoXEyre~b0Gm-xlhXijvavvS9Lvq~wnwpEPRXo~rd3aR8cqpkyVfrnmrosSM8uKKS2AUSksXbbyTwbS0YdmiFEtzZ6XWqhmGGL89qAKdWSjZnJXhue4tnLpcMBcqEfTsVcA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Cases of Myocarditis After mRNA-Based COVID-19 Vaccination by Age at Onset of Myocarditis" class="content-img lazy" path-from-xml="joi210145f1"></a>
</div>
</div>
<div class="figure-caption clip-last-child">
<p class="para">The reports to the Vaccine Adverse Event Reporting System met the case definition of myocarditis (reported cases). Among individuals older than 40 years of age, there were no more than 8 reports of myocarditis for
any individual age after receiving either vaccine. For the BNT162b2 vaccine, there were 114 246 837 first vaccination doses and 95 532 396 second vaccination doses; and for the mRNA-1273 vaccine, there were 78 158 611 and
66 163 001, respectively. The y-axis range differs between panels A and B.</p>
</div>
</div>
<div class="figure-table-wrapper thm-bd-top">
<div class="figure-label">Figure 2. Cases of Myocarditis After mRNA-Based COVID-19 Vaccination by Time From Vaccination to Symptom Onset</div><a id="joi210145f2" class="figure-table-anchor"> </a>
<div class="figure-table-links right">
<a class="view-large figure-table-link is-b desktop-only" path-from-xml="joi210145f2" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145f2_1643049434.40882.png?Expires=1646325914&Signature=dPhFWM1AxVk3TTGNiscRQCCq2nYOs-QLFdjkIjQkdVIe7UyiP8gpQ5wSpI-rxqfrZHDkQ2HoM~qNH9FTjHBNX2QHYD-YS3WKOuCa0uGy~Mtn5Q1cjTXEJ9upijvBfWI4mXgHn4u~B1gVdCajmrvlzNeSNPY2qX7IvYq6O8I7GM5cc2Zo4TQsCBSVQznAxcGdPJTfO3RLBaJSBGibgqpBQjxzUZDxV~SZLboNFi6jV4sr2CbV69YVuSzLh2oR1EE~l5HzAx7c0YFBZub7zx47GH5EAvIEQwHTbQI02WgUmigpd8klDQlwo1hJxPXzRlK2-2aR-W3r-YE7ZIMAb9sGNQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b" path-from-xml="joi210145f2" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145f2_1643049434.40882.png?Expires=1646325914&Signature=dPhFWM1AxVk3TTGNiscRQCCq2nYOs-QLFdjkIjQkdVIe7UyiP8gpQ5wSpI-rxqfrZHDkQ2HoM~qNH9FTjHBNX2QHYD-YS3WKOuCa0uGy~Mtn5Q1cjTXEJ9upijvBfWI4mXgHn4u~B1gVdCajmrvlzNeSNPY2qX7IvYq6O8I7GM5cc2Zo4TQsCBSVQznAxcGdPJTfO3RLBaJSBGibgqpBQjxzUZDxV~SZLboNFi6jV4sr2CbV69YVuSzLh2oR1EE~l5HzAx7c0YFBZub7zx47GH5EAvIEQwHTbQI02WgUmigpd8klDQlwo1hJxPXzRlK2-2aR-W3r-YE7ZIMAb9sGNQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=248198283&ar=2788346&imagename=&siteId=3" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b at300b" rel="nofollow" title="Twitter" href="#"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b at300b" rel="nofollow" title="Facebook" href="#"><span class="share-text"> </span></a>
</div>
<div class="figure-table cf cb">
<div class="figure-table-image">
<a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145f2_1643049434.40882.png?Expires=1646325914&Signature=dPhFWM1AxVk3TTGNiscRQCCq2nYOs-QLFdjkIjQkdVIe7UyiP8gpQ5wSpI-rxqfrZHDkQ2HoM~qNH9FTjHBNX2QHYD-YS3WKOuCa0uGy~Mtn5Q1cjTXEJ9upijvBfWI4mXgHn4u~B1gVdCajmrvlzNeSNPY2qX7IvYq6O8I7GM5cc2Zo4TQsCBSVQznAxcGdPJTfO3RLBaJSBGibgqpBQjxzUZDxV~SZLboNFi6jV4sr2CbV69YVuSzLh2oR1EE~l5HzAx7c0YFBZub7zx47GH5EAvIEQwHTbQI02WgUmigpd8klDQlwo1hJxPXzRlK2-2aR-W3r-YE7ZIMAb9sGNQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="joi210145f2" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/m_joi210145f2_1643049434.40882.png?Expires=1646325914&Signature=ey1fLvwGZRaYPG2-ufW5b6YlyFfUXhPiUc2Qnmip5nREHrlkX7asdLvR7wAQFECy0gJSqCheclmtZxzZv4JAQ8gLcAZCdau7lU5H0xHoDUCShuLpWst9Ho2~8MiW8SQALkqeiVUBocMsJvRdGbHLZlKDxKNcEAyMjvdQ-OwPHJGTopf7DVW0vg8ysJ7zzdlP6f0kLSa3eTmFE6n5c0zL~Fj~Mx9IheOMyjs1ZWFKZANwwaGZHTuhbQmxyUKQl0jmteCoLV2z8nogWexgAZkBKE~zeBKbjv9irzk3M7RxfShqkGKljSSugSxjBP9GPsnyTdy1nSEt7c5okutj0JjS9w__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Cases of Myocarditis After mRNA-Based COVID-19 Vaccination by Time From Vaccination to Symptom Onset" class="content-img lazy" path-from-xml="joi210145f2"></a>
</div>
</div>
<div class="figure-caption clip-last-child">
<p class="para">The reports to the Vaccine Adverse Event Reporting System met the case definition of myocarditis (reported cases). Among recipients of either vaccine, there were only 13 reports or less of myocarditis beyond 10
days for any individual time from vaccination to symptom onset. The y-axis range differs between panels A and B.</p>
<p class="para">A, For the BNT162b2 vaccine, there were 138 reported cases of myocarditis with known date for symptom onset and dose after 114 246 837 first vaccination doses and 888 reported cases after 95 532 396 second
vaccination doses.</p>
<p class="para">B, For the mRNA-1273 vaccine, there were 116 reported cases of myocarditis with known date for symptom onset and dose after 78 158 611 first vaccination doses and 311 reported cases after 66 163 001 second
vaccination doses.</p>
</div>
</div>
</div>
<div class="widget-ArticleFiguresAndTables widget-instance-AMA_Article_Tables_Tab">
<div class="figure-table-wrapper thm-bd-top">
<div class="table-label">Table 1. Characteristics of Reports to VAERS After mRNA-Based COVID-19 Vaccination That Met the CDC’s Case Definition for Myocarditis Between December 14, 2020, and August 31, 2021</div>
<a class="figure-table-anchor" id="joi210145t1"> </a>
<div class="figure-table-links right">
<a class="view-large figure-table-link is-b desktop-only" path-from-xml="joi210145t1" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145t1_1643049434.34332.png?Expires=1646325914&Signature=Hj26DNhrWWduz5CDPKDmQrEWn5KoXnfkUHcfWFsxmf4Y~Fd1tEWiuSHHswa9JtVb7tQDNV0NWXe-vUoekaL02Y27ly83TlOHhoPNvplFkr-uLclaH9Rj4khi5kH5l3zUFIgVrgp2Tdq6BszZQSL4cpC1KN64IutvUT~qFakcw4kwX7mIgSsX4oOk54z0WuydUoeOEnzidmi0rDWaqa87ePXXzwlcwp94~coXUjKb2940mwdEzCgTlN5b7oNnG--hjuRwewIhB2ph4eAXddCeL3puHa2UfqluhROepjvbv2s3U79l8HebjOJvnmJvOhd0AWJkT765kOH3ig7wZU1O9A__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b" path-from-xml="joi210145t1" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145t1_1643049434.34332.png?Expires=1646325914&Signature=Hj26DNhrWWduz5CDPKDmQrEWn5KoXnfkUHcfWFsxmf4Y~Fd1tEWiuSHHswa9JtVb7tQDNV0NWXe-vUoekaL02Y27ly83TlOHhoPNvplFkr-uLclaH9Rj4khi5kH5l3zUFIgVrgp2Tdq6BszZQSL4cpC1KN64IutvUT~qFakcw4kwX7mIgSsX4oOk54z0WuydUoeOEnzidmi0rDWaqa87ePXXzwlcwp94~coXUjKb2940mwdEzCgTlN5b7oNnG--hjuRwewIhB2ph4eAXddCeL3puHa2UfqluhROepjvbv2s3U79l8HebjOJvnmJvOhd0AWJkT765kOH3ig7wZU1O9A__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=248198281&ar=2788346&imagename=&siteId=3" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b at300b" rel="nofollow" title="Twitter" href="#"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b at300b" rel="nofollow" title="Facebook" href="#"><span class="share-text"> </span></a>
</div>
<div class="figure-table cf cb">
<div class="figure-table-image">
<a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145t1_1643049434.34332.png?Expires=1646325914&Signature=Hj26DNhrWWduz5CDPKDmQrEWn5KoXnfkUHcfWFsxmf4Y~Fd1tEWiuSHHswa9JtVb7tQDNV0NWXe-vUoekaL02Y27ly83TlOHhoPNvplFkr-uLclaH9Rj4khi5kH5l3zUFIgVrgp2Tdq6BszZQSL4cpC1KN64IutvUT~qFakcw4kwX7mIgSsX4oOk54z0WuydUoeOEnzidmi0rDWaqa87ePXXzwlcwp94~coXUjKb2940mwdEzCgTlN5b7oNnG--hjuRwewIhB2ph4eAXddCeL3puHa2UfqluhROepjvbv2s3U79l8HebjOJvnmJvOhd0AWJkT765kOH3ig7wZU1O9A__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="joi210145t1" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/m_joi210145t1_1643049434.34332.png?Expires=1646325914&Signature=0uY2PGmdjrBJI01x572HuGudBmCAC5rljbjqZfhf4wBpzr6Y5CPe3zXsKpQ24n143fmG5W~eUzPF7e8naRT5EFH~zpCmEmAQGy2VARoovi~SiCogQyImK5bFIY~uGWdFiXmIA3iB250WQ1oYEhqZqYCsHoWZxBMztfVZ-Jpmo0yKy14bVfDgWxTRmkM9vKGfPRR5vEAU-2UG-evWfMGfXpeuCcjKlJiilMjmm--a-RCD9IEOT-Y-h5peGaafOHMzc5kpiXZskimwHCEl4TUNC2urEqBJyRPV9~MKgfvDnfgbXi13TS0Kz1pb3WFLwFoz0HoDoU3Ae1Ehpn6-YWv2qw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Characteristics of Reports to VAERS After mRNA-Based COVID-19 Vaccination That Met the CDC’s Case Definition for Myocarditis Between December 14, 2020, and August 31, 2021" class="content-img lazy" path-from-xml="joi210145t1"></a>
</div>
</div>
<div class="table-caption"></div>
</div>
<div class="figure-table-wrapper thm-bd-top">
<div class="table-label">Table 2. Reports to VAERS After mRNA-Based COVID-19 Vaccination That Met the CDC’s Case Definition for Myocarditis Within a 7-Day Risk Interval per Million Doses of Vaccine Administered</div>
<a class="figure-table-anchor" id="joi210145t2"> </a>
<div class="figure-table-links right">
<a class="view-large figure-table-link is-b desktop-only" path-from-xml="joi210145t2" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145t2_1643049434.42885.png?Expires=1646325914&Signature=uu6xFszGU4oc6ZhR5YofuUjxknbnyeAK6~l~bx60kd8lQ7mKUCN2VekoDi~R7Jj5PCWNopPxY~WrZiu3TAZHZ0T7s3hdYrf-W12PfQg95jvUBgUasujZcfe2H24czdiNbJlh1t-Sn3shpRnlEr87NdG2bT~SYTUdAAk7Qy9xHYmBVPKVQsq0c~k1YpX0HwN7jwBbMpHVHZ4gPWG7q0CVSwFJeLC0NVRkOnJIO1kQKI~Q798KAT0s49rXy~Fn1iXD2uWZ1zsV3pvYu7~dzc8ANG4Alh5i9SmBWd7OCGsd1-ilL~FsAzmyP6mh6xcDLr91PPxIV0~~V5AZQ6jLP0P0lA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b" path-from-xml="joi210145t2" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145t2_1643049434.42885.png?Expires=1646325914&Signature=uu6xFszGU4oc6ZhR5YofuUjxknbnyeAK6~l~bx60kd8lQ7mKUCN2VekoDi~R7Jj5PCWNopPxY~WrZiu3TAZHZ0T7s3hdYrf-W12PfQg95jvUBgUasujZcfe2H24czdiNbJlh1t-Sn3shpRnlEr87NdG2bT~SYTUdAAk7Qy9xHYmBVPKVQsq0c~k1YpX0HwN7jwBbMpHVHZ4gPWG7q0CVSwFJeLC0NVRkOnJIO1kQKI~Q798KAT0s49rXy~Fn1iXD2uWZ1zsV3pvYu7~dzc8ANG4Alh5i9SmBWd7OCGsd1-ilL~FsAzmyP6mh6xcDLr91PPxIV0~~V5AZQ6jLP0P0lA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=248198287&ar=2788346&imagename=&siteId=3" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b at300b" rel="nofollow" title="Twitter" href="#"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b at300b" rel="nofollow" title="Facebook" href="#"><span class="share-text"> </span></a>
</div>
<div class="figure-table cf cb">
<div class="figure-table-image">
<a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145t2_1643049434.42885.png?Expires=1646325914&Signature=uu6xFszGU4oc6ZhR5YofuUjxknbnyeAK6~l~bx60kd8lQ7mKUCN2VekoDi~R7Jj5PCWNopPxY~WrZiu3TAZHZ0T7s3hdYrf-W12PfQg95jvUBgUasujZcfe2H24czdiNbJlh1t-Sn3shpRnlEr87NdG2bT~SYTUdAAk7Qy9xHYmBVPKVQsq0c~k1YpX0HwN7jwBbMpHVHZ4gPWG7q0CVSwFJeLC0NVRkOnJIO1kQKI~Q798KAT0s49rXy~Fn1iXD2uWZ1zsV3pvYu7~dzc8ANG4Alh5i9SmBWd7OCGsd1-ilL~FsAzmyP6mh6xcDLr91PPxIV0~~V5AZQ6jLP0P0lA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="joi210145t2" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/m_joi210145t2_1643049434.42885.png?Expires=1646325914&Signature=tuyUuWyqrxL3jmMJE29it8qxCJEJCMEDl9x5O62t1OAiluvsCRpP~TnMeom6~IvrhfaFoPosrozL1qJLUIQ4lBanC4FgXj64srFf4Es6nZANgqq2WSHEjqSgNJ2dVtFi6mzhmjZhhQN33QbqCwNVfBi3CNY7AW4alo27qW3yT3ab7GZ0F9sVtbLiywN1XMwIIfe0kn4sNgaZiYb4UbrZQX0ZQ-XlNedcSlcX5afxqDKlFkOmqoSnZ0wIGMmLXyngZS16Lp-n0I59mjBFDdec~rqICqBEj8rRUiUC6foshyRwEBHDp8nywmejrscUu39Gohjtlr4OoscERI2OSUtLCg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Reports to VAERS After mRNA-Based COVID-19 Vaccination That Met the CDC’s Case Definition for Myocarditis Within a 7-Day Risk Interval per Million Doses of Vaccine Administered" class="content-img lazy" path-from-xml="joi210145t2"></a>
</div>
</div>
<div class="table-caption"></div>
</div>
<div class="figure-table-wrapper thm-bd-top">
<div class="table-label">Table 3. Symptoms, Treatment, and Outcomes in 826 Patients Younger Than 30 Years of Age With Myocarditis</div><a class="figure-table-anchor" id="joi210145t3"> </a>
<div class="figure-table-links right">
<a class="view-large figure-table-link is-b desktop-only" path-from-xml="joi210145t3" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145t3_1643049434.45383.png?Expires=1646325914&Signature=Wx2XtJOThzzeTjF0-wlfF1n0FobxkcaAaeGrYVB17~0SEBEWZUBK~h8RsivLTui-ES059pOv7DY4FsKvsQB~ZxwWHswnP94OCUdhYX3z432NDnsW4Cq1GcscTLj0GAF6thIT8TbCMVtgkuATR1hJgSFAPdR1ZZ6fIkCgblFglJDXpDtRcV8U~F56fqHffUpi4IMoIqcldEat4YrNoqa8EzwdseQ7WqI5EygfydxXAS2n4EEH0POHeVqcCdS-eFqbv0Uiz5X86qJoJqmZgNFItZdiLbaT4wnxuQ~26XdaCwO5QvzG7hq-Y0S-pfZt9roZKquaf~-rcOGmkmFXRsdqJw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b" path-from-xml="joi210145t3" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145t3_1643049434.45383.png?Expires=1646325914&Signature=Wx2XtJOThzzeTjF0-wlfF1n0FobxkcaAaeGrYVB17~0SEBEWZUBK~h8RsivLTui-ES059pOv7DY4FsKvsQB~ZxwWHswnP94OCUdhYX3z432NDnsW4Cq1GcscTLj0GAF6thIT8TbCMVtgkuATR1hJgSFAPdR1ZZ6fIkCgblFglJDXpDtRcV8U~F56fqHffUpi4IMoIqcldEat4YrNoqa8EzwdseQ7WqI5EygfydxXAS2n4EEH0POHeVqcCdS-eFqbv0Uiz5X86qJoJqmZgNFItZdiLbaT4wnxuQ~26XdaCwO5QvzG7hq-Y0S-pfZt9roZKquaf~-rcOGmkmFXRsdqJw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=248198291&ar=2788346&imagename=&siteId=3" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b at300b" rel="nofollow" title="Twitter" href="#"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b at300b" rel="nofollow" title="Facebook" href="#"><span class="share-text"> </span></a>
</div>
<div class="figure-table cf cb">
<div class="figure-table-image">
<a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145t3_1643049434.45383.png?Expires=1646325914&Signature=Wx2XtJOThzzeTjF0-wlfF1n0FobxkcaAaeGrYVB17~0SEBEWZUBK~h8RsivLTui-ES059pOv7DY4FsKvsQB~ZxwWHswnP94OCUdhYX3z432NDnsW4Cq1GcscTLj0GAF6thIT8TbCMVtgkuATR1hJgSFAPdR1ZZ6fIkCgblFglJDXpDtRcV8U~F56fqHffUpi4IMoIqcldEat4YrNoqa8EzwdseQ7WqI5EygfydxXAS2n4EEH0POHeVqcCdS-eFqbv0Uiz5X86qJoJqmZgNFItZdiLbaT4wnxuQ~26XdaCwO5QvzG7hq-Y0S-pfZt9roZKquaf~-rcOGmkmFXRsdqJw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="joi210145t3" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/m_joi210145t3_1643049434.45383.png?Expires=1646325914&Signature=KgrT5da4g~C1ur3eL2W5rNZKFUXKStVN608O06ieNEeeXQqa-vxWWJU7PhxOw3GJhmLcbCGPJUI~LHyxWszH7kk2s3yNLK7QkpYG1ImrdcL7G-oZxp9ipQpSsTY4gB-q547nMVMcevdt7dixg4e8AR8t1rrC6f18sGxUt0B-QfT1uD4DH2vikDEvySHNI49ldqcX2BcRGoFhqVKuAnOh7eQRjzaQlKPZv2J1eBHth9k0MrMhzXUiTlafLuRFMeb2WsOQNOgOMcTdgF4soIG0QityYol5xGEDdFlhyR0P8JTQxnySAnL4U2-9uvovG-IahyRP~yK15AJKiqgrK1BGWQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Symptoms, Treatment, and Outcomes in 826 Patients Younger Than 30 Years of Age With Myocarditis" class="content-img lazy" path-from-xml="joi210145t3"></a>
</div>
</div>
<div class="table-caption"></div>
</div>
</div>
</div>
<div id="multimedia-tab" class="resource-tab multimedia-tab need-jobs-ad" style="display: none!important">
</div>
<div id="supplemental-tab" class="resource-tab supplemental-tab need-jobs-ad">
<div class="widget-ArticleDataSupplements widget-instance-AMA_Data_Supplements_Tab">
<div class="supplement">
<a id="note-JOI210145-1" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/938849/joi210145supp1_prod_1643049434.04327.pdf?Expires=1646325915&Signature=UxyH5A0zJJVs2rpRS-gSH1y42E0eTLxNCZ7k0HIszuqFfPWXJBRFTVpRBmr4pl98zV9HU6BA6S52FXILksya6KG7cWD5NpWpif5w9D2JLJbMS8SIvQFAf4UL5Av3EHhR8EcGEDq009Lh3K0w64tG-p4ZEDuk0QVN8-d~TyK~ZCL4X8Qf~Wm8R120YAymcd-9d3iFUK9eJZQN5gtMuXH9IZoslKkjAP7RzCNFju~EtLCA3E24Syb5wj2B6GiolAR6-QDrV52iXoxo-XdK8kTQ2JWtl7WGH-3GaBhC5vnIiuzejiWVDBBA2DP7Hze45ShwzK1FD5cqCVviozHMzKFtsg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" class="supplement-link supplement-download" rel=""nofollow"">
<div class="pdf supplement-type"></div>
<div class="supplement-title"><span class="title-label">Supplement.</span><p class="para"><strong>eMethods.</strong> Medical Dictionary for Regulatory Activities Preferred Terms, Definitions of Myocarditis and Pericarditis, Myocarditis medical review form</p><p class="para"><strong>eFigure.</strong> Flow diagram of cases of myocarditis and pericarditis reported to Vaccine Adverse Event Reporting System (VAERS) after receiving mRNA-based COVID-19 vaccine, United States, December 14, 2020-August 31, 2021.</p><p class="para"><strong>eTable 1.</strong> Characteristics of all myocarditis cases reported to Vaccine Adverse Event Reporting System (VAERS) after mRNA-based COVID-19 vaccination, United States, December 14, 2020–August 31, 2021.</p><p class="para"><strong>eTable 2.</strong> Characteristics of all pericarditis cases reported to Vaccine Adverse Event Reporting System (VAERS) after mRNA-based COVID-19 vaccination, United States, December 14, 2020–August 31, 2021.</p><p class="para"><strong>eTable 3.</strong> Characteristics of myocarditis cases reported to Vaccine Adverse Event Reporting System after mRNA-based COVID-19 vaccination by case definition status.</p></div>
</a>
</div>
</div>
</div>
<div id="references-tab" class="resource-tab references-tab need-jobs-ad">
<div class="references-wrap">
<div class="widget-SectionDisplay widget-instance-AMA_References_Tab">
<div class="references">
<div class="reference"><a class="reference-number" id="joi210145r1">1.</a>
<div class="reference-content">Cooper LT Jr. Myocarditis. <i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 2009;360(15):1526-1538.
doi:<a href="http://dx.doi.org/10.1056/NEJMra0800028">10.1056/NEJMra0800028</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/19357408" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis.&author=LT%20Cooper&publication_year=2009&journal=N%20Engl%20J%20Med&volume=360&pages=1526-1538" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMra0800028" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r2">2.</a>
<div class="reference-content">Vasudeva R, Bhatt P, Lilje C, et al. Trends in acute myocarditis–related pediatric hospitalizations in the United States, 2007-2016.
<i xmlns:helper="urn:XsltStringHelper"> Am J Cardiol</i>. 2021;149:95-102.
doi:<a href="http://dx.doi.org/10.1016/j.amjcard.2021.03.019">10.1016/j.amjcard.2021.03.019</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33757784" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Trends%20in%20acute%20myocarditis%E2%80%93related%20pediatric%20hospitalizations%20in%20the%20United%20States%2C%202007-2016.&author=R%20Vasudeva&author=P%20Bhatt&author=C%20Lilje&publication_year=2021&journal=Am%20J%20Cardiol&volume=149&pages=95-102" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.amjcard.2021.03.019" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r3">3.</a>
<div class="reference-content">Arola A, Pikkarainen E, Sipilä JO, Pykäri J, Rautava P, Kytö V. Occurrence and features of childhood myocarditis: a nationwide study in
Finland. <i xmlns:helper="urn:XsltStringHelper"> J Am Heart Assoc</i>. 2017;6(11):e005306.
doi:<a href="http://dx.doi.org/10.1161/JAHA.116.005306">10.1161/JAHA.116.005306</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/29151030" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Occurrence%20and%20features%20of%20childhood%20myocarditis%3A%20a%20nationwide%20study%20in%20Finland.&author=A%20Arola&author=E%20Pikkarainen&author=JO%20Sipilä&author=J%20Pykäri&author=P%20Rautava&author=V%20Kytö&publication_year=2017&journal=J%20Am%20Heart%20Assoc&volume=6&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r4">4.</a>
<div class="reference-content">Kytö V, Sipilä J, Rautava P. The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood.
<i xmlns:helper="urn:XsltStringHelper"> Heart</i>. 2013;99(22):1681-1684.
doi:<a href="http://dx.doi.org/10.1136/heartjnl-2013-304449">10.1136/heartjnl-2013-304449</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/24064227" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20effects%20of%20gender%20and%20age%20on%20occurrence%20of%20clinically%20suspected%20myocarditis%20in%20adulthood.&author=V%20Kytö&author=J%20Sipilä&author=P%20Rautava&publication_year=2013&journal=Heart&volume=99&pages=1681-1684" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1136/heartjnl-2013-304449" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r5">5.</a>
<div class="reference-content">Dasgupta S, Iannucci G, Mao C, Clabby M, Oster ME. Myocarditis in the pediatric population: a review.
<i xmlns:helper="urn:XsltStringHelper"> Congenit Heart Dis</i>. 2019;14(5):868-877.
doi:<a href="http://dx.doi.org/10.1111/chd.12835">10.1111/chd.12835</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31432626" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20in%20the%20pediatric%20population%3A%20a%20review.&author=S%20Dasgupta&author=G%20Iannucci&author=C%20Mao&author=M%20Clabby&author=ME%20Oster&publication_year=2019&journal=Congenit%20Heart%20Dis&volume=14&pages=868-877" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1111/chd.v14.5" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r6">6.</a>
<div class="reference-content">Pollack A, Kontorovich AR, Fuster V, Dec GW. Viral myocarditis—diagnosis, treatment options, and current controversies.
<i xmlns:helper="urn:XsltStringHelper"> Nat Rev Cardiol</i>. 2015;12(11):670-680.
doi:<a href="http://dx.doi.org/10.1038/nrcardio.2015.108">10.1038/nrcardio.2015.108</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26194549" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Viral%20myocarditis%E2%80%94diagnosis%2C%20treatment%20options%2C%20and%20current%20controversies.&author=A%20Pollack&author=AR%20Kontorovich&author=V%20Fuster&author=GW%20Dec&publication_year=2015&journal=Nat%20Rev%20Cardiol&volume=12&pages=670-680" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/nrcardio.2015.108" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r7">7.</a>
<div class="reference-content">Halsell JS, Riddle JR, Atwood JE, et al; Department of Defense Smallpox Vaccination Clinical Evaluation Team. Myopericarditis following smallpox vaccination among
vaccinia-naive US military personnel. <i xmlns:helper="urn:XsltStringHelper"> JAMA</i>. 2003;289(24):3283-3289.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jama.289.24.3283">10.1001/jama.289.24.3283</a><br><a href="https://jamanetwork.com/journals/jama/fullarticle/196808" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/12824210" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myopericarditis%20following%20smallpox%20vaccination%20among%20vaccinia-naive%20US%20military%20personnel.&author=JS%20Halsell&author=JR%20Riddle&author=JE%20Atwood&publication_year=2003&journal=JAMA&volume=289&pages=3283-3289" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jama.289.24.3283" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r8">8.</a>
<div class="reference-content">Gubernot D, Jazwa A, Niu M, et al. US population-based background incidence rates of medical conditions for use in safety assessment of COVID-19 vaccines.
<i xmlns:helper="urn:XsltStringHelper"> Vaccine</i>. 2021;39(28):3666-3677.
doi:<a href="http://dx.doi.org/10.1016/j.vaccine.2021.05.016">10.1016/j.vaccine.2021.05.016</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34088506" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=US%20population-based%20background%20incidence%20rates%20of%20medical%20conditions%20for%20use%20in%20safety%20assessment%20of%20COVID-19%20vaccines.&author=D%20Gubernot&author=A%20Jazwa&author=M%20Niu&publication_year=2021&journal=Vaccine&volume=39&pages=3666-3677" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.vaccine.2021.05.016" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r9">9.</a>
<div class="reference-content">US Centers for Disease Control and Prevention. Clinical Immunization Safety Assessment project. Accessed August 24, 2021.
<a href="https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/cisa/index.html">https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/cisa/index.html</a></div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r10">10.</a>
<div class="reference-content">Marshall M, Ferguson ID, Lewis P, et al. Symptomatic acute myocarditis in 7 adolescents after Pfizer-BioNTech COVID-19 vaccination.
<i xmlns:helper="urn:XsltStringHelper"> Pediatrics</i>. 2021;148(3):e2021052478.
doi:<a href="http://dx.doi.org/10.1542/peds.2021-052478">10.1542/peds.2021-052478</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34088762" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Symptomatic%20acute%20myocarditis%20in%207%20adolescents%20after%20Pfizer-BioNTech%20COVID-19%20vaccination.&author=M%20Marshall&author=ID%20Ferguson&author=P%20Lewis&publication_year=2021&journal=Pediatrics&volume=148&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r11">11.</a>
<div class="reference-content">Kim HW, Jenista ER, Wendell DC, et al. Patients with acute myocarditis following mRNA COVID-19 vaccination.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Cardiol</i>. 2021;6(10):1196-1201.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamacardio.2021.2828">10.1001/jamacardio.2021.2828</a><br><a href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2781602" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34185046" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Patients%20with%20acute%20myocarditis%20following%20mRNA%20COVID-19%20vaccination.&author=HW%20Kim&author=ER%20Jenista&author=DC%20Wendell&publication_year=2021&journal=JAMA%20Cardiol&volume=6&pages=1196-1201" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamacardio.2021.2828" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r12">12.</a>
<div class="reference-content">Montgomery J, Ryan M, Engler R, et al. Myocarditis following immunization with mRNA COVID-19 vaccines in members of the US military.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Cardiol</i>. 2021;6(10):1202-1206.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamacardio.2021.2833">10.1001/jamacardio.2021.2833</a><br><a href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2781601" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34185045" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20following%20immunization%20with%20mRNA%20COVID-19%20vaccines%20in%20members%20of%20the%20US%20military.&author=J%20Montgomery&author=M%20Ryan&author=R%20Engler&publication_year=2021&journal=JAMA%20Cardiol&volume=6&pages=1202-1206" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamacardio.2021.2833" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r13">13.</a>
<div class="reference-content">Diaz GA, Parsons GT, Gering SK, Meier AR, Hutchinson IV, Robicsek A. Myocarditis and pericarditis after vaccination for COVID-19.
<i xmlns:helper="urn:XsltStringHelper"> JAMA</i>. 2021;326(12):1210-1212.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jama.2021.13443">10.1001/jama.2021.13443</a><br><a href="https://jamanetwork.com/journals/jama/fullarticle/2782900" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34347001" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20and%20pericarditis%20after%20vaccination%20for%20COVID-19.&author=GA%20Diaz&author=GT%20Parsons&author=SK%20Gering&author=AR%20Meier&author=IV%20Hutchinson&author=A%20Robicsek&publication_year=2021&journal=JAMA&volume=326&pages=1210-1212" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jama.2021.13443" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r14">14.</a>
<div class="reference-content">Mevorach D, Anis E, Cedar N, et al. Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel.
<i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 2021;385(23):2140-2149.
doi:<a href="http://dx.doi.org/10.1056/NEJMoa2109730">10.1056/NEJMoa2109730</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34614328" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20after%20BNT162b2%20mRNA%20vaccine%20against%20Covid-19%20in%20Israel.&author=D%20Mevorach&author=E%20Anis&author=N%20Cedar&publication_year=2021&journal=N%20Engl%20J%20Med&volume=385&pages=2140-2149" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMoa2109730" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r15">15.</a>
<div class="reference-content">Witberg G, Barda N, Hoss S, et al. Myocarditis after Covid-19 vaccination in a large health care organization.
<i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 2021;385(23):2132-2139.
doi:<a href="http://dx.doi.org/10.1056/NEJMoa2110737">10.1056/NEJMoa2110737</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34614329" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20after%20Covid-19%20vaccination%20in%20a%20large%20health%20care%20organization.&author=G%20Witberg&author=N%20Barda&author=S%20Hoss&publication_year=2021&journal=N%20Engl%20J%20Med&volume=385&pages=2132-2139" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMoa2110737" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r16">16.</a>
<div class="reference-content">MedDRA. Medical Dictionary for Regulatory Activities. Accessed June 30, 2021. <a href="https://www.meddra.org">https://www.meddra.org</a></div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r17">17.</a>
<div class="reference-content">US Centers for Disease Control and Prevention. CDC COVID-19 data tracker. Accessed June 30, 2021. <a href="https://covid.cdc.gov/covid-data-tracker">https://covid.cdc.gov/covid-data-tracker</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r18">18.</a>
<div class="reference-content">Gargano JW, Wallace M, Hadler SC, et al. Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients: update from the Advisory Committee on
Immunization Practices—United States, June 2021. <i xmlns:helper="urn:XsltStringHelper"> MMWR Morb Mortal Wkly Rep</i>. 2021;70(27):977-982.
doi:<a href="http://dx.doi.org/10.15585/mmwr.mm7027e2">10.15585/mmwr.mm7027e2</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34237049" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Use%20of%20mRNA%20COVID-19%20vaccine%20after%20reports%20of%20myocarditis%20among%20vaccine%20recipients%3A%20update%20from%20the%20Advisory%20Committee%20on%20Immunization%20Practices%E2%80%94United%20States%2C%20June%202021.&author=JW%20Gargano&author=M%20Wallace&author=SC%20Hadler&publication_year=2021&journal=MMWR%20Morb%20Mortal%20Wkly%20Rep&volume=70&pages=977-982" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.15585/mmwr.mm7027e2" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r19">19.</a>
<div class="reference-content">Abu Mouch S, Roguin A, Hellou E, et al. Myocarditis following COVID-19 mRNA vaccination. <i xmlns:helper="urn:XsltStringHelper"> Vaccine</i>.
2021;39(29):3790-3793.
doi:<a href="http://dx.doi.org/10.1016/j.vaccine.2021.05.087">10.1016/j.vaccine.2021.05.087</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34092429" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20following%20COVID-19%20mRNA%20vaccination.&author=S%20Abu Mouch&author=A%20Roguin&author=E%20Hellou&publication_year=2021&journal=Vaccine&volume=39&pages=3790-3793" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.vaccine.2021.05.087" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r20">20.</a>
<div class="reference-content">Larson KF, Ammirati E, Adler ED, et al. Myocarditis after BNT162b2 and mRNA-1273 vaccination. <i xmlns:helper="urn:XsltStringHelper"> Circulation</i>.
2021;144(6):506-508.
doi:<a href="http://dx.doi.org/10.1161/CIRCULATIONAHA.121.055913">10.1161/CIRCULATIONAHA.121.055913</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34133884" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20after%20BNT162b2%20and%20mRNA-1273%20vaccination.&author=KF%20Larson&author=E%20Ammirati&author=ED%20Adler&publication_year=2021&journal=Circulation&volume=144&pages=506-508" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1161/CIRCULATIONAHA.121.055913" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r21">21.</a>
<div class="reference-content">Rosner CM, Genovese L, Tehrani BN, et al. Myocarditis temporally associated with COVID-19 vaccination.
<i xmlns:helper="urn:XsltStringHelper"> Circulation</i>. 2021;144(6):502-505.
doi:<a href="http://dx.doi.org/10.1161/CIRCULATIONAHA.121.055891">10.1161/CIRCULATIONAHA.121.055891</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34133885" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20temporally%20associated%20with%20COVID-19%20vaccination.&author=CM%20Rosner&author=L%20Genovese&author=BN%20Tehrani&publication_year=2021&journal=Circulation&volume=144&pages=502-505" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1161/CIRCULATIONAHA.121.055891" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r22">22.</a>
<div class="reference-content">Boehmer TK, Kompaniyets L, Lavery AM, et al. Association between COVID-19 and myocarditis using hospital-based administrative data—United States, March 2020-January
2021. <i xmlns:helper="urn:XsltStringHelper"> MMWR Morb Mortal Wkly Rep</i>. 2021;70(35):1228-1232.
doi:<a href="http://dx.doi.org/10.15585/mmwr.mm7035e5">10.15585/mmwr.mm7035e5</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34473684" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Association%20between%20COVID-19%20and%20myocarditis%20using%20hospital-based%20administrative%20data%E2%80%94United%20States%2C%20March%202020-January%202021.&author=TK%20Boehmer&author=L%20Kompaniyets&author=AM%20Lavery&publication_year=2021&journal=MMWR%20Morb%20Mortal%20Wkly%20Rep&volume=70&pages=1228-1232" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.15585/mmwr.mm7035e5" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r23">23.</a>
<div class="reference-content">Harris PA, Taylor R, Minor BL, et al; REDCap Consortium. The REDCap Consortium: building an international community of software platform partners.
<i xmlns:helper="urn:XsltStringHelper"> J Biomed Inform</i>. 2019;95:103208.
doi:<a href="http://dx.doi.org/10.1016/j.jbi.2019.103208">10.1016/j.jbi.2019.103208</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31078660" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20REDCap%20Consortium%3A%20building%20an%20international%20community%20of%20software%20platform%20partners.&author=PA%20Harris&author=R%20Taylor&author=BL%20Minor&publication_year=2019&journal=J%20Biomed%20Inform&volume=95&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r24">24.</a>
<div class="reference-content">Mahrholdt H, Wagner A, Deluigi CC, et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis.
<i xmlns:helper="urn:XsltStringHelper"> Circulation</i>. 2006;114(15):1581-1590.
doi:<a href="http://dx.doi.org/10.1161/CIRCULATIONAHA.105.606509">10.1161/CIRCULATIONAHA.105.606509</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/17015795" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Presentation%2C%20patterns%20of%20myocardial%20damage%2C%20and%20clinical%20course%20of%20viral%20myocarditis.&author=H%20Mahrholdt&author=A%20Wagner&author=CC%20Deluigi&publication_year=2006&journal=Circulation&volume=114&pages=1581-1590" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1161/CIRCULATIONAHA.105.606509" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r25">25.</a>
<div class="reference-content">Mason JW, O’Connell JB, Herskowitz A, et al; Myocarditis Treatment Trial Investigators. A clinical trial of immunosuppressive therapy for myocarditis.
<i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 1995;333(5):269-275.
doi:<a href="http://dx.doi.org/10.1056/NEJM199508033330501">10.1056/NEJM199508033330501</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/7596370" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=A%20clinical%20trial%20of%20immunosuppressive%20therapy%20for%20myocarditis.&author=JW%20Mason&author=JB%20O’Connell&author=A%20Herskowitz&publication_year=1995&journal=N%20Engl%20J%20Med&volume=333&pages=269-275" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJM199508033330501" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r26">26.</a>
<div class="reference-content">Saji T, Matsuura H, Hasegawa K, et al. Comparison of the clinical presentation, treatment, and outcome of fulminant and acute myocarditis in children.
<i xmlns:helper="urn:XsltStringHelper"> Circ J</i>. 2012;76(5):1222-1228.
doi:<a href="http://dx.doi.org/10.1253/circj.CJ-11-1032">10.1253/circj.CJ-11-1032</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/22307381" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Comparison%20of%20the%20clinical%20presentation%2C%20treatment%2C%20and%20outcome%20of%20fulminant%20and%20acute%20myocarditis%20in%20children.&author=T%20Saji&author=H%20Matsuura&author=K%20Hasegawa&publication_year=2012&journal=Circ%20J&volume=76&pages=1222-1228" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1253/circj.CJ-11-1032" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r27">27.</a>
<div class="reference-content">Ghelani SJ, Spaeder MC, Pastor W, Spurney CF, Klugman D. Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to
2011. <i xmlns:helper="urn:XsltStringHelper"> Circ Cardiovasc Qual Outcomes</i>. 2012;5(5):622-627.
doi:<a href="http://dx.doi.org/10.1161/CIRCOUTCOMES.112.965749">10.1161/CIRCOUTCOMES.112.965749</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/22828827" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Demographics%2C%20trends%2C%20and%20outcomes%20in%20pediatric%20acute%20myocarditis%20in%20the%20United%20States%2C%202006%20to%202011.&author=SJ%20Ghelani&author=MC%20Spaeder&author=W%20Pastor&author=CF%20Spurney&author=D%20Klugman&publication_year=2012&journal=Circ%20Cardiovasc%20Qual%20Outcomes&volume=5&pages=622-627" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1161/CIRCOUTCOMES.112.965749" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r28">28.</a>
<div class="reference-content">Caforio ALP, Pankuweit S, Arbustini E, et al; European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Current state of knowledge on
aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases.
<i xmlns:helper="urn:XsltStringHelper"> Eur Heart J</i>. 2013;34(33):2636-2648.
doi:<a href="http://dx.doi.org/10.1093/eurheartj/eht210">10.1093/eurheartj/eht210</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/23824828" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Current%20state%20of%20knowledge%20on%20aetiology%2C%20diagnosis%2C%20management%2C%20and%20therapy%20of%20myocarditis%3A%20a%20position%20statement%20of%20the%20European%20Society%20of%20Cardiology%20Working%20Group%20on%20Myocardial%20and%20Pericardial%20Diseases.&author=ALP%20Caforio&author=S%20Pankuweit&author=E%20Arbustini&publication_year=2013&journal=Eur%20Heart%20J&volume=34&pages=2636-2648" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1093/eurheartj/eht210" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r29">29.</a>
<div class="reference-content">Yancy CW, Jessup M, Bozkurt B, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA
guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
<i xmlns:helper="urn:XsltStringHelper"> J Am Coll Cardiol</i>. 2013;62(16):e147-e239.
doi:<a href="http://dx.doi.org/10.1016/j.jacc.2013.05.019">10.1016/j.jacc.2013.05.019</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/23747642" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=2013%20ACCF%2FAHA%20guideline%20for%20the%20management%20of%20heart%20failure%3A%20a%20report%20of%20the%20American%20College%20of%20Cardiology%20Foundation%2FAmerican%20Heart%20Association%20Task%20Force%20on%20Practice%20Guidelines.&author=CW%20Yancy&author=M%20Jessup&author=B%20Bozkurt&publication_year=2013&journal=J%20Am%20Coll%20Cardiol&volume=62&pages=e147-e239" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jacc.2013.05.019" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r30">30.</a>
<div class="reference-content">Law YM, Lal AK, Chen S, et al; American Heart Association Pediatric Heart Failure and Transplantation Committee of the Council on Lifelong Congenital Heart Disease and
Heart Health in the Young and Stroke Council. Diagnosis and management of myocarditis in children: a scientific statement from the American Heart Association.
<i xmlns:helper="urn:XsltStringHelper"> Circulation</i>. 2021;144(6):e123-e135.
doi:<a href="http://dx.doi.org/10.1161/CIR.0000000000001001">10.1161/CIR.0000000000001001</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34229446" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Diagnosis%20and%20management%20of%20myocarditis%20in%20children%3A%20a%20scientific%20statement%20from%20the%20American%20Heart%20Association.&author=YM%20Law&author=AK%20Lal&author=S%20Chen&publication_year=2021&journal=Circulation&volume=144&pages=e123-e135" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1161/CIR.0000000000001001" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r31">31.</a>
<div class="reference-content">US Centers for Disease Control and Prevention. Clinical considerations: myocarditis and pericarditis after receipt of mRNA COVID-19 vaccines among adolescents and young adults. Accessed August 24,
2021. <a href="https://www.cdc.gov/vaccines/covid-19/clinical-considerations/myocarditis.html">https://www.cdc.gov/vaccines/covid-19/clinical-considerations/myocarditis.html</a></div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r32">32.</a>
<div class="reference-content">Sachdeva S, Song X, Dham N, Heath DM, DeBiasi RL. Analysis of clinical parameters and cardiac magnetic resonance imaging as predictors of outcome in
pediatric myocarditis. <i xmlns:helper="urn:XsltStringHelper"> Am J Cardiol</i>. 2015;115(4):499-504.
doi:<a href="http://dx.doi.org/10.1016/j.amjcard.2014.11.029">10.1016/j.amjcard.2014.11.029</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/25554534" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Analysis%20of%20clinical%20parameters%20and%20cardiac%20magnetic%20resonance%20imaging%20as%20predictors%20of%20outcome%20in%20pediatric%20myocarditis.&author=S%20Sachdeva&author=X%20Song&author=N%20Dham&author=DM%20Heath&author=RL%20DeBiasi&publication_year=2015&journal=Am%20J%20Cardiol&volume=115&pages=499-504" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.amjcard.2014.11.029" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r33">33.</a>
<div class="reference-content">Ferreira VM, Schulz-Menger J, Holmvang G, et al. Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations.
<i xmlns:helper="urn:XsltStringHelper"> J Am Coll Cardiol</i>. 2018;72(24):3158-3176.
doi:<a href="http://dx.doi.org/10.1016/j.jacc.2018.09.072">10.1016/j.jacc.2018.09.072</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30545455" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cardiovascular%20magnetic%20resonance%20in%20nonischemic%20myocardial%20inflammation%3A%20expert%20recommendations.&author=VM%20Ferreira&author=J%20Schulz-Menger&author=G%20Holmvang&publication_year=2018&journal=J%20Am%20Coll%20Cardiol&volume=72&pages=3158-3176" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jacc.2018.09.072" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r34">34.</a>
<div class="reference-content">US Centers for Disease Control and Prevention. Investigating long-term effects of myocarditis. Accessed August 24, 2021.
<a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myo-outcomes.html">https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myo-outcomes.html</a></div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r35">35.</a>
<div class="reference-content">Maron BJ, Udelson JE, Bonow RO, et al; American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on
Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and disqualification
recommendations for competitive athletes with cardiovascular abnormalities: task force 3: hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: a scientific
statement from the American Heart Association and American College of Cardiology. <i xmlns:helper="urn:XsltStringHelper"> Circulation</i>. 2015;132(22):e273-e280.
doi:<a href="http://dx.doi.org/10.1161/CIR.0000000000000239">10.1161/CIR.0000000000000239</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26621644" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Eligibility%20and%20disqualification%20recommendations%20for%20competitive%20athletes%20with%20cardiovascular%20abnormalities%3A%20task%20force%203%3A%20hypertrophic%20cardiomyopathy%2C%20arrhythmogenic%20right%20ventricular%20cardiomyopathy%20and%20other%20cardiomyopathies%2C%20and%20myocarditis%3A%20a%20scientific%20statement%20from%20the%20American%20Heart%20Association%20and%20American%20College%20of%20Cardiology.&author=BJ%20Maron&author=JE%20Udelson&author=RO%20Bonow&publication_year=2015&journal=Circulation&volume=132&pages=e273-e280" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r36">36.</a>
<div class="reference-content">Aquaro GD, Ghebru Habtemicael Y, Camastra G, et al; Cardiac Magnetic Resonance Working Group of the Italian Society of Cardiology. Prognostic value of repeating
cardiac magnetic resonance in patients with acute myocarditis. <i xmlns:helper="urn:XsltStringHelper"> J Am Coll Cardiol</i>. 2019;74(20):2439-2448.
doi:<a href="http://dx.doi.org/10.1016/j.jacc.2019.08.1061">10.1016/j.jacc.2019.08.1061</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31727281" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prognostic%20value%20of%20repeating%20cardiac%20magnetic%20resonance%20in%20patients%20with%20acute%20myocarditis.&author=GD%20Aquaro&author=Y%20Ghebru Habtemicael&author=G%20Camastra&publication_year=2019&journal=J%20Am%20Coll%20Cardiol&volume=74&pages=2439-2448" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jacc.2019.08.1061" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r37">37.</a>
<div class="reference-content">US Centers for Disease Control and Prevention. Interim clinical considerations for use of COVID-19 vaccines currently authorized in the United States. Accessed August 24, 2021.
<a href="https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html">https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html</a></div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r38">38.</a>
<div class="reference-content">Shimabukuro TT, Nguyen M, Martin D, DeStefano F. Safety monitoring in the Vaccine Adverse Event Reporting System (VAERS).
<i xmlns:helper="urn:XsltStringHelper"> Vaccine</i>. 2015;33(36):4398-4405.
doi:<a href="http://dx.doi.org/10.1016/j.vaccine.2015.07.035">10.1016/j.vaccine.2015.07.035</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26209838" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Safety%20monitoring%20in%20the%20Vaccine%20Adverse%20Event%20Reporting%20System%20%28VAERS%29.&author=TT%20Shimabukuro&author=M%20Nguyen&author=D%20Martin&author=F%20DeStefano&publication_year=2015&journal=Vaccine&volume=33&pages=4398-4405" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.vaccine.2015.07.035" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r39">39.</a>
<div class="reference-content">US Centers for Disease Control and Prevention. HIPAA privacy rule and public health: guidance from CDC and the US Department of Health and Human Services.
<i xmlns:helper="urn:XsltStringHelper"> MMWR Suppl</i>. 2003;52:1-17,
19-20.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/12741579" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=HIPAA%20privacy%20rule%20and%20public%20health%3A%20guidance%20from%20CDC%20and%20the%20US%20Department%20of%20Health%20and%20Human%20Services.&publication_year=2003&journal=MMWR%20Suppl&volume=52&pages=1-17, 19-20" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
</div>
</div>
</div>
</div>
<div id="related-tab" class="resource-tab related-tab need-jobs-ad">
<div class="widget-ArticleLinks widget-instance-AMA_See_Also_Related_Content">
<ul class="article-links related-content">
<li class="article-link related-article odd">
<a href="https://jamanetwork.com/journals/jama/fullarticle/2782900" class="td-n">
<div class="related-article-title">Myocarditis and Pericarditis After Vaccination for COVID-19</div>
<div class="related-article-type">Research Letter</div>
<div class="related-article-date">September 28, 2021</div>
<div class="related-article-excerpt">This study investigates the incidence of myocarditis and pericarditis emergency department or inpatient hospital encounters before COVID-19 vaccine availability (January 2019–January 2021) and during a COVID-19 vaccination period (February-May 2021) in a large US health care system.</div>
<div class="related-article-authors">George A. Diaz, MD; Guilford T. Parsons, MD, MS; Sara K. Gering, BS, BSN; Audrey R. Meier, MPH; Ian V. Hutchinson, PhD, DSc; Ari Robicsek, MD</div>
</a>
</li>
<li class="article-link related-article even">
<a href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2781601" class="td-n">
<div class="related-article-title">Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military</div>
<div class="related-article-type">Brief Report</div>
<div class="related-article-date">October 1, 2021</div>
<div class="related-article-excerpt">This case series describes myocarditis presenting after COVID-19 vaccination within the Military Health System.</div>
<div class="related-article-authors">Jay Montgomery, MD; Margaret Ryan, MD, MPH; Renata Engler, MD; Donna Hoffman, MSN; Bruce McClenathan, MD; Limone Collins, MD; David Loran, DNP; David Hrncir, MD; Kelsie Herring, MD; Michael Platzer, MD; Nehkonti Adams, MD; Aliye Sanou, MD; Leslie T. Cooper Jr, MD</div>
</a>
</li>
<li class="article-link related-article odd">
<a href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2781602" class="td-n">
<div class="related-article-title">Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination</div>
<div class="related-article-type">Brief Report</div>
<div class="related-article-date">October 1, 2021</div>
<div class="related-article-excerpt">This study describes 4 patients who presented with acute myocarditis after mRNA COVID-19 vaccination.</div>
<div class="related-article-authors">Han W. Kim, MD; Elizabeth R. Jenista, PhD; David C. Wendell, PhD; Clerio F. Azevedo, MD; Michael J. Campbell, MD; Stephen N. Darty, BS; Michele A. Parker, MS; Raymond J. Kim, MD</div>
</a>
</li>
<li class="article-link related-article even">
<a href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2783052" class="td-n">
<div class="related-article-title">Association of Myocarditis With BNT162b2 Vaccination in Children</div>
<div class="related-article-type">Brief Report</div>
<div class="related-article-date">December 1, 2021</div>
<div class="related-article-excerpt">This case series reviews comprehensive cardiac imaging in children with myocarditis after COVID-19 vaccine.</div>
<div class="related-article-authors">Audrey Dionne, MD; Francesca Sperotto, MD; Stephanie Chamberlain; Annette L. Baker, MSN, CPNP; Andrew J. Powell, MD; Ashwin Prakash, MD; Daniel A. Castellanos, MD; Susan F. Saleeb, MD; Sarah D. de Ferranti, MD, MPH; Jane W. Newburger, MD, MPH; Kevin G. Friedman, MD</div>
</a>
</li>
</ul>
</div>
<div class="widget-EditorsChoice widget-instance-AMA_EditorsChoice_Links">
</div>
<div class="widget-RelatedTopics widget-instance-AMA_Related_Topics">
<div class="related-topics-block">
<h4 class="related-topics-heading topic-suggestions-heading sb-sc"> See More About </h4>
<div class="related-topics topic-suggestions">
<a href="https://jamanetwork.com/collections/42128/public-health" id="item_Link" class="related-topic topic-suggestion no-wrap sb-anchor-light">Public Health</a>
<a href="https://jamanetwork.com/collections/5950/vaccination" id="item_Link_1" class="related-topic topic-suggestion no-wrap sb-anchor-light">Vaccination</a>
<a href="https://jamanetwork.com/collections/5548/cardiology" id="item_Link_2" class="related-topic topic-suggestion no-wrap sb-anchor-light">Cardiology</a>
<a href="https://jamanetwork.com/collections/46099/coronavirus-covid-19" id="item_Link_3" class="related-topic topic-suggestion no-wrap sb-anchor-light">Coronavirus (COVID-19)</a>
</div>
</div>
</div>
<div class="ymal--footer">
<div class="widget-PersonalizedContent widget-instance-AMA_PersonalizedContent_SplitScreenView_Footer">
<div class="row ymal">
<h4 class="ymal--hed thm-col-sec"> Trending </h4>
<ul class="ymal--content featured-list--contents">
<li class="article ymal--item thm-bd-top bd-jama-cardiology-sec">
<a class="article--title d-b mb05" href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2783052?widget=personalizedcontent&previousarticle=2788346">Association of Myocarditis With BNT162b2 Vaccination in Children</a>
<div class="article--pub-name meta-item">JAMA Cardiology</div>
<div class="article--type meta-item">Research</div>
<div class="article--date meta-item no-wrap">December 1, 2021</div>
</li>
<li class="article ymal--item thm-bd-top bd-jama-sec">
<a class="article--title d-b mb05" href="https://jamanetwork.com/journals/jama/fullarticle/2788485?widget=personalizedcontent&previousarticle=2788346">Association Between 3 Doses of mRNA COVID-19 Vaccine and Symptomatic Infection Caused by Omicron and Delta Variants</a>
<div class="article--pub-name meta-item">JAMA</div>
<div class="article--type meta-item">Research</div>
<div class="article--date meta-item no-wrap">January 21, 2022</div>
</li>
<li class="article ymal--item thm-bd-top bd-jama-sec">
<a class="article--title d-b mb05" href="https://jamanetwork.com/journals/jama/fullarticle/2784015?widget=personalizedcontent&previousarticle=2788346">Surveillance for Adverse Events After COVID-19 mRNA Vaccination</a>
<div class="article--pub-name meta-item">JAMA</div>
<div class="article--type meta-item">Research</div>
<div class="article--date meta-item no-wrap">October 12, 2021</div>
</li>
</ul>
</div>
<script type="text/javascript">
SCM.AMA.DataLayerAsync.push("arrYMALbottom", "10.1001/jamacardio.2021.3471,10.1001/jama.2022.0470,10.1001/jama.2021.15072", "array");
</script>
</div>
</div>
<hr>
<div class="manage-interest">
<h4><a href="#" class="manage-interests-link-no-access thm-col-sec">Select Your Interests</a></h4>
<div class="widget-ManageCollectionInterests widget-instance-ManageCollectionInterests_SplitScreen">
<div class="manage-interests-modal reveal-modal small modal" data-reveal="">
<div class="manage-interests--header">
<div class="widget-SelfServeContent widget-instance-AMA_ManageInterests_Header">
<div class="self-serve">
<style>
h4 {
font-size: 20px !important;
}
</style>
<h4>Select Your Interests</h4>
<p>Customize your JAMA Network experience by selecting one or more topics from the list below.</p>
</div>
</div>
</div>
<div class="manage-interests--categories">
<ul class="category-list">
<li><span class="category-list-item " data-categoryid="5489">Acid Base, Electrolytes, Fluids</span></li>
<li><span class="category-list-item " data-categoryid="5921">Addiction Medicine</span></li>
<li><span class="category-list-item " data-categoryid="5504">Allergy and Clinical Immunology</span></li>
<li><span class="category-list-item " data-categoryid="5510">Anesthesiology</span></li>
<li><span class="category-list-item " data-categoryid="42143">Anticoagulation</span></li>
<li><span class="category-list-item " data-categoryid="6261">Art and Images in Psychiatry</span></li>
<li><span class="category-list-item " data-categoryid="42099">Bleeding and Transfusion</span></li>
<li><span class="category-list-item " data-categoryid="5548">Cardiology</span></li>
<li><span class="category-list-item " data-categoryid="44036">Caring for the Critically Ill Patient</span></li>
<li><span class="category-list-item " data-categoryid="6255">Challenges in Clinical Electrocardiography</span></li>
<li><span class="category-list-item " data-categoryid="44038">Clinical Challenge</span></li>
<li><span class="category-list-item " data-categoryid="5589">Clinical Decision Support</span></li>
<li><span class="category-list-item " data-categoryid="44039">Clinical Implications of Basic Neuroscience</span></li>
<li><span class="category-list-item " data-categoryid="5614">Clinical Pharmacy and Pharmacology</span></li>
<li><span class="category-list-item " data-categoryid="5575">Complementary and Alternative Medicine</span></li>
<li><span class="category-list-item " data-categoryid="44040">Consensus Statements</span></li>
<li><span class="category-list-item " data-categoryid="46099">Coronavirus (COVID-19)</span></li>
<li><span class="category-list-item " data-categoryid="5584">Critical Care Medicine</span></li>
<li><span class="category-list-item " data-categoryid="46325">Cultural Competency</span></li>
<li><span class="category-list-item " data-categoryid="44019">Dental Medicine</span></li>
<li><span class="category-list-item " data-categoryid="5598">Dermatology</span></li>
<li><span class="category-list-item " data-categoryid="44011">Diabetes and Endocrinology</span></li>
<li><span class="category-list-item " data-categoryid="46320">Diagnostic Test Interpretation</span></li>
<li><span class="category-list-item " data-categoryid="46387">Diversity, Equity, and Inclusion</span></li>
<li><span class="category-list-item " data-categoryid="42054">Drug Development</span></li>
<li><span class="category-list-item " data-categoryid="5620">Electronic Health Records</span></li>
<li><span class="category-list-item " data-categoryid="5621">Emergency Medicine</span></li>
<li><span class="category-list-item " data-categoryid="5819">End of Life</span></li>
<li><span class="category-list-item " data-categoryid="42107">Environmental Health</span></li>
<li><span class="category-list-item " data-categoryid="42108">Ethics</span></li>
<li><span class="category-list-item " data-categoryid="5644">Facial Plastic Surgery</span></li>
<li><span class="category-list-item " data-categoryid="44012">Gastroenterology and Hepatology</span></li>
<li><span class="category-list-item " data-categoryid="5664">Genetics and Genomics</span></li>
<li><span class="category-list-item " data-categoryid="44041">Genomics and Precision Health</span></li>
<li><span class="category-list-item " data-categoryid="5668">Geriatrics</span></li>
<li><span class="category-list-item " data-categoryid="5670">Global Health</span></li>
<li><span class="category-list-item " data-categoryid="44042">Guide to Statistics and Medicine</span></li>
<li><span class="category-list-item " data-categoryid="5672">Guidelines</span></li>
<li><span class="category-list-item " data-categoryid="5674">Hair Disorders</span></li>
<li><span class="category-list-item " data-categoryid="42113">Health Care Delivery Models</span></li>
<li><span class="category-list-item " data-categoryid="42114">Health Care Economics, Insurance, Payment</span></li>
<li><span class="category-list-item " data-categoryid="42116">Health Care Quality</span></li>
<li><span class="category-list-item " data-categoryid="5680">Health Care Reform</span></li>
<li><span class="category-list-item " data-categoryid="5830">Health Care Safety</span></li>
<li><span class="category-list-item " data-categoryid="5682">Health Care Workforce</span></li>
<li><span class="category-list-item " data-categoryid="5679">Health Disparities</span></li>
<li><span class="category-list-item " data-categoryid="46328">Health Inequities</span></li>
<li><span class="category-list-item " data-categoryid="44024">Health Informatics</span></li>
<li><span class="category-list-item " data-categoryid="44020">Health Policy</span></li>
<li><span class="category-list-item " data-categoryid="5688">Hematology</span></li>
<li><span class="category-list-item " data-categoryid="5692">History of Medicine</span></li>
<li><span class="category-list-item " data-categoryid="5514">Humanities</span></li>
<li><span class="category-list-item " data-categoryid="5697">Hypertension</span></li>
<li><span class="category-list-item " data-categoryid="44043">Images in Neurology</span></li>
<li><span class="category-list-item " data-categoryid="45887">Implementation Science</span></li>
<li><span class="category-list-item " data-categoryid="5702">Infectious Diseases</span></li>
<li><span class="category-list-item " data-categoryid="44044">Innovations in Health Care Delivery</span></li>
<li><span class="category-list-item " data-categoryid="44070">JAMA Infographic</span></li>
<li><span class="category-list-item " data-categoryid="5716">Law and Medicine</span></li>
<li><span class="category-list-item " data-categoryid="45308">Leading Change</span></li>
<li><span class="category-list-item " data-categoryid="44045">Less is More</span></li>
<li><span class="category-list-item " data-categoryid="46327">LGBTQ</span></li>
<li><span class="category-list-item " data-categoryid="5720">Lifestyle Behaviors</span></li>
<li><span class="category-list-item " data-categoryid="45311">Medical Coding</span></li>
<li><span class="category-list-item " data-categoryid="5738">Medical Devices and Equipment</span></li>
<li><span class="category-list-item " data-categoryid="44023">Medical Education</span></li>
<li><span class="category-list-item " data-categoryid="5739">Medical Education and Training</span></li>
<li><span class="category-list-item " data-categoryid="5713">Medical Journals and Publishing</span></li>
<li><span class="category-list-item " data-categoryid="5746">Melanoma</span></li>
<li><span class="category-list-item " data-categoryid="44025">Mobile Health and Telemedicine</span></li>
<li><span class="category-list-item " data-categoryid="5766">Narrative Medicine</span></li>
<li><span class="category-list-item " data-categoryid="5769">Nephrology</span></li>
<li><span class="category-list-item " data-categoryid="5777">Neurology</span></li>
<li><span class="category-list-item " data-categoryid="44052">Neuroscience and Psychiatry</span></li>
<li><span class="category-list-item " data-categoryid="44053">Notable Notes</span></li>
<li><span class="category-list-item " data-categoryid="5787">Nursing</span></li>
<li><span class="category-list-item " data-categoryid="5788">Nutrition</span></li>
<li><span class="category-list-item " data-categoryid="44027">Nutrition, Obesity, Exercise</span></li>
<li><span class="category-list-item " data-categoryid="5791">Obesity</span></li>
<li><span class="category-list-item " data-categoryid="44013">Obstetrics and Gynecology</span></li>
<li><span class="category-list-item " data-categoryid="5796">Occupational Health</span></li>
<li><span class="category-list-item " data-categoryid="5801">Oncology</span></li>
<li><span class="category-list-item " data-categoryid="44054">Ophthalmic Images</span></li>
<li><span class="category-list-item " data-categoryid="5804">Ophthalmology</span></li>
<li><span class="category-list-item " data-categoryid="5808">Orthopedics</span></li>
<li><span class="category-list-item " data-categoryid="5811">Otolaryngology</span></li>
<li><span class="category-list-item " data-categoryid="44028">Pain Medicine</span></li>
<li><span class="category-list-item " data-categoryid="44029">Pathology and Laboratory Medicine</span></li>
<li><span class="category-list-item " data-categoryid="45306">Patient Care</span></li>
<li><span class="category-list-item " data-categoryid="6258">Patient Information</span></li>
<li><span class="category-list-item " data-categoryid="5843">Pediatrics</span></li>
<li><span class="category-list-item " data-categoryid="44060">Performance Improvement</span></li>
<li><span class="category-list-item " data-categoryid="45315">Performance Measures</span></li>
<li><span class="category-list-item " data-categoryid="42050">Perioperative Care and Consultation</span></li>
<li><span class="category-list-item " data-categoryid="42125">Pharmacoeconomics</span></li>
<li><span class="category-list-item " data-categoryid="42126">Pharmacoepidemiology</span></li>
<li><span class="category-list-item " data-categoryid="5851">Pharmacogenetics</span></li>
<li><span class="category-list-item " data-categoryid="44030">Pharmacy and Clinical Pharmacology</span></li>
<li><span class="category-list-item " data-categoryid="5856">Physical Medicine and Rehabilitation</span></li>
<li><span class="category-list-item " data-categoryid="42059">Physical Therapy</span></li>
<li><span class="category-list-item " data-categoryid="45313">Physician Leadership</span></li>
<li><span class="category-list-item " data-categoryid="44061">Poetry</span></li>
<li><span class="category-list-item " data-categoryid="45316">Population Health</span></li>
<li><span class="category-list-item " data-categoryid="46324">Preventive Medicine</span></li>
<li><span class="category-list-item " data-categoryid="45309">Professional Well-being</span></li>
<li><span class="category-list-item " data-categoryid="44064">Professionalism</span></li>
<li><span class="category-list-item " data-categoryid="5871">Psychiatry and Behavioral Health</span></li>
<li><span class="category-list-item " data-categoryid="42128">Public Health</span></li>
<li><span class="category-list-item " data-categoryid="5877">Pulmonary Medicine</span></li>
<li><span class="category-list-item " data-categoryid="42129">Radiology</span></li>
<li><span class="category-list-item " data-categoryid="42058">Regulatory Agencies</span></li>
<li><span class="category-list-item " data-categoryid="5916">Research, Methods, Statistics</span></li>
<li><span class="category-list-item " data-categoryid="42142">Resuscitation</span></li>
<li><span class="category-list-item " data-categoryid="5896">Rheumatology</span></li>
<li><span class="category-list-item " data-categoryid="46326">Risk Management</span></li>
<li><span class="category-list-item " data-categoryid="38802">Scientific Discovery and the Future of Medicine</span></li>
<li><span class="category-list-item " data-categoryid="5833">Shared Decision Making and Communication</span></li>
<li><span class="category-list-item " data-categoryid="5912">Sleep Medicine</span></li>
<li><span class="category-list-item " data-categoryid="5915">Sports Medicine</span></li>
<li><span class="category-list-item " data-categoryid="5533">Stem Cell Transplantation</span></li>
<li><span class="category-list-item " data-categoryid="5923">Surgery</span></li>
<li><span class="category-list-item " data-categoryid="44065">Surgical Innovation</span></li>
<li><span class="category-list-item " data-categoryid="44066">Surgical Pearls</span></li>
<li><span class="category-list-item " data-categoryid="44067">Teachable Moment</span></li>
<li><span class="category-list-item " data-categoryid="45310">Technology and Finance</span></li>
<li><span class="category-list-item " data-categoryid="44034">The Art of JAMA</span></li>
<li><span class="category-list-item " data-categoryid="44037">The Arts and Medicine</span></li>
<li><span class="category-list-item " data-categoryid="6257">The Rational Clinical Examination</span></li>
<li><span class="category-list-item " data-categoryid="5936">Tobacco and e-Cigarettes</span></li>
<li><span class="category-list-item " data-categoryid="5938">Toxicology</span></li>
<li><span class="category-list-item " data-categoryid="42136">Trauma and Injury</span></li>
<li><span class="category-list-item " data-categoryid="5942">Treatment Adherence</span></li>
<li><span class="category-list-item " data-categoryid="46323">Ultrasonography</span></li>
<li><span class="category-list-item " data-categoryid="5947">Urology</span></li>
<li><span class="category-list-item " data-categoryid="44069">Users' Guide to the Medical Literature</span></li>
<li><span class="category-list-item " data-categoryid="5950">Vaccination</span></li>
<li><span class="category-list-item " data-categoryid="5955">Venous Thromboembolism</span></li>
<li><span class="category-list-item " data-categoryid="45312">Veterans Health</span></li>
<li><span class="category-list-item " data-categoryid="5957">Violence</span></li>
<li><span class="category-list-item " data-categoryid="42139">Women's Health</span></li>
<li><span class="category-list-item " data-categoryid="45307">Workflow and Process</span></li>
<li><span class="category-list-item " data-categoryid="42140">Wound Care, Infection, Healing</span></li>
</ul>
</div>
<div class="manage-interests--save-preferences">
<div class="save-preferences-btn thm-bg ">
<span class="save-preferences-btn-text fw-b">Save Preferences</span>
</div>
</div>
<div class="manage-interests--privacy-terms"> <a class="manage-interests--privacy-terms-color" href="/pages/privacy-policy">Privacy Policy</a> |
<a class="manage-interests--privacy-terms-color" href="/pages/terms-of-use">Terms of Use</a></div>
<a class="close-reveal-modal icon-close"></a>
</div>
</div>
</div>
<h4 class="thm-col-sec" align="center"> Others Also Liked </h4>
<div id="trendmd-suggestions">
<div class="trendmd-widget-container trendmd-widget_title-normal trendmd-widget_body-normal" data-trendmd-journal-id="39135" data-trendmd-article-id="51904afe-c391-4971-8abc-0d162c12f8ee" data-trendmd-swoop="e30="
similar-nonsponsored-merged="true" style="display: block;" data-trendmd-widget-id="0" similar-sponsored-merged="true">
<div class="trendmd-widget trendmd-widget_vertical">
<div class="trendmd-widget-inner">
<div class="trendmd-widget-section">
<div class="trendmd-widget-header">
<h3 class="trendmd-widget-header__heading">We recommend</h3>
</div>
<ol class="trendmd-widget-list">
<li class="trendmd-widget-list-item">
<a class="trendmd-widget-list-item__link" data-trendmd-id="60e7ca04-8a4b-42b3-8155-39470c617f70" data-trendmd-journal-id="24314" data-trendmd-content-category="Scholarly" data-trendmd-campaign-id="567" data-trendmd-ct="%7B%22i%22:true,%22c%22:true,%22n%22:%7B%22specificNpi%22:false,%22anyNpi%22:false%7D%7D" data-trendmd-sponsored="true" href="https://www.bmj.com/content/375/bmj.n3090?utm_campaign=tbmj&utm_medium=cpc&utm_source=trendmd&utm_term=usage-042019&utm_content=consumer" rel="noindex, nofollow" target="_blank" data-trendmd-flags="10" data-trendmd-model-type="0">Myocarditis after vaccination against covid-19<span class="trendmd-widget-list-item__link__external"></span></a>
<div class="trendmd-widget-list-item__meta">
<span class="js_authors">Walid F Gellad et al.,</span> The BMJ, <span class="js_publication_date">2021</span>
</div>
</li>
<li class="trendmd-widget-list-item">
<a class="trendmd-widget-list-item__link" data-trendmd-id="ffb4bdf7-7b76-459d-bf64-7e7323262939" data-trendmd-journal-id="54388" data-trendmd-content-category="Scholarly" data-trendmd-campaign-id="307" data-trendmd-ct="%7B%22i%22:true,%22c%22:true,%22n%22:%7B%22specificNpi%22:false,%22anyNpi%22:false%7D%7D" data-trendmd-sponsored="true" href="https://publications.aap.org/aapnews/news/17136/CDC-releases-guidance-for-clinicians-on-heart?searchresult=1&utm_source=TrendMD&utm_medium=TrendMD&utm_campaign=AAPNews_TrendMD_1" rel="noindex, nofollow" target="_blank" data-trendmd-flags="10" data-trendmd-model-type="0">CDC releases guidance for clinicians on heart inflammation after COVID-19 vaccination<span class="trendmd-widget-list-item__link__external"></span></a>
<div class="trendmd-widget-list-item__meta">
<span class="js_authors">Melissa Jenco et al.,</span> AAP News, <span class="js_publication_date">2021</span>
</div>
</li>
</ol>
</div>
<div class="trendmd-widget-section">
<div class="trendmd-widget-header">
</div>
<ol class="trendmd-widget-list">
<li class="trendmd-widget-list-item">
<a class="trendmd-widget-list-item__link" data-trendmd-id="67120ea4-13b8-44c7-aa31-655aadfd691a" data-trendmd-journal-id="24314" data-trendmd-content-category="Scholarly" data-trendmd-campaign-id="567" data-trendmd-ct="%7B%22i%22:true,%22c%22:true,%22n%22:%7B%22specificNpi%22:false,%22anyNpi%22:false%7D%7D" data-trendmd-sponsored="true" href="https://www.bmj.com/content/374/bmj.n2251?utm_campaign=tbmj&utm_medium=cpc&utm_source=trendmd&utm_term=usage-042019&utm_content=consumer" rel="noindex, nofollow" target="_blank" data-trendmd-flags="10" data-trendmd-model-type="0">Covid-19: Study that claimed boys are at increased risk of myocarditis after vaccination is deeply flawed, say critics<span class="trendmd-widget-list-item__link__external"></span></a>
<div class="trendmd-widget-list-item__meta">
<span class="js_authors">Clara Munro,</span> The BMJ, <span class="js_publication_date">2021</span>
</div>
</li>
<li class="trendmd-widget-list-item">
<a class="trendmd-widget-list-item__link" data-trendmd-id="49e93e7b-8307-4c30-8ac5-9b7d24292d4c" data-trendmd-journal-id="54388" data-trendmd-content-category="Scholarly" data-trendmd-campaign-id="307" data-trendmd-ct="%7B%22i%22:true,%22c%22:true,%22n%22:%7B%22specificNpi%22:false,%22anyNpi%22:false%7D%7D" data-trendmd-sponsored="true" href="https://publications.aap.org/aapnews/news/16738?utm_source=TrendMD&utm_medium=TrendMD&utm_campaign=AAPNews_TrendMD_1" rel="noindex, nofollow" target="_blank" data-trendmd-flags="10" data-trendmd-model-type="0">Health officials, AAP urge COVID-19 vaccination despite rare myocarditis cases<span class="trendmd-widget-list-item__link__external"></span></a>
<div class="trendmd-widget-list-item__meta">
<span class="js_authors">Melissa Jenco et al.,</span> AAP News, <span class="js_publication_date">2021</span>
</div>
</li>
</ol>
</div>
</div>
<div class="trendmd-widget-footer">
<div class="trendmd-widget-footer-inner">
<div class="trendmd-widget-footer-inner-left">
<a href="https://www.trendmd.com/how-it-works-readers" target="_blank" class="trendmd-widget-brand">
<span class="trendmd-widget-brand__recommended">Powered by</span>
<span class="trendmd-widget-brand__logo trendmd-widget-brand__logo__normal" style="display: inline-block; width: 93px">
<svg viewBox="0 0 234 57" version="1.1" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink">
<g id="logo">
<path d="M227.7,56.9 L149.7,56.9 C146.7,56.9 143.7,53.8 143.7,50.9 L143.7,6.9 C143.7,4 146.7,0.9 149.7,0.9 L227.7,0.9 C230.7,0.9 233.7,4 233.7,6.9 L233.7,50.9 C233.7,53.9 230.6,56.9 227.7,56.9 L227.7,56.9 Z" id="shape0" fill="#CA2127"></path>
<g id="group1" transform="translate(0.000000, 14.000000)" fill="#16325c">
<path d="M15.8,5.9 L15.8,29.6 L9.2,29.6 L9.2,5.9 L0.9,5.9 L0.9,0.2 L24.1,0.2 L24.1,5.9 L15.8,5.9 L15.8,5.9 Z" id="shape1"></path>
<path d="M50.2,10 C50.2,14.7 48.3,17.7 44.6,19.1 L52,29.6 L44,29.6 L37.5,20.2 L33,20.2 L33,29.6 L26.4,29.6 L26.4,0.2 L37.5,0.2 C42.1,0.2 45.3,1 47.3,2.5 C49.2,4.1 50.2,6.6 50.2,10 L50.2,10 Z M42.3,13.5 C43.1,12.8 43.5,11.6 43.5,10 C43.5,8.4 43.1,7.3 42.2,6.7 C41.4,6.1 39.9,5.8 37.8,5.8 L32.9,5.8 L32.9,14.5 L37.7,14.5 C40,14.6 41.5,14.2 42.3,13.5 L42.3,13.5 Z" id="shape2"></path>
<path d="M75.6,0.3 L75.6,6.1 L61,6.1 L61,12.1 L74.1,12.1 L74.1,17.7 L61,17.7 L61,23.8 L76,23.8 L76,29.6 L54.4,29.6 L54.4,0.2 L75.6,0.2 L75.6,0.3 Z" id="shape3"></path>
<path d="M99.9,0.3 L106.5,0.3 L106.5,29.7 L99.9,29.7 L85.9,11.3 L85.9,29.7 L79.3,29.7 L79.3,0.3 L85.4,0.3 L99.8,19.2 L99.8,0.3 L99.9,0.3 Z" id="shape4"></path>
<path d="M133.6,4.1 C136.4,6.7 137.8,10.2 137.8,14.8 C137.8,19.4 136.4,23 133.7,25.6 C131,28.3 126.8,29.6 121.2,29.6 L111.2,29.6 L111.2,0.2 L121.6,0.2 C126.7,0.3 130.8,1.5 133.6,4.1 L133.6,4.1 Z M128.8,21.6 C130.4,20.1 131.2,17.9 131.2,15 C131.2,12.1 130.4,9.9 128.8,8.3 C127.2,6.7 124.7,6 121.4,6 L117.7,6 L117.7,23.9 L121.9,23.9 C124.8,23.8 127.1,23.1 128.8,21.6 L128.8,21.6 Z" id="shape5"></path>
</g>
<g id="group2" transform="translate(156.000000, 14.000000)" fill="#FFFFFF">
<path d="M26.9,11.1 L19,27.1 L15,27.1 L7.1,11.1 L7.1,29.6 L0.5,29.6 L0.5,0.2 L9.4,0.2 L17,16.3 L24.6,0.2 L33.4,0.2 L33.4,29.6 L26.8,29.6 L26.8,11.1 L26.9,11.1 Z" id="shape6"></path>
<path d="M60.6,4.1 C63.4,6.7 64.8,10.2 64.8,14.8 C64.8,19.4 63.4,23 60.7,25.6 C58,28.3 53.8,29.6 48.2,29.6 L38.2,29.6 L38.2,0.2 L48.6,0.2 C53.7,0.3 57.8,1.5 60.6,4.1 L60.6,4.1 Z M55.8,21.6 C57.4,20.1 58.2,17.9 58.2,15 C58.2,12.1 57.4,9.9 55.8,8.3 C54.2,6.7 51.7,6 48.4,6 L44.7,6 L44.7,23.9 L48.9,23.9 C51.8,23.8 54.1,23.1 55.8,21.6 L55.8,21.6 Z" id="shape7"></path>
</g>
</g>
</svg>
</span>
</a>
</div>
<div class="trendmd-widget-footer-inner-right">
<div class="trendmd-widget-settings"><span class="trendmd-widget-settings__cog"></span>
<div class="trendmd-widget-settings__modal">
<ul class="trendmd-widget-settings__list">
<li class="trendmd-widget-settings__item">
<a href="https://www.trendmd.com/privacy" target="_blank" class="trendmd-widget-settings__link">Privacy policy</a>
</li>
<li class="trendmd-widget-settings__item trendmd-widget-dns" style="display:none">
<a href="https://www.trendmd.com/personaldata" target="_blank" class="trendmd-widget-settings__link">Do not sell my personal information</a>
</li>
<li class="trendmd-widget-settings__item">
<a href="https://www.trendmd.com/google-analytics" target="_blank" class="trendmd-widget-settings__link">Google Analytics settings</a>
</li>
</ul>
</div>
</div>
</div>
<div class="trendmd-widget-footer-inner-clear"></div>
<div class="trendmd-widget-footer-inner-bottom">
<div class="trendmd-widget-cookie-notification" style="display: block!important">
<div class="trendmd-widget-cookie-notification__info"><span>I consent to the use of Google Analytics and related cookies across the TrendMD network (widget, website, blog).
</span><a href="https://www.trendmd.com/google-analytics#" target="_blank">Learn more</a></div>
<div class="trendmd-widget-cookie-notification__actions">
<button onclick="(function() { window.TrendMD.gdpr().setGaConsent(true); })(); return false;" style="display: inline-block;">Yes</button>
<button onclick="(function() { window.TrendMD.gdpr().setGaConsent(false); })(); return false;" style="display: inline-block;">No</button>
<span></span>
</div>
</div>
</div>
</div>
</div>
</div>
<div id="trendmd-check">
<div id="ad-holder"></div>
</div>
</div>
</div>
</div>
<div id="comments-tab" class="resource-tab comments-tab" style="display: none!important">
</div>
</div>
</div>
<a id="skip-to-navigation" href="#" tabindex="-1"></a>
<div id="content-panel" class="content-panel">
<a id="top"></a>
<div id="full-text-tab" class="resource-tab full-text-tab">
<div class="widget-ArticleLinks widget-instance-AMA_ErrataArticleLinks_FullText">
</div>
<div class="widget-ArticleLinks widget-instance-AMA_ArticleLinks_ToErrata_FullText">
</div>
<div class="widget-ArticleNavLinks widget-instance-AMA_ArticleNavLinks">
<a class="toc-link btn" href="https://jamanetwork.com/journals/jama/currentissue">This Issue</a>
</div>
<div class="article-metrics-wrapper" id="divArticleLevelMetrics">
<div class="widget-ArticleLevelMetrics widget-instance-AMA_ArticleMetrics">
<div class="artmet-condensed-wrap clearfix">
<div class="artmet-condensed-stats clearfix">
<div class="artmet-item artmet-views">
<span class="artmet-text sb-sc">Views</span>
<span class="artmet-number sb-sc">111,491</span>
</div>
<div class="artmet-item artmet-citations">
<span class="artmet-text">Citations</span>
<span class="artmet-number">0</span>
</div>
<div class="artmet-item artmet-altmetric">
<div class="widget-AltmetricLink widget-instance-AMAv2_ArticleLevelMetrics_AltmetricLinkSummary">
<!-- Altmetrics -->
<div id="altmetricEmbedId" class="altmetric-embed" data-link-target="_blank" data-badge-type="text" data-hide-no-mentions="false" data-doi="10.1001/jama.2021.24110" data-uuid="a1be1ba3-ef75-8cd6-63fb-cccce4aeb679"><a target="_blank" href="https://www.altmetric.com/details.php?domain=jamanetwork.com&citation_id=121557704" style="display:inline-block;">
<span class="_altmetric_score sb-sc visible">3000</span>
</a></div>
</div>
</div>
</div>
<div class="artmet-modal-trigger-wrap">
<a rel="nofollow" class="artmet-modal-trigger" data-article-id="2788346"><i class="icon-metrics"></i><span>View Metrics</span></a>
</div>
</div>
</div>
</div>
<ul class="toolbar">
<li class="toolbar-pdf-wrap toolbar-tool-wrap">
<a id="pdf-link" class="toolbar-tool toolbar-pdf al-link pdfaccess" data-article-id="2788346" data-article-url="/ama/content_public/journal/jama/938849/jama_oster_2022_oi_210145_1643049434.03827.pdf" data-ajax-url="/Content/CheckPdfAccess"><span class="toolbar-pdf-text"><span class="toolbar-link-text-extra">Download </span><span class="toolbar-link-text">PDF</span></span>
</a>
</li>
<li class="toolbar-share-wrap toolbar-tool-wrap">
<div class="toolbar-tool">
<a class="addthis_button_twitter is-b toolbar-twitter toolbar-share at300b" rel="nofollow" data-utm-source="twitter" title="Twitter" href="#"><span class="share-text">Twitter</span></a>
<a class="addthis_button_facebook is-b toolbar-facebook toolbar-share at300b" rel="nofollow" data-utm-source="facebook" title="Facebook" href="#"><span class="share-text">Facebook</span></a>
<a class="toolbar-share-more-link is-a" rel="nofollow"><span class="icon icon-carrot_down social-arrow"></span><span class="more-text-wrap">More</span></a>
<div class="toolbar-share-more">
<a class="addthis_button_linkedin is-b toolbar-linkedin toolbar-share at300b" rel="nofollow" data-utm-source="linkedin" target="_blank" title="LinkedIn" href="#"><span class="share-text">LinkedIn</span></a>
</div>
</div>
</li>
<li class="toolbar-cme-wrap toolbar-tool-wrap">
<a class="toolbar-tool toolbar-cme is-b jama-active-cme-button" rel="nofollow" href="https://edhub.ama-assn.org/jn-learning/module/2788346">CME & MOC</a>
</li>
<li class="toolbar-citation-wrap toolbar-tool-wrap">
<div class="widget-ToolboxGetCitation widget-instance-AMA_Get_Citation">
<a class="toolbar-tool toolbar-citation is-b" rel="nofollow" data-reveal-id="get-citation" data-reveal="">
<span class="toolbar-link-text">Cite</span>
<span class="toolbar-link-text-extra">This</span>
</a>
<div id="get-citation" class="reveal-modal get-citation" data-reveal="">
<h3 class="get-citation-title">Citation</h3>
<p class="get-citation-citation">Oster ME, Shay DK, Su JR, et al. Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021. <em>JAMA.</em> 2022;327(4):331–340.
doi:10.1001/jama.2021.24110</p>
<h4 class="get-citation-download-heading">Download citation file:</h4>
<div class="get-citation-types">
<a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2788346&resourceType=3&citationFormat=0">Ris (Zotero)</a>
<a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2788346&resourceType=3&citationFormat=1">EndNote</a>
<a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2788346&resourceType=3&citationFormat=2">BibTex</a>
<a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2788346&resourceType=3&citationFormat=3">Medlars</a>
<a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2788346&resourceType=3&citationFormat=0">ProCite</a>
<a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2788346&resourceType=3&citationFormat=3">RefWorks</a>
<a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2788346&resourceType=3&citationFormat=0">Reference Manager</a>
<a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=2788346&resourceType=3&citationFormat=0">Mendeley</a>
</div>
<p class="get-citation-copyright">© 2022 </p>
<a class="close-reveal-modal icon-close" rel="nofollow"></a>
</div>
</div>
</li>
<li class="toolbar-permissions-wrap toolbar-tool-wrap">
<div class="widget-ToolboxPermissions widget-instance-AMA_Get_Permissions">
<a href="http://s100.copyright.com/AppDispatchServlet?publisherName=AMA&publication=0098-7484&title=Myocarditis+Cases+Reported+After+mRNA-Based+COVID-19+Vaccination+in+the+US+From+December+2020+to+August+2021&publicationDate=2022-01-25&volumeNum=327&issueNum=4&author=Oster%2c+Matthew+E.%3b+Shay%2c+David+K.&startPage=331&endPage=340&contentId=10.1001%2fjama.2021.24110&oa=&orderBeanReset=True" rel="nofollow" id="PermissionsLink" class="toolbar-tool toolbar-permissions is-b" target="_blank"><span class="toolbar-link-text">Permissions</span></a>
</div>
</li>
</ul>
<div class="widget-ArticleTopInfo widget-instance-AMA_ArticleTop_Info_Widget">
<div class="meta-access-type free-access is-b"></div>
<span class="hide tagmanagervalue" data-attribute="articleId" data-value="2788346" data-type="string"></span>
<span class="hide tagmanagervalue" data-attribute="arrArticleAuthor"
data-value="Matthew%20E.%C2%A0Oster%2C%C2%A0MD%2C%20MPH,David%20K.%C2%A0Shay%2C%C2%A0MD%2C%20MPH,John%20R.%C2%A0Su%2C%C2%A0MD%2C%20PhD%2C%20MPH,Julianne%C2%A0Gee%2C%C2%A0MPH,C.%20Buddy%C2%A0Creech%2C%C2%A0MD%2C%20MPH,Karen%20R.%C2%A0Broder%2C%C2%A0MD,Kathryn%C2%A0Edwards%2C%C2%A0MD,Jonathan%20H.%C2%A0Soslow%2C%C2%A0MD%2C%20MSCI,Jeffrey%20M.%C2%A0Dendy%2C%C2%A0MD,Elizabeth%C2%A0Schlaudecker%2C%C2%A0MD%2C%20MPH,Sean%20M.%C2%A0Lang%2C%C2%A0MD,Elizabeth%20D.%C2%A0Barnett%2C%C2%A0MD,Frederick%20L.%C2%A0Ruberg%2C%C2%A0MD,Michael%20J.%C2%A0Smith%2C%C2%A0MD%2C%20MSCE,M.%20Jay%C2%A0Campbell%2C%C2%A0MD%2C%20MHA,Renato%20D.%C2%A0Lopes%2C%C2%A0MD%2C%20PhD%2C%20MHS,Laurence%20S.%C2%A0Sperling%2C%C2%A0MD,Jane%20A.%C2%A0Baumblatt%2C%C2%A0MD,Deborah%20L.%C2%A0Thompson%2C%C2%A0MD%2C%20MSPH,Paige%20L.%C2%A0Marquez%2C%C2%A0MSPH,Penelope%C2%A0Strid%2C%C2%A0MPH,Jared%C2%A0Woo%2C%C2%A0MPH,River%C2%A0Pugsley%2C%C2%A0PhD%2C%20MPH,Sarah%C2%A0Reagan-Steiner%2C%C2%A0MD%2C%20MPH,Frank%C2%A0DeStefano%2C%C2%A0MD%2C%20MPH,Tom%20T.%C2%A0Shimabukuro%2C%C2%A0MD%2C%20MPH%2C%20MBA"
data-type="array"></span>
<span class="hide tagmanagervalue" data-attribute="articleDOI" data-value="10.1001/jama.2021.24110" data-type="string"></span>
<span class="hide tagmanagervalue" data-attribute="articleTitle" data-value="Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021" data-type="string"></span>
<span class="hide tagmanagervalue" data-attribute="articleType" data-value="Original Investigation" data-type="string"></span>
<span class="hide tagmanagervalue" data-attribute="issueVolume" data-value="327" data-type="string"></span>
<span class="hide tagmanagervalue" data-attribute="issueNo" data-value="4" data-type="string"></span>
<span class="hide tagmanagervalue" data-attribute="publishDate" data-value="January 25, 2022" data-type="string"></span>
<span class="hide tagmanagervalue" data-attribute="journalClub" data-value="No" data-type="string"></span>
<span class="hide tagmanagervalue" data-attribute="articleStatus" data-value="Free" data-type="string"></span>
<span class="hide tagmanagervalue" data-attribute="articlePubState" data-value="Final" data-type="string"></span>
<div class="meta-article-type-wrap">
<div class="meta-article-type thm-col">Original Investigation </div>
</div>
<div class="meta-date"><span class="ppub"><span class="month">January </span><span class="day">25, </span><span class="year">2022</span></span></div>
<div class="meta-article-title-wrap">
<h1 class="meta-article-title ">Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021</h1>
</div>
<div class="meta-authors">
<span class="meta-authors--limited"><span
class="wi-fullname brand-fg"><a href="/searchresults?author=Matthew+E.+Oster&q=Matthew+E.+Oster" rel="nofollow" target="_blank">Matthew E. Oster, MD, MPH<sup>1,2,3</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=David+K.+Shay&q=David+K.+Shay" rel="nofollow" target="_blank">David K. Shay, MD, MPH<sup>1</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=John+R.+Su&q=John+R.+Su" rel="nofollow" target="_blank">John R. Su, MD, PhD, MPH<sup>1</sup></a></span>;
<a class="meta-authors--etal td-u">et al</a></span>
<span class="meta-authors--remaining"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Julianne+Gee&q=Julianne+Gee" rel="nofollow" target="_blank">Julianne Gee, MPH<sup>1</sup></a></span><span
class="al-author-delim">; </span><span
class="wi-fullname brand-fg"><a href="/searchresults?author=C.+Buddy+Creech&q=C.+Buddy+Creech" rel="nofollow" target="_blank">C. Buddy Creech, MD, MPH<sup>4</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Karen+R.+Broder&q=Karen+R.+Broder" rel="nofollow" target="_blank">Karen R. Broder, MD<sup>1</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Kathryn+Edwards&q=Kathryn+Edwards" rel="nofollow" target="_blank">Kathryn Edwards, MD<sup>4</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jonathan+H.+Soslow&q=Jonathan+H.+Soslow" rel="nofollow" target="_blank">Jonathan H. Soslow, MD, MSCI<sup>4</sup></a></span><span
class="al-author-delim">; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jeffrey+M.+Dendy&q=Jeffrey+M.+Dendy" rel="nofollow" target="_blank">Jeffrey M. Dendy, MD<sup>4</sup></a></span><span
class="al-author-delim">; </span><span
class="wi-fullname brand-fg"><a href="/searchresults?author=Elizabeth+Schlaudecker&q=Elizabeth+Schlaudecker" rel="nofollow" target="_blank">Elizabeth Schlaudecker, MD, MPH<sup>5</sup></a></span><span
class="al-author-delim">; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Sean+M.+Lang&q=Sean+M.+Lang" rel="nofollow" target="_blank">Sean M. Lang, MD<sup>5</sup></a></span><span
class="al-author-delim">; </span><span
class="wi-fullname brand-fg"><a href="/searchresults?author=Elizabeth+D.+Barnett&q=Elizabeth+D.+Barnett" rel="nofollow" target="_blank">Elizabeth D. Barnett, MD<sup>6</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Frederick+L.+Ruberg&q=Frederick+L.+Ruberg" rel="nofollow" target="_blank">Frederick L. Ruberg, MD<sup>6</sup></a></span><span
class="al-author-delim">; </span><span
class="wi-fullname brand-fg"><a href="/searchresults?author=Michael+J.+Smith&q=Michael+J.+Smith" rel="nofollow" target="_blank">Michael J. Smith, MD, MSCE<sup>7</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=M.+Jay+Campbell&q=M.+Jay+Campbell" rel="nofollow" target="_blank">M. Jay Campbell, MD, MHA<sup>7</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Renato+D.+Lopes&q=Renato+D.+Lopes" rel="nofollow" target="_blank">Renato D. Lopes, MD, PhD, MHS<sup>7</sup></a></span><span
class="al-author-delim">; </span><span
class="wi-fullname brand-fg"><a href="/searchresults?author=Laurence+S.+Sperling&q=Laurence+S.+Sperling" rel="nofollow" target="_blank">Laurence S. Sperling, MD<sup>1,2</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jane+A.+Baumblatt&q=Jane+A.+Baumblatt" rel="nofollow" target="_blank">Jane A. Baumblatt, MD<sup>8</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Deborah+L.+Thompson&q=Deborah+L.+Thompson" rel="nofollow" target="_blank">Deborah L. Thompson, MD, MSPH<sup>8</sup></a></span><span
class="al-author-delim">; </span><span
class="wi-fullname brand-fg"><a href="/searchresults?author=Paige+L.+Marquez&q=Paige+L.+Marquez" rel="nofollow" target="_blank">Paige L. Marquez, MSPH<sup>1</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Penelope+Strid&q=Penelope+Strid" rel="nofollow" target="_blank">Penelope Strid, MPH<sup>1</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jared+Woo&q=Jared+Woo" rel="nofollow" target="_blank">Jared Woo, MPH<sup>1</sup></a></span><span class="al-author-delim">; </span><span
class="wi-fullname brand-fg"><a href="/searchresults?author=River+Pugsley&q=River+Pugsley" rel="nofollow" target="_blank">River Pugsley, PhD, MPH<sup>1</sup></a></span><span class="al-author-delim">; </span><span
class="wi-fullname brand-fg"><a href="/searchresults?author=Sarah+Reagan-Steiner&q=Sarah+Reagan-Steiner" rel="nofollow" target="_blank">Sarah Reagan-Steiner, MD, MPH<sup>1</sup></a></span><span
class="al-author-delim">; </span><span
class="wi-fullname brand-fg"><a href="/searchresults?author=Frank+DeStefano&q=Frank+DeStefano" rel="nofollow" target="_blank">Frank DeStefano, MD, MPH<sup>1</sup></a></span><span class="al-author-delim">;
</span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Tom+T.+Shimabukuro&q=Tom+T.+Shimabukuro" rel="nofollow" target="_blank">Tom T. Shimabukuro, MD, MPH, MBA<sup>1</sup></a></span></span>
</div>
<div class="meta-author">
<a class="meta-author-title is-b" data-tog-target=".meta-author-content">Author Affiliations</a>
<a class="meta-articleinfo-jumplink section-jump-link scroll-to target-exists" data-tab-toggle=".tab-nav-full-text" href="#248198305">Article Information</a>
<div class="meta-author-content">
<ul class="meta-author-affiliations">
<li class="meta-author-affiliation">
<div class="meta-author-name"><sup>1</sup>US Centers for Disease Control and Prevention, Atlanta, Georgia</div>
</li>
<li class="meta-author-affiliation">
<div class="meta-author-name"><sup>2</sup>School of Medicine, Emory University, Atlanta, Georgia</div>
</li>
<li class="meta-author-affiliation">
<div class="meta-author-name"><sup>3</sup>Children’s Healthcare of Atlanta, Atlanta, Georgia</div>
</li>
<li class="meta-author-affiliation">
<div class="meta-author-name"><sup>4</sup>Vanderbilt University Medical Center, Nashville, Tennessee</div>
</li>
<li class="meta-author-affiliation">
<div class="meta-author-name"><sup>5</sup>Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio</div>
</li>
<li class="meta-author-affiliation">
<div class="meta-author-name"><sup>6</sup>Boston Medical Center, Boston, Massachusetts</div>
</li>
<li class="meta-author-affiliation">
<div class="meta-author-name"><sup>7</sup>Duke University, Durham, North Carolina</div>
</li>
<li class="meta-author-affiliation">
<div class="meta-author-name"><sup>8</sup>US Food and Drug Administration, Silver Spring, Maryland</div>
</li>
</ul>
</div>
</div>
<div class="meta-citation-wrap">
<span class="meta-citation-journal-name">JAMA. </span><span class="meta-citation"> 2022;327(4):331-340. doi:10.1001/jama.2021.24110</span>
</div>
</div>
<div class="widget-EditorsChoice widget-instance-AMA_EditorsChoice_Links">
</div>
<div class="widget-LinkedContentToolbar widget-instance-AMA_LinkedContentToolbar">
<div class="linked-content-toolbar activated">
<div class="hidden js-search-open-multimedia-by-default" showcontentbydefault="False"></div>
<div class="linked-content-controls">
<a class="linked-content-trigger td-n tab-no-content" href="#graphical-abstract-tab" style="display: none!important">
<i class="icon-visual-abstract"><span class="sr-t">visual abstract icon</span></i>
<div class="trigger-text d-ib va-m ta-l fw-5 visuallyhidden">Visual <div>Abstract</div></div>
</a>
<a class="linked-content-trigger td-n tab-no-content" href="#editorial-comment-tab" style="display: none!important">
<i class="icon-document"><span class="sr-t">editorial comment icon</span></i>
<div class="trigger-text d-ib va-m ta-l fw-5 visuallyhidden">Editorial <div>Comment</div></div>
</a>
<a class="linked-content-trigger td-n" href="#related-articles-tab">
<i class="icon-related"><span class="sr-t">related articles icon</span></i>
<div class="trigger-text d-ib va-m ta-l fw-5 visuallyhidden">Related <div>Articles</div></div>
</a>
<a class="linked-content-trigger td-n tab-no-content" href="#author-interviews-tab" style="display: none!important">
<i class="icon-author_interview"><span class="sr-t">author interview icon</span></i>
<div class="trigger-text d-ib va-m ta-l fw-5 visuallyhidden">Interviews</div>
</a>
<a class="linked-content-trigger td-n tab-no-content" href="#more-multimedia-tab" style="display: none!important">
<i class="icon-multimedia"><span class="sr-t">multimedia icon</span></i>
<div class="trigger-text d-ib va-m ta-l fw-5 visuallyhidden">Multimedia</div>
</a>
</div>
<div class="linked-content-tabs">
<div id="graphical-abstract-tab" class="linked-content-tab graphical-abstract-tab" style="display: none!important">
<div class="widget-SectionDisplay widget-instance-AMA_GraphicalAbstract_Tab">
</div>
</div>
<div id="editorial-comment-tab" class="linked-content-tab editorial-comment-tab" style="display: none!important">
<div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_EditorialComments">
</div>
</div>
<div id="related-articles-tab" class="linked-content-tab related-article-tab">
<div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_RelatedArticle">
<ul class="article-abstract-links related-abstract-content">
<li class="article-link related-abstract-article">
<a class="related-article-title" href="https://jamanetwork.com/journals/jama/fullarticle/2782900">
<div class="related-article-type">Research Letter</div>
<div class="related-article-title sb-tc">Myocarditis and Pericarditis After Vaccination for COVID-19</div>
</a>
<div class="related-article-authors">George A. Diaz, MD; Guilford T. Parsons, MD, MS; Sara K. Gering, BS, BSN; Audrey R. Meier, MPH; Ian V. Hutchinson, PhD, DSc;
Ari Robicsek, MD</div>
</li>
<li class="article-link related-abstract-article">
<a class="related-article-title" href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2781601">
<div class="related-article-type">Brief Report</div>
<div class="related-article-title sb-tc">Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military</div>
</a>
<div class="related-article-authors">Jay Montgomery, MD; Margaret Ryan, MD, MPH; Renata Engler, MD; Donna Hoffman, MSN; Bruce McClenathan, MD; Limone Collins, MD;
David Loran, DNP; David Hrncir, MD; Kelsie Herring, MD; Michael Platzer, MD; Nehkonti Adams, MD; Aliye Sanou, MD; Leslie T. Cooper Jr, MD</div>
</li>
<li class="article-link related-abstract-article">
<a class="related-article-title" href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2781602">
<div class="related-article-type">Brief Report</div>
<div class="related-article-title sb-tc">Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination</div>
</a>
<div class="related-article-authors">Han W. Kim, MD; Elizabeth R. Jenista, PhD; David C. Wendell, PhD; Clerio F. Azevedo, MD; Michael J. Campbell, MD; Stephen
N. Darty, BS; Michele A. Parker, MS; Raymond J. Kim, MD</div>
</li>
<li class="article-link related-abstract-article">
<a class="related-article-title" href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2783052">
<div class="related-article-type">Brief Report</div>
<div class="related-article-title sb-tc">Association of Myocarditis With BNT162b2 Vaccination in Children</div>
</a>
<div class="related-article-authors">Audrey Dionne, MD; Francesca Sperotto, MD; Stephanie Chamberlain; Annette L. Baker, MSN, CPNP; Andrew J. Powell, MD;
Ashwin Prakash, MD; Daniel A. Castellanos, MD; Susan F. Saleeb, MD; Sarah D. de Ferranti, MD, MPH; Jane W. Newburger, MD, MPH; Kevin G. Friedman, MD</div>
</li>
</ul>
</div>
<div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_RelatedEditorsChoices">
</div>
</div>
<div id="author-interviews-tab" class="linked-content-tab linked-author-interviews-tab" style="display: none!important">
<div class="widget-AudioPlayer widget-instance-AMA_LinkedContentToolbar_PlatformAudioPlayer_AuthorInterviews">
</div>
</div>
<div id="more-multimedia-tab" class="linked-content-tab more-multimedia-tab" style="display: none!important">
</div>
</div>
</div>
</div>
<div class="widget-ArticleFulltext widget-instance-AMA_Article_FullText_Widget">
<div class="article-full-text" data-userhasaccess="True">
<a class="article-section-id-anchor" id="248198253"></a>
<span class="heading-text thm-col h3 cb section-type-keyPoints decorated-hed sb-sc ">Key Points</span>
<p><strong>Question</strong> <span>What is the risk of myocarditis after mRNA-based COVID-19 vaccination in the US?</span></p>
<p><strong>Findings</strong> <span>In this descriptive study of 1626 cases of myocarditis in a national passive reporting system, the crude reporting rates within 7 days after vaccination exceeded the expected rates across
multiple age and sex strata. The rates of myocarditis cases were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17
years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively).</span></p>
<p><strong>Meaning</strong> <span>Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the
second vaccination dose in adolescent males and young men.</span></p> <a class="article-section-id-anchor" id="248198254"></a>
<div class="h3 cb section-type-abstract decorated-hed ">
<div class="heading-text thm-col sb-sc"> Abstract </div>
</div>
<p><strong>Importance</strong> <span>Vaccination against COVID-19 provides clear public health benefits, but vaccination also carries potential risks. The risks and outcomes of myocarditis after COVID-19 vaccination are
unclear.</span></p>
<p><strong>Objective</strong> <span>To describe reports of myocarditis and the reporting rates after mRNA-based COVID-19 vaccination in the US.</span></p>
<p><strong>Design, Setting, and Participants</strong> <span>Descriptive study of reports of myocarditis to the Vaccine Adverse Event Reporting System (VAERS) that occurred after mRNA-based COVID-19 vaccine administration between
December 2020 and August 2021 in 192 405 448 individuals older than 12 years of age in the US; data were processed by VAERS as of September 30, 2021.</span></p>
<p><strong>Exposures</strong> <span>Vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna).</span></p>
<p><strong>Main Outcomes and Measures</strong> <span>Reports of myocarditis to VAERS were adjudicated and summarized for all age groups. Crude reporting rates were calculated across age and sex strata. Expected rates of
myocarditis by age and sex were calculated using 2017-2019 claims data. For persons younger than 30 years of age, medical record reviews and clinician interviews were conducted to describe clinical presentation, diagnostic test
results, treatment, and early outcomes.</span></p>
<p><strong>Results</strong> <span>Among 192 405 448 persons receiving a total of 354 100 845 mRNA-based COVID-19 vaccines during the study period, there were 1991 reports of myocarditis to VAERS and 1626 of these reports met the
case definition of myocarditis. Of those with myocarditis, the median age was 21 years (IQR, 16-31 years) and the median time to symptom onset was 2 days (IQR, 1-3 days). Males comprised 82% of the myocarditis cases for whom sex
was reported. The crude reporting rates for cases of myocarditis within 7 days after COVID-19 vaccination exceeded the expected rates of myocarditis across multiple age and sex strata. The rates of myocarditis were highest after
the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged
18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively). There were 826 cases of myocarditis among those younger than 30 years of age who had detailed clinical information
available; of these cases, 792 of 809 (98%) had elevated troponin levels, 569 of 794 (72%) had abnormal electrocardiogram results, and 223 of 312 (72%) had abnormal cardiac magnetic resonance imaging results. Approximately 96% of
persons (784/813) were hospitalized and 87% (577/661) of these had resolution of presenting symptoms by hospital discharge. The most common treatment was nonsteroidal anti-inflammatory drugs (589/676; 87%).</span></p>
<p><strong>Conclusions and Relevance</strong> <span>Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was
highest after the second vaccination dose in adolescent males and young men. This risk should be considered in the context of the benefits of COVID-19 vaccination.</span></p>
<div class="movable-ad-target bta">
<div class="movable-ad bta">
<div id="ad-dual-box-mobile" class="ad-dual-box-mobile lazy-ad advertisement ad-text tablet-down" data-slot="8">
<script>
googletag.cmd.push(function() {
if (!App.suppressAds && (App.isAbstract || ((App.isSplitScreen || App.isMag) && !App.hasAccess))) {
App.Ads.Mappings.dualMobile = googletag.sizeMapping().addSize([1023, 600], [0, 0]).addSize([0, 600], [
[300, 250],
[300, 600]
]).addSize([0, 0], [300, 250]).build();
App.Ads.slots[8] = googletag.defineSlot(App.Ads.adPath + '/textbreak', [300, 250], 'ad-dual-box-mobile').setTargeting('pos', ['bta']).defineSizeMapping(App.Ads.Mappings.dualMobile).addService(googletag.pubads());
googletag.display('ad-dual-box-mobile');
} else {
$(".ad-dual-box-mobile").removeClass("ad-text");
}
});
</script>
</div>
</div>
</div>
<a class="article-section-id-anchor" id="248198259"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Introduction </div>
</div>
<a class="article-section-id-anchor" id="248198260"></a>
<p class="para">Myocarditis is an inflammatory condition of the heart muscle that has a bimodal peak incidence during infancy and adolescence or young
adulthood.<sup><a href="#joi210145r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup><sup>-<a href="#joi210145r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">4</a></sup>
The clinical presentation and course of myocarditis is variable, with some patients not requiring treatment and others experiencing severe heart failure that requires subsequent heart transplantation or leads to
death.<sup><a href="#joi210145r5" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">5</a></sup> Onset of myocarditis typically follows an inciting process, often a viral illness; however, no antecedent cause
is identified in many cases.<sup><a href="#joi210145r6" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">6</a></sup> It has been hypothesized that vaccination can serve as a trigger for myocarditis; however,
only the smallpox vaccine has previously been causally associated with myocarditis based on reports among US military personnel, with cases typically occurring 7 to 12 days after
vaccination.<sup><a href="#joi210145r7" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup></p> <a class="article-section-id-anchor" id="248198261"></a>
<p class="para">With the implementation of a large-scale, national COVID-19 vaccination program starting in December 2020, the US Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration began
monitoring for a number of adverse events of special interest, including myocarditis and pericarditis, in the Vaccine Adverse Event Reporting System (VAERS), a long-standing national spontaneous reporting (passive surveillance)
system.<sup><a href="#joi210145r8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a></sup> As the reports of myocarditis after COVID-19 vaccination were reported to VAERS, the Clinical Immunization
Safety Assessment Project,<sup><a href="#joi210145r9" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">9</a></sup> a collaboration between the CDC and medical research centers, which includes physicians
treating infectious diseases and other specialists (eg, cardiologists), consulted on several of the cases. In addition, reports from several countries raised concerns that mRNA-based COVID-19 vaccines may be associated with acute
myocarditis.<sup><a href="#joi210145r10" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">10</a></sup><sup>-<a href="#joi210145r10" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">15</a></sup>
</p> <a class="article-section-id-anchor" id="248198262"></a>
<p class="para">Given this concern, the aims were to describe reports and confirmed cases of myocarditis initially reported to VAERS after mRNA-based COVID-19 vaccination and to provide estimates of the risk of myocarditis after
mRNA-based COVID-19 vaccination based on age, sex, and vaccine type.</p> <a class="article-section-id-anchor" id="248198263"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Methods </div>
</div>
<a class="article-section-id-anchor" id="248198264"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Data Sources </div>
</div>
<a class="article-section-id-anchor" id="248198265"></a>
<p class="para">VAERS is a US spontaneous reporting (passive surveillance) system that functions as an early warning system for potential vaccine adverse
events.<sup><a href="#joi210145r8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a></sup> Co-administered by the CDC and the US Food and Drug Administration, VAERS accepts reports of all adverse events
after vaccination from patients, parents, clinicians, vaccine manufacturers, and others regardless of whether the events could plausibly be associated with receipt of the vaccine. Reports to VAERS include information about the
vaccinated person, the vaccine or vaccines administered, and the adverse events experienced by the vaccinated person. The reports to VAERS are then reviewed by third-party professional coders who have been trained in the assignment
of Medical Dictionary for Regulatory Activities preferred terms.<sup><a href="#joi210145r16" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">16</a></sup> The coders then assign appropriate terms based on the
information available in the reports.</p> <a class="article-section-id-anchor" id="248198266"></a>
<p class="para">This activity was reviewed by the CDC and was conducted to be consistent with applicable federal law and CDC policy. The activities herein were confirmed to be nonresearch under the Common Rule in accordance with
institutional procedures and therefore were not subject to institutional review board requirements. Informed consent was not obtained for this secondary use of existing information; see 45 CFR part 46.102(l)(2), 21 CFR part 56, 42
USC §241(d), 5 USC §552a, and 44 USC §3501 et seq.</p> <a class="article-section-id-anchor" id="248198267"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Exposure </div>
</div>
<a class="article-section-id-anchor" id="248198268"></a>
<p class="para">The exposure of concern was vaccination with one of the mRNA-based COVID-19 vaccines: the BNT162b2 vaccine (Pfizer-BioNTech) or the mRNA-1273 vaccine (Moderna). During the analytic period, persons aged 12 years or
older were eligible for the BNT162b2 vaccine and persons aged 18 years or older were eligible for the mRNA-1273 vaccine. The number of COVID-19 vaccine doses administered during the analytic period was obtained through the CDC’s
COVID-19 Data Tracker.<sup><a href="#joi210145r17" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">17</a></sup></p> <a class="article-section-id-anchor" id="248198269"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Outcomes </div>
</div>
<a class="article-section-id-anchor" id="248198270"></a>
<p class="para">The primary outcome was the occurrence of myocarditis and the secondary outcome was pericarditis. Reports to VAERS with these outcomes were initially characterized using the Medical Dictionary for Regulatory Activities
preferred terms of myocarditis or pericarditis (specific terms are listed in the eMethods in the <a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-JOI210145-1">Supplement</a>). After
initial review of reports of myocarditis to VAERS and review of the patient’s medical records (when available), the reports were further reviewed by CDC physicians and public health professionals to verify that they met the CDC’s
case definition for probable or confirmed myocarditis (descriptions previously published and included in the eMethods in the
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-JOI210145-1">Supplement</a>).<sup><a href="#joi210145r18" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">18</a></sup>
The CDC’s case definition of probable myocarditis requires the presence of new concerning symptoms, abnormal cardiac test results, and no other identifiable cause of the symptoms and findings. Confirmed cases of myocarditis further
require histopathological confirmation of myocarditis or cardiac magnetic resonance imaging (MRI) findings consistent with myocarditis.</p> <a class="article-section-id-anchor" id="248198271"></a>
<p class="para">Deaths were included only if the individual had met the case definition for confirmed myocarditis and there was no other identifiable cause of death. Individual cases not involving death were included only if the
person had met the case definition for probable myocarditis or confirmed myocarditis.</p> <a class="article-section-id-anchor" id="248198272"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Statistical Analysis </div>
</div>
<a class="article-section-id-anchor" id="248198273"></a>
<p class="para">We characterized reports of myocarditis or pericarditis after COVID-19 vaccination that met the CDC’s case definition and were received by VAERS between December 14, 2020 (when COVID-19 vaccines were first publicly
available in the US), and August 31, 2021, by age, sex, race, ethnicity, and vaccine type; data were processed by VAERS as of September 30, 2021. Race and ethnicity were optional fixed categories available by self-identification at
the time of vaccination or by the individual filing a VAERS report. Race and ethnicity were included to provide the most complete baseline description possible for individual reports; however, further analyses were not stratified by
race and ethnicity due to the high percentage of missing data. Reports of pericarditis with evidence of potential myocardial involvement were included in the review of reports of myocarditis. The eFigure in the
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-JOI210145-1">Supplement</a> outlines the categorization of the reports of myocarditis and pericarditis reviewed.</p>
<a class="article-section-id-anchor" id="248198274"></a>
<p class="para">Further analyses were conducted only for myocarditis because of the preponderance of those reports to VAERS, in Clinical Immunization Safety Assessment Project consultations, and in published
articles.<sup><a href="#joi210145r10" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">10</a></sup><sup>-<a href="#joi210145r10" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">12</a>,<a href="#joi210145r19" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">19</a></sup><sup>-<a href="#joi210145r19" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">21</a></sup>
Crude reporting rates for myocarditis during a 7-day risk interval were calculated using the number of reports of myocarditis to VAERS per million doses of COVID-19 vaccine administered during the analytic period and stratified by
age, sex, vaccination dose (first, second, or unknown), and vaccine type. Expected rates of myocarditis by age and sex were calculated using 2017-2019 data from the IBM MarketScan Commercial Research Database. This database contains
individual-level, deidentified, inpatient and outpatient medical and prescription drug claims, and enrollment information submitted to IBM Watson Health by large employers and health plans. The data were accessed using version 4.0
of the IBM MarketScan Treatment Pathways analytic platform. Age- and sex-specific rates were calculated by determining the number of individuals with myocarditis
(<i>International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10]</i> codes B33.20, B33.22, B33.24, I40.0, I40.1, I40.8, I40.9, or
I51.4)<sup><a href="#joi210145r22" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">22</a></sup> identified during an inpatient encounter in 2017-2019 relative to the number of individuals of similar age and
sex who were continually enrolled during the year in which the myocarditis-related hospitalization occurred; individuals with any diagnosis of myocarditis prior to that year were excluded. Given the limitations of the IBM MarketScan
Commercial Research Database to capture enrollees aged 65 years or older, an expected rate for myocarditis was not calculated for this population. A 95% CI was calculated using Poisson distribution in SAS version 9.4 (SAS Institute
Inc) for each expected rate of myocarditis and for each observed rate in a strata with at least 1 case.</p> <a class="article-section-id-anchor" id="248198275"></a>
<p class="para">In cases of probable or confirmed myocarditis among those younger than 30 years of age, their clinical course was then summarized to the extent possible based on medical review and clinician interviews. This clinical
course included presenting symptoms, diagnostic test results, treatment, and early outcomes (abstraction form appears in the eMethods in the
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-JOI210145-1">Supplement</a>).<sup><a href="#joi210145r23" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">23</a></sup>
</p> <a class="article-section-id-anchor" id="248198276"></a>
<p class="para">When applicable, missing data were delineated in the results or the numbers with complete data were listed. No assumptions or imputations were made regarding missing data. Any percentages that were calculated included
only those cases of myocarditis with adequate data to calculate the percentages.</p> <a class="article-section-id-anchor" id="248198277"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Results </div>
</div>
<a class="article-section-id-anchor" id="248198278"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Case Characteristics </div>
</div>
<a class="article-section-id-anchor" id="248198279"></a>
<p class="para">Between December 14, 2020, and August 31, 2021, 192 405 448 individuals older than 12 years of age received a total of 354 100 845 mRNA-based COVID-19 vaccines. VAERS received 1991 reports of myocarditis (391 of which
also included pericarditis) after receipt of at least 1 dose of mRNA-based COVID-19 vaccine (eTable 1 in the
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-JOI210145-1">Supplement</a>) and 684 reports of pericarditis without the presence of myocarditis (eTable 2 in the
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-JOI210145-1">Supplement</a>).</p> <a class="article-section-id-anchor" id="248198280"></a>
<p class="para">Of the 1991 reports of myocarditis, 1626 met the CDC’s case definition for probable or confirmed myocarditis
(<a href="#joi210145t1" class="table-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 1</a>). There were 208 reports that did not meet the CDC’s case definition for myocarditis and 157 reports that required more
information to perform adjudication (eTable 3 in the <a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-JOI210145-1">Supplement</a>). Of the 1626 reports that met the CDC’s case
definition for myocarditis, 1195 (73%) were younger than 30 years of age, 543 (33%) were younger than 18 years of age, and the median age was 21 years (IQR, 16-31 years)
(<a href="#joi210145f1" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure 1</a>). Of the reports of myocarditis with dose information, 82% (1265/1538) occurred after the second vaccination dose. Of
those with a reported dose and time to symptom onset, the median time from vaccination to symptom onset was 3 days (IQR, 1-8 days) after the first vaccination dose and 74% (187/254) of myocarditis events occurred within 7 days.
After the second vaccination dose, the median time to symptom onset was 2 days (IQR, 1-3 days) and 90% (1081/1199) of myocarditis events occurred within 7 days
(<a href="#joi210145f2" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure 2</a>).</p> <a class="article-section-id-anchor" id="248198284"></a>
<p class="para">Males comprised 82% (1334/1625) of the cases of myocarditis for whom sex was reported. The largest proportions of cases of myocarditis were among White persons (non-Hispanic or ethnicity not reported; 69% [914/1330])
and Hispanic persons (of all races; 17% [228/1330]). Among persons younger than 30 years of age, there were no confirmed cases of myocarditis in those who died after mRNA-based COVID-19 vaccination without another identifiable cause
and there was 1 probable case of myocarditis but there was insufficient information available for a thorough investigation. At the time of data review, there were 2 reports of death in persons younger than 30 years of age with
potential myocarditis that remain under investigation and are not included in the case counts.</p> <a class="article-section-id-anchor" id="248198285"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Reporting Rates of Myocarditis Within 7 Days After COVID-19 Vaccination </div>
</div>
<a class="article-section-id-anchor" id="248198286"></a>
<p class="para">Symptom onset of myocarditis was within 7 days after vaccination for 947 reports of individuals who received the BNT162b2 vaccine and for 382 reports of individuals who received the mRNA-1273 vaccine. The rates of
myocarditis varied by vaccine type, sex, age, and first or second vaccination dose (<a href="#joi210145t2" class="table-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 2</a>). The reporting rates of myocarditis
were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.73 [95% CI, 61.68-81.11] per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.86 [95% CI, 91.65-122.27]
per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.43 [95% CI, 45.56-60.33] per million doses of the BNT162b2 vaccine and 56.31 [95% CI, 47.08-67.34] per million doses of the mRNA-1273 vaccine). The
lower estimate of the 95% CI for reporting rates of myocarditis in adolescent males and young men exceeded the upper bound of the expected rates after the first vaccination dose with the BNT162b2 vaccine in those aged 12 to 24
years, after the second vaccination dose with the BNT162b2 vaccine in those aged 12 to 49 years, after the first vaccination dose with the mRNA-1273 vaccine in those aged 18 to 39 years, and after the second vaccination dose with
the mRNA-1273 vaccine in those aged 18 to 49 years.</p> <a class="article-section-id-anchor" id="248198288"></a>
<p class="para">The reporting rates of myocarditis in females were lower than those in males across all age strata younger than 50 years of age. The reporting rates of myocarditis were highest after the second vaccination dose in
adolescent females aged 12 to 15 years (6.35 [95% CI, 4.05-9.96] per million doses of the BNT162b2 vaccine), in adolescent females aged 16 to 17 years (10.98 [95% CI, 7.16-16.84] per million doses of the BNT162b2 vaccine), in young
women aged 18 to 24 years (6.87 [95% CI, 4.27-11.05] per million doses of the mRNA-1273 vaccine), and in women aged 25 to 29 years (8.22 [95% CI, 5.03-13.41] per million doses of the mRNA-1273 vaccine). The lower estimate of the 95%
CI for reporting rates of myocarditis in females exceeded the upper bound of the expected rates after the second vaccination dose with the BNT162b2 vaccine in those aged 12 to 29 years and after the second vaccination dose with the
mRNA-1273 vaccine in those aged 18 to 29 years.</p> <a class="article-section-id-anchor" id="248198289"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Clinical Course of Myocarditis After COVID-19 Vaccination in Persons Younger Than 30 Years of Age </div>
</div>
<a class="article-section-id-anchor" id="248198290"></a>
<p class="para">Among the 1372 reports of myocarditis in persons younger than 30 years of age, 1305 were able to be adjudicated, with 92% (1195/1305) meeting the CDC’s case definition. Of these, chart abstractions or medical
interviews were completed for 69% (826/1195) (<a href="#joi210145t3" class="table-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 3</a>). The symptoms commonly reported in the verified cases of myocarditis in
persons younger than 30 years of age included chest pain, pressure, or discomfort (727/817; 89%) and dyspnea or shortness of breath (242/817; 30%). Troponin levels were elevated in 98% (792/809) of the cases of myocarditis. The
electrocardiogram result was abnormal in 72% (569/794) of cases of myocarditis. Of the patients who had received a cardiac MRI, 72% (223/312) had abnormal findings consistent with myocarditis. The echocardiogram results were
available for 721 cases of myocarditis; of these, 84 (12%) demonstrated a notable decreased left ventricular ejection fraction (<50%). Among the 676 cases for whom treatment data were available, 589 (87%) received nonsteroidal
anti-inflammatory drugs. Intravenous immunoglobulin and glucocorticoids were each used in 12% of the cases of myocarditis (78/676 and 81/676, respectively). Intensive therapies such as vasoactive medications (12 cases of
myocarditis) and intubation or mechanical ventilation (2 cases) were rare. There were no verified cases of myocarditis requiring a heart transplant, extracorporeal membrane oxygenation, or a ventricular assist device. Of the 96%
(784/813) of cases of myocarditis who were hospitalized, 98% (747/762) were discharged from the hospital at time of review. In 87% (577/661) of discharged cases of myocarditis, there was resolution of the presenting symptoms by
hospital discharge.</p> <a class="article-section-id-anchor" id="248198292"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Discussion </div>
</div>
<a class="article-section-id-anchor" id="248198293"></a>
<p class="para">In this review of reports to VAERS between December 2020 and August 2021, myocarditis was identified as a rare but serious adverse event that can occur after mRNA-based COVID-19 vaccination, particularly in adolescent
males and young men. However, this increased risk must be weighed against the benefits of COVID-19 vaccination.<sup><a href="#joi210145r18" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">18</a></sup></p>
<a class="article-section-id-anchor" id="248198294"></a>
<p class="para">Compared with cases of non–vaccine-associated myocarditis, the reports of myocarditis to VAERS after mRNA-based COVID-19 vaccination were similar in demographic characteristics but different in their acute clinical
course. First, the greater frequency noted among vaccine recipients aged 12 to 29 years vs those aged 30 years or older was similar to the age distribution seen in typical cases of
myocarditis.<sup><a href="#joi210145r2" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">2</a></sup><sup>,<a href="#joi210145r4" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">4</a></sup>
This pattern may explain why cases of myocarditis were not discovered until months after initial Emergency Use Authorization of the vaccines in the US (ie, until the vaccines were widely available to younger persons). Second, the
sex distribution in cases of myocarditis after COVID-19 vaccination was similar to that seen in typical cases of myocarditis; there is a strong male predominance for both
conditions.<sup><a href="#joi210145r2" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">2</a></sup><sup>,<a href="#joi210145r4" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">4</a></sup>
</p> <a class="article-section-id-anchor" id="248198295"></a>
<p class="para">However, the onset of myocarditis symptoms after exposure to a potential immunological trigger was shorter for COVID-19 vaccine–associated cases of myocarditis than is typical for myocarditis cases diagnosed after a
viral
illness.<sup><a href="#joi210145r24" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">24</a></sup><sup>-<a href="#joi210145r24" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">26</a></sup>
Cases of myocarditis reported after COVID-19 vaccination were typically diagnosed within days of vaccination, whereas cases of typical viral myocarditis can often have indolent courses with symptoms sometimes present for weeks to
months after a trigger if the cause is ever identified.<sup><a href="#joi210145r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup> The major presenting symptoms appeared to resolve faster in
cases of myocarditis after COVID-19 vaccination than in typical viral cases of myocarditis. Even though almost all individuals with cases of myocarditis were hospitalized and clinically monitored, they typically experienced
symptomatic recovery after receiving only pain management. In contrast, typical viral cases of myocarditis can have a more variable clinical course. For example, up to 6% of typical viral myocarditis cases in adolescents require a
heart transplant or result in mortality.<sup><a href="#joi210145r27" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">27</a></sup></p> <a class="article-section-id-anchor" id="248198296"></a>
<p class="para">In the current study, the initial evaluation and treatment of COVID-19 vaccine–associated myocarditis cases was similar to that of typical myocarditis
cases.<sup><a href="#joi210145r28" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">28</a></sup><sup>-<a href="#joi210145r28" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">31</a></sup>
Initial evaluation usually included measurement of troponin level, electrocardiography, and echocardiography.<sup><a href="#joi210145r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup> Cardiac
MRI was often used for diagnostic purposes and also for possible prognostic
purposes.<sup><a href="#joi210145r32" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">32</a></sup><sup>,<a href="#joi210145r33" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">33</a></sup>
Supportive care was a mainstay of treatment, with specific cardiac or intensive care therapies as indicated by the patient’s clinical status.</p> <a class="article-section-id-anchor" id="248198297"></a>
<p class="para">Long-term outcome data are not yet available for COVID-19 vaccine–associated myocarditis cases. The CDC has started active follow-up surveillance in adolescents and young adults to assess the health and functional
status and cardiac outcomes at 3 to 6 months in probable and confirmed cases of myocarditis reported to VAERS after COVID-19
vaccination.<sup><a href="#joi210145r34" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">34</a></sup> For patients with myocarditis, the American Heart Association and the American College of Cardiology
guidelines advise that patients should be instructed to refrain from competitive sports for 3 to 6 months, and that documentation of a normal electrocardiogram result, ambulatory rhythm monitoring, and an exercise test should be
obtained prior to resumption of sports.<sup><a href="#joi210145r35" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">35</a></sup> The use of cardiac MRI is unclear, but it may be useful in evaluating the
progression or resolution of myocarditis in those with abnormalities on the baseline cardiac MRI.<sup><a href="#joi210145r36" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">36</a></sup> Further doses of
mRNA-based COVID-19 vaccines should be deferred, but may be considered in select circumstances.<sup><a href="#joi210145r37" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">37</a></sup></p>
<a class="article-section-id-anchor" id="248198298"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Limitations </div>
</div>
<a class="article-section-id-anchor" id="248198299"></a>
<p class="para">This study has several limitations. First, although clinicians are required to report serious adverse events after COVID-19 vaccination, including all events leading to hospitalization, VAERS is a passive reporting
system. As such, the reports of myocarditis to VAERS may be incomplete, and the quality of the information reported is variable. Missing data for sex, vaccination dose number, and race and ethnicity were not uncommon in the reports
received; history of prior SARS-CoV-2 infection also was not known. Furthermore, as a passive system, VAERS data are subject to reporting biases in that both underreporting and overreporting are
possible.<sup><a href="#joi210145r38" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">38</a></sup> Given the high verification rate of reports of myocarditis to VAERS after mRNA-based COVID-19 vaccination,
underreporting is more likely. Therefore, the actual rates of myocarditis per million doses of vaccine are likely higher than estimated.</p> <a class="article-section-id-anchor" id="248198300"></a>
<p class="para">Second, efforts by CDC investigators to obtain medical records or interview physicians were not always successful despite the special allowance for sharing information with the CDC under the Health Insurance
Portability and Accountability Act of 1996.<sup><a href="#joi210145r39" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">39</a></sup> This challenge limited the ability to perform case adjudication and
complete investigations for some reports of myocarditis, although efforts are still ongoing when feasible.</p> <a class="article-section-id-anchor" id="248198301"></a>
<p class="para">Third, the data from vaccination administration were limited to what is reported to the CDC and thus may be incomplete, particularly with regard to demographics.</p>
<a class="article-section-id-anchor" id="248198302"></a>
<p class="para">Fourth, calculation of expected rates from the IBM MarketScan Commercial Research Database relied on administrative data via the use of <i>ICD-10</i> codes and there was no opportunity for clinical review. Furthermore,
these data had limited information regarding the Medicare population; thus expected rates for those older than 65 years of age were not calculated. However, it is expected that the rates in those older than 65 years of age would not
be higher than the rates in those aged 50 to 64 years.<sup><a href="#joi210145r4" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">4</a></sup></p> <a class="article-section-id-anchor" id="248198303"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Conclusions </div>
</div>
<a class="article-section-id-anchor" id="248198304"></a>
<p class="para">Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose
in adolescent males and young men. This risk should be considered in the context of the benefits of COVID-19 vaccination.</p> <a class="article-section-id-anchor" id="248198305"></a>
<div class="h3 cb section-type-acknowledgements has-back-to-top">
<a href="#top" class="section-jump-link back-to-top" data-tab-toggle=".tab-nav-full-text">Back to top</a>
<div class="heading-text thm-col sb-sc"> Article Information </div>
</div>
<p class="authorInfoSection"><strong>Corresponding Author:</strong> Matthew E. Oster, MD, MPH, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333
(<a href="mailto:eocevent416@cdc.gov" target="_blank">eocevent416@cdc.gov</a>).</p>
<p class="para"><strong>Accepted for Publication:</strong> December 16, 2021.</p>
<p class="paraauthor-contributions"><strong>Author Contributions:</strong> Drs Oster and Su had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
</p>
<p class="para"><i>Concept and design:</i> Oster, Shay, Su, Creech, Edwards, Dendy, Schlaudecker, Woo, Shimabukuro.</p>
<p class="para"><i>Acquisition, analysis, or interpretation of data:</i> Oster, Shay, Su, Gee, Creech, Broder, Edwards, Soslow, Schlaudecker, Lang, Barnett, Ruberg, Smith, Campbell, Lopes, Sperling, Baumblatt, Thompson, Marquez,
Strid, Woo, Pugsley, Reagan-Steiner, DeStefano, Shimabukuro.</p>
<p class="para"><i>Drafting of the manuscript:</i> Oster, Shay, Su, Gee, Creech, Marquez, Strid, Woo, Shimabukuro.</p>
<p class="para"><i>Critical revision of the manuscript for important intellectual content: </i>Oster, Shay, Su, Creech, Broder, Edwards, Soslow, Dendy, Schlaudecker, Lang, Barnett, Ruberg, Smith, Campbell, Lopes, Sperling, Baumblatt,
Thompson, Pugsley, Reagan-Steiner, DeStefano, Shimabukuro.</p>
<p class="para"><i>Statistical analysis:</i> Oster, Su, Marquez, Strid, Woo, Shimabukuro.</p>
<p class="para"><i>Obtained funding:</i> Edwards, DeStefano.</p>
<p class="para"><i>Administrative, technical, or material support:</i> Oster, Gee, Creech, Broder, Edwards, Soslow, Schlaudecker, Smith, Baumblatt, Thompson, Reagan-Steiner, DeStefano.</p>
<p class="para"><i>Supervision:</i> Su, Edwards, Soslow, Dendy, Schlaudecker, Campbell, Sperling, DeStefano, Shimabukuro.</p>
<p class="parafinancial-disclosure"><strong>Conflict of Interest Disclosures:</strong> Dr Creech reported receiving grants from the National Institutes of Health for the Moderna and Janssen clinical trials and receiving personal fees
from Astellas and Horizon. Dr Edwards reported receiving grants from the National Institutes of Health; receiving personal fees from BioNet, IBM, X-4 Pharma, Seqirus, Roche, Pfizer, Merck, Moderna, and Sanofi; and receiving
compensation for being the associate editor of <i>Clinical Infectious Diseases</i>. Dr Soslow reported receiving personal fees from Esperare. Dr Schlaudecker reported receiving grants from Pfizer and receiving personal fees from
Sanofi Pasteur. Drs Barnett, Ruberg, and Smith reported receiving grants from Pfizer. Dr Lopes reported receiving personal fees from Bayer, Boehringer Ingleheim, Bristol Myers Squibb, Daiichi Sankyo, GlaxoSmithKline, Medtronic,
Merck, Pfizer, Portola, and Sanofi and receiving grants from Bristol Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi. No other disclosures were reported.</p>
<p class="parafunding-statement"><strong>Funding/Support:</strong> This work was supported by contracts 200-2012-53709 (Boston Medical Center), 200-2012-53661 (Cincinnati Children’s Hospital Medical Center), 200-2012-53663 (Duke
University), and 200-2012-50430 (Vanderbilt University Medical Center) with the US Centers for Disease Control and Prevention (CDC) Clinical Immunization Safety Assessment Project.</p>
<p class="para"><strong>Role of the Funder/Sponsor:</strong> The CDC provided funding via the Clinical Immunization Safety Assessment Project to Drs Creech, Edwards, Soslow, Dendy, Schlaudecker, Lang, Barnett, Ruberg, Smith, Campbell,
and Lopes. The authors affiliated with the CDC along with the other coauthors conducted the investigations; performed collection, management, analysis, and interpretation of the data; were involved in the preparation, review, and
approval of the manuscript; and made the decision to submit the manuscript for publication.</p>
<p class="para"><strong>Disclaimer:</strong> The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the CDC or the US Food and Drug Administration. Mention of a
product or company name is for identification purposes only and does not constitute endorsement by the CDC or the US Food and Drug Administration.</p>
<p class="para"><strong>Additional Contributions:</strong> We thank the following CDC staff who contributed to this article without compensation outside their normal salaries (in alphabetical order and contribution specified in
parenthesis at end of each list of names): Nickolas Agathis, MD, MPH, Stephen R. Benoit, MD, MPH, Beau B. Bruce, MD, PhD, Abigail L. Carlson, MD, MPH, Meredith G. Dixon, MD, Jonathan Duffy, MD, MPH, Charles Duke, MD, MPH, Charles
Edge, MSN, MS, Robyn Neblett Fanfair, MD, MPH, Nathan W. Furukawa, MD, MPH, Gavin Grant, MD, MPH, Grace Marx, MD, MPH, Maureen J. Miller, MD, MPH, Pedro Moro, MD, MPH, Meredith Oakley, DVM, MPH, Kia Padgett, MPH, BSN, RN, Janice
Perez-Padilla, MPH, BSN, RN, Robert Perry, MD, MPH, Nimia Reyes, MD, MPH, Ernest E. Smith, MD, MPH&TM, David Sniadack, MD, MPH, Pamela Tucker, MD, Edward C. Weiss, MD, MPH, Erin Whitehouse, PhD, MPH, RN, Pascale M. Wortley, MD,
MPH, and Rachael Zacks, MD (for clinical investigations and interviews); Amelia Jazwa, MSPH, Tara Johnson, MPH, MS, and Jamila Shields, MPH (for project coordination); Charles Licata, PhD, and Bicheng Zhang, MS (for data acquisition
and organization); Charles E. Rose, PhD (for statistical consultation); and Scott D. Grosse, PhD (for calculation of expected rates of myocarditis). We also thank the clinical staff who cared for these patients and reported the
adverse events to the Vaccine Adverse Event Reporting System.</p> <a class="article-section-id-anchor" id="248198306"></a>
<div class="h3 cb section-type-references ">
<div class="heading-text thm-col sb-sc"> References </div>
</div>
<div class="references">
<div class="reference"><a class="reference-number" id="joi210145r1">1.</a>
<div class="reference-content">Cooper LT Jr. Myocarditis. <i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 2009;360(15):1526-1538.
doi:<a href="http://dx.doi.org/10.1056/NEJMra0800028">10.1056/NEJMra0800028</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/19357408" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis.&author=LT%20Cooper&publication_year=2009&journal=N%20Engl%20J%20Med&volume=360&pages=1526-1538" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMra0800028" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r2">2.</a>
<div class="reference-content">Vasudeva R, Bhatt P, Lilje C, et al. Trends in acute myocarditis–related pediatric hospitalizations in the United States, 2007-2016.
<i xmlns:helper="urn:XsltStringHelper"> Am J Cardiol</i>. 2021;149:95-102.
doi:<a href="http://dx.doi.org/10.1016/j.amjcard.2021.03.019">10.1016/j.amjcard.2021.03.019</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33757784" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Trends%20in%20acute%20myocarditis%E2%80%93related%20pediatric%20hospitalizations%20in%20the%20United%20States%2C%202007-2016.&author=R%20Vasudeva&author=P%20Bhatt&author=C%20Lilje&publication_year=2021&journal=Am%20J%20Cardiol&volume=149&pages=95-102" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.amjcard.2021.03.019" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r3">3.</a>
<div class="reference-content">Arola A, Pikkarainen E, Sipilä JO, Pykäri J, Rautava P, Kytö V. Occurrence and features of childhood myocarditis: a nationwide study in Finland.
<i xmlns:helper="urn:XsltStringHelper"> J Am Heart Assoc</i>. 2017;6(11):e005306.
doi:<a href="http://dx.doi.org/10.1161/JAHA.116.005306">10.1161/JAHA.116.005306</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/29151030" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Occurrence%20and%20features%20of%20childhood%20myocarditis%3A%20a%20nationwide%20study%20in%20Finland.&author=A%20Arola&author=E%20Pikkarainen&author=JO%20Sipilä&author=J%20Pykäri&author=P%20Rautava&author=V%20Kytö&publication_year=2017&journal=J%20Am%20Heart%20Assoc&volume=6&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r4">4.</a>
<div class="reference-content">Kytö V, Sipilä J, Rautava P. The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood.
<i xmlns:helper="urn:XsltStringHelper"> Heart</i>. 2013;99(22):1681-1684.
doi:<a href="http://dx.doi.org/10.1136/heartjnl-2013-304449">10.1136/heartjnl-2013-304449</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/24064227" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20effects%20of%20gender%20and%20age%20on%20occurrence%20of%20clinically%20suspected%20myocarditis%20in%20adulthood.&author=V%20Kytö&author=J%20Sipilä&author=P%20Rautava&publication_year=2013&journal=Heart&volume=99&pages=1681-1684" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1136/heartjnl-2013-304449" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r5">5.</a>
<div class="reference-content">Dasgupta S, Iannucci G, Mao C, Clabby M, Oster ME. Myocarditis in the pediatric population: a review.
<i xmlns:helper="urn:XsltStringHelper"> Congenit Heart Dis</i>. 2019;14(5):868-877.
doi:<a href="http://dx.doi.org/10.1111/chd.12835">10.1111/chd.12835</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31432626" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20in%20the%20pediatric%20population%3A%20a%20review.&author=S%20Dasgupta&author=G%20Iannucci&author=C%20Mao&author=M%20Clabby&author=ME%20Oster&publication_year=2019&journal=Congenit%20Heart%20Dis&volume=14&pages=868-877" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1111/chd.v14.5" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r6">6.</a>
<div class="reference-content">Pollack A, Kontorovich AR, Fuster V, Dec GW. Viral myocarditis—diagnosis, treatment options, and current controversies.
<i xmlns:helper="urn:XsltStringHelper"> Nat Rev Cardiol</i>. 2015;12(11):670-680.
doi:<a href="http://dx.doi.org/10.1038/nrcardio.2015.108">10.1038/nrcardio.2015.108</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26194549" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Viral%20myocarditis%E2%80%94diagnosis%2C%20treatment%20options%2C%20and%20current%20controversies.&author=A%20Pollack&author=AR%20Kontorovich&author=V%20Fuster&author=GW%20Dec&publication_year=2015&journal=Nat%20Rev%20Cardiol&volume=12&pages=670-680" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1038/nrcardio.2015.108" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r7">7.</a>
<div class="reference-content">Halsell JS, Riddle JR, Atwood JE, et al; Department of Defense Smallpox Vaccination Clinical Evaluation Team. Myopericarditis following smallpox vaccination among
vaccinia-naive US military personnel. <i xmlns:helper="urn:XsltStringHelper"> JAMA</i>. 2003;289(24):3283-3289.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jama.289.24.3283">10.1001/jama.289.24.3283</a><br><a href="https://jamanetwork.com/journals/jama/fullarticle/196808" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/12824210" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myopericarditis%20following%20smallpox%20vaccination%20among%20vaccinia-naive%20US%20military%20personnel.&author=JS%20Halsell&author=JR%20Riddle&author=JE%20Atwood&publication_year=2003&journal=JAMA&volume=289&pages=3283-3289" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jama.289.24.3283" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r8">8.</a>
<div class="reference-content">Gubernot D, Jazwa A, Niu M, et al. US population-based background incidence rates of medical conditions for use in safety assessment of COVID-19 vaccines.
<i xmlns:helper="urn:XsltStringHelper"> Vaccine</i>. 2021;39(28):3666-3677.
doi:<a href="http://dx.doi.org/10.1016/j.vaccine.2021.05.016">10.1016/j.vaccine.2021.05.016</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34088506" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=US%20population-based%20background%20incidence%20rates%20of%20medical%20conditions%20for%20use%20in%20safety%20assessment%20of%20COVID-19%20vaccines.&author=D%20Gubernot&author=A%20Jazwa&author=M%20Niu&publication_year=2021&journal=Vaccine&volume=39&pages=3666-3677" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.vaccine.2021.05.016" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r9">9.</a>
<div class="reference-content">US Centers for Disease Control and Prevention. Clinical Immunization Safety Assessment project. Accessed August 24, 2021.
<a href="https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/cisa/index.html">https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/cisa/index.html</a></div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r10">10.</a>
<div class="reference-content">Marshall M, Ferguson ID, Lewis P, et al. Symptomatic acute myocarditis in 7 adolescents after Pfizer-BioNTech COVID-19 vaccination.
<i xmlns:helper="urn:XsltStringHelper"> Pediatrics</i>. 2021;148(3):e2021052478.
doi:<a href="http://dx.doi.org/10.1542/peds.2021-052478">10.1542/peds.2021-052478</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34088762" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Symptomatic%20acute%20myocarditis%20in%207%20adolescents%20after%20Pfizer-BioNTech%20COVID-19%20vaccination.&author=M%20Marshall&author=ID%20Ferguson&author=P%20Lewis&publication_year=2021&journal=Pediatrics&volume=148&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r11">11.</a>
<div class="reference-content">Kim HW, Jenista ER, Wendell DC, et al. Patients with acute myocarditis following mRNA COVID-19 vaccination.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Cardiol</i>. 2021;6(10):1196-1201.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamacardio.2021.2828">10.1001/jamacardio.2021.2828</a><br><a href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2781602" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34185046" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Patients%20with%20acute%20myocarditis%20following%20mRNA%20COVID-19%20vaccination.&author=HW%20Kim&author=ER%20Jenista&author=DC%20Wendell&publication_year=2021&journal=JAMA%20Cardiol&volume=6&pages=1196-1201" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamacardio.2021.2828" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r12">12.</a>
<div class="reference-content">Montgomery J, Ryan M, Engler R, et al. Myocarditis following immunization with mRNA COVID-19 vaccines in members of the US military.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Cardiol</i>. 2021;6(10):1202-1206.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamacardio.2021.2833">10.1001/jamacardio.2021.2833</a><br><a href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2781601" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34185045" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20following%20immunization%20with%20mRNA%20COVID-19%20vaccines%20in%20members%20of%20the%20US%20military.&author=J%20Montgomery&author=M%20Ryan&author=R%20Engler&publication_year=2021&journal=JAMA%20Cardiol&volume=6&pages=1202-1206" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamacardio.2021.2833" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r13">13.</a>
<div class="reference-content">Diaz GA, Parsons GT, Gering SK, Meier AR, Hutchinson IV, Robicsek A. Myocarditis and pericarditis after vaccination for COVID-19.
<i xmlns:helper="urn:XsltStringHelper"> JAMA</i>. 2021;326(12):1210-1212.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jama.2021.13443">10.1001/jama.2021.13443</a><br><a href="https://jamanetwork.com/journals/jama/fullarticle/2782900" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34347001" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20and%20pericarditis%20after%20vaccination%20for%20COVID-19.&author=GA%20Diaz&author=GT%20Parsons&author=SK%20Gering&author=AR%20Meier&author=IV%20Hutchinson&author=A%20Robicsek&publication_year=2021&journal=JAMA&volume=326&pages=1210-1212" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jama.2021.13443" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r14">14.</a>
<div class="reference-content">Mevorach D, Anis E, Cedar N, et al. Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel.
<i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 2021;385(23):2140-2149.
doi:<a href="http://dx.doi.org/10.1056/NEJMoa2109730">10.1056/NEJMoa2109730</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34614328" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20after%20BNT162b2%20mRNA%20vaccine%20against%20Covid-19%20in%20Israel.&author=D%20Mevorach&author=E%20Anis&author=N%20Cedar&publication_year=2021&journal=N%20Engl%20J%20Med&volume=385&pages=2140-2149" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMoa2109730" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r15">15.</a>
<div class="reference-content">Witberg G, Barda N, Hoss S, et al. Myocarditis after Covid-19 vaccination in a large health care organization.
<i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 2021;385(23):2132-2139.
doi:<a href="http://dx.doi.org/10.1056/NEJMoa2110737">10.1056/NEJMoa2110737</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34614329" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20after%20Covid-19%20vaccination%20in%20a%20large%20health%20care%20organization.&author=G%20Witberg&author=N%20Barda&author=S%20Hoss&publication_year=2021&journal=N%20Engl%20J%20Med&volume=385&pages=2132-2139" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMoa2110737" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r16">16.</a>
<div class="reference-content">MedDRA. Medical Dictionary for Regulatory Activities. Accessed June 30, 2021. <a href="https://www.meddra.org">https://www.meddra.org</a></div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r17">17.</a>
<div class="reference-content">US Centers for Disease Control and Prevention. CDC COVID-19 data tracker. Accessed June 30, 2021. <a href="https://covid.cdc.gov/covid-data-tracker">https://covid.cdc.gov/covid-data-tracker</a></div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r18">18.</a>
<div class="reference-content">Gargano JW, Wallace M, Hadler SC, et al. Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients: update from the Advisory Committee on
Immunization Practices—United States, June 2021. <i xmlns:helper="urn:XsltStringHelper"> MMWR Morb Mortal Wkly Rep</i>. 2021;70(27):977-982.
doi:<a href="http://dx.doi.org/10.15585/mmwr.mm7027e2">10.15585/mmwr.mm7027e2</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34237049" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Use%20of%20mRNA%20COVID-19%20vaccine%20after%20reports%20of%20myocarditis%20among%20vaccine%20recipients%3A%20update%20from%20the%20Advisory%20Committee%20on%20Immunization%20Practices%E2%80%94United%20States%2C%20June%202021.&author=JW%20Gargano&author=M%20Wallace&author=SC%20Hadler&publication_year=2021&journal=MMWR%20Morb%20Mortal%20Wkly%20Rep&volume=70&pages=977-982" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.15585/mmwr.mm7027e2" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r19">19.</a>
<div class="reference-content">Abu Mouch S, Roguin A, Hellou E, et al. Myocarditis following COVID-19 mRNA vaccination. <i xmlns:helper="urn:XsltStringHelper"> Vaccine</i>.
2021;39(29):3790-3793.
doi:<a href="http://dx.doi.org/10.1016/j.vaccine.2021.05.087">10.1016/j.vaccine.2021.05.087</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34092429" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20following%20COVID-19%20mRNA%20vaccination.&author=S%20Abu Mouch&author=A%20Roguin&author=E%20Hellou&publication_year=2021&journal=Vaccine&volume=39&pages=3790-3793" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.vaccine.2021.05.087" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r20">20.</a>
<div class="reference-content">Larson KF, Ammirati E, Adler ED, et al. Myocarditis after BNT162b2 and mRNA-1273 vaccination. <i xmlns:helper="urn:XsltStringHelper"> Circulation</i>.
2021;144(6):506-508.
doi:<a href="http://dx.doi.org/10.1161/CIRCULATIONAHA.121.055913">10.1161/CIRCULATIONAHA.121.055913</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34133884" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20after%20BNT162b2%20and%20mRNA-1273%20vaccination.&author=KF%20Larson&author=E%20Ammirati&author=ED%20Adler&publication_year=2021&journal=Circulation&volume=144&pages=506-508" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1161/CIRCULATIONAHA.121.055913" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r21">21.</a>
<div class="reference-content">Rosner CM, Genovese L, Tehrani BN, et al. Myocarditis temporally associated with COVID-19 vaccination.
<i xmlns:helper="urn:XsltStringHelper"> Circulation</i>. 2021;144(6):502-505.
doi:<a href="http://dx.doi.org/10.1161/CIRCULATIONAHA.121.055891">10.1161/CIRCULATIONAHA.121.055891</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34133885" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Myocarditis%20temporally%20associated%20with%20COVID-19%20vaccination.&author=CM%20Rosner&author=L%20Genovese&author=BN%20Tehrani&publication_year=2021&journal=Circulation&volume=144&pages=502-505" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1161/CIRCULATIONAHA.121.055891" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r22">22.</a>
<div class="reference-content">Boehmer TK, Kompaniyets L, Lavery AM, et al. Association between COVID-19 and myocarditis using hospital-based administrative data—United States, March 2020-January
2021. <i xmlns:helper="urn:XsltStringHelper"> MMWR Morb Mortal Wkly Rep</i>. 2021;70(35):1228-1232.
doi:<a href="http://dx.doi.org/10.15585/mmwr.mm7035e5">10.15585/mmwr.mm7035e5</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34473684" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Association%20between%20COVID-19%20and%20myocarditis%20using%20hospital-based%20administrative%20data%E2%80%94United%20States%2C%20March%202020-January%202021.&author=TK%20Boehmer&author=L%20Kompaniyets&author=AM%20Lavery&publication_year=2021&journal=MMWR%20Morb%20Mortal%20Wkly%20Rep&volume=70&pages=1228-1232" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.15585/mmwr.mm7035e5" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r23">23.</a>
<div class="reference-content">Harris PA, Taylor R, Minor BL, et al; REDCap Consortium. The REDCap Consortium: building an international community of software platform partners.
<i xmlns:helper="urn:XsltStringHelper"> J Biomed Inform</i>. 2019;95:103208.
doi:<a href="http://dx.doi.org/10.1016/j.jbi.2019.103208">10.1016/j.jbi.2019.103208</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31078660" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20REDCap%20Consortium%3A%20building%20an%20international%20community%20of%20software%20platform%20partners.&author=PA%20Harris&author=R%20Taylor&author=BL%20Minor&publication_year=2019&journal=J%20Biomed%20Inform&volume=95&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r24">24.</a>
<div class="reference-content">Mahrholdt H, Wagner A, Deluigi CC, et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis.
<i xmlns:helper="urn:XsltStringHelper"> Circulation</i>. 2006;114(15):1581-1590.
doi:<a href="http://dx.doi.org/10.1161/CIRCULATIONAHA.105.606509">10.1161/CIRCULATIONAHA.105.606509</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/17015795" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Presentation%2C%20patterns%20of%20myocardial%20damage%2C%20and%20clinical%20course%20of%20viral%20myocarditis.&author=H%20Mahrholdt&author=A%20Wagner&author=CC%20Deluigi&publication_year=2006&journal=Circulation&volume=114&pages=1581-1590" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1161/CIRCULATIONAHA.105.606509" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r25">25.</a>
<div class="reference-content">Mason JW, O’Connell JB, Herskowitz A, et al; Myocarditis Treatment Trial Investigators. A clinical trial of immunosuppressive therapy for myocarditis.
<i xmlns:helper="urn:XsltStringHelper"> N Engl J Med</i>. 1995;333(5):269-275.
doi:<a href="http://dx.doi.org/10.1056/NEJM199508033330501">10.1056/NEJM199508033330501</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/7596370" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=A%20clinical%20trial%20of%20immunosuppressive%20therapy%20for%20myocarditis.&author=JW%20Mason&author=JB%20O’Connell&author=A%20Herskowitz&publication_year=1995&journal=N%20Engl%20J%20Med&volume=333&pages=269-275" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJM199508033330501" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r26">26.</a>
<div class="reference-content">Saji T, Matsuura H, Hasegawa K, et al. Comparison of the clinical presentation, treatment, and outcome of fulminant and acute myocarditis in children.
<i xmlns:helper="urn:XsltStringHelper"> Circ J</i>. 2012;76(5):1222-1228.
doi:<a href="http://dx.doi.org/10.1253/circj.CJ-11-1032">10.1253/circj.CJ-11-1032</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/22307381" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Comparison%20of%20the%20clinical%20presentation%2C%20treatment%2C%20and%20outcome%20of%20fulminant%20and%20acute%20myocarditis%20in%20children.&author=T%20Saji&author=H%20Matsuura&author=K%20Hasegawa&publication_year=2012&journal=Circ%20J&volume=76&pages=1222-1228" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1253/circj.CJ-11-1032" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r27">27.</a>
<div class="reference-content">Ghelani SJ, Spaeder MC, Pastor W, Spurney CF, Klugman D. Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to
2011. <i xmlns:helper="urn:XsltStringHelper"> Circ Cardiovasc Qual Outcomes</i>. 2012;5(5):622-627.
doi:<a href="http://dx.doi.org/10.1161/CIRCOUTCOMES.112.965749">10.1161/CIRCOUTCOMES.112.965749</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/22828827" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Demographics%2C%20trends%2C%20and%20outcomes%20in%20pediatric%20acute%20myocarditis%20in%20the%20United%20States%2C%202006%20to%202011.&author=SJ%20Ghelani&author=MC%20Spaeder&author=W%20Pastor&author=CF%20Spurney&author=D%20Klugman&publication_year=2012&journal=Circ%20Cardiovasc%20Qual%20Outcomes&volume=5&pages=622-627" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1161/CIRCOUTCOMES.112.965749" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r28">28.</a>
<div class="reference-content">Caforio ALP, Pankuweit S, Arbustini E, et al; European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Current state of knowledge on
aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases.
<i xmlns:helper="urn:XsltStringHelper"> Eur Heart J</i>. 2013;34(33):2636-2648.
doi:<a href="http://dx.doi.org/10.1093/eurheartj/eht210">10.1093/eurheartj/eht210</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/23824828" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Current%20state%20of%20knowledge%20on%20aetiology%2C%20diagnosis%2C%20management%2C%20and%20therapy%20of%20myocarditis%3A%20a%20position%20statement%20of%20the%20European%20Society%20of%20Cardiology%20Working%20Group%20on%20Myocardial%20and%20Pericardial%20Diseases.&author=ALP%20Caforio&author=S%20Pankuweit&author=E%20Arbustini&publication_year=2013&journal=Eur%20Heart%20J&volume=34&pages=2636-2648" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1093/eurheartj/eht210" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r29">29.</a>
<div class="reference-content">Yancy CW, Jessup M, Bozkurt B, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline
for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
<i xmlns:helper="urn:XsltStringHelper"> J Am Coll Cardiol</i>. 2013;62(16):e147-e239.
doi:<a href="http://dx.doi.org/10.1016/j.jacc.2013.05.019">10.1016/j.jacc.2013.05.019</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/23747642" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=2013%20ACCF%2FAHA%20guideline%20for%20the%20management%20of%20heart%20failure%3A%20a%20report%20of%20the%20American%20College%20of%20Cardiology%20Foundation%2FAmerican%20Heart%20Association%20Task%20Force%20on%20Practice%20Guidelines.&author=CW%20Yancy&author=M%20Jessup&author=B%20Bozkurt&publication_year=2013&journal=J%20Am%20Coll%20Cardiol&volume=62&pages=e147-e239" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jacc.2013.05.019" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r30">30.</a>
<div class="reference-content">Law YM, Lal AK, Chen S, et al; American Heart Association Pediatric Heart Failure and Transplantation Committee of the Council on Lifelong Congenital Heart Disease and
Heart Health in the Young and Stroke Council. Diagnosis and management of myocarditis in children: a scientific statement from the American Heart Association.
<i xmlns:helper="urn:XsltStringHelper"> Circulation</i>. 2021;144(6):e123-e135.
doi:<a href="http://dx.doi.org/10.1161/CIR.0000000000001001">10.1161/CIR.0000000000001001</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/34229446" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Diagnosis%20and%20management%20of%20myocarditis%20in%20children%3A%20a%20scientific%20statement%20from%20the%20American%20Heart%20Association.&author=YM%20Law&author=AK%20Lal&author=S%20Chen&publication_year=2021&journal=Circulation&volume=144&pages=e123-e135" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1161/CIR.0000000000001001" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r31">31.</a>
<div class="reference-content">US Centers for Disease Control and Prevention. Clinical considerations: myocarditis and pericarditis after receipt of mRNA COVID-19 vaccines among adolescents and young adults. Accessed August 24,
2021. <a href="https://www.cdc.gov/vaccines/covid-19/clinical-considerations/myocarditis.html">https://www.cdc.gov/vaccines/covid-19/clinical-considerations/myocarditis.html</a></div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r32">32.</a>
<div class="reference-content">Sachdeva S, Song X, Dham N, Heath DM, DeBiasi RL. Analysis of clinical parameters and cardiac magnetic resonance imaging as predictors of outcome in pediatric
myocarditis. <i xmlns:helper="urn:XsltStringHelper"> Am J Cardiol</i>. 2015;115(4):499-504.
doi:<a href="http://dx.doi.org/10.1016/j.amjcard.2014.11.029">10.1016/j.amjcard.2014.11.029</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/25554534" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Analysis%20of%20clinical%20parameters%20and%20cardiac%20magnetic%20resonance%20imaging%20as%20predictors%20of%20outcome%20in%20pediatric%20myocarditis.&author=S%20Sachdeva&author=X%20Song&author=N%20Dham&author=DM%20Heath&author=RL%20DeBiasi&publication_year=2015&journal=Am%20J%20Cardiol&volume=115&pages=499-504" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.amjcard.2014.11.029" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r33">33.</a>
<div class="reference-content">Ferreira VM, Schulz-Menger J, Holmvang G, et al. Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations.
<i xmlns:helper="urn:XsltStringHelper"> J Am Coll Cardiol</i>. 2018;72(24):3158-3176.
doi:<a href="http://dx.doi.org/10.1016/j.jacc.2018.09.072">10.1016/j.jacc.2018.09.072</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30545455" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cardiovascular%20magnetic%20resonance%20in%20nonischemic%20myocardial%20inflammation%3A%20expert%20recommendations.&author=VM%20Ferreira&author=J%20Schulz-Menger&author=G%20Holmvang&publication_year=2018&journal=J%20Am%20Coll%20Cardiol&volume=72&pages=3158-3176" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jacc.2018.09.072" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r34">34.</a>
<div class="reference-content">US Centers for Disease Control and Prevention. Investigating long-term effects of myocarditis. Accessed August 24, 2021.
<a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myo-outcomes.html">https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myo-outcomes.html</a></div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r35">35.</a>
<div class="reference-content">Maron BJ, Udelson JE, Bonow RO, et al; American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular
Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and disqualification recommendations for competitive
athletes with cardiovascular abnormalities: task force 3: hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: a scientific statement from the American Heart
Association and American College of Cardiology. <i xmlns:helper="urn:XsltStringHelper"> Circulation</i>. 2015;132(22):e273-e280.
doi:<a href="http://dx.doi.org/10.1161/CIR.0000000000000239">10.1161/CIR.0000000000000239</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26621644" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Eligibility%20and%20disqualification%20recommendations%20for%20competitive%20athletes%20with%20cardiovascular%20abnormalities%3A%20task%20force%203%3A%20hypertrophic%20cardiomyopathy%2C%20arrhythmogenic%20right%20ventricular%20cardiomyopathy%20and%20other%20cardiomyopathies%2C%20and%20myocarditis%3A%20a%20scientific%20statement%20from%20the%20American%20Heart%20Association%20and%20American%20College%20of%20Cardiology.&author=BJ%20Maron&author=JE%20Udelson&author=RO%20Bonow&publication_year=2015&journal=Circulation&volume=132&pages=e273-e280" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r36">36.</a>
<div class="reference-content">Aquaro GD, Ghebru Habtemicael Y, Camastra G, et al; Cardiac Magnetic Resonance Working Group of the Italian Society of Cardiology. Prognostic value of repeating
cardiac magnetic resonance in patients with acute myocarditis. <i xmlns:helper="urn:XsltStringHelper"> J Am Coll Cardiol</i>. 2019;74(20):2439-2448.
doi:<a href="http://dx.doi.org/10.1016/j.jacc.2019.08.1061">10.1016/j.jacc.2019.08.1061</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/31727281" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prognostic%20value%20of%20repeating%20cardiac%20magnetic%20resonance%20in%20patients%20with%20acute%20myocarditis.&author=GD%20Aquaro&author=Y%20Ghebru Habtemicael&author=G%20Camastra&publication_year=2019&journal=J%20Am%20Coll%20Cardiol&volume=74&pages=2439-2448" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jacc.2019.08.1061" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r37">37.</a>
<div class="reference-content">US Centers for Disease Control and Prevention. Interim clinical considerations for use of COVID-19 vaccines currently authorized in the United States. Accessed August 24, 2021.
<a href="https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html">https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html</a></div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r38">38.</a>
<div class="reference-content">Shimabukuro TT, Nguyen M, Martin D, DeStefano F. Safety monitoring in the Vaccine Adverse Event Reporting System (VAERS).
<i xmlns:helper="urn:XsltStringHelper"> Vaccine</i>. 2015;33(36):4398-4405.
doi:<a href="http://dx.doi.org/10.1016/j.vaccine.2015.07.035">10.1016/j.vaccine.2015.07.035</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/26209838" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Safety%20monitoring%20in%20the%20Vaccine%20Adverse%20Event%20Reporting%20System%20%28VAERS%29.&author=TT%20Shimabukuro&author=M%20Nguyen&author=D%20Martin&author=F%20DeStefano&publication_year=2015&journal=Vaccine&volume=33&pages=4398-4405" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.vaccine.2015.07.035" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="joi210145r39">39.</a>
<div class="reference-content">US Centers for Disease Control and Prevention. HIPAA privacy rule and public health: guidance from CDC and the US Department of Health and Human Services.
<i xmlns:helper="urn:XsltStringHelper"> MMWR Suppl</i>. 2003;52:1-17,
19-20.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/12741579" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=HIPAA%20privacy%20rule%20and%20public%20health%3A%20guidance%20from%20CDC%20and%20the%20US%20Department%20of%20Health%20and%20Human%20Services.&publication_year=2003&journal=MMWR%20Suppl&volume=52&pages=1-17, 19-20" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
</div>
</div>
</div>
</div>
<footer class="footer" id="footer">
<div id="footer-microsite" class="footer-microsite">
<style type="text/css">
@media (min-width: 1024px) {
.split-screen .footer-microsite-contents {
border-bottom: 0 !important;
}
}
.footer-microsite-contents {
margin-bottom: 1em;
width: 100%;
}
.footer-network-other .link-apps:before {
width: 23px;
}
.footer-network-other .link-institutions-librarians:before {
width: 23px;
}
.jn-ss-footer-border-top {
border-top: 1px solid #555;
padding-top: 15px;
}
.jn-ss-footer-border-bottom {
border-bottom: 1px solid #555;
padding-bottom: 10px;
padding-right: 3px;
}
</style>
<div class="footer-heading-wrap">
<h3 id="BodyContent_Footer_h3SiteName" class="footer-heading is-b footer-microsite-heading" data-mobile-tog-target=".footer-microsite-links-wrap">JAMA</h3>
</div>
<div class="footer-microsite-links-wrap">
<div class="footer-microsite-contents jn-ss-footer-border-bottom">
<h4 id="BodyContent_Footer_ContentHeader" class="footer-subheading">Content</h4>
<a href="/journals/jama">Home</a>
<a href="/journals/jama/newonline">New Online</a>
<a href="/journals/jama/currentissue">Current Issue</a>
</div>
<div class="footer-microsite-contents jn-ss-footer-border-bottom">
<h4 class="footer-subheading">Podcasts</h4>
<a href="/journals/jama/pages/covid-19-interviews#audio">Coronavirus (COVID-19) Q&A</a>
<a href="/journals/jama/pages/jama-clinical-reviews">Clinical Reviews</a>
<a href="/journals/jama/pages/jama-editors-summary">Editors' Summary</a>
<a href="/journals/jama/pages/jama-medical-news">Medical News</a>
<a href="/journals/jama/pages/jama-author-interviews">Author Interviews</a>
<a href="/journals/jama/pages/jama-performance-improvement">Performance Improvement: Do No Harm</a>
<a href="/journals/jama/pages/jama-professionalism">Professionalism: Best Practice</a>
<a href="/journals/jama/pages/jamaevidence-care-at-the-close-of-life">JAMAevidence: Care at the Close of Life</a>
<a href="/journals/jama/pages/jamaevidence-jama-guide-to-statistics-and-methods">JAMAevidence: <em>JAMA Guide to Statistics and Methods</em></a>
<a href="/journals/jama/pages/jamaevidence-the-rational-clinical-examination">JAMAevidence: The Rational Clinical Examination</a>
<a href="/journals/jama/pages/jamaevidence-users-guides-to-the-medical-literature">JAMAevidence: Users' Guides to the Medical Literature</a>
</div>
<div class="footer-microsite-services cf">
<h4 id="BodyContent_Footer_ServiceHeader" class="footer-subheading">Journal Information</h4>
<a href="/journals/jama/pages/for-authors">For Authors</a>
<a href="/journals/jama/editors-and-publishers">Editors & Publishers</a>
<a href="/pages/rss">RSS</a>
<a href="/journals/jama/pages/contact-us">Contact Us</a>
</div>
<div class="footer-network-other jn-ss-footer-border-bottom">
<a href="https://edhub.ama-assn.org/jn-learning" class="link-network-other is-b link-learning">JN Learning / CME</a>
<a href="https://store.jamanetwork.com" class="link-network-other is-b link-store" target="_blank">Store</a>
<a href="/pages/apps" class="link-network-other is-b link-mobile" target="_blank">Apps</a>
<a href="https://careers.jamanetwork.com/" class="link-network-other is-b link-jobs" target="_blank">Jobs</a>
<a href="/pages/institutions-and-librarians" class="link-network-other is-b link-institutions-librarians" target="_blank">Institutions</a>
<a href="/pages/reprints-and-permissions" class="link-network-other is-b link-reprints-permissions">Reprints & Permissions</a>
</div>
<div id="BodyContent_Footer_divSubscribe" class="footer-microsite-subscribe">
<img src="//cdn.jamanetwork.com/UI/app/img/covers/jama.jpg" class="subscribe-image" alt="Journal Cover">
<div class="subscribe-meta">
<h4 class="subscribe-heading footer-subheading">Subscribe</h4>
<a href="https://store.jamanetwork.com/productDetails.aspx?productcodeID=64" class="subscribe-submit btn">Go</a>
</div>
</div>
</div>
</div>
<div id="footer-network" class="footer-network">
<style type="text/css">
.footer-network-sites {
width: 62.85542%;
}
.footer-network-info {
width: 35.93976%
}
.jn-ss-subheading-mt {
margin-top: 1.5em;
}
.jn-registered:after {
content: "\00AE";
font-size: 50%;
vertical-align: top;
}
.jn-trademark:after {
content: "\2122";
font-size: 50%;
vertical-align: top;
}
</style>
<div class="footer-heading-wrap">
<h3 class="footer-heading is-b jn-trademark" data-mobile-tog-target=".footer-network-links-wrap"><strong>JAMA</strong> Network</h3>
</div>
<div class="footer-network-links-wrap">
<div class="footer-network-sites">
<div class="internal">
<h4 id="BodyContent_Footer_JournalHeader" class="footer-subheading">Publications</h4>
<a href="/journals/jama">JAMA</a>
<a href="/journals/jamanetworkopen" target="_blank">JAMA Network Open</a>
<a href="/journals/jamacardiology">JAMA Cardiology</a>
<a href="/journals/jamadermatology">JAMA Dermatology</a>
<a href="/journals/jama-health-forum">JAMA Health Forum</a>
<a href="/journals/jamainternalmedicine">JAMA Internal Medicine</a>
<a href="/journals/jamaneurology">JAMA Neurology</a>
<a href="/journals/jamaoncology">JAMA Oncology</a>
<a href="/journals/jamaophthalmology">JAMA Ophthalmology</a>
<a href="/journals/jamaotolaryngology">JAMA Otolaryngology–Head & Neck Surgery</a>
<a href="/journals/jamapediatrics">JAMA Pediatrics</a>
<a href="/journals/jamapsychiatry">JAMA Psychiatry</a>
<a href="/journals/jamasurgery">JAMA Surgery</a>
<a href="/journals/archneurpsyc">Archives of Neurology & Psychiatry (1919-1959)</a>
</div>
<div class="external">
<h4 class="footer-subheading">Sites</h4>
<div id="BodyContent_Footer_ssFooterSiteMenu">
<div class="selfServe">
<a target="_blank" href="https://sites.jamanetwork.com/art-and-images-in-psychiatry/">Art and Images in Psychiatry</a>
<a target="_blank" href="/journals/jama/pages/2021-most-viewed-jama">Best of the JAMA Network</a>
<a target="_blank" href="/journals/jama/pages/crosswords">Clinical Crosswords from JAMA</a>
<a target="_blank" href="/journals/jama/pages/coronavirus-alert">Coronavirus Resource Center</a>
<a target="_blank" href="/pages/digital-media-editorial-fellowship">Digital Media Editorial Fellowship</a>
<a target="_blank" href="https://ebm.jamanetwork.com/index.html">Evidence-Based Medicine: An Oral History</a>
<a target="_blank" href="/pages/fishbein-fellowship">Fishbein Fellowship</a>
<a target="_blank" href="https://sites.jamanetwork.com/genetics/">Genomics and Precision Health</a>
<a target="_blank" href="/channels/hypertension">Hypertension</a>
<a target="_blank" href="/channels/health-forum/archive">JAMA Forum Archive</a>
<a target="_blank" href="https://sites.jamanetwork.com/audio">JAMA Network Audio</a>
<a target="_blank" href="/pages/conferences">JAMA Network Conferences </a>
<a target="_blank" href="/channels/machine-learning">Machine Learning</a>
<a target="_blank" href="https://sites.jamanetwork.com/research-ethics/">Research Ethics</a>
<a target="_blank" href="/pages/collections">Topics and Collections</a>
<h4 class="footer-subheading jn-ss-subheading-mt">Special Communications</h4>
<a href="/journals/jama/fullarticle/2758605">FDA Approval and Regulation of Pharmaceuticals, 1983-2018</a>
<a href="/journals/jamaoncology/fullarticle/2752381">Global Burden of Cancer, 1990-2017</a>
<a href="/journals/jamadermatology/fullarticle/2767074">Global Burden of Skin Diseases, 1990-2017</a>
<a href="/journals/jama/fullarticle/2698492">Global Firearm Mortality, 1990-2016</a>
<a href="/journals/jama/fullarticle/2674671">Health Care Spending in the US and Other High-Income Countries</a>
<a href="/journals/jama/fullarticle/2756187">Life Expectancy and Mortality Rates in the United States, 1959-2017</a>
<a href="/journals/jama/fullarticle/2720029">Medical Marketing in the United States, 1997-2016</a>
<a href="/journals/jama/fullarticle/2758456">Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter</a>
<a href="/journals/jama/fullarticle/2533698">President Obama on US Health Care Reform</a>
<a href="/journals/jama/fullarticle/2678018">The State of US Health, 1990-2016</a>
<a href="/journals/jamacardiology/fullarticle/2678113">US Burden of Cardiovascular Disease, 1990-2016</a>
<a href="/journals/jamaneurology/fullarticle/2772579">US Burden of Neurological Disease, 1990-2017</a>
<a href="/journals/jama/fullarticle/2752664">Waste in the US Health Care System: Estimated Costs and Potential for Savings</a>
<h4 class="footer-subheading jn-ss-subheading-mt">Blogs</h4>
<a target="_blank" href="http://amastyleinsider.com/">AMA Style Insider</a>
</div>
</div>
</div>
</div>
<div id="footer-network-info" class="footer-network-info">
<div class="information-for-links">
<h4 id="BodyContent_Footer_InfoHeader" class="footer-subheading">Information</h4>
<a href="/pages/for-authors">For Authors</a>
<a href="/pages/resources-for-librarians">For Institutions & Librarians</a>
<a href="/pages/advertisers">For Advertisers</a>
<a href="/pages/subscription-agents">For Subscription Agents</a>
<a href="https://careers.jamanetwork.com/" target="_blank">For Employers & Job Seekers</a>
<a href="https://media.jamanetwork.com" rel="nofollow" target="_blank">For the Media</a>
<a href="/pages/offensive-content-statement">Statement on Potentially Offensive Content</a>
</div>
<div class="services-links">
<h4 id="BodyContent_Footer_JAMANetworkProductsHeader" class="footer-subheading">JAMA Network Products</h4>
<a href="http://www.amamanualofstyle.com/" class="footer-service-link" target="_blank">AMA Manual of Style</a>
<a href="https://jamaevidence.mhmedical.com/" class="footer-service-link" target="_blank"><span class="jn-registered">JAMAevidence</span></a>
<a href="/pages/listen" class="footer-service-link" target="_blank"><span class="jn-trademark">JN Listen</span></a>
<a href="http://www.peerreviewcongress.org/" class="footer-service-link" target="_blank">Peer Review Congress</a>
</div>
<div class="learning-links">
<h4 id="BodyContent_Footer_LearningHeader" class="footer-subheading">JN Learning</h4>
<a href="https://edhub.ama-assn.org/jn-learning">Home</a>
<a href="https://edhub.ama-assn.org/jn-learning/by-topic?page=1&hd=edhub&f_SiteDisplayNames=JN+Learning&f_CmeCreditTypeGroupNames=CME">CME Quizzes</a>
<a href="https://edhub.ama-assn.org/jn-learning/state-cme">State CME</a>
<a href="https://edhub.ama-assn.org/jn-learning/by-topic?hd=edhub&f_SiteDisplayNames=JN+Learning&f_ContentFormat=Audio&page=1">Audio / Podcast Courses</a>
<a href="https://edhub.ama-assn.org/jn-learning/pages/clinical-challenge-courses">Clinical Challenge CME</a>
<a href="https://edhub.ama-assn.org/jn-learning/pages/atrial-fibrillation-cme-course ">Atrial Fibrillation Course</a>
<a href="https://edhub.ama-assn.org/jn-learning/pages/marijuana-cme-course">Marijuana Course</a>
<a href="https://edhub.ama-assn.org/jn-learning/pages/penicillin-allergy-testing">Penicillin Allergy Course</a>
<a href="https://edhub.ama-assn.org/jn-learning/pages/cervical-cancer-cme">Cervical Cancer Screening Course</a>
<a target="_blank" href="https://edhub.ama-assn.org/pages/auto-credit-reporting">CME / MOC Reporting Preferences</a>
<a href="https://edhub.ama-assn.org/jn-learning/pages/about-cme">About CME & MOC</a>
</div>
</div>
</div>
</div>
<div id="footer-resources-wrap" class="footer-resources-wrap">
<style type="text/css">
.footer-resources-wrap .footer-subheading {
color: grey;
display: block !important;
font-size: 1.17647em;
font-weight: 400;
text-transform: uppercase;
}
</style>
<div class="footer-heading-wrap">
<h3 class="footer-heading is-b footer-resources-heading" data-mobile-tog-target=".footer-resources">Help</h3>
</div>
<div class="footer-resources">
<a href="https://store.jamanetwork.com" class="footer-service-link" target="_blank">Subscriptions & Renewals</a>
<a href="https://jamanetwork.com/oauthsignin?return_url=http%3A%2F%2Fjamanetwork.com%2Fmyaccount%23my-alerts" class="footer-service-link" rel="nofollow">Email Subscriptions</a>
<a href="https://jamanetwork.com/oauthsignin?return_url=http%3A%2F%2Fjamanetwork.com%2Fmyaccount%23my-profile" class="footer-service-link" rel="nofollow">Update Your Address</a>
<a href="https://sites.jamanetwork.com/help/" class="footer-service-link">Contact Us</a>
<a href="https://sites.jamanetwork.com/help/" class="footer-service-link">Frequently Asked Questions</a>
<h4 class="footer-subheading jn-ss-subheading-mt">JAMA Career Center</h4>
<a href="https://careers.jamanetwork.com/" class="footer-service-link" target="_blank">Physician Job Listings</a>
</div>
<style type="text/css">
.widget-instance-AMA_Journal_Home_Socials .iconsocial {
display: inline-block !important;
width: 34px;
height: 34px;
min-width: unset !important;
margin: 0 2px !important;
background-color: #fff;
border-radius: 20px;
border: 1px solid #191919;
vertical-align: middle;
}
.widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram {
background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-black.svg);
background-position: 7px 7px;
background-repeat: no-repeat;
background-size: 18px;
}
.widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram:hover,
.widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram:focus {
background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-fill.png);
border-color: #C13584;
}
.footer-resources-wrap .iconsocial {
display: inline-block !important;
width: 32px;
height: 32px;
min-width: unset !important;
margin: 0 2px 0 3px !important;
background-color: #fff;
border-radius: 20px;
border: 1px solid #191919;
vertical-align: middle;
}
.footer-resources-wrap .iconsocial.instagram {
background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-black.svg);
background-position: 6px 6px;
background-repeat: no-repeat;
background-size: 18px;
}
.footer-resources-wrap .iconsocial.instagram:hover,
.footer-resources-wrap .iconsocial.instagram:focus {
background-color: #C13584;
border-color: #191919;
}
#load-instagram-image {
background: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-fill.png) no-repeat -9999px -9999px;
}
</style>
<div id="BodyContent_Footer_divSocial" class="social-links footer-social-links">
<a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.facebook.com/JAMAJournal/" class="social-link is-b facebook"></a>
<a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://twitter.com/JAMA_current" class="social-link is-b twitter"></a>
<a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.instagram.com/jamanetwork/?hl=en" class="iconsocial instagram"></a>
<a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.linkedin.com/company/jamanetwork/" class="social-link is-b linked-in"></a>
<a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.youtube.com/jamanetwork" class="social-link is-b you-tube"></a>
<a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.pinterest.com/jamanetwork/" class="social-link is-b pinterest"></a>
<a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="/rss/site_3/67.xml" class="social-link is-b rss"></a>
<a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://jamanetwork.com/journals/jama/pages/jama-editors-summary" class="social-link is-b podcast"></a>
<div id="load-instagram-image"> </div>
</div>
<div id="BodyContent_Footer_divEmailUpdate" class="footer-email-updates">
<div class="widget-EmailListSignUp widget-instance-AMAv2_EmailListSignUp_Footer">
<div class="email-signup">
<div class="email-signup--text sb-pc">Get the latest from JAMA</div>
<div class="email-signup--input-wrap is-b">
<input type="text" name="email" class="email-signup--input" placeholder="Email address" title="Email address">
<a rel="nofollow" href="javascript:;" class="email-signup--submit sb-sc btn">Sign Up</a>
</div>
<div class="email-signup--link"> <a class="email-signup--privacy" href="/pages/privacy-policy">Privacy Policy</a> | <a class="email-signup--terms" href="/pages/terms-of-use">Terms of Use</a></div>
<div class="email-signup--user-message"></div>
</div>
</div>
</div>
</div>
<div class="footer-bar" itemscope="" itemtype="https://schema.org/Organization">
<style type="text/css">
.nav-journals a.theme-jama-health-forum:before {
background: #133763;
}
.jn-bottom-bar {
color: #fff;
float: left;
font-size: 10px;
padding: 13px 20px;
width: 33.33%;
}
.jn-bottom-bar p {
line-height: 2;
}
@media (max-width: 900px) {
.jn-bottom-bar {
float: none;
width: 100%;
}
}
.jn-footer-copyright {
font-size: 12px;
}
.jn-footer-pipe {
margin: 0 10px;
}
.footer-bar-jn-logo img {
width: 230px;
}
@media (max-width: 900px) {
.footer-bar-jn-logo img {
width: 200px;
}
}
[data-thm=umb] .jobs-ad--text h6 {
color: #d71635 !important;
}
[data-thm=jama] .jobs-ad--text h6 {
color: #d71635 !important;
}
[data-thm=jaman] .jobs-ad--text h6 {
color: #ed0973 !important;
}
[data-thm=cardi] .jobs-ad--text h6 {
color: #be1e32 !important;
}
[data-thm=derm] .jobs-ad--text h6 {
color: #006f3b !important;
}
[data-thm=faci] .jobs-ad--text h6 {
color: #ed1c24 !important;
}
[data-thm=jama-] .jobs-ad--text h6 {
color: #fb5252 !important;
}
[data-thm=intem] .jobs-ad--text h6 {
color: #006e96 !important;
}
[data-thm=neur] .jobs-ad--text h6 {
color: #981b1e !important;
}
[data-thm=oncol] .jobs-ad--text h6 {
color: #3b923f !important;
}
[data-thm=ophth] .jobs-ad--text h6 {
color: #66bc29 !important;
}
[data-thm=otol] .jobs-ad--text h6 {
color: #34b6e4 !important;
}
[data-thm=peds] .jobs-ad--text h6 {
color: #0084c0 !important;
}
[data-thm=psych] .jobs-ad--text h6 {
color: #005276 !important;
}
[data-thm=surg] .jobs-ad--text h6 {
color: #f47920 !important;
}
.blockquote .para {
margin: 0 0 1em 1em;
}
</style>
<!-- This version of the code includes CSS changes to size the new logo -->
<a class="footer-bar-jn-logo d-b no-mw mb1" href="/" title="JAMA Network Home"><img class="mw-100" src="https://cdn.jamanetwork.com/ImageLibrary/global/jn-signature-reversed.svg?versionId=73925" alt="Jama Network Logo"></a>
<div class="jn-bottom-bar">
<p>
<span class="jn-footer-copyright">© 2022 American Medical Association. All Rights Reserved.</span><br>
<a href="/pages/conditions-of-use" rel="nofollow" class="p0">Terms of Use</a><span class="jn-footer-pipe">|</span>
<a href="/pages/privacy-policy" rel="nofollow" class="p0">Privacy Policy</a><span class="jn-footer-pipe">|</span>
<a href="/pages/accessibility-statement" rel="nofollow" class="p0">Accessibility Statement</a>
</p>
</div>
<!--
#selfserve-maintenance {display:block;margin:20px 0;max-height:none !important;min-height:200px;visibility:visible;}
-->
<a class="footer-bar-sis no-mw relative nudge-down" href="https://www.silverchair.com" target="_blank"><img class="footer-bar-sis-img mt05 mw-100" width="600" height="70" src="//cdn.jamanetwork.com/UI/app/img/powered.png" alt="Silverchair Logo"></a>
</div>
</footer>
</div>
<div class="hidden-jobs-ad hide">
<div class="widget-JobsAd widget-instance-AMA_JobsAd">
<div class="jobs-ad">
<div class="jobs-ad--text">
<h6 class="tt-u black">JOB LISTINGS ON JAMA CAREER CENTER®</h6>
<div class="jobs-ad-wrapper thm-col-sec">
<a href="https://careers.jamanetwork.com/job/110202957/invasive-non-interventional-cardiology/?TrackID=34&utm_source=widget&utm_medium=referral&utm_campaign=34" target="_blank">
<span class="jobs-ad-title">Invasive Non-Interventional Cardiology</span>
<span class="jobs-ad-location">Grand Rapids, Michigan</span>
</a>
</div>
<div class="jobs-ad-wrapper thm-col-sec">
<a href="https://careers.jamanetwork.com/job/110200603/neuro-critical-care-cardiologist/?TrackID=34&utm_source=widget&utm_medium=referral&utm_campaign=34" target="_blank">
<span class="jobs-ad-title">Neuro-Critical Care Cardiologist</span>
<span class="jobs-ad-location">DE</span>
</a>
</div>
<div class="jobs-ad-wrapper thm-col-sec">
<a href="https://careers.jamanetwork.com/job/110200547/cardiologist/?TrackID=34&utm_source=widget&utm_medium=referral&utm_campaign=34" target="_blank">
<span class="jobs-ad-title">Cardiologist</span>
<span class="jobs-ad-location">GA</span>
</a>
</div>
<div class="jobs-ad-wrapper thm-col-sec">
<a href="https://careers.jamanetwork.com/job/110200546/cardiologist/?TrackID=34&utm_source=widget&utm_medium=referral&utm_campaign=34" target="_blank">
<span class="jobs-ad-title">Cardiologist</span>
<span class="jobs-ad-location">OR</span>
</a>
</div>
<div class="jobs-ad-wrapper thm-col-sec">
<a href="https://careers.jamanetwork.com/job/110200036/physician-cardiology-non-invasive-/?TrackID=34&utm_source=widget&utm_medium=referral&utm_campaign=34" target="_blank">
<span class="jobs-ad-title">Physician (Cardiology-Non-Invasive)</span>
<span class="jobs-ad-location">Ft. Hood, TX</span>
</a>
</div>
<a href="https://careers.jamanetwork.com" target="_blank" class="jobs-ad-see-more"> See more at JAMA Career Center </a>
</div>
</div>
</div>
</div>
<script>
var App = App || {};
App.ArticleSplitScreen = App.ArticleSplitScreen || {};
App.ArticleSplitScreen.siteName = 'jama';
App.ArticleSplitScreen.siteId = 3;
App.ArticleSplitScreen.journalId = 67;
App.ArticleSplitScreen.adDisplay = 'ArticleContentsSkyBox';
App.ArticleSplitScreen.adSection = "scholarly";
App.ArticleSplitScreen.adPosition = "contab";
App.ArticleSplitScreen.controlId = "AMA_AdTag_Contents_Skybox";
App.ArticleSplitScreen.fromGoogle = "False";
App.ArticleSplitScreen.slotLocationOverride = "50";
</script>
</div>
</div>
</section>
<section id="secFooterControl" class="master-footer">
<script>
var App = App || {};
function scmByClass(className) {
return document.getElementsByClassName(className);
}
function scmById(id) {
return document.getElementById(id);
}
function scmquery(selector) {
return document.querySelector(selector);
}
function queryAll(selector) {
return document.querySelectorAll(selector);
}
function isTrueString(string) {
if (typeof string === 'string') {
return string.toLowerCase() === 'true';
}
return undefined;
}
function updateViewportDimensions() {
var w = window,
d = document,
e = d.documentElement,
g = d.getElementsByTagName('body')[0],
x = w.innerWidth || e.clientWidth || g.clientWidth,
y = w.innerHeight || e.clientHeight || g.clientHeight;
return {
width: x,
height: y
};
}
var viewport = updateViewportDimensions();
var debounce = function(func, wait, immediate) {
var timeout;
return function() {
var context = this,
args = arguments;
var later = function() {
timeout = null;
if (!immediate) func.apply(context, args);
};
var callNow = immediate && !timeout;
clearTimeout(timeout);
timeout = setTimeout(later, wait);
if (callNow) func.apply(context, args);
};
};
(function(App) {
App.mobileUpperBreakpoint = 767;
App.mobileAltBreakpoint = 640;
App.tabletUpperBreakpoint = 1023;
function setVariables() {
viewport = updateViewportDimensions();
App.isMobile = (viewport.width <= App.mobileUpperBreakpoint);
App.isMobileAlt = (viewport.width <= App.mobileAltBreakpoint);
App.isTablet = (viewport.width > App.mobileUpperBreakpoint && viewport.width <= App.tabletUpperBreakpoint);
App.isTabletDown = (viewport.width <= App.tabletUpperBreakpoint);
App.isDesktop = (viewport.width > App.tabletUpperBreakpoint);
App.activeViewport = App.isMobile ? 'small' : App.isTablet ? 'med' : 'large';
}
setVariables();
App.cachedViewport = App.isMobile ? 'small' : App.isTablet ? 'med' : 'large';
App.isAnyArticle = !!(scmByClass('widget-ArticleFullView').length || scmByClass('pg_abstract').length || scmByClass('widget-MagazineView').length || scmByClass('widget-ChannelsMagazineView').length);
App.isSplitScreen = !!scmByClass('widget-ArticleFullView').length;
App.isAbstract = !!scmByClass('pg_abstract').length;
App.isMag = !!(scmByClass('widget-MagazineView').length);
App.isChannel = !!(scmByClass('channel-site').length);
App.isChannelMag = !!(scmByClass('widget-ChannelsMagazineView').length);
App.isFreeArticle = !!(scmquery('.widget-ArticleTopInfo .free-access') || scmquery('.widget-ArticleTopInfo .open-access') || scmquery('.widget-ArticleTopInfo .icon-free') || scmquery('.widget-ChannelsMagazineView .free-access'));
App.isTollFreeAccess = false;
App.isIssue = !!scmByClass('pg_issue').length || !!scmByClass('pg_newonline').length || !!scmByClass('pg_currentissue').length || !!scmByClass('pg_pastissues').length;
App.isNewOnline = !!scmByClass('pg_newonline').length;
App.isCurrentIssue = !!scmByClass('pg_currentissue').length;
App.isPastIssues = !!scmByClass('pg_pastissues').length;
App.isJournal = !!scmByClass('pg_journal').length;
App.isNetworkHome = !!scmByClass('pg_index').length;
App.isSearch = !!scmByClass('pg_searchresults').length;
App.isAdvancedSearch = !!scmByClass('pg_advancedsearch').length;
App.isPlayer = !!scmByClass('pg_multimediaplayer').length;
App.isSelfServe = !!scmByClass('pg_sspage').length;
App.isMyAccount = !!scmByClass('pg_myaccount').length;
App.supportsFlexbox = !!scmByClass('flexbox').length;
App.isCollection = !!scmByClass('pg_collection').length;
App.isPaidUser = isTrueString(scmById('hfAppIsPaidUser').getAttribute('value'));
App.isMember = isTrueString(scmById('hfAppIsMember').getAttribute('value'));
App.isIndividual = isTrueString(scmById('hfAppIsIndividual').getAttribute('value'));
App.hasAccess = isTrueString(scmById('hfAppHasAccess').getAttribute('value'));
App.isReferredFromGoogle = isTrueString(scmById('hfAppIsReferredFromGoogle').getAttribute('value'));
var subscribedTo = scmById('hfAppSubscribedTo').getAttribute('value');
App.userSubscribedTo = subscribedTo ? subscribedTo.split(',') : undefined;
App.isLucy = isTrueString(scmById('hfAppIsLucy').getAttribute('value'));
App.currentJournalCount = 18;
App.isChannelPage = !!(scmByClass('channels-page'));
App.updateAppVariables = debounce(function() {
setVariables();
}, 50, false);
})(App);
</script>
<div class="footer-ad-wrapper">
<div id="BodyContent_Footer_divAds" class="footer-ad desktop-only">
</div>
</div>
<div class="ad-riser-wrap desktop-only ad-loaded">
<div class="ad-riser--dismiss t-c">X</div>
<div id="ad-riser" class="ad-riser advertisement desktop-only ad-text vert" data-slot="12" data-google-query-id="CObP9_aw0vUCFZe4dwod5ykNug">
<div id="google_ads_iframe_/6479/ama.jama/scholarly_2__container__" style="border: 0pt none;"><iframe id="google_ads_iframe_/6479/ama.jama/scholarly_2" title="3rd party ad content" name="google_ads_iframe_/6479/ama.jama/scholarly_2"
width="728" height="90" scrolling="no" marginwidth="0" marginheight="0" frameborder="0" role="region" aria-label="Advertisement" tabindex="0" srcdoc="" data-google-container-id="3" style="border: 0px; vertical-align: bottom;"
data-load-complete="true"></iframe></div>
</div>
</div>
<div class="footer-wrap">
</div>
<div class="ss-ui-only">
<div class="widget-SelfServeContent widget-instance-AMA_SS_UI_Only">
<div class="self-serve">.</div>
</div>
</div>
</section>
<div id="revealModal" class="reveal-modal" data-reveal="">
<div id="revealContent"></div>
<a class="close-reveal-modal icon-close"></a>
</div>
<div class="artmet-modal" id="MetricsModal">
<div class="artmet-modal-contents">
<a class="artmet-close-modal">×</a>
</div>
</div>
<div class="widget-SigninModals widget-instance-AMA_SigninModals">
<div class="js-modal-no-access-reveal no-access reveal-modal modal tiny" data-reveal="">
<div class="modal--box">
<div class="modal--title">Access your subscriptions</div>
<hr>
<button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2788346"> Sign in<span
class="fw-normal"> | personal account</span>
</button>
<div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_NoAccess_AdvancedSeamlessAccessButton">
<div class="seamless-access-button--wrap">
<button class="d-flex sa-button align-items-center" role="button" type="button">
<div class="sa-button-logo-wrap">
<img src="/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo">
</div>
<div class="d-flex justify-content-center align-items-center sa-button-text text-truncate">
<div class="sa-button-text-primary text-truncate">Access through your institution</div>
</div>
</button>
<div class="sa-access-text text-truncate hide">
<div class="sa-cta-access"><span>Add or change institution</span></div>
</div>
</div>
</div>
<div class="widget-SelfServeContent widget-instance-AMA_NoAccess_SigninModal_CreateAccount">
<div class="self-serve">
<div class="modal--title">Free access to newly published articles</div>
<hr>
<button class="modal--btn js-btn-create-personal-account" type="button" role="button">
<div class="text-truncate">Create a free personal account</div>
</button>
<div class="modal--btn-desc">To register for email alerts with links to free full-text articles</div>
<!--<div class="jn-selfServe-modal-label">JAMA|SigninModal_CreateAccount</div>-->
</div>
</div>
<div class="widget-SelfServeContent widget-instance-AMA_NoAccess_SigninModal_PurchaseOptions_NoAccessAndPaidPDF">
<div class="self-serve">
<div class="modal--title">Purchase access</div>
<hr>
<button class="modal--btn js-btn-subscribe-journal" type="button" role="button">
<div class="text-truncate">Subscribe to journal</div>
</button>
<div class="modal--btn-desc">Get full journal access for 1 year</div>
<button class="modal--btn js-btn-purchase-article" type="button" role="button">
<div class="text-truncate">Buy article</div>
</button>
<div class="modal--btn-desc">Get unlimited access and a printable PDF ($40.00)—<br>
<em>Sign in or create a free account</em>
</div>
<!--<div class="jn-selfServe-modal-label">JAMA|SigninModal_PurchaseOptions_NoAccessAndPaidPDF</div>-->
</div>
</div>
<div class="widget-DeepDyve widget-instance-AMA_NoAccess_DeepDyve">
<button type="button" role="button" class="modal--btn js-deepdyve-link hiddenRentalLink" data-deepdyveurl="https://www.deepdyve.com/doc-view?docId=10.1001/jama.2021.24110&fieldName=journal_doi&affiliateId=JAMA"
data-doi="10.1001/jama.2021.24110" data-fieldname="journal_doi" data-issneissn="0098-7484" data-affiliate="JAMA">Rent article</button>
<div class="modal--btn-desc js-deepdyve-desc hiddenRentalLink">Rent this article from DeepDyve</div>
</div>
</div>
<a class="close-reveal-modal icon-close"></a>
</div>
<div class="js-modal-paid-pdf-reveal no-access reveal-modal modal tiny" data-reveal="">
<div class="modal--box">
<div class="modal--title">Access your subscriptions</div>
<hr>
<button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2788346"> Sign in<span
class="fw-normal"> | personal account</span>
</button>
<div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_PaidPdf_AdvancedSeamlessAccessButton">
<div class="seamless-access-button--wrap">
<button class="d-flex sa-button align-items-center" role="button" type="button">
<div class="sa-button-logo-wrap">
<img src="/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo">
</div>
<div class="d-flex justify-content-center align-items-center sa-button-text text-truncate">
<div class="sa-button-text-primary text-truncate">Access through your institution</div>
</div>
</button>
<div class="sa-access-text text-truncate hide">
<div class="sa-cta-access"><span>Add or change institution</span></div>
</div>
</div>
</div>
<div class="widget-SelfServeContent widget-instance-AMA_PaidPdf_SigninModal_CreateAccount">
<div class="self-serve">
<div class="modal--title">Free access to newly published articles</div>
<hr>
<button class="modal--btn js-btn-create-personal-account" type="button" role="button">
<div class="text-truncate">Create a free personal account</div>
</button>
<div class="modal--btn-desc">To register for email alerts with links to free full-text articles</div>
<!--<div class="jn-selfServe-modal-label">JAMA|SigninModal_CreateAccount</div>-->
</div>
</div>
<div class="widget-SelfServeContent widget-instance-AMA_PaidPdf_SigninModal_PurchaseOptions_NoAccessAndPaidPDF">
<div class="self-serve">
<div class="modal--title">Purchase access</div>
<hr>
<button class="modal--btn js-btn-subscribe-journal" type="button" role="button">
<div class="text-truncate">Subscribe to journal</div>
</button>
<div class="modal--btn-desc">Get full journal access for 1 year</div>
<button class="modal--btn js-btn-purchase-article" type="button" role="button">
<div class="text-truncate">Buy article</div>
</button>
<div class="modal--btn-desc">Get unlimited access and a printable PDF ($40.00)—<br>
<em>Sign in or create a free account</em>
</div>
<!--<div class="jn-selfServe-modal-label">JAMA|SigninModal_PurchaseOptions_NoAccessAndPaidPDF</div>-->
</div>
</div>
<div class="widget-DeepDyve widget-instance-AMA_PaidPDF_DeepDyve">
<button type="button" role="button" class="modal--btn js-deepdyve-link hiddenRentalLink" data-deepdyveurl="https://www.deepdyve.com/doc-view?docId=10.1001/jama.2021.24110&fieldName=journal_doi&affiliateId=JAMA"
data-doi="10.1001/jama.2021.24110" data-fieldname="journal_doi" data-issneissn="0098-7484" data-affiliate="JAMA">Rent article</button>
<div class="modal--btn-desc js-deepdyve-desc hiddenRentalLink">Rent this article from DeepDyve</div>
</div>
</div>
<a class="close-reveal-modal icon-close"></a>
</div>
<div class="js-modal-free-pdf-reveal no-access reveal-modal modal tiny" data-reveal="">
<div class="modal--box">
<div class="modal--title">Access to free article PDF downloads</div>
<hr>
<button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2788346"> Sign in<span
class="fw-normal"> | personal account</span>
</button>
<div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_FreePdf_AdvancedSeamlessAccessButton">
<div class="seamless-access-button--wrap">
<button class="d-flex sa-button align-items-center" role="button" type="button">
<div class="sa-button-logo-wrap">
<img src="/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo">
</div>
<div class="d-flex justify-content-center align-items-center sa-button-text text-truncate">
<div class="sa-button-text-primary text-truncate">Access through your institution</div>
</div>
</button>
<div class="sa-access-text text-truncate hide">
<div class="sa-cta-access"><span>Add or change institution</span></div>
</div>
</div>
</div>
<div class="widget-SelfServeContent widget-instance-AMA_FreePdf_SigninModal_CreateAccount">
<div class="self-serve">
<div class="modal--title">Free access to newly published articles</div>
<hr>
<button class="modal--btn js-btn-create-personal-account" type="button" role="button">
<div class="text-truncate">Create a free personal account</div>
</button>
<div class="modal--btn-desc">To register for email alerts with links to free full-text articles</div>
<!--<div class="jn-selfServe-modal-label">JAMA|SigninModal_CreateAccount</div>-->
</div>
</div>
</div>
<a class="close-reveal-modal icon-close"></a>
</div>
<div class="js-modal-save-search-reveal no-access reveal-modal modal tiny" data-reveal="">
<div class="modal--box">
<div class="modal--title">Save your search</div>
<hr>
<button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2788346"> Sign in<span
class="fw-normal"> | personal account</span>
</button>
<div class="widget-SelfServeContent widget-instance-AMA_SaveSearch_SigninModal_CreateAccount">
<div class="self-serve">
<div class="modal--title">Free access to newly published articles</div>
<hr>
<button class="modal--btn js-btn-create-personal-account" type="button" role="button">
<div class="text-truncate">Create a free personal account</div>
</button>
<div class="modal--btn-desc">To register for email alerts with links to free full-text articles</div>
<!--<div class="jn-selfServe-modal-label">JAMA|SigninModal_CreateAccount</div>-->
</div>
</div>
<div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_SaveSearch">
<div class="self-serve">
<div class="modal--title">Purchase access</div>
<hr>
<button class="modal--btn js-btn-subscribe-now">Subscribe now</button>
<!--<div class="jn-selfServe-modal-label">JAMA|SigninModal_PurchaseOptions_SaveSearch</div>-->
</div>
</div>
</div>
<a class="close-reveal-modal icon-close"></a>
</div>
<div class="js-modal-follow-collection-reveal no-access reveal-modal modal tiny" data-reveal="">
<div class="modal--box">
<div class="modal--title">Customize your interests</div>
<hr>
<button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2788346"> Sign in<span
class="fw-normal"> | personal account</span>
</button>
<div class="widget-SelfServeContent widget-instance-AMA_FollowCollection_SigninModal_CreateAccount">
<div class="self-serve">
<div class="modal--title">Free access to newly published articles</div>
<hr>
<button class="modal--btn js-btn-create-personal-account" type="button" role="button">
<div class="text-truncate">Create a free personal account</div>
</button>
<div class="modal--btn-desc">To register for email alerts with links to free full-text articles</div>
<!--<div class="jn-selfServe-modal-label">JAMA|SigninModal_CreateAccount</div>-->
</div>
</div>
<div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_FollowCollection">
<div class="self-serve">
<div class="modal--sub-title">Create a personal account or sign in to:</div>
<ul>
<li>Register for email alerts with links to free full-text articles</li>
<li>Access PDFs of free articles</li>
<li>Manage your interests</li>
<li>Save searches and receive search alerts</li>
<ul>
<!--<div class="jn-selfServe-modal-label">JAMA|SigninModal_PurchaseOptions_FollowCollection</div>-->
</ul>
</ul>
</div>
</div>
<div class="modal--link-wrap">
<a class="modal--link" href="/pages/privacy-policy" rel="nofollow">Privacy Policy</a>
</div>
</div>
<a class="close-reveal-modal icon-close"></a>
</div>
<div class="js-modal-user-comment-reveal no-access reveal-modal modal tiny" data-reveal="">
<div class="modal--box">
<div class="modal--title">Make a comment</div>
<hr>
<button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f2788346"> Sign in<span
class="fw-normal"> | personal account</span>
</button>
<div class="widget-SelfServeContent widget-instance-AMA_UserComment_SigninModal_CreateAccount">
<div class="self-serve">
<div class="modal--title">Free access to newly published articles</div>
<hr>
<button class="modal--btn js-btn-create-personal-account" type="button" role="button">
<div class="text-truncate">Create a free personal account</div>
</button>
<div class="modal--btn-desc">To register for email alerts with links to free full-text articles</div>
<!--<div class="jn-selfServe-modal-label">JAMA|SigninModal_CreateAccount</div>-->
</div>
</div>
<div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_UserComment">
<div class="self-serve">
<div class="modal--sub-title">Create a personal account or sign in to:</div>
<ul>
<li>Register for email alerts with links to free full-text articles</li>
<li>Access PDFs of free articles</li>
<li>Manage your interests</li>
<li>Save searches and receive search alerts</li>
<ul>
<!--<div class="jn-selfServe-modal-label">JAMA|SigninModal_PurchaseOptions_UserComment</div>-->
</ul>
</ul>
</div>
</div>
<div class="modal--link-wrap">
<a class="modal--link" href="/pages/privacy-policy" rel="nofollow">Privacy Policy</a>
</div>
</div>
<a class="close-reveal-modal icon-close"></a>
</div>
<div class="hidden-true js-modal-page-data" data-store-url="https://store.jamanetwork.com" data-store-purchase-url="https://jamanetwork.com/oauthsignin?return_url=https://store.jamanetwork.com"
data-store-subscribe-url="https://store.jamanetwork.com/index.aspx?productcode=64">
</div>
</div>
<script src="//cdn.jamanetwork.com/UI/app/vendor/jquery-2.2.4.min.js?v=637775817724778362"></script>
<script>
window.jQuery || document.write('<script src="/UI/app/vendor/jquery-2.2.4.min.js">\x3C/script>')
</script>
<script src="//cdn.jamanetwork.com/UI/app/dist/app.min.js?v=637783554990703350"></script>
<script src="//cdn.jsdelivr.net/chartist.js/latest/chartist.min.js" type="text/javascript"></script>
<script src="//d1bxh8uas1mnw7.cloudfront.net/assets/embed.js" type="text/javascript"></script>
<script type="text/javascript" src="//s7.addthis.com/js/300/addthis_widget.js#pubid=ra-53346900644c40ac"></script>
<script defer="" src="//js.trendmd.com/trendmd.min.js" data-trendmdconfig="{"element":"#trendmd-suggestions"}"></script>
<script>
var App = App || {};
App.showCmePromo = false;
</script><iframe src="https://50b71637aa9ee39938e010353ac4ed3e.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html" style="visibility: hidden; display: none;"></iframe>
</form>GET https://tr.snapchat.com/cm/i
<form method="GET" action="https://tr.snapchat.com/cm/i" target="snap02854757152302818" accept-charset="utf-8" style="display: none;"><iframe id="snap02854757152302818" name="snap02854757152302818"></iframe><input name="pid"></form>Text Content
Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From
December 2020 to August 2021 | Cardiology | JAMA | JAMA Network
Our website uses cookies to enhance your experience. By continuing to use our
site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue
[Skip to Navigation]
JAMA
HomeNew OnlineCurrent IssueFor Authors
PODCASTS
Clinical Reviews Editors' Summary Medical News Author Interviews More
PUBLICATIONS
JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA
Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA
Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery
Archives of Neurology & Psychiatry (1919-1959)
JN Learning / CMESubscribeAppsJobsInstitutions / LibrariansReprints &
Permissions
Terms of Use | Privacy Policy | Accessibility Statement
2022 American Medical Association. All Rights Reserved
Search All
* Search All
* JAMA
* JAMA Network Open
* JAMA Cardiology
* JAMA Dermatology
* JAMA Forum Archive
* JAMA Health Forum
* JAMA Internal Medicine
* JAMA Neurology
* JAMA Oncology
* JAMA Ophthalmology
* JAMA Otolaryngology–Head & Neck Surgery
* JAMA Pediatrics
* JAMA Psychiatry
* JAMA Surgery
* Archives of Neurology & Psychiatry
Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum
Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology
JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA
Psychiatry JAMA Surgery Archives of Neurology & Psychiatry
Input Search Term
Sign In
Individual Sign In
Sign inCreate an Account
Access through your institution
Sign In
Purchase Options:
Subscribe to the JAMA journal
full text icon
Full Text
contents icon
Contents
figure icon
Figures /
Tables
multimedia icon
Multimedia
attach icon
Supplemental
Content
references icon
References
related icon
Related
comments icon
Comments
Download PDF
Top of Article
* Key Points
* Abstract
* Introduction
* Methods
* Results
* Discussion
* Conclusions
* Article Information
* References
Figure 1. Cases of Myocarditis After mRNA-Based COVID-19 Vaccination by Age at
Onset of Myocarditis
View LargeDownload
The reports to the Vaccine Adverse Event Reporting System met the case
definition of myocarditis (reported cases). Among individuals older than 40
years of age, there were no more than 8 reports of myocarditis for any
individual age after receiving either vaccine. For the BNT162b2 vaccine, there
were 114 246 837 first vaccination doses and 95 532 396 second vaccination
doses; and for the mRNA-1273 vaccine, there were 78 158 611 and 66 163 001,
respectively. The y-axis range differs between panels A and B.
Figure 2. Cases of Myocarditis After mRNA-Based COVID-19 Vaccination by Time
From Vaccination to Symptom Onset
View LargeDownload
The reports to the Vaccine Adverse Event Reporting System met the case
definition of myocarditis (reported cases). Among recipients of either vaccine,
there were only 13 reports or less of myocarditis beyond 10 days for any
individual time from vaccination to symptom onset. The y-axis range differs
between panels A and B.
A, For the BNT162b2 vaccine, there were 138 reported cases of myocarditis with
known date for symptom onset and dose after 114 246 837 first vaccination doses
and 888 reported cases after 95 532 396 second vaccination doses.
B, For the mRNA-1273 vaccine, there were 116 reported cases of myocarditis with
known date for symptom onset and dose after 78 158 611 first vaccination doses
and 311 reported cases after 66 163 001 second vaccination doses.
Table 1. Characteristics of Reports to VAERS After mRNA-Based COVID-19
Vaccination That Met the CDC’s Case Definition for Myocarditis Between December
14, 2020, and August 31, 2021
View LargeDownload
Table 2. Reports to VAERS After mRNA-Based COVID-19 Vaccination That Met the
CDC’s Case Definition for Myocarditis Within a 7-Day Risk Interval per Million
Doses of Vaccine Administered
View LargeDownload
Table 3. Symptoms, Treatment, and Outcomes in 826 Patients Younger Than 30
Years of Age With Myocarditis
View LargeDownload
Supplement.
eMethods. Medical Dictionary for Regulatory Activities Preferred Terms,
Definitions of Myocarditis and Pericarditis, Myocarditis medical review form
eFigure. Flow diagram of cases of myocarditis and pericarditis reported to
Vaccine Adverse Event Reporting System (VAERS) after receiving mRNA-based
COVID-19 vaccine, United States, December 14, 2020-August 31, 2021.
eTable 1. Characteristics of all myocarditis cases reported to Vaccine Adverse
Event Reporting System (VAERS) after mRNA-based COVID-19 vaccination, United
States, December 14, 2020–August 31, 2021.
eTable 2. Characteristics of all pericarditis cases reported to Vaccine Adverse
Event Reporting System (VAERS) after mRNA-based COVID-19 vaccination, United
States, December 14, 2020–August 31, 2021.
eTable 3. Characteristics of myocarditis cases reported to Vaccine Adverse Event
Reporting System after mRNA-based COVID-19 vaccination by case definition
status.
1.
Cooper LT Jr. Myocarditis. N Engl J Med. 2009;360(15):1526-1538.
doi:10.1056/NEJMra0800028PubMedGoogle ScholarCrossref
2.
Vasudeva R, Bhatt P, Lilje C, et al. Trends in acute myocarditis–related
pediatric hospitalizations in the United States, 2007-2016. Am J Cardiol.
2021;149:95-102. doi:10.1016/j.amjcard.2021.03.019PubMedGoogle ScholarCrossref
3.
Arola A, Pikkarainen E, Sipilä JO, Pykäri J, Rautava P, Kytö V.
Occurrence and features of childhood myocarditis: a nationwide study in
Finland. J Am Heart Assoc. 2017;6(11):e005306.
doi:10.1161/JAHA.116.005306PubMedGoogle Scholar
4.
Kytö V, Sipilä J, Rautava P. The effects of gender and age on occurrence
of clinically suspected myocarditis in adulthood. Heart.
2013;99(22):1681-1684. doi:10.1136/heartjnl-2013-304449PubMedGoogle
ScholarCrossref
5.
Dasgupta S, Iannucci G, Mao C, Clabby M, Oster ME. Myocarditis in the
pediatric population: a review. Congenit Heart Dis. 2019;14(5):868-877.
doi:10.1111/chd.12835PubMedGoogle ScholarCrossref
6.
Pollack A, Kontorovich AR, Fuster V, Dec GW. Viral
myocarditis—diagnosis, treatment options, and current controversies. Nat Rev
Cardiol. 2015;12(11):670-680. doi:10.1038/nrcardio.2015.108PubMedGoogle
ScholarCrossref
7.
Halsell JS, Riddle JR, Atwood JE, et al; Department of Defense Smallpox
Vaccination Clinical Evaluation Team. Myopericarditis following smallpox
vaccination among vaccinia-naive US military personnel. JAMA.
2003;289(24):3283-3289. doi:10.1001/jama.289.24.3283
ArticlePubMedGoogle ScholarCrossref
8.
Gubernot D, Jazwa A, Niu M, et al. US population-based background
incidence rates of medical conditions for use in safety assessment of COVID-19
vaccines. Vaccine. 2021;39(28):3666-3677.
doi:10.1016/j.vaccine.2021.05.016PubMedGoogle ScholarCrossref
9.
US Centers for Disease Control and Prevention. Clinical Immunization Safety
Assessment project. Accessed August 24, 2021.
https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/cisa/index.html
10.
Marshall M, Ferguson ID, Lewis P, et al. Symptomatic acute myocarditis
in 7 adolescents after Pfizer-BioNTech COVID-19 vaccination. Pediatrics.
2021;148(3):e2021052478. doi:10.1542/peds.2021-052478PubMedGoogle Scholar
11.
Kim HW, Jenista ER, Wendell DC, et al. Patients with acute myocarditis
following mRNA COVID-19 vaccination. JAMA Cardiol. 2021;6(10):1196-1201.
doi:10.1001/jamacardio.2021.2828
ArticlePubMedGoogle ScholarCrossref
12.
Montgomery J, Ryan M, Engler R, et al. Myocarditis following
immunization with mRNA COVID-19 vaccines in members of the US military. JAMA
Cardiol. 2021;6(10):1202-1206. doi:10.1001/jamacardio.2021.2833
ArticlePubMedGoogle ScholarCrossref
13.
Diaz GA, Parsons GT, Gering SK, Meier AR, Hutchinson IV, Robicsek A.
Myocarditis and pericarditis after vaccination for COVID-19. JAMA.
2021;326(12):1210-1212. doi:10.1001/jama.2021.13443
ArticlePubMedGoogle ScholarCrossref
14.
Mevorach D, Anis E, Cedar N, et al. Myocarditis after BNT162b2 mRNA
vaccine against Covid-19 in Israel. N Engl J Med. 2021;385(23):2140-2149.
doi:10.1056/NEJMoa2109730PubMedGoogle ScholarCrossref
15.
Witberg G, Barda N, Hoss S, et al. Myocarditis after Covid-19
vaccination in a large health care organization. N Engl J Med.
2021;385(23):2132-2139. doi:10.1056/NEJMoa2110737PubMedGoogle ScholarCrossref
16.
MedDRA. Medical Dictionary for Regulatory Activities. Accessed June 30, 2021.
https://www.meddra.org
17.
US Centers for Disease Control and Prevention. CDC COVID-19 data tracker.
Accessed June 30, 2021. https://covid.cdc.gov/covid-data-tracker
18.
Gargano JW, Wallace M, Hadler SC, et al. Use of mRNA COVID-19 vaccine
after reports of myocarditis among vaccine recipients: update from the Advisory
Committee on Immunization Practices—United States, June 2021. MMWR Morb
Mortal Wkly Rep. 2021;70(27):977-982. doi:10.15585/mmwr.mm7027e2PubMedGoogle
ScholarCrossref
19.
Abu Mouch S, Roguin A, Hellou E, et al. Myocarditis following COVID-19
mRNA vaccination. Vaccine. 2021;39(29):3790-3793.
doi:10.1016/j.vaccine.2021.05.087PubMedGoogle ScholarCrossref
20.
Larson KF, Ammirati E, Adler ED, et al. Myocarditis after BNT162b2 and
mRNA-1273 vaccination. Circulation. 2021;144(6):506-508.
doi:10.1161/CIRCULATIONAHA.121.055913PubMedGoogle ScholarCrossref
21.
Rosner CM, Genovese L, Tehrani BN, et al. Myocarditis temporally
associated with COVID-19 vaccination. Circulation. 2021;144(6):502-505.
doi:10.1161/CIRCULATIONAHA.121.055891PubMedGoogle ScholarCrossref
22.
Boehmer TK, Kompaniyets L, Lavery AM, et al. Association between
COVID-19 and myocarditis using hospital-based administrative data—United States,
March 2020-January 2021. MMWR Morb Mortal Wkly Rep. 2021;70(35):1228-1232.
doi:10.15585/mmwr.mm7035e5PubMedGoogle ScholarCrossref
23.
Harris PA, Taylor R, Minor BL, et al; REDCap Consortium. The REDCap
Consortium: building an international community of software platform partners.
J Biomed Inform. 2019;95:103208. doi:10.1016/j.jbi.2019.103208PubMedGoogle
Scholar
24.
Mahrholdt H, Wagner A, Deluigi CC, et al. Presentation, patterns of
myocardial damage, and clinical course of viral myocarditis. Circulation.
2006;114(15):1581-1590. doi:10.1161/CIRCULATIONAHA.105.606509PubMedGoogle
ScholarCrossref
25.
Mason JW, O’Connell JB, Herskowitz A, et al; Myocarditis Treatment Trial
Investigators. A clinical trial of immunosuppressive therapy for myocarditis.
N Engl J Med. 1995;333(5):269-275. doi:10.1056/NEJM199508033330501PubMedGoogle
ScholarCrossref
26.
Saji T, Matsuura H, Hasegawa K, et al. Comparison of the clinical
presentation, treatment, and outcome of fulminant and acute myocarditis in
children. Circ J. 2012;76(5):1222-1228.
doi:10.1253/circj.CJ-11-1032PubMedGoogle ScholarCrossref
27.
Ghelani SJ, Spaeder MC, Pastor W, Spurney CF, Klugman D.
Demographics, trends, and outcomes in pediatric acute myocarditis in the United
States, 2006 to 2011. Circ Cardiovasc Qual Outcomes. 2012;5(5):622-627.
doi:10.1161/CIRCOUTCOMES.112.965749PubMedGoogle ScholarCrossref
28.
Caforio ALP, Pankuweit S, Arbustini E, et al; European Society of
Cardiology Working Group on Myocardial and Pericardial Diseases. Current state
of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a
position statement of the European Society of Cardiology Working Group on
Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636-2648.
doi:10.1093/eurheartj/eht210PubMedGoogle ScholarCrossref
29.
Yancy CW, Jessup M, Bozkurt B, et al; American College of Cardiology
Foundation; American Heart Association Task Force on Practice Guidelines. 2013
ACCF/AHA guideline for the management of heart failure: a report of the American
College of Cardiology Foundation/American Heart Association Task Force on
Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-e239.
doi:10.1016/j.jacc.2013.05.019PubMedGoogle ScholarCrossref
30.
Law YM, Lal AK, Chen S, et al; American Heart Association Pediatric Heart
Failure and Transplantation Committee of the Council on Lifelong Congenital
Heart Disease and Heart Health in the Young and Stroke Council. Diagnosis and
management of myocarditis in children: a scientific statement from the American
Heart Association. Circulation. 2021;144(6):e123-e135.
doi:10.1161/CIR.0000000000001001PubMedGoogle ScholarCrossref
31.
US Centers for Disease Control and Prevention. Clinical considerations:
myocarditis and pericarditis after receipt of mRNA COVID-19 vaccines among
adolescents and young adults. Accessed August 24, 2021.
https://www.cdc.gov/vaccines/covid-19/clinical-considerations/myocarditis.html
32.
Sachdeva S, Song X, Dham N, Heath DM, DeBiasi RL. Analysis of
clinical parameters and cardiac magnetic resonance imaging as predictors of
outcome in pediatric myocarditis. Am J Cardiol. 2015;115(4):499-504.
doi:10.1016/j.amjcard.2014.11.029PubMedGoogle ScholarCrossref
33.
Ferreira VM, Schulz-Menger J, Holmvang G, et al. Cardiovascular magnetic
resonance in nonischemic myocardial inflammation: expert recommendations. J
Am Coll Cardiol. 2018;72(24):3158-3176.
doi:10.1016/j.jacc.2018.09.072PubMedGoogle ScholarCrossref
34.
US Centers for Disease Control and Prevention. Investigating long-term effects
of myocarditis. Accessed August 24, 2021.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myo-outcomes.html
35.
Maron BJ, Udelson JE, Bonow RO, et al; American Heart Association
Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology,
Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke
Nursing, Council on Functional Genomics and Translational Biology, and American
College of Cardiology. Eligibility and disqualification recommendations for
competitive athletes with cardiovascular abnormalities: task force 3:
hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and
other cardiomyopathies, and myocarditis: a scientific statement from the
American Heart Association and American College of Cardiology. Circulation.
2015;132(22):e273-e280. doi:10.1161/CIR.0000000000000239PubMedGoogle Scholar
36.
Aquaro GD, Ghebru Habtemicael Y, Camastra G, et al; Cardiac Magnetic
Resonance Working Group of the Italian Society of Cardiology. Prognostic value
of repeating cardiac magnetic resonance in patients with acute myocarditis. J
Am Coll Cardiol. 2019;74(20):2439-2448.
doi:10.1016/j.jacc.2019.08.1061PubMedGoogle ScholarCrossref
37.
US Centers for Disease Control and Prevention. Interim clinical considerations
for use of COVID-19 vaccines currently authorized in the United States. Accessed
August 24, 2021.
https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html
38.
Shimabukuro TT, Nguyen M, Martin D, DeStefano F. Safety monitoring in
the Vaccine Adverse Event Reporting System (VAERS). Vaccine.
2015;33(36):4398-4405. doi:10.1016/j.vaccine.2015.07.035PubMedGoogle
ScholarCrossref
39.
US Centers for Disease Control and Prevention. HIPAA privacy rule and public
health: guidance from CDC and the US Department of Health and Human Services.
MMWR Suppl. 2003;52:1-17, 19-20.PubMedGoogle Scholar
* Myocarditis and Pericarditis After Vaccination for COVID-19
Research Letter
September 28, 2021
This study investigates the incidence of myocarditis and pericarditis
emergency department or inpatient hospital encounters before COVID-19 vaccine
availability (January 2019–January 2021) and during a COVID-19 vaccination
period (February-May 2021) in a large US health care system.
George A. Diaz, MD; Guilford T. Parsons, MD, MS; Sara K. Gering, BS, BSN;
Audrey R. Meier, MPH; Ian V. Hutchinson, PhD, DSc; Ari Robicsek, MD
* Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of
the US Military
Brief Report
October 1, 2021
This case series describes myocarditis presenting after COVID-19 vaccination
within the Military Health System.
Jay Montgomery, MD; Margaret Ryan, MD, MPH; Renata Engler, MD;
Donna Hoffman, MSN; Bruce McClenathan, MD; Limone Collins, MD;
David Loran, DNP; David Hrncir, MD; Kelsie Herring, MD; Michael Platzer, MD;
Nehkonti Adams, MD; Aliye Sanou, MD; Leslie T. Cooper Jr, MD
* Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination
Brief Report
October 1, 2021
This study describes 4 patients who presented with acute myocarditis after
mRNA COVID-19 vaccination.
Han W. Kim, MD; Elizabeth R. Jenista, PhD; David C. Wendell, PhD; Clerio
F. Azevedo, MD; Michael J. Campbell, MD; Stephen N. Darty, BS; Michele
A. Parker, MS; Raymond J. Kim, MD
* Association of Myocarditis With BNT162b2 Vaccination in Children
Brief Report
December 1, 2021
This case series reviews comprehensive cardiac imaging in children with
myocarditis after COVID-19 vaccine.
Audrey Dionne, MD; Francesca Sperotto, MD; Stephanie Chamberlain; Annette
L. Baker, MSN, CPNP; Andrew J. Powell, MD; Ashwin Prakash, MD; Daniel
A. Castellanos, MD; Susan F. Saleeb, MD; Sarah D. de Ferranti, MD, MPH; Jane
W. Newburger, MD, MPH; Kevin G. Friedman, MD
SEE MORE ABOUT
Public Health Vaccination Cardiology Coronavirus (COVID-19)
TRENDING
* Association of Myocarditis With BNT162b2 Vaccination in Children
JAMA Cardiology
Research
December 1, 2021
* Association Between 3 Doses of mRNA COVID-19 Vaccine and Symptomatic
Infection Caused by Omicron and Delta Variants
JAMA
Research
January 21, 2022
* Surveillance for Adverse Events After COVID-19 mRNA Vaccination
JAMA
Research
October 12, 2021
--------------------------------------------------------------------------------
SELECT YOUR INTERESTS
SELECT YOUR INTERESTS
Customize your JAMA Network experience by selecting one or more topics from the
list below.
* Acid Base, Electrolytes, Fluids
* Addiction Medicine
* Allergy and Clinical Immunology
* Anesthesiology
* Anticoagulation
* Art and Images in Psychiatry
* Bleeding and Transfusion
* Cardiology
* Caring for the Critically Ill Patient
* Challenges in Clinical Electrocardiography
* Clinical Challenge
* Clinical Decision Support
* Clinical Implications of Basic Neuroscience
* Clinical Pharmacy and Pharmacology
* Complementary and Alternative Medicine
* Consensus Statements
* Coronavirus (COVID-19)
* Critical Care Medicine
* Cultural Competency
* Dental Medicine
* Dermatology
* Diabetes and Endocrinology
* Diagnostic Test Interpretation
* Diversity, Equity, and Inclusion
* Drug Development
* Electronic Health Records
* Emergency Medicine
* End of Life
* Environmental Health
* Ethics
* Facial Plastic Surgery
* Gastroenterology and Hepatology
* Genetics and Genomics
* Genomics and Precision Health
* Geriatrics
* Global Health
* Guide to Statistics and Medicine
* Guidelines
* Hair Disorders
* Health Care Delivery Models
* Health Care Economics, Insurance, Payment
* Health Care Quality
* Health Care Reform
* Health Care Safety
* Health Care Workforce
* Health Disparities
* Health Inequities
* Health Informatics
* Health Policy
* Hematology
* History of Medicine
* Humanities
* Hypertension
* Images in Neurology
* Implementation Science
* Infectious Diseases
* Innovations in Health Care Delivery
* JAMA Infographic
* Law and Medicine
* Leading Change
* Less is More
* LGBTQ
* Lifestyle Behaviors
* Medical Coding
* Medical Devices and Equipment
* Medical Education
* Medical Education and Training
* Medical Journals and Publishing
* Melanoma
* Mobile Health and Telemedicine
* Narrative Medicine
* Nephrology
* Neurology
* Neuroscience and Psychiatry
* Notable Notes
* Nursing
* Nutrition
* Nutrition, Obesity, Exercise
* Obesity
* Obstetrics and Gynecology
* Occupational Health
* Oncology
* Ophthalmic Images
* Ophthalmology
* Orthopedics
* Otolaryngology
* Pain Medicine
* Pathology and Laboratory Medicine
* Patient Care
* Patient Information
* Pediatrics
* Performance Improvement
* Performance Measures
* Perioperative Care and Consultation
* Pharmacoeconomics
* Pharmacoepidemiology
* Pharmacogenetics
* Pharmacy and Clinical Pharmacology
* Physical Medicine and Rehabilitation
* Physical Therapy
* Physician Leadership
* Poetry
* Population Health
* Preventive Medicine
* Professional Well-being
* Professionalism
* Psychiatry and Behavioral Health
* Public Health
* Pulmonary Medicine
* Radiology
* Regulatory Agencies
* Research, Methods, Statistics
* Resuscitation
* Rheumatology
* Risk Management
* Scientific Discovery and the Future of Medicine
* Shared Decision Making and Communication
* Sleep Medicine
* Sports Medicine
* Stem Cell Transplantation
* Surgery
* Surgical Innovation
* Surgical Pearls
* Teachable Moment
* Technology and Finance
* The Art of JAMA
* The Arts and Medicine
* The Rational Clinical Examination
* Tobacco and e-Cigarettes
* Toxicology
* Trauma and Injury
* Treatment Adherence
* Ultrasonography
* Urology
* Users' Guide to the Medical Literature
* Vaccination
* Venous Thromboembolism
* Veterans Health
* Violence
* Women's Health
* Workflow and Process
* Wound Care, Infection, Healing
Save Preferences
Privacy Policy | Terms of Use
OTHERS ALSO LIKED
WE RECOMMEND
1. Myocarditis after vaccination against covid-19
Walid F Gellad et al., The BMJ, 2021
2. CDC releases guidance for clinicians on heart inflammation after COVID-19
vaccination
Melissa Jenco et al., AAP News, 2021
1. Covid-19: Study that claimed boys are at increased risk of myocarditis after
vaccination is deeply flawed, say critics
Clara Munro, The BMJ, 2021
2. Health officials, AAP urge COVID-19 vaccination despite rare myocarditis
cases
Melissa Jenco et al., AAP News, 2021
Powered by
* Privacy policy
* Do not sell my personal information
* Google Analytics settings
I consent to the use of Google Analytics and related cookies across the TrendMD
network (widget, website, blog). Learn more
Yes No
This Issue
Views 111,491
Citations 0
3000
View Metrics
* Download PDF
* Twitter Facebook More
LinkedIn
* CME & MOC
* Cite This
CITATION
Oster ME, Shay DK, Su JR, et al. Myocarditis Cases Reported After mRNA-Based
COVID-19 Vaccination in the US From December 2020 to August 2021. JAMA.
2022;327(4):331–340. doi:10.1001/jama.2021.24110
DOWNLOAD CITATION FILE:
Ris (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager
Mendeley
© 2022
* Permissions
Original Investigation
January 25, 2022
MYOCARDITIS CASES REPORTED AFTER MRNA-BASED COVID-19 VACCINATION IN THE US FROM
DECEMBER 2020 TO AUGUST 2021
Matthew E. Oster, MD, MPH1,2,3; David K. Shay, MD, MPH1; John R. Su, MD, PhD,
MPH1; et al Julianne Gee, MPH1; C. Buddy Creech, MD, MPH4; Karen R. Broder, MD1;
Kathryn Edwards, MD4; Jonathan H. Soslow, MD, MSCI4; Jeffrey M. Dendy, MD4;
Elizabeth Schlaudecker, MD, MPH5; Sean M. Lang, MD5; Elizabeth D. Barnett, MD6;
Frederick L. Ruberg, MD6; Michael J. Smith, MD, MSCE7; M. Jay Campbell, MD,
MHA7; Renato D. Lopes, MD, PhD, MHS7; Laurence S. Sperling, MD1,2; Jane
A. Baumblatt, MD8; Deborah L. Thompson, MD, MSPH8; Paige L. Marquez, MSPH1;
Penelope Strid, MPH1; Jared Woo, MPH1; River Pugsley, PhD, MPH1;
Sarah Reagan-Steiner, MD, MPH1; Frank DeStefano, MD, MPH1; Tom
T. Shimabukuro, MD, MPH, MBA1
Author Affiliations Article Information
* 1US Centers for Disease Control and Prevention, Atlanta, Georgia
* 2School of Medicine, Emory University, Atlanta, Georgia
* 3Children’s Healthcare of Atlanta, Atlanta, Georgia
* 4Vanderbilt University Medical Center, Nashville, Tennessee
* 5Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
* 6Boston Medical Center, Boston, Massachusetts
* 7Duke University, Durham, North Carolina
* 8US Food and Drug Administration, Silver Spring, Maryland
JAMA. 2022;327(4):331-340. doi:10.1001/jama.2021.24110
visual abstract icon
Visual
Abstract
editorial comment icon
Editorial
Comment
related articles icon
Related
Articles
author interview icon
Interviews
multimedia icon
Multimedia
* Research Letter
Myocarditis and Pericarditis After Vaccination for COVID-19
George A. Diaz, MD; Guilford T. Parsons, MD, MS; Sara K. Gering, BS, BSN;
Audrey R. Meier, MPH; Ian V. Hutchinson, PhD, DSc; Ari Robicsek, MD
* Brief Report
Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of
the US Military
Jay Montgomery, MD; Margaret Ryan, MD, MPH; Renata Engler, MD;
Donna Hoffman, MSN; Bruce McClenathan, MD; Limone Collins, MD;
David Loran, DNP; David Hrncir, MD; Kelsie Herring, MD; Michael Platzer, MD;
Nehkonti Adams, MD; Aliye Sanou, MD; Leslie T. Cooper Jr, MD
* Brief Report
Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination
Han W. Kim, MD; Elizabeth R. Jenista, PhD; David C. Wendell, PhD; Clerio
F. Azevedo, MD; Michael J. Campbell, MD; Stephen N. Darty, BS; Michele
A. Parker, MS; Raymond J. Kim, MD
* Brief Report
Association of Myocarditis With BNT162b2 Vaccination in Children
Audrey Dionne, MD; Francesca Sperotto, MD; Stephanie Chamberlain; Annette
L. Baker, MSN, CPNP; Andrew J. Powell, MD; Ashwin Prakash, MD; Daniel
A. Castellanos, MD; Susan F. Saleeb, MD; Sarah D. de Ferranti, MD, MPH; Jane
W. Newburger, MD, MPH; Kevin G. Friedman, MD
Key Points
Question What is the risk of myocarditis after mRNA-based COVID-19 vaccination
in the US?
Findings In this descriptive study of 1626 cases of myocarditis in a national
passive reporting system, the crude reporting rates within 7 days after
vaccination exceeded the expected rates across multiple age and sex strata. The
rates of myocarditis cases were highest after the second vaccination dose in
adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2
vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of
the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per
million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively).
Meaning Based on passive surveillance reporting in the US, the risk of
myocarditis after receiving mRNA-based COVID-19 vaccines was increased across
multiple age and sex strata and was highest after the second vaccination dose in
adolescent males and young men.
Abstract
Importance Vaccination against COVID-19 provides clear public health benefits,
but vaccination also carries potential risks. The risks and outcomes of
myocarditis after COVID-19 vaccination are unclear.
Objective To describe reports of myocarditis and the reporting rates after
mRNA-based COVID-19 vaccination in the US.
Design, Setting, and Participants Descriptive study of reports of myocarditis
to the Vaccine Adverse Event Reporting System (VAERS) that occurred after
mRNA-based COVID-19 vaccine administration between December 2020 and August 2021
in 192 405 448 individuals older than 12 years of age in the US; data were
processed by VAERS as of September 30, 2021.
Exposures Vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna).
Main Outcomes and Measures Reports of myocarditis to VAERS were adjudicated and
summarized for all age groups. Crude reporting rates were calculated across age
and sex strata. Expected rates of myocarditis by age and sex were calculated
using 2017-2019 claims data. For persons younger than 30 years of age, medical
record reviews and clinician interviews were conducted to describe clinical
presentation, diagnostic test results, treatment, and early outcomes.
Results Among 192 405 448 persons receiving a total of 354 100 845 mRNA-based
COVID-19 vaccines during the study period, there were 1991 reports of
myocarditis to VAERS and 1626 of these reports met the case definition of
myocarditis. Of those with myocarditis, the median age was 21 years (IQR, 16-31
years) and the median time to symptom onset was 2 days (IQR, 1-3 days). Males
comprised 82% of the myocarditis cases for whom sex was reported. The crude
reporting rates for cases of myocarditis within 7 days after COVID-19
vaccination exceeded the expected rates of myocarditis across multiple age and
sex strata. The rates of myocarditis were highest after the second vaccination
dose in adolescent males aged 12 to 15 years (70.7 per million doses of the
BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million
doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and
56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine,
respectively). There were 826 cases of myocarditis among those younger than 30
years of age who had detailed clinical information available; of these cases,
792 of 809 (98%) had elevated troponin levels, 569 of 794 (72%) had abnormal
electrocardiogram results, and 223 of 312 (72%) had abnormal cardiac magnetic
resonance imaging results. Approximately 96% of persons (784/813) were
hospitalized and 87% (577/661) of these had resolution of presenting symptoms by
hospital discharge. The most common treatment was nonsteroidal anti-inflammatory
drugs (589/676; 87%).
Conclusions and Relevance Based on passive surveillance reporting in the US,
the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was
increased across multiple age and sex strata and was highest after the second
vaccination dose in adolescent males and young men. This risk should be
considered in the context of the benefits of COVID-19 vaccination.
Introduction
Myocarditis is an inflammatory condition of the heart muscle that has a bimodal
peak incidence during infancy and adolescence or young adulthood.1-4 The
clinical presentation and course of myocarditis is variable, with some patients
not requiring treatment and others experiencing severe heart failure that
requires subsequent heart transplantation or leads to death.5 Onset of
myocarditis typically follows an inciting process, often a viral illness;
however, no antecedent cause is identified in many cases.6 It has been
hypothesized that vaccination can serve as a trigger for myocarditis; however,
only the smallpox vaccine has previously been causally associated with
myocarditis based on reports among US military personnel, with cases typically
occurring 7 to 12 days after vaccination.7
With the implementation of a large-scale, national COVID-19 vaccination program
starting in December 2020, the US Centers for Disease Control and Prevention
(CDC) and the US Food and Drug Administration began monitoring for a number of
adverse events of special interest, including myocarditis and pericarditis, in
the Vaccine Adverse Event Reporting System (VAERS), a long-standing national
spontaneous reporting (passive surveillance) system.8 As the reports of
myocarditis after COVID-19 vaccination were reported to VAERS, the Clinical
Immunization Safety Assessment Project,9 a collaboration between the CDC and
medical research centers, which includes physicians treating infectious diseases
and other specialists (eg, cardiologists), consulted on several of the cases. In
addition, reports from several countries raised concerns that mRNA-based
COVID-19 vaccines may be associated with acute myocarditis.10-15
Given this concern, the aims were to describe reports and confirmed cases of
myocarditis initially reported to VAERS after mRNA-based COVID-19 vaccination
and to provide estimates of the risk of myocarditis after mRNA-based COVID-19
vaccination based on age, sex, and vaccine type.
Methods
Data Sources
VAERS is a US spontaneous reporting (passive surveillance) system that functions
as an early warning system for potential vaccine adverse events.8
Co-administered by the CDC and the US Food and Drug Administration, VAERS
accepts reports of all adverse events after vaccination from patients, parents,
clinicians, vaccine manufacturers, and others regardless of whether the events
could plausibly be associated with receipt of the vaccine. Reports to VAERS
include information about the vaccinated person, the vaccine or vaccines
administered, and the adverse events experienced by the vaccinated person. The
reports to VAERS are then reviewed by third-party professional coders who have
been trained in the assignment of Medical Dictionary for Regulatory Activities
preferred terms.16 The coders then assign appropriate terms based on the
information available in the reports.
This activity was reviewed by the CDC and was conducted to be consistent with
applicable federal law and CDC policy. The activities herein were confirmed to
be nonresearch under the Common Rule in accordance with institutional procedures
and therefore were not subject to institutional review board requirements.
Informed consent was not obtained for this secondary use of existing
information; see 45 CFR part 46.102(l)(2), 21 CFR part 56, 42 USC §241(d), 5 USC
§552a, and 44 USC §3501 et seq.
Exposure
The exposure of concern was vaccination with one of the mRNA-based COVID-19
vaccines: the BNT162b2 vaccine (Pfizer-BioNTech) or the mRNA-1273 vaccine
(Moderna). During the analytic period, persons aged 12 years or older were
eligible for the BNT162b2 vaccine and persons aged 18 years or older were
eligible for the mRNA-1273 vaccine. The number of COVID-19 vaccine doses
administered during the analytic period was obtained through the CDC’s COVID-19
Data Tracker.17
Outcomes
The primary outcome was the occurrence of myocarditis and the secondary outcome
was pericarditis. Reports to VAERS with these outcomes were initially
characterized using the Medical Dictionary for Regulatory Activities preferred
terms of myocarditis or pericarditis (specific terms are listed in the eMethods
in the Supplement). After initial review of reports of myocarditis to VAERS and
review of the patient’s medical records (when available), the reports were
further reviewed by CDC physicians and public health professionals to verify
that they met the CDC’s case definition for probable or confirmed myocarditis
(descriptions previously published and included in the eMethods in the
Supplement).18 The CDC’s case definition of probable myocarditis requires the
presence of new concerning symptoms, abnormal cardiac test results, and no other
identifiable cause of the symptoms and findings. Confirmed cases of myocarditis
further require histopathological confirmation of myocarditis or cardiac
magnetic resonance imaging (MRI) findings consistent with myocarditis.
Deaths were included only if the individual had met the case definition for
confirmed myocarditis and there was no other identifiable cause of death.
Individual cases not involving death were included only if the person had met
the case definition for probable myocarditis or confirmed myocarditis.
Statistical Analysis
We characterized reports of myocarditis or pericarditis after COVID-19
vaccination that met the CDC’s case definition and were received by VAERS
between December 14, 2020 (when COVID-19 vaccines were first publicly available
in the US), and August 31, 2021, by age, sex, race, ethnicity, and vaccine type;
data were processed by VAERS as of September 30, 2021. Race and ethnicity were
optional fixed categories available by self-identification at the time of
vaccination or by the individual filing a VAERS report. Race and ethnicity were
included to provide the most complete baseline description possible for
individual reports; however, further analyses were not stratified by race and
ethnicity due to the high percentage of missing data. Reports of pericarditis
with evidence of potential myocardial involvement were included in the review of
reports of myocarditis. The eFigure in the Supplement outlines the
categorization of the reports of myocarditis and pericarditis reviewed.
Further analyses were conducted only for myocarditis because of the
preponderance of those reports to VAERS, in Clinical Immunization Safety
Assessment Project consultations, and in published articles.10-12,19-21 Crude
reporting rates for myocarditis during a 7-day risk interval were calculated
using the number of reports of myocarditis to VAERS per million doses of
COVID-19 vaccine administered during the analytic period and stratified by age,
sex, vaccination dose (first, second, or unknown), and vaccine type. Expected
rates of myocarditis by age and sex were calculated using 2017-2019 data from
the IBM MarketScan Commercial Research Database. This database contains
individual-level, deidentified, inpatient and outpatient medical and
prescription drug claims, and enrollment information submitted to IBM Watson
Health by large employers and health plans. The data were accessed using version
4.0 of the IBM MarketScan Treatment Pathways analytic platform. Age- and
sex-specific rates were calculated by determining the number of individuals with
myocarditis (International Statistical Classification of Diseases and Related
Health Problems, Tenth Revision [ICD-10] codes B33.20, B33.22, B33.24, I40.0,
I40.1, I40.8, I40.9, or I51.4)22 identified during an inpatient encounter in
2017-2019 relative to the number of individuals of similar age and sex who were
continually enrolled during the year in which the myocarditis-related
hospitalization occurred; individuals with any diagnosis of myocarditis prior to
that year were excluded. Given the limitations of the IBM MarketScan Commercial
Research Database to capture enrollees aged 65 years or older, an expected rate
for myocarditis was not calculated for this population. A 95% CI was calculated
using Poisson distribution in SAS version 9.4 (SAS Institute Inc) for each
expected rate of myocarditis and for each observed rate in a strata with at
least 1 case.
In cases of probable or confirmed myocarditis among those younger than 30 years
of age, their clinical course was then summarized to the extent possible based
on medical review and clinician interviews. This clinical course included
presenting symptoms, diagnostic test results, treatment, and early outcomes
(abstraction form appears in the eMethods in the Supplement).23
When applicable, missing data were delineated in the results or the numbers with
complete data were listed. No assumptions or imputations were made regarding
missing data. Any percentages that were calculated included only those cases of
myocarditis with adequate data to calculate the percentages.
Results
Case Characteristics
Between December 14, 2020, and August 31, 2021, 192 405 448 individuals older
than 12 years of age received a total of 354 100 845 mRNA-based COVID-19
vaccines. VAERS received 1991 reports of myocarditis (391 of which also included
pericarditis) after receipt of at least 1 dose of mRNA-based COVID-19 vaccine
(eTable 1 in the Supplement) and 684 reports of pericarditis without the
presence of myocarditis (eTable 2 in the Supplement).
Of the 1991 reports of myocarditis, 1626 met the CDC’s case definition for
probable or confirmed myocarditis (Table 1). There were 208 reports that did not
meet the CDC’s case definition for myocarditis and 157 reports that required
more information to perform adjudication (eTable 3 in the Supplement). Of the
1626 reports that met the CDC’s case definition for myocarditis, 1195 (73%) were
younger than 30 years of age, 543 (33%) were younger than 18 years of age, and
the median age was 21 years (IQR, 16-31 years) (Figure 1). Of the reports of
myocarditis with dose information, 82% (1265/1538) occurred after the second
vaccination dose. Of those with a reported dose and time to symptom onset, the
median time from vaccination to symptom onset was 3 days (IQR, 1-8 days) after
the first vaccination dose and 74% (187/254) of myocarditis events occurred
within 7 days. After the second vaccination dose, the median time to symptom
onset was 2 days (IQR, 1-3 days) and 90% (1081/1199) of myocarditis events
occurred within 7 days (Figure 2).
Males comprised 82% (1334/1625) of the cases of myocarditis for whom sex was
reported. The largest proportions of cases of myocarditis were among White
persons (non-Hispanic or ethnicity not reported; 69% [914/1330]) and Hispanic
persons (of all races; 17% [228/1330]). Among persons younger than 30 years of
age, there were no confirmed cases of myocarditis in those who died after
mRNA-based COVID-19 vaccination without another identifiable cause and there was
1 probable case of myocarditis but there was insufficient information available
for a thorough investigation. At the time of data review, there were 2 reports
of death in persons younger than 30 years of age with potential myocarditis that
remain under investigation and are not included in the case counts.
Reporting Rates of Myocarditis Within 7 Days After COVID-19 Vaccination
Symptom onset of myocarditis was within 7 days after vaccination for 947 reports
of individuals who received the BNT162b2 vaccine and for 382 reports of
individuals who received the mRNA-1273 vaccine. The rates of myocarditis varied
by vaccine type, sex, age, and first or second vaccination dose (Table 2). The
reporting rates of myocarditis were highest after the second vaccination dose in
adolescent males aged 12 to 15 years (70.73 [95% CI, 61.68-81.11] per million
doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.86
[95% CI, 91.65-122.27] per million doses of the BNT162b2 vaccine), and in young
men aged 18 to 24 years (52.43 [95% CI, 45.56-60.33] per million doses of the
BNT162b2 vaccine and 56.31 [95% CI, 47.08-67.34] per million doses of the
mRNA-1273 vaccine). The lower estimate of the 95% CI for reporting rates of
myocarditis in adolescent males and young men exceeded the upper bound of the
expected rates after the first vaccination dose with the BNT162b2 vaccine in
those aged 12 to 24 years, after the second vaccination dose with the BNT162b2
vaccine in those aged 12 to 49 years, after the first vaccination dose with the
mRNA-1273 vaccine in those aged 18 to 39 years, and after the second vaccination
dose with the mRNA-1273 vaccine in those aged 18 to 49 years.
The reporting rates of myocarditis in females were lower than those in males
across all age strata younger than 50 years of age. The reporting rates of
myocarditis were highest after the second vaccination dose in adolescent females
aged 12 to 15 years (6.35 [95% CI, 4.05-9.96] per million doses of the BNT162b2
vaccine), in adolescent females aged 16 to 17 years (10.98 [95% CI, 7.16-16.84]
per million doses of the BNT162b2 vaccine), in young women aged 18 to 24 years
(6.87 [95% CI, 4.27-11.05] per million doses of the mRNA-1273 vaccine), and in
women aged 25 to 29 years (8.22 [95% CI, 5.03-13.41] per million doses of the
mRNA-1273 vaccine). The lower estimate of the 95% CI for reporting rates of
myocarditis in females exceeded the upper bound of the expected rates after the
second vaccination dose with the BNT162b2 vaccine in those aged 12 to 29 years
and after the second vaccination dose with the mRNA-1273 vaccine in those aged
18 to 29 years.
Clinical Course of Myocarditis After COVID-19 Vaccination in Persons Younger
Than 30 Years of Age
Among the 1372 reports of myocarditis in persons younger than 30 years of age,
1305 were able to be adjudicated, with 92% (1195/1305) meeting the CDC’s case
definition. Of these, chart abstractions or medical interviews were completed
for 69% (826/1195) (Table 3). The symptoms commonly reported in the verified
cases of myocarditis in persons younger than 30 years of age included chest
pain, pressure, or discomfort (727/817; 89%) and dyspnea or shortness of breath
(242/817; 30%). Troponin levels were elevated in 98% (792/809) of the cases of
myocarditis. The electrocardiogram result was abnormal in 72% (569/794) of cases
of myocarditis. Of the patients who had received a cardiac MRI, 72% (223/312)
had abnormal findings consistent with myocarditis. The echocardiogram results
were available for 721 cases of myocarditis; of these, 84 (12%) demonstrated a
notable decreased left ventricular ejection fraction (<50%). Among the 676 cases
for whom treatment data were available, 589 (87%) received nonsteroidal
anti-inflammatory drugs. Intravenous immunoglobulin and glucocorticoids were
each used in 12% of the cases of myocarditis (78/676 and 81/676, respectively).
Intensive therapies such as vasoactive medications (12 cases of myocarditis) and
intubation or mechanical ventilation (2 cases) were rare. There were no verified
cases of myocarditis requiring a heart transplant, extracorporeal membrane
oxygenation, or a ventricular assist device. Of the 96% (784/813) of cases of
myocarditis who were hospitalized, 98% (747/762) were discharged from the
hospital at time of review. In 87% (577/661) of discharged cases of myocarditis,
there was resolution of the presenting symptoms by hospital discharge.
Discussion
In this review of reports to VAERS between December 2020 and August 2021,
myocarditis was identified as a rare but serious adverse event that can occur
after mRNA-based COVID-19 vaccination, particularly in adolescent males and
young men. However, this increased risk must be weighed against the benefits of
COVID-19 vaccination.18
Compared with cases of non–vaccine-associated myocarditis, the reports of
myocarditis to VAERS after mRNA-based COVID-19 vaccination were similar in
demographic characteristics but different in their acute clinical course. First,
the greater frequency noted among vaccine recipients aged 12 to 29 years vs
those aged 30 years or older was similar to the age distribution seen in typical
cases of myocarditis.2,4 This pattern may explain why cases of myocarditis were
not discovered until months after initial Emergency Use Authorization of the
vaccines in the US (ie, until the vaccines were widely available to younger
persons). Second, the sex distribution in cases of myocarditis after COVID-19
vaccination was similar to that seen in typical cases of myocarditis; there is a
strong male predominance for both conditions.2,4
However, the onset of myocarditis symptoms after exposure to a potential
immunological trigger was shorter for COVID-19 vaccine–associated cases of
myocarditis than is typical for myocarditis cases diagnosed after a viral
illness.24-26 Cases of myocarditis reported after COVID-19 vaccination were
typically diagnosed within days of vaccination, whereas cases of typical viral
myocarditis can often have indolent courses with symptoms sometimes present for
weeks to months after a trigger if the cause is ever identified.1 The major
presenting symptoms appeared to resolve faster in cases of myocarditis after
COVID-19 vaccination than in typical viral cases of myocarditis. Even though
almost all individuals with cases of myocarditis were hospitalized and
clinically monitored, they typically experienced symptomatic recovery after
receiving only pain management. In contrast, typical viral cases of myocarditis
can have a more variable clinical course. For example, up to 6% of typical viral
myocarditis cases in adolescents require a heart transplant or result in
mortality.27
In the current study, the initial evaluation and treatment of COVID-19
vaccine–associated myocarditis cases was similar to that of typical myocarditis
cases.28-31 Initial evaluation usually included measurement of troponin level,
electrocardiography, and echocardiography.1 Cardiac MRI was often used for
diagnostic purposes and also for possible prognostic purposes.32,33 Supportive
care was a mainstay of treatment, with specific cardiac or intensive care
therapies as indicated by the patient’s clinical status.
Long-term outcome data are not yet available for COVID-19 vaccine–associated
myocarditis cases. The CDC has started active follow-up surveillance in
adolescents and young adults to assess the health and functional status and
cardiac outcomes at 3 to 6 months in probable and confirmed cases of myocarditis
reported to VAERS after COVID-19 vaccination.34 For patients with myocarditis,
the American Heart Association and the American College of Cardiology guidelines
advise that patients should be instructed to refrain from competitive sports for
3 to 6 months, and that documentation of a normal electrocardiogram result,
ambulatory rhythm monitoring, and an exercise test should be obtained prior to
resumption of sports.35 The use of cardiac MRI is unclear, but it may be useful
in evaluating the progression or resolution of myocarditis in those with
abnormalities on the baseline cardiac MRI.36 Further doses of mRNA-based
COVID-19 vaccines should be deferred, but may be considered in select
circumstances.37
Limitations
This study has several limitations. First, although clinicians are required to
report serious adverse events after COVID-19 vaccination, including all events
leading to hospitalization, VAERS is a passive reporting system. As such, the
reports of myocarditis to VAERS may be incomplete, and the quality of the
information reported is variable. Missing data for sex, vaccination dose number,
and race and ethnicity were not uncommon in the reports received; history of
prior SARS-CoV-2 infection also was not known. Furthermore, as a passive system,
VAERS data are subject to reporting biases in that both underreporting and
overreporting are possible.38 Given the high verification rate of reports of
myocarditis to VAERS after mRNA-based COVID-19 vaccination, underreporting is
more likely. Therefore, the actual rates of myocarditis per million doses of
vaccine are likely higher than estimated.
Second, efforts by CDC investigators to obtain medical records or interview
physicians were not always successful despite the special allowance for sharing
information with the CDC under the Health Insurance Portability and
Accountability Act of 1996.39 This challenge limited the ability to perform case
adjudication and complete investigations for some reports of myocarditis,
although efforts are still ongoing when feasible.
Third, the data from vaccination administration were limited to what is reported
to the CDC and thus may be incomplete, particularly with regard to demographics.
Fourth, calculation of expected rates from the IBM MarketScan Commercial
Research Database relied on administrative data via the use of ICD-10 codes and
there was no opportunity for clinical review. Furthermore, these data had
limited information regarding the Medicare population; thus expected rates for
those older than 65 years of age were not calculated. However, it is expected
that the rates in those older than 65 years of age would not be higher than the
rates in those aged 50 to 64 years.4
Conclusions
Based on passive surveillance reporting in the US, the risk of myocarditis after
receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex
strata and was highest after the second vaccination dose in adolescent males and
young men. This risk should be considered in the context of the benefits of
COVID-19 vaccination.
Back to top
Article Information
Corresponding Author: Matthew E. Oster, MD, MPH, US Centers for Disease Control
and Prevention, 1600 Clifton Rd, Atlanta, GA 30333 (eocevent416@cdc.gov).
Accepted for Publication: December 16, 2021.
Author Contributions: Drs Oster and Su had full access to all of the data in the
study and take responsibility for the integrity of the data and the accuracy of
the data analysis.
Concept and design: Oster, Shay, Su, Creech, Edwards, Dendy, Schlaudecker, Woo,
Shimabukuro.
Acquisition, analysis, or interpretation of data: Oster, Shay, Su, Gee, Creech,
Broder, Edwards, Soslow, Schlaudecker, Lang, Barnett, Ruberg, Smith, Campbell,
Lopes, Sperling, Baumblatt, Thompson, Marquez, Strid, Woo, Pugsley,
Reagan-Steiner, DeStefano, Shimabukuro.
Drafting of the manuscript: Oster, Shay, Su, Gee, Creech, Marquez, Strid, Woo,
Shimabukuro.
Critical revision of the manuscript for important intellectual content: Oster,
Shay, Su, Creech, Broder, Edwards, Soslow, Dendy, Schlaudecker, Lang, Barnett,
Ruberg, Smith, Campbell, Lopes, Sperling, Baumblatt, Thompson, Pugsley,
Reagan-Steiner, DeStefano, Shimabukuro.
Statistical analysis: Oster, Su, Marquez, Strid, Woo, Shimabukuro.
Obtained funding: Edwards, DeStefano.
Administrative, technical, or material support: Oster, Gee, Creech, Broder,
Edwards, Soslow, Schlaudecker, Smith, Baumblatt, Thompson, Reagan-Steiner,
DeStefano.
Supervision: Su, Edwards, Soslow, Dendy, Schlaudecker, Campbell, Sperling,
DeStefano, Shimabukuro.
Conflict of Interest Disclosures: Dr Creech reported receiving grants from the
National Institutes of Health for the Moderna and Janssen clinical trials and
receiving personal fees from Astellas and Horizon. Dr Edwards reported receiving
grants from the National Institutes of Health; receiving personal fees from
BioNet, IBM, X-4 Pharma, Seqirus, Roche, Pfizer, Merck, Moderna, and Sanofi; and
receiving compensation for being the associate editor of Clinical Infectious
Diseases. Dr Soslow reported receiving personal fees from Esperare. Dr
Schlaudecker reported receiving grants from Pfizer and receiving personal fees
from Sanofi Pasteur. Drs Barnett, Ruberg, and Smith reported receiving grants
from Pfizer. Dr Lopes reported receiving personal fees from Bayer, Boehringer
Ingleheim, Bristol Myers Squibb, Daiichi Sankyo, GlaxoSmithKline, Medtronic,
Merck, Pfizer, Portola, and Sanofi and receiving grants from Bristol Myers
Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi. No other disclosures
were reported.
Funding/Support: This work was supported by contracts 200-2012-53709 (Boston
Medical Center), 200-2012-53661 (Cincinnati Children’s Hospital Medical Center),
200-2012-53663 (Duke University), and 200-2012-50430 (Vanderbilt University
Medical Center) with the US Centers for Disease Control and Prevention (CDC)
Clinical Immunization Safety Assessment Project.
Role of the Funder/Sponsor: The CDC provided funding via the Clinical
Immunization Safety Assessment Project to Drs Creech, Edwards, Soslow, Dendy,
Schlaudecker, Lang, Barnett, Ruberg, Smith, Campbell, and Lopes. The authors
affiliated with the CDC along with the other coauthors conducted the
investigations; performed collection, management, analysis, and interpretation
of the data; were involved in the preparation, review, and approval of the
manuscript; and made the decision to submit the manuscript for publication.
Disclaimer: The findings and conclusions in this article are those of the
authors and do not necessarily represent the official position of the CDC or the
US Food and Drug Administration. Mention of a product or company name is for
identification purposes only and does not constitute endorsement by the CDC or
the US Food and Drug Administration.
Additional Contributions: We thank the following CDC staff who contributed to
this article without compensation outside their normal salaries (in alphabetical
order and contribution specified in parenthesis at end of each list of names):
Nickolas Agathis, MD, MPH, Stephen R. Benoit, MD, MPH, Beau B. Bruce, MD, PhD,
Abigail L. Carlson, MD, MPH, Meredith G. Dixon, MD, Jonathan Duffy, MD, MPH,
Charles Duke, MD, MPH, Charles Edge, MSN, MS, Robyn Neblett Fanfair, MD, MPH,
Nathan W. Furukawa, MD, MPH, Gavin Grant, MD, MPH, Grace Marx, MD, MPH, Maureen
J. Miller, MD, MPH, Pedro Moro, MD, MPH, Meredith Oakley, DVM, MPH, Kia Padgett,
MPH, BSN, RN, Janice Perez-Padilla, MPH, BSN, RN, Robert Perry, MD, MPH, Nimia
Reyes, MD, MPH, Ernest E. Smith, MD, MPH&TM, David Sniadack, MD, MPH, Pamela
Tucker, MD, Edward C. Weiss, MD, MPH, Erin Whitehouse, PhD, MPH, RN, Pascale M.
Wortley, MD, MPH, and Rachael Zacks, MD (for clinical investigations and
interviews); Amelia Jazwa, MSPH, Tara Johnson, MPH, MS, and Jamila Shields, MPH
(for project coordination); Charles Licata, PhD, and Bicheng Zhang, MS (for data
acquisition and organization); Charles E. Rose, PhD (for statistical
consultation); and Scott D. Grosse, PhD (for calculation of expected rates of
myocarditis). We also thank the clinical staff who cared for these patients and
reported the adverse events to the Vaccine Adverse Event Reporting System.
References
1.
Cooper LT Jr. Myocarditis. N Engl J Med. 2009;360(15):1526-1538.
doi:10.1056/NEJMra0800028PubMedGoogle ScholarCrossref
2.
Vasudeva R, Bhatt P, Lilje C, et al. Trends in acute myocarditis–related
pediatric hospitalizations in the United States, 2007-2016. Am J Cardiol.
2021;149:95-102. doi:10.1016/j.amjcard.2021.03.019PubMedGoogle ScholarCrossref
3.
Arola A, Pikkarainen E, Sipilä JO, Pykäri J, Rautava P, Kytö V.
Occurrence and features of childhood myocarditis: a nationwide study in
Finland. J Am Heart Assoc. 2017;6(11):e005306.
doi:10.1161/JAHA.116.005306PubMedGoogle Scholar
4.
Kytö V, Sipilä J, Rautava P. The effects of gender and age on occurrence
of clinically suspected myocarditis in adulthood. Heart.
2013;99(22):1681-1684. doi:10.1136/heartjnl-2013-304449PubMedGoogle
ScholarCrossref
5.
Dasgupta S, Iannucci G, Mao C, Clabby M, Oster ME. Myocarditis in the
pediatric population: a review. Congenit Heart Dis. 2019;14(5):868-877.
doi:10.1111/chd.12835PubMedGoogle ScholarCrossref
6.
Pollack A, Kontorovich AR, Fuster V, Dec GW. Viral
myocarditis—diagnosis, treatment options, and current controversies. Nat Rev
Cardiol. 2015;12(11):670-680. doi:10.1038/nrcardio.2015.108PubMedGoogle
ScholarCrossref
7.
Halsell JS, Riddle JR, Atwood JE, et al; Department of Defense Smallpox
Vaccination Clinical Evaluation Team. Myopericarditis following smallpox
vaccination among vaccinia-naive US military personnel. JAMA.
2003;289(24):3283-3289. doi:10.1001/jama.289.24.3283
ArticlePubMedGoogle ScholarCrossref
8.
Gubernot D, Jazwa A, Niu M, et al. US population-based background
incidence rates of medical conditions for use in safety assessment of COVID-19
vaccines. Vaccine. 2021;39(28):3666-3677.
doi:10.1016/j.vaccine.2021.05.016PubMedGoogle ScholarCrossref
9.
US Centers for Disease Control and Prevention. Clinical Immunization Safety
Assessment project. Accessed August 24, 2021.
https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/cisa/index.html
10.
Marshall M, Ferguson ID, Lewis P, et al. Symptomatic acute myocarditis
in 7 adolescents after Pfizer-BioNTech COVID-19 vaccination. Pediatrics.
2021;148(3):e2021052478. doi:10.1542/peds.2021-052478PubMedGoogle Scholar
11.
Kim HW, Jenista ER, Wendell DC, et al. Patients with acute myocarditis
following mRNA COVID-19 vaccination. JAMA Cardiol. 2021;6(10):1196-1201.
doi:10.1001/jamacardio.2021.2828
ArticlePubMedGoogle ScholarCrossref
12.
Montgomery J, Ryan M, Engler R, et al. Myocarditis following
immunization with mRNA COVID-19 vaccines in members of the US military. JAMA
Cardiol. 2021;6(10):1202-1206. doi:10.1001/jamacardio.2021.2833
ArticlePubMedGoogle ScholarCrossref
13.
Diaz GA, Parsons GT, Gering SK, Meier AR, Hutchinson IV, Robicsek A.
Myocarditis and pericarditis after vaccination for COVID-19. JAMA.
2021;326(12):1210-1212. doi:10.1001/jama.2021.13443
ArticlePubMedGoogle ScholarCrossref
14.
Mevorach D, Anis E, Cedar N, et al. Myocarditis after BNT162b2 mRNA
vaccine against Covid-19 in Israel. N Engl J Med. 2021;385(23):2140-2149.
doi:10.1056/NEJMoa2109730PubMedGoogle ScholarCrossref
15.
Witberg G, Barda N, Hoss S, et al. Myocarditis after Covid-19
vaccination in a large health care organization. N Engl J Med.
2021;385(23):2132-2139. doi:10.1056/NEJMoa2110737PubMedGoogle ScholarCrossref
16.
MedDRA. Medical Dictionary for Regulatory Activities. Accessed June 30, 2021.
https://www.meddra.org
17.
US Centers for Disease Control and Prevention. CDC COVID-19 data tracker.
Accessed June 30, 2021. https://covid.cdc.gov/covid-data-tracker
18.
Gargano JW, Wallace M, Hadler SC, et al. Use of mRNA COVID-19 vaccine
after reports of myocarditis among vaccine recipients: update from the Advisory
Committee on Immunization Practices—United States, June 2021. MMWR Morb
Mortal Wkly Rep. 2021;70(27):977-982. doi:10.15585/mmwr.mm7027e2PubMedGoogle
ScholarCrossref
19.
Abu Mouch S, Roguin A, Hellou E, et al. Myocarditis following COVID-19
mRNA vaccination. Vaccine. 2021;39(29):3790-3793.
doi:10.1016/j.vaccine.2021.05.087PubMedGoogle ScholarCrossref
20.
Larson KF, Ammirati E, Adler ED, et al. Myocarditis after BNT162b2 and
mRNA-1273 vaccination. Circulation. 2021;144(6):506-508.
doi:10.1161/CIRCULATIONAHA.121.055913PubMedGoogle ScholarCrossref
21.
Rosner CM, Genovese L, Tehrani BN, et al. Myocarditis temporally
associated with COVID-19 vaccination. Circulation. 2021;144(6):502-505.
doi:10.1161/CIRCULATIONAHA.121.055891PubMedGoogle ScholarCrossref
22.
Boehmer TK, Kompaniyets L, Lavery AM, et al. Association between
COVID-19 and myocarditis using hospital-based administrative data—United States,
March 2020-January 2021. MMWR Morb Mortal Wkly Rep. 2021;70(35):1228-1232.
doi:10.15585/mmwr.mm7035e5PubMedGoogle ScholarCrossref
23.
Harris PA, Taylor R, Minor BL, et al; REDCap Consortium. The REDCap
Consortium: building an international community of software platform partners.
J Biomed Inform. 2019;95:103208. doi:10.1016/j.jbi.2019.103208PubMedGoogle
Scholar
24.
Mahrholdt H, Wagner A, Deluigi CC, et al. Presentation, patterns of
myocardial damage, and clinical course of viral myocarditis. Circulation.
2006;114(15):1581-1590. doi:10.1161/CIRCULATIONAHA.105.606509PubMedGoogle
ScholarCrossref
25.
Mason JW, O’Connell JB, Herskowitz A, et al; Myocarditis Treatment Trial
Investigators. A clinical trial of immunosuppressive therapy for myocarditis.
N Engl J Med. 1995;333(5):269-275. doi:10.1056/NEJM199508033330501PubMedGoogle
ScholarCrossref
26.
Saji T, Matsuura H, Hasegawa K, et al. Comparison of the clinical
presentation, treatment, and outcome of fulminant and acute myocarditis in
children. Circ J. 2012;76(5):1222-1228.
doi:10.1253/circj.CJ-11-1032PubMedGoogle ScholarCrossref
27.
Ghelani SJ, Spaeder MC, Pastor W, Spurney CF, Klugman D.
Demographics, trends, and outcomes in pediatric acute myocarditis in the United
States, 2006 to 2011. Circ Cardiovasc Qual Outcomes. 2012;5(5):622-627.
doi:10.1161/CIRCOUTCOMES.112.965749PubMedGoogle ScholarCrossref
28.
Caforio ALP, Pankuweit S, Arbustini E, et al; European Society of
Cardiology Working Group on Myocardial and Pericardial Diseases. Current state
of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a
position statement of the European Society of Cardiology Working Group on
Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636-2648.
doi:10.1093/eurheartj/eht210PubMedGoogle ScholarCrossref
29.
Yancy CW, Jessup M, Bozkurt B, et al; American College of Cardiology
Foundation; American Heart Association Task Force on Practice Guidelines. 2013
ACCF/AHA guideline for the management of heart failure: a report of the American
College of Cardiology Foundation/American Heart Association Task Force on
Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-e239.
doi:10.1016/j.jacc.2013.05.019PubMedGoogle ScholarCrossref
30.
Law YM, Lal AK, Chen S, et al; American Heart Association Pediatric Heart
Failure and Transplantation Committee of the Council on Lifelong Congenital
Heart Disease and Heart Health in the Young and Stroke Council. Diagnosis and
management of myocarditis in children: a scientific statement from the American
Heart Association. Circulation. 2021;144(6):e123-e135.
doi:10.1161/CIR.0000000000001001PubMedGoogle ScholarCrossref
31.
US Centers for Disease Control and Prevention. Clinical considerations:
myocarditis and pericarditis after receipt of mRNA COVID-19 vaccines among
adolescents and young adults. Accessed August 24, 2021.
https://www.cdc.gov/vaccines/covid-19/clinical-considerations/myocarditis.html
32.
Sachdeva S, Song X, Dham N, Heath DM, DeBiasi RL. Analysis of
clinical parameters and cardiac magnetic resonance imaging as predictors of
outcome in pediatric myocarditis. Am J Cardiol. 2015;115(4):499-504.
doi:10.1016/j.amjcard.2014.11.029PubMedGoogle ScholarCrossref
33.
Ferreira VM, Schulz-Menger J, Holmvang G, et al. Cardiovascular magnetic
resonance in nonischemic myocardial inflammation: expert recommendations. J
Am Coll Cardiol. 2018;72(24):3158-3176.
doi:10.1016/j.jacc.2018.09.072PubMedGoogle ScholarCrossref
34.
US Centers for Disease Control and Prevention. Investigating long-term effects
of myocarditis. Accessed August 24, 2021.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myo-outcomes.html
35.
Maron BJ, Udelson JE, Bonow RO, et al; American Heart Association
Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology,
Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke
Nursing, Council on Functional Genomics and Translational Biology, and American
College of Cardiology. Eligibility and disqualification recommendations for
competitive athletes with cardiovascular abnormalities: task force 3:
hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and
other cardiomyopathies, and myocarditis: a scientific statement from the
American Heart Association and American College of Cardiology. Circulation.
2015;132(22):e273-e280. doi:10.1161/CIR.0000000000000239PubMedGoogle Scholar
36.
Aquaro GD, Ghebru Habtemicael Y, Camastra G, et al; Cardiac Magnetic
Resonance Working Group of the Italian Society of Cardiology. Prognostic value
of repeating cardiac magnetic resonance in patients with acute myocarditis. J
Am Coll Cardiol. 2019;74(20):2439-2448.
doi:10.1016/j.jacc.2019.08.1061PubMedGoogle ScholarCrossref
37.
US Centers for Disease Control and Prevention. Interim clinical considerations
for use of COVID-19 vaccines currently authorized in the United States. Accessed
August 24, 2021.
https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html
38.
Shimabukuro TT, Nguyen M, Martin D, DeStefano F. Safety monitoring in
the Vaccine Adverse Event Reporting System (VAERS). Vaccine.
2015;33(36):4398-4405. doi:10.1016/j.vaccine.2015.07.035PubMedGoogle
ScholarCrossref
39.
US Centers for Disease Control and Prevention. HIPAA privacy rule and public
health: guidance from CDC and the US Department of Health and Human Services.
MMWR Suppl. 2003;52:1-17, 19-20.PubMedGoogle Scholar
JAMA
CONTENT
Home New Online Current Issue
PODCASTS
Coronavirus (COVID-19) Q&A Clinical Reviews Editors' Summary Medical News Author
Interviews Performance Improvement: Do No Harm Professionalism: Best Practice
JAMAevidence: Care at the Close of Life JAMAevidence: JAMA Guide to Statistics
and Methods JAMAevidence: The Rational Clinical Examination JAMAevidence: Users'
Guides to the Medical Literature
JOURNAL INFORMATION
For Authors Editors & Publishers RSS Contact Us
JN Learning / CME Store Apps Jobs Institutions Reprints & Permissions
SUBSCRIBE
Go
JAMA NETWORK
PUBLICATIONS
JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA
Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA
Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery
Archives of Neurology & Psychiatry (1919-1959)
SITES
Art and Images in Psychiatry Best of the JAMA Network Clinical Crosswords from
JAMA Coronavirus Resource Center Digital Media Editorial Fellowship
Evidence-Based Medicine: An Oral History Fishbein Fellowship Genomics and
Precision Health Hypertension JAMA Forum Archive JAMA Network Audio JAMA Network
Conferences Machine Learning Research Ethics Topics and Collections
SPECIAL COMMUNICATIONS
FDA Approval and Regulation of Pharmaceuticals, 1983-2018 Global Burden of
Cancer, 1990-2017 Global Burden of Skin Diseases, 1990-2017 Global Firearm
Mortality, 1990-2016 Health Care Spending in the US and Other High-Income
Countries Life Expectancy and Mortality Rates in the United States, 1959-2017
Medical Marketing in the United States, 1997-2016 Practices to Foster Physician
Presence and Connection With Patients in the Clinical Encounter President Obama
on US Health Care Reform The State of US Health, 1990-2016 US Burden of
Cardiovascular Disease, 1990-2016 US Burden of Neurological Disease, 1990-2017
Waste in the US Health Care System: Estimated Costs and Potential for Savings
BLOGS
AMA Style Insider
INFORMATION
For Authors For Institutions & Librarians For Advertisers For Subscription
Agents For Employers & Job Seekers For the Media Statement on Potentially
Offensive Content
JAMA NETWORK PRODUCTS
AMA Manual of Style JAMAevidence JN Listen Peer Review Congress
JN LEARNING
Home CME Quizzes State CME Audio / Podcast Courses Clinical Challenge CME Atrial
Fibrillation Course Marijuana Course Penicillin Allergy Course Cervical Cancer
Screening Course CME / MOC Reporting Preferences About CME & MOC
HELP
Subscriptions & Renewals Email Subscriptions Update Your Address Contact Us
Frequently Asked Questions
JAMA CAREER CENTER
Physician Job Listings
Get the latest from JAMA
Sign Up
Privacy Policy | Terms of Use
© 2022 American Medical Association. All Rights Reserved.
Terms of Use| Privacy Policy| Accessibility Statement
JOB LISTINGS ON JAMA CAREER CENTER®
Invasive Non-Interventional Cardiology Grand Rapids, Michigan
Neuro-Critical Care Cardiologist DE
Cardiologist GA
Cardiologist OR
Physician (Cardiology-Non-Invasive) Ft. Hood, TX
See more at JAMA Career Center
X
.
×
Access your subscriptions
--------------------------------------------------------------------------------
Sign in | personal account
Access through your institution
Add or change institution
Free access to newly published articles
--------------------------------------------------------------------------------
Create a free personal account
To register for email alerts with links to free full-text articles
Purchase access
--------------------------------------------------------------------------------
Subscribe to journal
Get full journal access for 1 year
Buy article
Get unlimited access and a printable PDF ($40.00)—
Sign in or create a free account
Rent article
Rent this article from DeepDyve
Access your subscriptions
--------------------------------------------------------------------------------
Sign in | personal account
Access through your institution
Add or change institution
Free access to newly published articles
--------------------------------------------------------------------------------
Create a free personal account
To register for email alerts with links to free full-text articles
Purchase access
--------------------------------------------------------------------------------
Subscribe to journal
Get full journal access for 1 year
Buy article
Get unlimited access and a printable PDF ($40.00)—
Sign in or create a free account
Rent article
Rent this article from DeepDyve
Access to free article PDF downloads
--------------------------------------------------------------------------------
Sign in | personal account
Access through your institution
Add or change institution
Free access to newly published articles
--------------------------------------------------------------------------------
Create a free personal account
To register for email alerts with links to free full-text articles
Save your search
--------------------------------------------------------------------------------
Sign in | personal account
Free access to newly published articles
--------------------------------------------------------------------------------
Create a free personal account
To register for email alerts with links to free full-text articles
Purchase access
--------------------------------------------------------------------------------
Subscribe now
Customize your interests
--------------------------------------------------------------------------------
Sign in | personal account
Free access to newly published articles
--------------------------------------------------------------------------------
Create a free personal account
To register for email alerts with links to free full-text articles
Create a personal account or sign in to:
* Register for email alerts with links to free full-text articles
* Access PDFs of free articles
* Manage your interests
* Save searches and receive search alerts
Privacy Policy
Make a comment
--------------------------------------------------------------------------------
Sign in | personal account
Free access to newly published articles
--------------------------------------------------------------------------------
Create a free personal account
To register for email alerts with links to free full-text articles
Create a personal account or sign in to:
* Register for email alerts with links to free full-text articles
* Access PDFs of free articles
* Manage your interests
* Save searches and receive search alerts
Privacy Policy
CLOSE [X]
ADVERTISEMENT
x