Symptomatic Acute Myocarditis in 7 Adolescents After Pfizer-BioNTech COVID-19 Vaccination

Pediatrics. 2021 Sep;148(3):e2021052478. doi: 10.1542/peds.2021-052478. Epub 2021 Jun 4.


Trials of coronavirus disease 2019 (COVID-19) vaccination included limited numbers of children, so they may not have detected rare but important adverse events in this population. We report 7 cases of acute myocarditis or myopericarditis in healthy male adolescents who presented with chest pain all within 4 days after the second dose of Pfizer-BioNTech COVID-19 vaccination. Five patients had fever around the time of presentation. Acute COVID-19 was ruled out in all 7 cases on the basis of negative severe acute respiratory syndrome coronavirus 2 real-time reverse transcription polymerase chain reaction test results of specimens obtained by using nasopharyngeal swabs. None of the patients met criteria for multisystem inflammatory syndrome in children. Six of the 7 patients had negative severe acute respiratory syndrome coronavirus 2 nucleocapsid antibody assay results, suggesting no previous infection. All patients had an elevated troponin. Cardiac MRI revealed late gadolinium enhancement characteristic of myocarditis. All 7 patients resolved their symptoms rapidly. Three patients were treated with nonsteroidal antiinflammatory drugs only, and 4 received intravenous immunoglobulin and corticosteroids. In this report, we provide a summary of each adolescent's clinical course and evaluation. No causal relationship between vaccine administration and myocarditis has been established. Continued monitoring and reporting to the US Food and Drug Administration Vaccine Adverse Event Reporting System is strongly recommended.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adolescent
  • BNT162 Vaccine
  • COVID-19 / diagnosis
  • COVID-19 / prevention & control
  • COVID-19 Nucleic Acid Testing
  • COVID-19 Vaccines / administration & dosage
  • COVID-19 Vaccines / adverse effects*
  • Coronavirus Nucleocapsid Proteins / immunology
  • Gadolinium
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Myocarditis / diagnostic imaging
  • Myocarditis / etiology*
  • Phosphoproteins / immunology
  • Systemic Inflammatory Response Syndrome / diagnosis
  • Time Factors
  • Troponin / blood
  • Young Adult


  • COVID-19 Vaccines
  • Coronavirus Nucleocapsid Proteins
  • Phosphoproteins
  • Troponin
  • nucleocapsid phosphoprotein, SARS-CoV-2
  • Gadolinium
  • BNT162 Vaccine

Supplementary concepts

  • pediatric multisystem inflammatory disease, COVID-19 related