Risk for Myocardial Infarction, Stroke, and Pulmonary Embolism Following COVID-19 Vaccines in Adults Younger Than 75 Years in France

Ann Intern Med. 2022 Sep;175(9):1250-1257. doi: 10.7326/M22-0988. Epub 2022 Aug 23.


Background: The BNT162b2 (Pfizer-BioNTech) vaccine has been shown to be safe with regard to risk for severe cardiovascular events (such as myocardial infarction [MI], pulmonary embolism [PE], and stroke) in persons aged 75 years or older. Less is known about the safety of other COVID-19 vaccines or outcomes in younger populations.

Objective: To assess short-term risk for severe cardiovascular events (excluding myocarditis and pericarditis) after COVID-19 vaccination in France's 46.5 million adults younger than 75 years.

Design: Self-controlled case series method adapted to event-dependent exposure and high event-related mortality.

Setting: France, 27 December 2020 to 20 July 2021.

Patients: All adults younger than 75 years hospitalized for PE, acute MI, hemorrhagic stroke, or ischemic stroke (n = 73 325 total events).

Measurements: Linkage between the French National Health Data System and COVID-19 vaccine databases enabled identification of hospitalizations for cardiovascular events (MI, PE, or stroke) and receipt of a first or second dose of the Pfizer-BioNTech, mRNA-1273 (Moderna), Ad26.COV2.S (Janssen), or ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine. The relative incidence (RI) of each cardiovascular event was estimated in the 3 weeks after vaccination compared with other periods, with adjustment for temporality (7-day periods).

Results: No association was found between the Pfizer-BioNTech or Moderna vaccine and severe cardiovascular events. The first dose of the Oxford-AstraZeneca vaccine was associated with acute MI and PE in the second week after vaccination (RI, 1.29 [95% CI, 1.11 to 1.51] and 1.41 [CI, 1.13 to 1.75], respectively). An association with MI in the second week after a single dose of the Janssen vaccine could not be ruled out (RI, 1.75 [CI, 1.16 to 2.62]).

Limitations: It was not possible to ascertain the relative timing of injection and cardiovascular events on the day of vaccination. Outpatient deaths related to cardiovascular events were not included.

Conclusion: In persons aged 18 to 74 years, adenoviral-based vaccines may be associated with increased incidence of MI and PE. No association between mRNA-based vaccines and the cardiovascular events studied was observed.

Primary funding source: None.

MeSH terms

  • Ad26COVS1
  • Adult
  • BNT162 Vaccine
  • COVID-19 Vaccines* / adverse effects
  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • ChAdOx1 nCoV-19
  • Humans
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / etiology
  • Pulmonary Embolism* / complications
  • Pulmonary Embolism* / etiology
  • RNA, Messenger
  • Stroke* / epidemiology
  • Stroke* / etiology
  • Vaccination / adverse effects


  • Ad26COVS1
  • COVID-19 Vaccines
  • RNA, Messenger
  • ChAdOx1 nCoV-19
  • BNT162 Vaccine