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Myocarditis reporting rates were 40.6 cases per million second doses of mRNA COVID-19 vaccines administered to males aged 1229 years and 2.4 per million second doses administered to males aged 30 years; reporting rates among females in these age groups were 4.2 and 1.0 per million second doses, respectively. The benefit of vaccination against COVID-19 outweighs the potential risk of myocarditis and pericarditis. Association Between Myocarditis and Mortality in COVID-19 Patients in a Large Registry. Chary M, Barbuto AF, Izadmehr S, Tarsillo M, Fleischer E, Burns MM. Based on ACIPs conclusion regarding the benefit-risk assessment on June 23, 2021, COVID-19 vaccination continues to be recommended for all persons aged 12 years under the FDAs EUA. The CONNECTS-Collaborative Cohort of Cohorts for COVID-19 Research (CONNECTS-C4R) trial is enrolling 50,000 people to determine factors that may predict disease severity and long-term side effects of COVID-19. The vaccines are very effective against severe COVID-19 and protect your heart from the serious health consequences of the disease. Of the nearly 21 million women, 7.2 million (34%) were younger than age 40, and a slightly increased risk of myocarditis was found among this younger age group after receiving a second dose of the Moderna COVID-19 vaccine: 7 estimated extra cases of myocarditis for every one million women vaccinated. and/or the original MMWR paper copy for printable versions of official text, figures, and tables. The most common treatment was nonsteroidal anti-inflammatory drugs (589/676; 87%). Myocarditis linked with COVID-19 illness may also be more severe because these patients are usually older and have other health conditions that increase their risk of complications. Treatment data in VAERS are preliminary and incomplete; however, many patients have experienced resolution of symptoms with conservative treatment, such as receipt of nonsteroidal antiinflammatory drugs. Its clear that vaccination can protect you from myocarditis by protecting you from COVID-19 infection. Jerome Fleg, M.D. Accessed June 29, 2022, from. Information on v-safe is available at https://www.cdc.gov/vsafe. The ACIP recommendation for use of mRNA COVID-19 vaccines under an EUA is interim and will be updated as additional information becomes available. Abara WE, Gee J, Marquez P, Woo J, Myers TR, DeSantis A, Baumblatt JAG, Woo EJ, Thompson D, Nair N, Su JR, Shimabukuro TT, Shay DK. (2022). US researchers say teenagers are more likely to get vaccine-related myocarditis than end up in hospital with Covid Skip to main content Skip to navigation Print subscriptions 2021 Oct 1;6(10):1202-1206. doi: 10.1001/jamacardio.2021.2833. Pericarditisis inflammation of the outer lining of the heart. 2 0 obj They help us to know which pages are the most and least popular and see how visitors move around the site. ". endorsement of these organizations or their programs by CDC or the U.S. Severe problems linked with myocarditis include chest pain, arrhythmias, trouble breathing, ankle or leg swelling, and fainting. Your chance of getting myocarditis after getting a COVID-19 vaccine is less than the chance of being struck by lightning during your lifetime. But the risk of myocarditis associated with the vaccine was lower than the risk associated with COVID-19 infection before or after vaccination - with one exception. . Suggested citation for this article: Gargano JW, Wallace M, Hadler SC, et al. For children ages 6 months to 2 years, efficacy was 43.7 percent, and in children ages 2 to 6, it was only 37.5 percent. Researchers are still investigating what triggers myocarditis after Covid vaccination. Payne AB, Gilani Z, Godfred-Cato S, et al. Page last updated: FDA requires that vaccine providers report to VAERS vaccination administration errors, serious adverse events, cases of multisystem inflammatory syndrome, and cases of COVID-19 that result in hospitalization or death after administration of a COVID-19 vaccine under an EUA. Most people (95%) who develop myocarditis after receiving a COVID-19 mRNA vaccine have only mild symptoms that go away within a few days.5 Vaccine-linked myocarditis is less likely to cause lingering heart problems than myocarditis due to COVID-19 illness. Both mRNA vaccines were authorized and recommended as a 2-dose schedule, with second doses administered 21 days (Pfizer-BioNTech) or 28 days (Moderna) after the first dose. Treatment is often given in a hospital. On July 6, 2021, this report was posted online as an MMWR Early Release. 5 Vaccine-linked myocarditis is less likely to cause lingering heart problems than myocarditis due to COVID-19 illness. Gurdasani, D., Bhatt, S., Costello, A., Denaxas, S., Flaxman, S., Greenhalgh, T., Griffin, S., Hyde, Z., Katzourakis, A., McKee, M., Michie, S., Ratmann, O., Reicher, S., Scally, G., Tomlinson, C., Yates, C., Ziauddeen, H., & Pagel, C. (2021). CDC twenty four seven. The .gov means its official. FDA has added information to the Pfizer-BioNTech and Moderna COVID-19 vaccine EUA and fact sheets regarding myocarditis cases that have been reported among vaccine recipients. Trends in acute myocarditis related pediatric hospitalizations in the United States, 20072016. The risk of getting myocarditis from a COVID-19 vaccine is less than 1%. Using myocarditis cases reported to VAERS with onset within 7 days after dose 2 of an mRNA vaccine, crude reporting rates (i.e., using confirmed and unconfirmed cases) per million second dose recipients were calculated using national COVID-19 vaccine administration data as of June 11, 2021. Dr Schlaudecker reported receiving grants from Pfizer and receiving personal fees from Sanofi Pasteur. People who experience a serious side effect of a vaccine or other medical products for COVID-19 may be eligible for compensation under the federal Countermeasures Injury Compensation Program. Current guidelines from the American Heart Association and American College of Cardiology recommend exercise restriction until the heart recovers.. https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html. The F.D.A. In addition, CDC has updated patient education and communication materials reflecting this information for the Pfizer-BioNTech and Moderna****** COVID-19 vaccines; these are important to ensure that vaccine recipients, especially males aged 1229 years, are aware of increased risk for myocarditis and to seek care if they develop symptoms of myocarditis. Reporting rates of myocarditis > background rates for males (12-49 years, depending upon dose and manufacturer) and females (after dose 2, 12-29 . At that meeting, a chart showed that through early June, there was a higher rate of myocarditis among people who received Moderna than Pfizer-BioNTech about 20 per 1 million doses for. Myocarditis was reported at a higher rate than expected among some people who received the Pfizer or Moderna vaccines, according to a July 2021 study. To assess the benefit-risk balance of mRNA vaccines in adolescents and young adults, ACIP reviewed an individual-level assessment that compared the benefits (i.e., COVID-19 infections and severe disease prevented) to the risks (number of cases of myocarditis) of vaccination, using methods similar to those described previously. Specifically, the benefits per million second doses administered (i.e., the benefits of being fully vaccinated in accordance with the FDA EUA) were assessed, including 1) COVID-19 cases prevented based on rates the week of May 29, 2021; 2) COVID-19 hospitalizations prevented based on rates the week of May 22, 2021; and 3) COVID-19 intensive care unit (ICU) admissions and deaths prevented based on the proportion of hospitalized patients who were admitted to the ICU or died. If you have any health problems after vaccination, report them toVAERS. Though both complications were rare, data from Ontario show higher rates of myocarditis and pericarditis with the Moderna COVID-19 vaccine than with the Pfizer-BioNTech vaccine, but the rates were lower for both vaccines if the spacing between receiving two doses was extended, according to a study late last week in JAMA Network Open.. Myocarditis is an inflammation of the heart muscle, and . CDC and its partners are actively monitoring reports of myocarditis and pericarditis after COVID-19 vaccination. Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military. Were currently supporting two large studies looking at long-term effects of COVID-19, including myocarditis and other heart conditions. OR, infants and children aged <12 years might instead have 2 of the following symptoms: troponin level above upper limit of normal (any type of troponin), Histopathologic confirmation of myocarditis, abnormal electrocardiogram (ECG or EKG) or rhythm monitoring findings consistent with myocarditis, abnormal cardiac function or wall motion abnormalities on echocardiogram, cMRI findings consistent with myocarditis, No other identifiable cause of the symptoms and findings. Reports of myocarditis and pericarditis after vaccination are rare. Men and boys between the ages of 16 and 29 have been most often affected by COVID-19vaccine-related myocarditis, usually a few days after their second dose.5 Myocarditis may be due to their strong immune response to the vaccine. The data that the agencies are reviewing were provided by the Canadian government. COVID-19 is more likely than vaccines to cause myocarditis, and symptoms and outcomes are often worse. If you have already gotten the first dose of Pfizer-BioNTech or Moderna vaccine, or if your child has already gotten the first dose of the Pfizer-BioNTech vaccine, its important to get the second dose unless a vaccination provider or your doctor tells you not to get it. A., & 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 (2021). Vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna). Bookshelf Hromi-Jahjefendi A, Barh D, Uversky V, Aljabali AA, Tambuwala MM, Alzahrani KJ, Alzahrani FM, Alshammeri S, Lundstrom K. Vaccines (Basel). View Large Download. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Viruses. Another study is enrolling 500 survivors of COVID-19 to monitor their hearts for long-term effects of COVID-19, using cardiac MRI and echocardiography scans. What are the implications for public health practice? Canadian public health authorities also found that the rate of myocarditis was higher for both Moderna. As of now, the FDA Fact Sheet for Moderna's shot says "Myocarditis and pericarditis have occurred . MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services. Objective: FLEG: Yes, but this is rare, and the symptoms are usually mild. Myocarditis is rare, but it occurs more often following SARS-CoV-2 infection than after receiving an mRNA COVID-19 vaccine for people of all ages.10, We know that boys and men between the ages of 16 and 29 have a higher risk of COVID-19vaccine-related myocarditis. A recent study classifying Long COVID into four types can help health care providers better target treatments for a patients specific symptoms. Myocarditis after RNA-based vaccines for coronavirus. The ACIP COVID-19 Vaccines Work Group, comprising experts in infectious diseases, vaccinology, vaccine safety, public health, and ethics, has held weekly meetings since April 2020 to review COVID-19 surveillance data, evidence for vaccine efficacy and safety, and implementation considerations for COVID-19 vaccination programs. The EUA has been modified to include information on myocarditis after receipt of mRNA COVID-19 vaccines. Although numbers were too small to show rates in all subgroups by age, VSD data indicated increased risk of myocarditis in the 7 days after receipt of dose 1 or dose 2 of an mRNA COVID-19 vaccine compared with the risk 2242 days after the second dose, particularly among younger males after dose 2 (5). The median interval from vaccination to symptom onset was 2 days (range=040 days); 92% of patients experienced onset of symptoms within 7 days of vaccination. Potential cases of postvaccine myocarditis were identified based on reports . There were no cases. As of June 11, 2021, approximately 296 million doses of mRNA COVID-19 vaccines had been administered in the United States, with 52 million administered to persons aged 1229 years; of these, 30 million were first and 22 million were second doses. The clinical presentation and severity of myocarditis vary among patients. Your health care provider can provide more information thats specific to your situation. Acute clinical courses were generally mild; among 304 hospitalized patients with known clinical outcomes, 95% had been discharged at time of review, and none had died. "If you're focused on heart inflammation, the safer bet is to take the vaccine," said Mendel Singer at Case Western Reserve University in Ohio, who helped carry out the study. The work group also reviewed a benefit-risk assessment of myocarditis events after receipt of mRNA COVID-19 vaccines, considering recent epidemiology of COVID-19 and sequelae of COVID-19, including myocarditis and multisystem inflammatory syndrome in children (MIS-C). Incidence Rates and Rate Ratios of Myocarditis in Vaccinated Individuals Compared With Control Groups. Montgomery J, Ryan M, Engler R, Hoffman D, McClenathan B, Collins L, Loran D, Hrncir D, Herring K, Platzer M, Adams N, Sanou A, Cooper LT Jr. JAMA Cardiol. PMC Crude reporting rates were calculated across age and sex strata. Unfortunately, inflammation in the heart muscle can lead to serious complications, including heart failure, shock, or death. Approximately 96% of persons (784/813) were hospitalized and 87% (577/661) of these had resolution of presenting symptoms by hospital discharge. NHLBI-supported research aims to identify the causes of lasting heart and lung symptoms of COVID-19, find ways to prevent these problems, and improve treatment to promote rapid healing. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of * These authors contributed equally to this work. Information about CDCs ongoing study of myocarditis after COVID-19 vaccination can be found here: Investigating Long-Term Effects of Myocarditis | CDC. Learn about the four phases of clinical research, what questions researchers try to answer in each, and how a vaccine is developed, approved, and manufactured. CDC has provided guidance regarding evaluation and management of myocarditis after mRNA COVID-19 vaccine (https://www.cdc.gov/vaccines/covid-19/clinical-considerations/myocarditis.html), as well as considerations for a second vaccine dose in persons who develop myocarditis after a first dose (https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html). Moderna defended the use of its Covid vaccine, saying the protection it offers against severe disease, hospitalization and death outweighs the risk of myocarditis. The estimated incidence of myocarditis was 2 per 100,000 individuals, with the highest reported rate in males aged 16 to 29. Department of Health and Human Services. Myocarditisisinflammation of the heart muscle. The https:// ensures that you are connecting to the Coronavirus-induced myocarditis: A meta-summary of cases. 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. The ACIP discussion concluded that 1) the benefits of vaccinating all recommended age groups with mRNA COVID-19 vaccine clearly outweigh the risks of vaccination, including the risk of myocarditis after vaccination; 2) continuing to monitor outcomes of myocarditis cases after COVID-19 vaccination is important; and 3) providers and the public should be informed about these myocarditis cases and the use of COVID-19 vaccines. 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. * This analysis evaluated direct benefits and harms, per million second doses of mRNA COVID-19 vaccine given in each age group, over 120 days. Centers for Disease Control and Prevention. Reports of Guillain-Barr Syndrome After COVID-19 Vaccination in the United States. Among all participants aged 16 to 24, myocarditis rates were 18.8 and 4.4 per 100,000 person-years for males and females, respectively. I doubt we'll ever know. According to an analysis presented by a C.D.C. Would you like email updates of new search results? Shimabukuro TT, Nguyen M, Martin D, DeStefano F. Safety monitoring in the Vaccine Adverse Event Reporting System (VAERS). Myocarditis has been linked with other vaccines, such as those that prevent influenza (flu), smallpox, and shingles.6. <>/Metadata 2557 0 R/ViewerPreferences 2558 0 R>> Adenoviral Vector-Based Vaccine Platform for COVID-19: Current Status. It is unclear how many of these cases are a direct consequence of the vaccine versus coincidental. In December 2020, the Food and Drug Administration (FDA) issued Emergency Use Authorizations (EUAs) for the Pfizer-BioNTech COVID-19 (BNT162b2) vaccine and the Moderna COVID-19 (mRNA-1273) vaccine, and the Advisory Committee on Immunization Practices (ACIP) issued interim recommendations for their use in persons aged 16 years and 18 years, respectively. In May 2021, FDA expanded the EUA for the Pfizer-BioNTech COVID-19 vaccine to include adolescents aged 1215 years; ACIP recommends that all persons aged 12 years receive a COVID-19 vaccine. 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. To receive email updates about COVID-19, enter your email address: We take your privacy seriously. Among teenage boys, the rate of myocarditis or pericarditis after infection was at least 50 cases per 100,000 people, compared to at least 22 cases per 100,000 after the second vaccine dose.. On June 23, 2021, the Advisory Committee on Immunization Practices concluded that the benefits of COVID-19 vaccination to individual persons and at the population level clearly outweighed the risks of myocarditis after vaccination. More information is available, Travel requirements to enter the United States are changing, starting November 8, 2021. Informed by early reports, CDC prioritized rapid review of myocarditis in persons aged <30 years reported during May 1June 11, 2021; the 484 patient records in this subset were evaluated by physicians at CDC, and several reports were also reviewed with Clinical Immunization Safety Assessment Project investigators, including cardiologists. B, For the mRNA-1273 vaccine, there were 116 reported cases of myocarditis with known date for symptom onset and dose after 78158611 first vaccination doses and 311 reported cases after 66163001 second vaccination doses. Even in this group, though, heart inflammation is seven or eight times more common after SARS-CoV-2 infection.10 And the data suggest that young adults with myocarditis possibly linked with COVID-19 vaccines recover quickly with supportive care.11. NHLBI Information & Resources on COVID-19. From an analysis done on just 26 medical chart-confirmed cases of myocarditis in people ages 12 to 39, the CDC scientists estimated a rate of 12.6 cases per million second doses. 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). FOIA Patel, T., Kelleman, West, Z., M., Peter, A., Dove, M., Butto, A., & Oster, M. E. (2021). endobj Mary Chamberland, Thomas Clark, Amanda Cohn, Frank DeStefano, Ruth Gallego, Alice Guh, Theresa Harrington, Fiona P. Havers, Lauri Hicks, Amelia Jazwa, Tara Johnson, Brian Kit, Paige Marquez, Sarah Mbaeyi, Elaine Miller, Hannah Rosenblum, Monica Parise, Kadam Patel, Pragati Prasad, David Shay, Jamila Shields, Christopher A. Taylor, Joshua Wong, CDC COVID-19 Response Team; Clinical Immunization Safety Assessment (CISA) Project; Vaccine Safety Datalink; Center for Biologics Evaluation and Research, Food and Drug Administration; Voting members of the Advisory Committee on Immunization Practices: Kevin A. Ault, University of Kansas Medical Center; Lynn Bahta, Minnesota Department of Health; Henry Bernstein, Zucker School of Medicine at Hofstra/Northwell Cohen Childrens Medical Center; Beth Bell, University of Washington, Seattle, Washington; Wilbur Chen, University of Maryland School of Medicine; Sharon E. Frey, Saint Louis University Medical School; Camille Kotton, Harvard Medical School; Sarah Long, Drexel University College of Medicine; Katherine A. Poehling, Wake Forest School of Medicine; Pablo J. Snchez, The Research Institute at Nationwide Childrens Hospital. doi: 10.1001/jamanetworkopen.2022.18505. Abbreviations: AV = atrioventricular; cMRI=cardiac magnetic resonance imaging; ECG or EKG=electrocardiogram. Continued use of mRNA COVID-19 vaccines in all recommended age groups will prevent morbidity and mortality from COVID-19 that far exceed the number of cases of myocarditis expected. Those who have been diagnosed with myocarditis should consult with their cardiologist (heart doctor) about return to exercise or sports. CDC and FDA will continue to closely monitor reports of myocarditis after receipt of the mRNA COVID-19 vaccines and will bring any additional data to ACIP for consideration. Learn how NIH has improved basic understanding of the SARS-CoV-2 virus and sped up the development of COVID-19 vaccines, treatments, and testing. National Library of Medicine the date of publication. Of the 323 persons meeting CDCs case definitions, 309 (96%) were hospitalized. In those aged under 18 years, the reported rate for heart inflammation (myocarditis and pericarditis) was 13 per million first doses and 8 per million second doses of the monovalent. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Among teenaged boys the group with the highest risk of myocarditis after COVID-19 vaccination the risk is between 2 and 5 times higher after SARS-CoV-2 infection than after vaccination.10, A study of children ages 12 to 17 in England estimated that COVID-19 vaccination prevented 4,500 hospitalizations, 300 ICU hospital stays, and 36 deaths during the summer of 2021 when infection rates were high.11, Children with myocarditis linked with vaccination are less likely to be hospitalized, admitted to the ICU, or need ventilator support, compared with children who had myocarditis after a COVID-19 diagnosis. Kyt V, Sipil J, Rautava P. The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood. Cardiac Complications After SARS-CoV-2 Infection and mRNA COVID-19 Vaccination PCORnet, United States, January 2021-January 2022. Vaccinating adolescents against SARS-CoV-2 in England: a risk-benefit analysis. Among persons with reported myocarditis after mRNA vaccination, the median age was 26 years (range=1294 years), with median symptom onset interval of 3 days after vaccination (range=0179). The Pfizer and Moderna mRNA vaccines are available in the U.S. For more severe cases of myocarditis caused by a virus, such as SARS-CoV-2, people may need to stay in the hospital for a week or two often in the ICU. 3 0 obj Per million second doses of mRNA COVID-19 vaccine administered to males aged 1229 years, 11,000 COVID-19 cases, 560 hospitalizations, 138 ICU admissions, and six deaths due to COVID-19 could be prevented, compared with 3947 expected myocarditis cases after COVID-19 vaccination (Table 2). Vaccination against COVID-19 provides clear public health benefits, but vaccination also carries potential risks. Comparisons of the risk of myopericarditis between COVID-19 patients and individuals receiving COVID-19 vaccines: a population-based study. [Preprint]. Am J Cardiovasc Pathol 1987; 1:314). An elevated risk for myocarditis among mRNA COVID-19 vaccinees has been observed, particularly in males aged 1229 years. ; MIS-C Incidence Authorship Group. Overall myocarditis rates among males in this age group were 2.97 per 100,000, which rose to 2.27 per 100,000 after the second dose. Preliminary evidence on long COVID in children. Comparison of MIS-C Related Myocarditis, Classic Viral Myocarditis, and COVID-19 Vaccine related Myocarditis in Children. Overall, the investigators found 2.13 myocarditis cases per 100,000 peopleagain, about a 0.002% incidencewith the highest incidence in men 16 to 29 years old, where it was 10.69 cases per 100,000 people, or a 0.011% incidence (95% CIs, 1.56 to 2.70 and 6.93 to 14.46, respectively). After reports of myocarditis and pericarditis in mRNA vaccine recipients, which predominantly occurred in young males after the second dose, an ACIP meeting was rapidly convened to review reported cases of myocarditis and pericarditis and discuss the benefits and risks of mRNA COVID-19 vaccination in the United States. Saving Lives, Protecting People, https://www.cdc.gov/vaccines/covid-19/clinical-considerations/myocarditis.html, https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html, https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines, https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html, https://www.cdc.gov/vaccines/acip/work-groups-vast/index.html, https://www.ahajournals.org/doi/10.1161/CIR.0000000000000239?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed#d3e785, https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/cisa/index.html, https://www.cdc.gov/vaccines/covid-19/info-by-product/janssen/risk-benefit-analysis.html, https://covid.cdc.gov/covid-data-tracker/#demographicsovertime, https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html, https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html, https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html, https://covid.cdc.gov/covid-data-tracker/#variant-proportions, https://covid.cdc.gov/covid-data-tracker/#demographics, https://www.fda.gov/media/144413/download, https://www.fda.gov/media/144637/download, https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/index.html, https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/index.html, https://doi.org/10.1136/heartjnl-2013-304449, https://doi.org/10.1016/j.amjcard.2021.03.019, https://doi.org/10.1016/j.vaccine.2015.07.035, https://doi.org/10.1001/jamanetworkopen.2021.16420, https://www.sciencedirect.com/science/article/pii/S0735109718388430?via%3Dihub, https://academic.oup.com/eurheartj/article/36/42/2921/2293375, Centers for Disease Control and Prevention, U.S. Department of Health & Human Services, Presence of 1 new or worsening of the following clinical symptoms:*, dyspnea, shortness of breath, or pain with breathing.