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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. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. The data that the agencies are reviewing were provided by the Canadian government. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Abbreviations: ICU=intensive care unit; VAERS = Vaccine Adverse Event Reporting System. According to an analysis presented by a C.D.C. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. No alternatives to mRNA COVID-19 vaccines for adolescents will be available for the foreseeable future, and vaccination of adolescents offers protection against COVID-19 that can be important for returning to educational, social, and extracurricular activities. FLEG: Vaccination helps protect people from getting sick or severely ill with COVID-19 and helps protect those around them. 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. 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. COVID-19 Vaccinations in the United States. Conclusions and relevance: Myocarditis and Pericarditis After mRNA COVID-19 Vaccination, Centers for Disease Control and Prevention. 2 0 obj Among patients in a large Israeli health care system who had received at least one dose of the BNT162b2 mRNA vaccine, the estimated incidence of myocarditis was 2.13 cases per 100,000 persons; the . Its clear that vaccination can protect you from myocarditis by protecting you from COVID-19 infection. J Med Toxicol. <>/ExtGState<>/Pattern<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 960 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Members of the Advisory Committee on Immunization Practices COVID-19 Vaccines Safety Technical Work Group: Robert Hopkins, National Vaccine Advisory Committee; Kathryn Edwards, Vanderbilt University School of Medicine; Lisa Jackson, Kaiser Permanente Washington Health Research Institute; Jennifer Nelson: Kaiser Permanente Washington Health Research Institute; Laura Riley, American College of Obstetricians and Gynecologists; Patricia Whitley-Williams, National Medical Association; Tatiana Beresnev, National Institutes of Health; Karen Farizo, Food and Drug Administration; Hui Lee Wong, Food and Drug Administration; Judith Steinberg, U.S. Department of Health and Human Services; Matthew Clark, Indian Health Service; Mary Rubin, Health Resources & Services Administration; Fran Cunningham, Veterans Administration; Limone Collins, Department of Defense. Autopsy cases may be classified as confirmed clinical myocarditis on the basis of meeting histopathologic criteria if no other identifiable cause. To meet the ECG or rhythm monitoring criterion, a probable case must include at least one of 1) ST-segment or T-wave abnormalities; 2) Paroxysmal or sustained atrial, supraventricular, or ventricular arrhythmias; or 3) AV nodal conduction delays or intraventricular conduction defects. Using either the original or the revised Lake Louise criteria. They help us to know which pages are the most and least popular and see how visitors move around the site. The FDA - which generally follows the recommendations of its advisers but is not obligated to do so - is likely to authorize the Moderna vaccine for ages 6-17 soon. Incidence of multisystem inflammatory syndrome in children among US persons infected with SARS-CoV-2. Potential cases of postvaccine myocarditis were identified based on reports . Because these studies are in their early phases, the results are not ready yet. It is estimated there are around 2 more cases per 100,000 second vaccine doses in people under 40 who received Moderna original formulation than Pfizer original formulation. Table 2. 2022 Jun 11;399(10342):2191-2199. doi: 10.1016/S0140-6736(22)00791-7. Incidence Rates and Rate Ratios of Myocarditis in Vaccinated Individuals Compared With Control Groups. The analysis assumed 95% vaccine effectiveness of 2 doses of a mRNA COVID-19 vaccine in preventing COVID-19 cases and hospitalization and assessed outcomes for a 120-day period. Cookies used to make website functionality more relevant to you. This analysis did not include the potential benefit of preventing post-COVID-19 conditions, such as prolonged symptoms and MIS-C (6,7). Importance: Reporting rates (per 1 million doses administered) of myocarditis among females after Moderna COVID-19 vaccination, days 0-7 after vaccination (through Jan 13, 2022 6 Moderna (Females) Ages (years) Dose 1 Dose 2 18-24 0.5 5.5 25-29 0.3 5.8 30-39 0.6 0.6 40-49 0.8 1.6 50-64 0.8 0.4 65+ 0.1 0.5 85,729,766 official website and that any information you provide is encrypted Centers for Disease Control and Prevention. 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. 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. 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 . Broken down by age and sex, a second dose of the Moderna vaccine was associated with a higher rate of myocarditis or pericarditis compared with a second dose of the Pfizer/BioNTech vaccine among males ages 18 to 24 (adjusted rate ratio 6.6; 95% CI 3.3-13.2) and 25 to 39 (adjusted rate ratio 5.1; 95% CI 2.3-11.5), as well as females ages 18 to . and transmitted securely. MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services. The median age of the 323 patients meeting CDCs case definitions was 19 years (range=1229 years); 291 were male, and 32 were female. Males under age 40 who received the Moderna vaccine were shown to have the highest rates of myocarditis, and the researchers said the study's findings support the idea of recommending. . The y-axis range differs between panels A and B. They help us to know which pages are the most and least popular and see how visitors move around the site. Information about CDCs ongoing study of myocarditis after COVID-19 vaccination can be found here: Investigating Long-Term Effects of Myocarditis | CDC. Among 1,194 reports for which patient age was known, 687 were among persons aged <30 years and 507 were among persons aged 30 years; of 1,212 with sex reported, 923 were male, and 289 were female. Among 1,094 patients with number of vaccine doses received reported, 76% occurred after receipt of dose 2 of mRNA vaccine; cases were reported after both Pfizer-BioNTech and Moderna vaccines. 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. Moderna defended the use of its Covid vaccine, saying the protection it offers against severe disease, hospitalization and death outweighs the risk of myocarditis. According to the CDC, as of June 23, 2021, more than 177 million people had received at least one dose of a COVID-19 vaccine in the U.S. Canadian public health authorities also found that the rate of myocarditis was higher for both Moderna. Parents should speak with their childrens health care providers regarding the benefits and risks of vaccination against COVID-19. 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. They also recover normal heart function sooner.12. Case Description and Clinical Course a. . https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/cisa/index.html. Bookshelf 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. Recent research about myocarditis, . Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military. Reporting rates of myocarditis > background rates for males (12-49 years, depending upon dose and manufacturer) and females (after dose 2, 12-29 . The Researching COVID to Enhance Recovery (RECOVER) Initiative is taking place at 80 centers across the country. CDC twenty four seven. Researchers are still investigating what triggers myocarditis after Covid vaccination. 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. Key factors to consider are the current rates of COVID-19 infection, the childs overall health, and the parents assessment of risks. Yes. Centers for Disease Control and Prevention. The site is secure. (Pfizer) or mRNA-1273 (Moderna) mRNA vaccine between December 14, 2020, and July 20, 2021. If you have any health problems after vaccination, report them to theVaccine Adverse Event Reporting System. The NHLBI supports and conducts research aimed at understanding risk factors for COVID-19, developing prevention and treatment strategies, and finding ways to hasten and enhance recovery. Myocarditisisinflammation of the heart muscle. Comparison of MIS-C Related Myocarditis, Classic Viral Myocarditis, and COVID-19 Vaccine related Myocarditis in Children. doi: 10.1001/jamanetworkopen.2022.53845. Vaccination against COVID-19 provides clear public health benefits, but vaccination also carries potential risks. A non-peer-reviewed retrospective paper, released as a pre-print, analyzed the rate of post-vaccination cardiac myocarditis in children aged 12-15 and 16-17 years who had received mRNA COVID . Buchan SA, Seo CY, Johnson C, Alley S, Kwong JC, Nasreen S, Calzavara A, Lu D, Harris TM, Yu K, Wilson SE. Most of the suspected myocarditis cases in that study developed after the second dose and were among males between 12 and 39 years old. Many people have no side effects at all. Can COVID-19 Vaccines Induce Premature Non-Communicable Diseases: Where Are We Heading to. Serious side effects are very uncommon. JAMA Netw Open. Am J Cardiol 2021;149:95102. Its also possible that myocarditis linked with vaccination is less serious because of the younger average age and healthier status of people getting vaccinated. Vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna). of pages found at these sites. You will be subject to the destination website's privacy policy when you follow the link. The Vaccine Safety Datalink: a model for monitoring immunization safety. %PDF-1.7 COVID-19 Vaccine Safety Technical Work Group Reports are available at https://www.cdc.gov/vaccines/acip/work-groups-vast/index.html. doi: 10.1136/bmj-2021-069445. Department of Health and Human Services. 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. Estimates include cases of myocarditis, pericarditis, and myopericarditis. As of now, the FDA Fact Sheet for Moderna's shot says "Myocarditis and pericarditis have occurred . There were likely many cases that went unreported. Presence of 2 new or worsening of the following clinical features: new ST-elevation or PR-depression on EKG, new or worsening pericardial effusion on echocardiogram or MRI. Thank you for taking the time to confirm your preferences. Those who have been diagnosed with myocarditis should consult with their cardiologist (heart doctor) about return to exercise or sports. The clinical presentation and severity of myocarditis vary among patients. The known risks of COVID-19 illness and its related, possibly severe complications, such as long-term health problems, hospitalization, and even death, far outweigh the potential risks of having a rare adverse reaction to vaccination, including the possible risk of myocarditis or pericarditis. Some groups have a higher risk of developing myocarditis from COVID-19. (2022). Most people (95%) who develop myocarditis after receiving a COVID-19 mRNA vaccine have only mild symptoms that go away within a few days. : Myocarditis is an inflammation of the heart muscle. Myocarditis is a rare complication of COVID-19 vaccination. Abbreviations: AV = atrioventricular; cMRI=cardiac magnetic resonance imaging; ECG or EKG=electrocardiogram. Vaccination with mRNA-1273 (Moderna) was associated with a significantly increased rate of myocarditis or myopericarditis, especially among individuals aged 12-39 years (adjusted hazard ratio 5.24 (95% confidence interval 2.47 to 11.12); absolute rate 5.7 (3.3 to 9.3) per 100 000 individuals aged 12-39 years within 28 days of vaccination) JAMA. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Among males aged 30 years, 15,300 COVID-19 cases, 4,598 hospitalizations, 1,242 ICU admissions, and 700 deaths could be prevented, compared with three to four expected myocarditis cases after COVID-19 vaccination. [Preprint]. CDC and its partners are actively monitoring reports of myocarditis and pericarditis after COVID-19 vaccination. 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. Association Between Myocarditis and Mortality in COVID-19 Patients in a Large Registry. Most patients with myocarditis or pericarditis who received care responded well to medicine and rest and felt better quickly. Law, Y. M., Lal, A. K., Chen, S., ihkov, D., Cooper, L. T., Jr, Deshpande, S., Godown, J., Grosse-Wortmann, L., Robinson, J. D., Towbin, J. *** Data collection for race/ethnicity of myocarditis cases is ongoing. Between 2001 and 2020, the Institute has funded 139 myocarditis studies at a cost of $43.6 million. Among men ages 18 to 29 who received the Moderna vaccine, the rate was 22.9 per 100,000 doses. Chou, O., Zhou, J., Lee, T., Kot, T., Lee, S., Wai, A., Wong, W. T., Zhang, Q., Cheng, S. H., Liu, T., Vassiliou, V. S., Cheung, B., & Tse, G. (2022). 76% were classified as mild and 22% intermediate. SARS-CoV-2 can cause serious heart problems by infecting heart cells and by causing inflammation that injures the heart muscle. When reported, the cases have especially been in adolescents and young adult males within several days after mRNA COVID-19 vaccination (Pfizer-BioNTech or Moderna). 1 0 obj Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr) This is a recognised risk with the Comirnaty (Pfizer) and Spikevax (Moderna) vaccines and we are closely monitoring these events. Please enable it to take advantage of the complete set of features! (Jolygon/iStock via Getty Images) The risk of developing myocarditis - an inflammation of the heart muscle - following a booster dose of the Pfizer COVID-19 vaccine is low, according to new research from Israel. 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. At the time of this report, 323 of these 484 cases were determined to meet criteria in CDCs case definitions for myocarditis, pericarditis, or myopericarditis by provider interview or medical record review (Table 1). 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. In the past few weeks, anti-vaxxers have rallied behind a nonpeer-reviewed study by a group of Canadian researchers as evidence against COVID-19 vaccines. **** The risks were assessed as the number of myocarditis patients reported to VAERS that occurred within 7 days of receipt of a second dose of an mRNA COVID-19 vaccine per million second doses administered through the week of June 11, 2021. The benefit-risk assessment was stratified by age group and sex. 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/downloadexternal icon, https://www.fda.gov/media/144637/downloadexternal icon, 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://vaers.hhs.gov/faq.htmlexternal icon. Disclaimer. What are the implications for public health practice? I can't remember when I heard about the myocarditis risk with the mRNA vaccines, especially Moderna, but it was definitely by the end of 2021. The risk of myocarditis linked with COVID-19 illness is several times greater than the risk from vaccination, and it is often more serious.3,5,8 This is because the SARS-CoV-2 virus invades cells of the heart, plus the body generates an overactive immune response to the infection. 2023 Mar 2:1-14. doi: 10.1007/s13181-023-00931-9. Clipboard, Search History, and several other advanced features are temporarily unavailable. Bethesda, MD 20894, Web Policies <> **** https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html. The cases have been most common in male adolescents and young adults, occurring most often after the second dose, and usually within several days of receiving the vaccine. If you have concerns about COVID-19 vaccination, talk with your healthcare provider or your childs doctor, nurse, or clinic. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Evidence suggests that AstraZeneca and Novavax are probably associated with a small increased risk of myocarditis and pericarditis. (2022). Information on v-safe is available at https://www.cdc.gov/vsafe. 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. View Large Download. 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. 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. N Engl J Med 2009;360:152638. Myocarditis usually goes away on its own with supportive care, including IV fluids, steroid therapy, and medicines to treat disorders of heart rhythm or pumping function. Vasudeva R, Bhatt P, Lilje C, et al. Figure 1.. Cases of Myocarditis After mRNA-Based, Figure 1.. Cases of Myocarditis After mRNA-Based COVID-19 Vaccination by Age at Onset of Myocarditis, Figure 2.. Cases of Myocarditis After mRNA-Based, Figure 2.. Cases of Myocarditis After mRNA-Based COVID-19 Vaccination by Time From Vaccination to Symptom, MeSH The study showed males younger than 40 years old who received the Moderna vaccine were shown to have the highest rates of myocarditis, which according to the authors, may have implications for choosing specific vaccines for certain populations. Key Points There have been more than 1,200 reported cases of a myocarditis or pericarditis mostly in people 30 and under who received Pfizer's or Moderna's Covid-19 vaccine, according to CDC. Side effects of COVID-19 vaccination are generally mild discomfort at the injection site, fatigue, and muscle aches and go away in a few days. <> Your chance of getting myocarditis after getting a COVID-19 vaccine is less than the chance of being struck by lightning during your lifetime. Members of the Advisory Committee on Immunization Practices COVID-19 Vaccines Work Group: Edward Belongia, Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute; Dayna Bowen Matthew, George Washington University Law School; Oliver Brooks, National Medical Association; Jillian Doss-Walker, Indian Health Service; Marci Drees, Society for Healthcare Epidemiology of America; Jeffrey Duchin, Infectious Diseases Society of America; Kathy Kinlaw, Center for Ethics, Emory University; Doran Fink, Food and Drug Administration; Sandra Fryhofer, American Medical Association; Jason M. Goldman, American College of Physicians; Michael Hogue, American Pharmacists Association; Denise Jamieson, American College of Obstetricians and Gynecologists; Jeffery Kelman, Centers for Medicare & Medicaid Services; David Kim, U.S. Department of Health and Human Services; Susan Lett, Council of State and Territorial Epidemiologists; Kendra McMillan, American Nurses Association; Kathleen Neuzil, Center for Vaccine Development and Global Health, University of Maryland School of Medicine; Sean OLeary, American Academy of Pediatrics; Christine Oshansky, Biomedical Advanced Research and Development Authority; Stanley Perlman, Department of Microbiology and Immunology, University of Iowa; Marcus Plescia, Association of State and Territorial Health Officials; Chris Roberts, National Institutes of Health; William Schaffner, National Foundation for Infectious Diseases; Kenneth Schmader, American Geriatrics Society; Bryan Schumacher, Department of Defense; Rob Schechter, Association of Immunization Managers; Jonathan Temte, American Academy of Family Physicians; Peter Szilagyi, University of California, Los Angeles; Matthew Tunis, National Advisory Committee on Immunization Secretariat, Public Health Agency of Canada; Thomas Weiser, Indian Health Service; Matt Zahn, National Association of County and City Health Officials; Rachel Zhang, Food and Drug Administration. Hromi-Jahjefendi A, Barh D, Uversky V, Aljabali AA, Tambuwala MM, Alzahrani KJ, Alzahrani FM, Alshammeri S, Lundstrom K. Vaccines (Basel). Exposures were first and second dose of Pfizer, AstraZeneca, Moderna, and Janssen COVID-19 vaccines. July 5, 2022, U.S. Department of Health and Human Services, Benefits of COVID-19 vaccines outweigh a very small risk of heart complications, You can learn more about myocarditis symptoms, diagnosis, and treatment from the NHLBI, Countermeasures Injury Compensation Program, Researching COVID to Enhance Recovery (RECOVER), CONNECTS-Collaborative Cohort of Cohorts for COVID-19 Research (CONNECTS-C4R), https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total, https://doi.org/10.1161/CIR.0000000000001001, https://doi.org/10.1038/s41591-021-01630-0, https://doi.org/10.1016/j.hrtlng.2020.08.013, https://doi.org/10.1007/s12471-022-01677-9, https://doi.org/10.1016/j.vaccine.2020.12.046, https://doi.org/10.1016/j.ijcard.2022.01.037, https://doi.org/10.1007/s00392-022-02007-0, https://doi.org/10.1016/j.mayocpiqo.2021.12.006, https://doi.org/10.1177/01410768211052589, https://doi.org/10.1101/2021.10.05.21264581. The EUA fact sheets should be provided before vaccination; in addition, CDC has developed patient and provider education materials about the possibility of myocarditis and symptoms of concern, to ensure prompt recognition and management of myocarditis. endobj 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 study shows a low but significant rate of myocarditis among vaccine recipients, at less than 1 per 100,000 recipients. 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). 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. Julia W. Gargano, PhD1,*; Megan Wallace, DrPH1,*; Stephen C. Hadler, MD1; Gayle Langley, MD1; John R. Su, MD, PhD1; Matthew E. Oster, MD1; Karen R. Broder, MD1; Julianne Gee, MPH1; Eric Weintraub, MPH1; Tom Shimabukuro, MD1; Heather M. Scobie, PhD1; Danielle Moulia, MPH1; Lauri E. Markowitz, MD1; Melinda Wharton, MD1; Veronica V. McNally, JD2; Jos R. Romero, MD3; H. Keipp Talbot, MD4; Grace M. Lee, MD5; Matthew F. Daley, MD6; Sara E. Oliver, MD1 (View author affiliations).