Myopericarditis and Acute Aortic Dissection after Receiving mRNA Based COVID 19 Vaccine: Cases Report and Literature Reviewed
Keywords:
pericarditis, myocarditis, myopericarditis, acute aortic dissection, adverse effect after second MRNAbased vaccineAbstract
The fastest ever seen, pandemic spreading of the new corona virus, SAR-CoV-2, so-called COVID-19, rapidly infected more than five million cases globally within two years; and created enormous burden to socio-economic and public health systems worldwide. This impact forced vaccine pharmaceutical companies to use newer technology, by using synthetic mRNA, injecting into host body to produce spike proteins and later antibody against them, in faster and cheaper ways than the conventional live attenuated vaccine. Although mRNA based vaccines were prematurely approved for emergently used, preliminary and later studies confirmed their safety and efficacy to prevent previous viral variants, from alpha to delta strains, in over 90%, in comparison to placebo group. After widely used in large population worldwide, several adverse effects had been reported, from anaphylaxis, myopericarditis, stress induced cardiomyopathy, bone marrow failure, ruptured arterial aneurysm and death. We reported five cases of pericarditis (2), myopericarditis (2), myocarditis(1), occurring from 2 to 56 days (average 22, median 14 days) after second vaccine exposure (four cases after Pfizer and Moderna vaccines) and first dose (one case after Moderna half dose), with relative high age [average 49.5 (20-67), median of 55 years]. Clinical manifestations varied from asymptomatic to chest pain, dyspnea, palpitation which resolved within three months. However, one of them had DeBakey type 1 acute aortic dissection of silent fusiform abdominal aortic aneurysm, size 4 cm, and became hypotensive, shock required emergent but uneventful vascular repair. Up to our knowledge this is the first report of these adverse cardiovascular effects of mRNA based vaccine in Thai people. We hoped that this paper will urge medical attention to monitor, early detect and prevent these serious conditions.
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