| AUTHOR | CASE | AGE | SEX | VACCINE | DOSE* | DISEASE | PERIOD** | POST-MORTEM FINDINGS |
|---|---|---|---|---|---|---|---|---|
| NUSHIDA, (JAPAN) 2023 [25] | 1 | 14 | F | Pfizer | 3 | MIS, Myopericarditis | 2 days | Congestive edema of the lungs, T-cell lymphocytic and macrophage infiltration in the lungs, pericardium, and myocardium of the left atria and left ventricle, liver, kidneys, stomach, duodenum, bladder, and diaphragm. The presence of foci centered on the atria and breathlessness are the findings that led to the diagnosis that the cause of death was vaccine-related myopericarditis, which led to severe arrhythmias and progressive heart failure. |
| MORZ, (GERMANY) 2022 [26] | 1 | 76 | M | Pfizer | 2 | encephalitis, myocarditis | 21 days | Signs of aspiration pneumonia and systemic arteriosclerosis were evident. Brain examination uncovered acute vasculitis (predominantly lymphocytic) as well as multifocal necrotizing encephalitis of unknown etiology with pronounced inflammation including glial and lymphocytic reaction. In the heart, signs of chronic cardiomyopathy as well as mild acute lympho-histiocytic myocarditis and vasculitis were present. Only spike protein but no nucleocapsid protein could be detected within the foci of inflammation in both the brain and the heart. Also, mild acute splenitis, gastric mucosal bleeding, liver lipofuscinosis, and mild active nephritis were found |
| TAKAHASHI, (JAPAN) 2022 [27] | 1 | ‘90s’ | M | Pfizer | 3 | Pericarditis | 14 days | Dissection of the ascending aorta and pericardial hemotamponade. The heart showed a white villous surface, and the pericardium was fibrously thick. Microscopic examination revealed pericarditis with predominantly macrophage and lymphocyte infiltration |
| SATOMI, (JAPAN) 2022 [28] | 1 | 61 | F | Pfizer | 1 | Myocarditis | 10 days | The heart showed moderate dilatation of both ventricles, and the myocardium showed an uneven color change and decreased elasticity. Histologically, severe myocarditis with extensive myocytolysis was observed. The myocarditis showed severe inflammatory cell infiltration with T-lymphocyte and macrophage predominance, and vast nuclear dust accompanying neutrophilic infiltration was observed. In the bone marrow and lymph nodes, hemophagocytosis was observed. SARS-CoV-2 nucleic acids were not detected using multivirus real-time PCR system |
| SUZUKI, (JAPAN) 2021 [29] | 1 | 91 | M | Moderna | 1 | Ischemic heart disease, myocarditis | 6 days | Old myocardial infarction in the post lateral wall, severe coronary artery sclerosis, leukocyte and lymphocyte infiltration in the left anterior wall, diabetic nephropathy, aortic sclerosis |
| SUZUKI, (JAPAN) 2021 [29] | 2 | 24 | M | Moderna | 2 | Myocarditis | 3 days | Scattered necrosis and fibrosis of cardiomyocytes with a perivascular pattern of inflammatory cell infiltration (consisting of predominantly lymphocytes) |
| SUZUKI, (JAPAN) 2021 [29] | 3 | 39 | M | Moderna | 2 | Myocarditis | 3 days | Scattered inflammatory cell infiltration (consisting of predominantly monocytes) in the interstitial space of cardiomyocytes/around the coronary arteries, interstitial edema, eosinophilic and wavy change of cardiomyocytes, Lung edema, coronary sclerosis |
| GILL, 2022 (USA) [30] | 1 | ‘teenage’ | M | Pfizer | 2 | Myocarditis | 3 days | No molecular evidence of SARS-CoV-2 infection. Global myocardial injury with areas of coagulative myocytolysis and contractions bands, with a perivascular pattern of inflammation consisting of mainly neutrophils and histocytes, scant lymphocytes, and occasional eosinophils. No acute or organizing thrombi were detected. Pattern of injury is consistent with stress cardiomyopathy |
| GILL, 2022 (USA) [30] | 2 | ‘teenage’ | M | Pfizer | 2 | Myocarditis | 4 days | No molecular evidence of SARS-CoV-2 infection. As with the previous case, global myocardial injury was found but with more widespread transmural ischemic changes and more interstitial inflammation. Subepicardial distribution of injury was not seen. No acute or organizing thrombi were detected |
| AMERATUNGA, 2022 (NEW ZEALAND) [31] | 1 | 57 | F | Pfizer | 1 | Myocarditis | 3 days | Left pleural mass originating from the mediastinum was found. Multifocal inflammatory cell infiltration in the myocardium and areas of eosinophil-rich inflammatory aggregates with myocyte necrosis were found. An abundant eosinophilic infiltrate with myocyte necrosis was observed. Antibodies to SARS-CoV-2 were not detected |
| CHOI, 2021 (KOREA) [32] | 1 | 22 | M | Pfizer | 1 | Myocarditis | 5 days | Histological examination of the heart showed isolated atrial myocarditis, with neutrophil and histiocyte predominance. Immunohistochemical C4d staining showed scattered single-cell necrosis of myocytes which was not accompanied by inflammatory infiltrates. Extensive contraction band necrosis was seen in the atria and ventricles. There was no evidence of microthrombosis or infection in the heart and other organs |
| SCHNEIDER, 2021 (GERMANY) [33] | 1 | 65 | M | Pfizer | 1 | Myocarditis | 1 day | Severe coronary sclerosis, massive cardiac hypertrophy, myocardial infarction scars, myocarditis, anaphylaxis diagnostics negative |
| VERMA, 2021 (USA) [34] | 1 | 42 | M | Moderna | 2 | Myocarditis | ~14 days | Autopsy revealed biventricular myocarditis. An inflammatory infiltrate admixed with macrophages, T-cells, eosinophils, and B cells was also observed |
| SCHWAB, 2023 (GERMANY) [35] | 1 | 46 | M | Pfizer | 1 | Myocarditis | 0 days | Histological examination showed inflammatory infiltration of the myocardium. The infiltrate was focal and interstitial. It was predominantly detected in sections taken from the right ventricular wall and interventricular septum. The histological and immunohistochemical characterization revealed that the inflammatory infiltrate was predominantly composed of lymphocytes. Micro focal myocyte injury was demonstrable. Lacked pre-existing, clinically relevant heart disease |
| SCHWAB, 2023 (GERMANY) [35] | 2 | 50 | F | Moderna | 1 | Myocarditis | 1 day | Histological examination showed inflammatory infiltration of the myocardium. The infiltrate was focal and interstitial. It was predominantly detected in sections taken from the right ventricular wall and interventricular septum. The histological and immunohistochemical characterization revealed that the inflammatory infiltrate was predominantly composed of lymphocytes. Micro focal myocyte injury was demonstrable. An inflammatory infiltration of the epicardium and the subepicardial fat tissue was concomitantly found. Lacked pre-existing, clinically relevant heart disease |
| SCHWAB, 2023 (GERMANY) [35] | 4 | 62 | F | Pfizer | 1 | Myocarditis | 7 days | Histological examination showed inflammatory infiltration of the myocardium. The infiltrate was focal and interstitial. It was predominantly detected in sections taken from the right ventricular wall and interventricular septum. The histological and immunohistochemical characterization revealed that the inflammatory infiltrate was predominantly composed of lymphocytes. Micro focal myocyte injury was demonstrable. An inflammatory infiltration of the epicardium and the subepicardial fat tissue was concomitantly found. Lacked pre-existing, clinically relevant heart disease |
| SCHWAB, 2023 (GERMANY) [35] | 5 | 55 | M | Pfizer | 2 | Myocarditis | 4 days | Histological examination showed inflammatory infiltration of the myocardium. The infiltrate was focal and interstitial. It was predominantly detected in sections taken from the right ventricular wall and interventricular septum. The histological and immunohistochemical characterization revealed that the inflammatory infiltrate was predominantly composed of lymphocytes. An inflammatory infiltration of the epicardium and the subepicardial fat tissue was concomitantly found. Lacked pre-existing, clinically relevant heart disease |
| SCHWAB, 2023 (GERMANY) [35] | 6 | 75 | F | Pfizer | 1 | Myocarditis | 1 day | Histological examination showed inflammatory infiltration of the myocardium. The infiltrate was focal and interstitial. It was predominantly detected in sections taken from the right ventricular wall and interventricular septum. The histological and immunohistochemical characterization revealed that the inflammatory infiltrate was predominantly composed of lymphocytes. An inflammatory infiltration of the epicardium and the subepicardial fat tissue was concomitantly found. Lacked pre-existing, clinically relevant heart disease. Analysis for potential infectious agents causing a myocarditis revealed low viral copy numbers of human herpes virus 6 |
| HOSHINO, 2022 (JAPAN) [36] | 1 | 27 | M | Moderna | 1 | Myocarditis | 36 days | An autopsy revealed asymmetric left ventricular hypertrophy, thickening of the right ventricular wall (550 g; LV wall, 11-16 mm; RV wall, 5-7 mm), myxomatous degeneration of the posterior leaflet of the mitral valve, and hypertrophy of the posteromedial papillary muscle. Microscopic findings revealed that cardiac myocytolysis and widespread fibrosis were observed, and significant mixed inflammatory infiltration (T cells, macrophages, and eosinophils) was observed in the left ventricular free wall and the anterior potion of the ventricular septum |
| DONG, 2022 (CHINA) [37] | 1 | 34 | F | Zifivax | 1 | Myocarditis | 12 days | Autopsy showed severe interstitial myocarditis, including multiple patchy infiltrations of lymphocytes and monocytes in the myocardium of the left and right ventricular walls associated with myocyte degeneration and necrosis |
| CHO, 2023 (KOREA) [38] | 1 | 22 | M | Pfizer | 1 | SCD from Myocarditis | 6 days | Diffuse inflammatory infiltration, with neutrophil and histiocyte predominance in both atria and near AV node and SA node. Free of inflammatory infiltrates in ventricular myocardium |
| CHO, 2023 (KOREA) [38] | 2 | 30 | F | Pfizer | 1 | SCD from Myocarditis | 3 days | Diffuse inflammatory cell infiltration, myocardial fiber disarray, interstitial fibrosis, and localized necrosis of myocyte |
| CHO, 2023 (KOREA) [38] | 3 | 45 | M | Pfizer | 2 | SCD from Myocarditis | 3 days | Localized infiltration of neutrophils, lymphocytes, histocyte, and a few eosinophils was noted. A small number of cardiomyocyte necrosis were also seen |
| CHO, 2023 (KOREA) [38] | 4 | 25 | M | Pfizer | 2 | SCD from Myocarditis | 3 days | Autopsy revealed myocarditis |
| CHO, 2023 (KOREA) [38] | 5 | 45 | M | Pfizer | 2 | SCD from Myocarditis | 3 days | Interstitial infiltration of various inflammatory cells including lymphocyte, neutrophil, eosinophil, and focal necrosis suggesting the diagnosis of myocarditis |
| CHO, 2023 (KOREA) [38] | 6 | 36 | F | Moderna | 1 | SCD from Myocarditis | 2 days | Neutrophil, eosinophil, and histiocyte infiltration in the myocardium suggesting acute myocarditis |
| CHO, 2023 (KOREA) [38] | 7 | 33 | M | Moderna | 2 | SCD from Myocarditis | 1 day | Multiple focal infiltrations of acute inflammatory cells and chronic inflammatory cells in the myocardium |
| CHO, 2023 (KOREA) [38] | 8 | 33 | M | Moderna | 2 | SCD from Myocarditis | 3 days | Various inflammatory cells such as neutrophils, eosinophils, lymphocytes, macrophages, and cardiomyocyte necrosis in the myocardial interstitium and epicardium suggested myocarditis |
Table 1 : Case information from all included studies on autopsy-confirmed COVID-19 vaccination related myocarditis.
*Dose = Total number of vaccine doses received.
**Period = Days from most recent vaccine administration to death.
~ = Inferred Period (Estimated period using all available information).
