Evidence map›Paper›PMID 34978002›Full record

ArticleJournal of clinical immunology2022

First Identified Case of Fatal Fulminant Necrotizing Eosinophilic Myocarditis Following the Initial Dose of the Pfizer-BioNTech mRNA COVID-19 Vaccine (BNT162b2, Comirnaty): an Extremely Rare Idiosyncratic Hypersensitivity Reaction.

Rohan Ameratunga, See-Tarn Woon, Mary N Sheppard, Jack Garland, Benjamin Ondruschka, Christopher X Wong, Ralph A H Stewart, Michael Tatley, Simon R Stables, Rexson D Tse

Open access · bronzeAbstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical immunology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
35citing papers in PubMed, 3 pooled it
9.0field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

35 citing papers in PubMed, 3 syntheses or guidelines pooled it, 54 citations in OpenAlex.

  1. Pooled it
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  4. Review
  5. Eosinophilic Myocarditis: A Concise Review.Current cardiology reports · 2025
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  20. Myocarditis Following COVID-19 Vaccination.Heart failure clinics · 2023
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 5 countries.

Rohan AmeratungaDepartment of Virology and Immunology, Auckland City Hospital, Park Rd, 1010, Grafton, Auckland, New Zealand.
See-Tarn WoonDepartment of Virology and Immunology, Auckland City Hospital, Park Rd, 1010, Grafton, Auckland, New Zealand.
Mary N SheppardCardiovascular Pathology Unit and Cardiology Clinical and Academic Group, St George's University of London, London, UK.
Jack GarlandForensic and Analytical Science Service, NSW Health Pathology, Sydney, NSW, Australia.
Benjamin OndruschkaInstitute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Christopher X WongCentre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Ralph A H StewartDepartment of Cardiology, Auckland City Hospital, Park Rd, 1010, Grafton, Auckland, New Zealand.
Michael TatleyDivision of Health Sciences, New Zealand Pharmacovigilance Centre, University of Otago, Dunedin, New Zealand.
Simon R StablesDepartment of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Rexson D TseDepartment of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. rexsont@adhb.govt.nz.ORCID 0000-0002-1388-9537
University of Auckland · NZNew South Wales Department of Health · AURoyal Adelaide Hospital · AUSt George's, University of London · GBUniversität Hamburg · DEUniversity of Otago · NZ

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

rationaleTransient myopericarditis has been recognised as an uncommon and usually mild adverse event predominantly linked to mRNA-based COVID-19 vaccines. These have mostly occurred in young males after the second dose of mRNA COVID-19 vaccines.

objectivesFulminant necrotising eosinophilic myocarditis triggered by a variety of drugs or vaccines is an extremely rare hypersensitivity reaction carrying a substantial mortality risk. Early recognition of this medical emergency may facilitate urgent hospital admission for investigation and treatment. Timely intervention can lead to complete cardiac recovery, but the non-specific clinical features and rarity make early diagnosis challenging.

findingsThe clinical and pathological observations from a case of fatal fulminant necrotising myocarditis in a 57-year-old woman, following the first dose of the Pfizer-BioNTech vaccine, are described. Other causes have been discounted with reasonable certainty.

conclusionThese extremely rare vaccine-related adverse events are much less common than the risk of myocarditis and other lethal complications from COVID-19 infection. The benefits of vaccination far exceed the risks of COVID-19 infection.

Indexed as

COVID-19HypersensitivityLeukocyte DisordersMyocarditisVaccinesBNT162 VaccineCOVID-19 VaccinesFemaleHumansMaleMiddle AgedRNA, MessengerBNT162 VaccineCOVID-19 VaccinesRNA, MessengerVaccinesadverse eventsautopsyCOVID-19deatheosinophilhypersensitivitymyocarditisvaccine

Identifiers

PMID34978002
PMCPMC8720536
OpenAlexW4206842700

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.