J Korean Med Sci.  2022 Mar;37(9):e73. 10.3346/jkms.2022.37.e73.

Clinical Features of Patients Presenting to the Emergency Department With Cardiovascular Adverse Reactions After COVID-19 mRNA Vaccination

• Oh TH
• Woo SH
• Hong S
• Lee C
• Lee WJ
• Jeong SK

• KMID: 2526971
• DOI: http://doi.org/10.3346/jkms.2022.37.e73

Abstract

Background
Since the implementation of the nationwide coronavirus disease 2019 (COVID-19) vaccination campaign, emergency departments (EDs) have had an increasing number of patients reporting postvaccination cardiovascular adverse effects. We investigated the clinical features of patients who visited the ED for cardiovascular adverse reactions after COVID-19 mRNA vaccination.
Methods
We conducted a retrospective observational study in two EDs. Patients with cardiovascular adverse reactions after COVID-19 mRNA vaccination who visited EDs between June 1, 2021, and October 15, 2021, were selected. The clinical data of these patients were collected by reviewing medical records.
Results
Among 683 patients, 426 (62.4%) were female. The number of patients in their 20s was the highest (38.9% of males, 28.2% of females) (P < 0.001). More patients visited the ED for adverse reactions following the first vaccine dose than following the second dose (67.6% vs. 32.2%). Chief complaints were chest pain/discomfort (74.4%), dyspnea (14.3%) and palpitation (11.3%). The final diagnosis was a nonspecific cause (63.1%), and 663 (97.1%) patients were discharged from the ED. The admission rate was higher in males than in females (3.9% vs. 1.9%). Myocarditis was diagnosed in four males, who showed mild clinical progression and were discharged within 5 hospital days.
Conclusion
Most patients who visited the ED with cardiovascular adverse reactions were discharged from the ED, but some were admitted for other medical diseases as well as adverse vaccine reactions. Therefore, further surveillance and a differential diagnosis of cardiovascular adverse events after COVID-19 mRNA vaccination should be considered by emergency physicians.

Keyword

COVID-19 mRNA Vaccination; Adverse Reaction; Cardiovascular Symptoms; Emergency Department

Figure

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  Fig. 1 Study population. Viral vector vaccines; AZD1222 [AstraZeneca] and Ad26.COV2.S [Janssen]. mRNA vaccines; BNT162b2 [Pfizer-BioNTech] and mRNA-1273 [Moderna].

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  Fig. 2 Distribution by age group. Except for the 17-19 age group, there were more females in all age groups (426 [62.4%] vs. 257 [27.6%]). The number of patients in their 20s was the highest for both males and females (38.9% vs. 28.2%), and the number of patients decreased with age (P < 0.001).

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  Fig. 3 Distribution of patients after the first and second vaccine dose. A total of 70.8% of males and 65.7% of females visited the ED following the first vaccine dose. (A) In males, the number of visits was larger after the first dose than after the second dose in all age groups, except for the 17–19 age group. Males in their 20s visited the ED four time more frequently after the first than after the second (P < 0.001). (B) Females also visited the ED more often after the first dose, except for those in the 17–19 and 60–65 age groups (P = 0.110).ED = emergency department.

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  Fig. 4 Onset days since vaccination by sex. Most patients reported cardiovascular symptoms during the first few days after vaccination. (A) After the first vaccine dose, 68.1% of males and 61.8% of females reported symptoms within 3 days. The latest onset days were 23 and 33 days in males and females, respectively. (B) After the second dose, 77.3% of males and 74.0% of females reported adverse reactions within 3 days. The latest onset days were 30 and 38 days in males and females, respectively.

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