June 9, 2021- 4:29 p.m.
The rest of his family had been immunized with no problem, so on the first day he was eligible in early May, the then-15-year-old from Beaverton was ready for his COVID-19 vaccine.
The teen, who asked that his name not be used to protect his privacy, had his second shot of the Pfizer-BioNTech vaccine last Thursday, and was looking forward to getting back to a semblance of normal, even if it was just hanging with his friends in public with no mask.
The next day, however, he started feeling some of the more common side effects of the vaccine: a fever, lack of appetite. He even mentioned to his mom that his heart hurt.
“I didn’t really catch that,” she said, though she says she’s been reading COVID news obsessively for months and was aware of some of the early reports on heart problems in children following vaccinations. “I thought he was joking.”
He wasn’t. It felt like something was squeezing his heart. He even searched the internet that night and found some of the limited information circulating on the side effect that’s being anecdotally linked to COVID vaccinations. When he woke up the following morning and the pain was still there, he went into his parents’ room and told them again.
A half hour later, they were walking into a deserted emergency room at Providence St. Vincent Medical Center. The docs took some blood, did an electrocardiogram, and 45 minutes later he was being admitted to the hospital, put on anti-inflammatories and oxygen, his mom said.
The diagnosis, according to Providence: myocarditis, literally a swelling of the heart.
It’s a condition that’s on the radar of physicians and infectious disease experts around the world, both when it comes to actual cases of the coronavirus, and increasingly, cases that are cropping up among otherwise healthy adolescents. The condition typically involves boys or young men and generally follows their second shot of the Pfizer-BioNTech COVID vaccine, which is the only one that has an emergency use authorization for 12- to 17-year-olds in the United States.
Some 6.4 million adolescents aged 12 to 17 in the United States have received at least one dose of COVID-19 vaccine, according to data from the Centers for Disease Control and Prevention. And since April, there have been increased reports from Israel, Canada and the United States of inflammation of the heart happening after immunization mostly in that age group.
The CDC is actively tracking those cases, but is still recommending vaccination for everyone 12 years or older.
The Oregon Health Authority is aware of at least 11 cases in Oregon of myocarditis or pericarditis, inflammation of the sac surrounding the heart, following COVID-19 vaccinations. That total includes adults and adolescents.
“The hallmark symptom of myocarditis and pericarditis is chest pain or shortness of breath,” Jonathan Modie, an agency spokesperson, said in an email. “In rare cases, it can also present in the form of heart palpitations. Anyone suffering from unexplained chest pain should contact a medical provider or seek immediate emergency care.”
Public health officials and specialists say it’s not clear yet whether there’s a causal link between the vaccine and the heart condition. Chest pain is atypical in pediatric patients, but myocarditis can be a side effect from other vaccinations, particularly smallpox, as well as viral infections, drug use or toxins in the system.
The case rate of myocarditis potentially connected to COVID vaccinations is still below the background rate in that age group from other causes, said Dr. Genevieve Buser, a pediatric infectious disease specialist at Providence St. Vincent. Moreover, the reported cases have generally been mild, and resolved quickly with chest pain going away and heart function returning to normal with the aid of Ibuprofen and other anti-inflammatories, she said. Hospital stays have been short and there don’t seem to be any other lingering effects.
But the cases are slowly trickling in. So the CDC and state health authority are tracking it, asking physicians and hospitals to report cases where there may be a link.
Meanwhile, health experts are concerned that even rare reports of myocarditis, like previously reported adverse effects associated with COVID vaccines, will increase vaccine hesitancy. And the overwhelming consensus is that the benefits of COVID-19 vaccinations still far outweigh the low risk of developing the heart condition.
Some have questioned whether adolescents could benefit from only one dose or delaying the second dose of the vaccine. But Buser was adamant that it’s important to receive both doses, as each has its own role. The second dose is particularly important for long-term immunity, she said.
Gluckman agreed. The benefits of vaccination outweigh the risks, and spreading out the doses “is more speculative,” he said. “It’s biologically plausible, but I haven’t seen anything formal issued that would advocate for that approach. We don’t have enough information to adequately answer that.”
The Beaverton teen was discharged from St. Vincent Tuesday after an MRI. His chest pains went away after a day in the hospital. His heart rate is much more consistent. He’ll be taking it easy for a couple weeks and checking in with his cardiologist.
