COVID-19 infection and subsequent thromboembolism: A self-controlled case series analysis of a population cohort

AbstractImportanceAn unexpectedly large number of people infected with Covid-19 appear to have experienced ischaemic stroke or thrombotic event.ObjectiveThis study aims to assess the risk associations between Covid-19 infection and thromboembolism.DesignThis is a self-controlled case-series study in Scotland. Their incidence rates during the risk interval (5 days before to 56 days after the positive test) and the control interval (the remaining periods) were compared intra-personally.SettingPopulation-based.ParticipantsIndividuals with confirmed (positive test) Covid-19 and at least one thromboembolic event between March 2018 and October 2020.ExposureCovid-19 test positive.Main Outcomes and MeasuresMyocardial infarction (MI), ischaemic stroke, deep-vein thrombosis (DVT), and pulmonary embolism (PE) hospital admissions and deaths.ResultsAcross Scotland, 1,449 individuals tested positive for Covid-19 and experienced a thromboembolic event. The risk of thromboembolism was significantly elevated over the whole risk period but highest in the 7 days following the positive test (IRR 12.01, 95% CI 9.91-14.56), especially among people ≤75 years (IRR 22.78, 95% CI 17.58-29.53). Risk of MI, stroke, PE and DVT were all significantly higher in the week following a positive test. The risk of PE and DVT was particularly high and remained significantly elevated even 56 days following the test.Conclusions and relevanceConfirmed Covid-19 infection was associated with early elevated risk of MI, ischaemic stroke, and stronger and long elevations in risk with DVT and PE, reinforcing the need to consider monitoring and early diagnosis. Treatment and prevention trials may need to be considered out of hospital on the basis of risk stratification.Key PointsQuestionDoes Covid-19 infection increase the risk of thromboembolism?FindingsAmong 1,449 individuals in Scotland who were tested positive of Covid-19 and had at least one thromboembolic events, the risk of thromboembolism was significantly elevated in the 7 days following the positive test (IRR 12.01, 95% CI 9.91-14.56). The risk of PE and DVT was particularly high and remained significantly elevated even 56 days following the test.MeaningConfirmed Covid-19 infection was associated with early elevated risk of MI, ischaemic stroke, and stronger and long elevations in risk with DVT and PE, reinforcing the need to consider monitoring and early diagnosis.

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Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study

BMJ ◽

10.1136/bmj.n1931 ◽

2021 ◽

pp. n1931 ◽

Cited By ~ 6

Author(s):

Julia Hippisley-Cox ◽

Martina Patone ◽

Xue W Mei ◽

Defne Saatci ◽

Sharon Dixon ◽

...

Keyword(s):

Venous Thromboembolism ◽

Hospital Admission ◽

Ischaemic Stroke ◽

Case Series ◽

Positive Test ◽

Vascular Events ◽

Arterial Thromboembolism ◽

Case Series Study ◽

Increased Risk ◽

Series Study

Abstract Objective To assess the association between covid-19 vaccines and risk of thrombocytopenia and thromboembolic events in England among adults. Design Self-controlled case series study using national data on covid-19 vaccination and hospital admissions. Setting Patient level data were obtained for approximately 30 million people vaccinated in England between 1 December 2020 and 24 April 2021. Electronic health records were linked with death data from the Office for National Statistics, SARS-CoV-2 positive test data, and hospital admission data from the United Kingdom’s health service (NHS). Participants 29 121 633 people were vaccinated with first doses (19 608 008 with Oxford-AstraZeneca (ChAdOx1 nCoV-19) and 9 513 625 with Pfizer-BioNTech (BNT162b2 mRNA)) and 1 758 095 people had a positive SARS-CoV-2 test. People aged ≥16 years who had first doses of the ChAdOx1 nCoV-19 or BNT162b2 mRNA vaccines and any outcome of interest were included in the study. Main outcome measures The primary outcomes were hospital admission or death associated with thrombocytopenia, venous thromboembolism, and arterial thromboembolism within 28 days of three exposures: first dose of the ChAdOx1 nCoV-19 vaccine; first dose of the BNT162b2 mRNA vaccine; and a SARS-CoV-2 positive test. Secondary outcomes were subsets of the primary outcomes: cerebral venous sinus thrombosis (CVST), ischaemic stroke, myocardial infarction, and other rare arterial thrombotic events. Results The study found increased risk of thrombocytopenia after ChAdOx1 nCoV-19 vaccination (incidence rate ratio 1.33, 95% confidence interval 1.19 to 1.47 at 8-14 days) and after a positive SARS-CoV-2 test (5.27, 4.34 to 6.40 at 8-14 days); increased risk of venous thromboembolism after ChAdOx1 nCoV-19 vaccination (1.10, 1.02 to 1.18 at 8-14 days) and after SARS-CoV-2 infection (13.86, 12.76 to 15.05 at 8-14 days); and increased risk of arterial thromboembolism after BNT162b2 mRNA vaccination (1.06, 1.01 to 1.10 at 15-21 days) and after SARS-CoV-2 infection (2.02, 1.82 to 2.24 at 15-21 days). Secondary analyses found increased risk of CVST after ChAdOx1 nCoV-19 vaccination (4.01, 2.08 to 7.71 at 8-14 days), after BNT162b2 mRNA vaccination (3.58, 1.39 to 9.27 at 15-21 days), and after a positive SARS-CoV-2 test; increased risk of ischaemic stroke after BNT162b2 mRNA vaccination (1.12, 1.04 to 1.20 at 15-21 days) and after a positive SARS-CoV-2 test; and increased risk of other rare arterial thrombotic events after ChAdOx1 nCoV-19 vaccination (1.21, 1.02 to 1.43 at 8-14 days) and after a positive SARS-CoV-2 test. Conclusion Increased risks of haematological and vascular events that led to hospital admission or death were observed for short time intervals after first doses of the ChAdOx1 nCoV-19 and BNT162b2 mRNA vaccines. The risks of most of these events were substantially higher and more prolonged after SARS-CoV-2 infection than after vaccination in the same population.

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Effects of the COVID-19 Epidemic on Hospital Admissions for Non-Communicable Diseases in a Large Italian University-Hospital: A Descriptive Case-Series Study

Journal of Clinical Medicine ◽

10.3390/jcm10040880 ◽

2021 ◽

Vol 10 (4) ◽

pp. 880

Author(s):

Caterina Caminiti ◽

Giuseppe Maglietta ◽

Tiziana Meschi ◽

Andrea Ticinesi ◽

Mario Silva ◽

...

Keyword(s):

Hospital Admissions ◽

Case Series ◽

Communicable Diseases ◽

University Hospital ◽

Negative Consequences ◽

Non Communicable Diseases ◽

Case Series Study ◽

And Gender ◽

Long Term Impact ◽

Series Study

Background: Concern is growing about the negative consequences that response measures to the COVID-19 epidemic may have on the management of other medical conditions. Methods: A retrospective descriptive case-series study conducted at a large University-hospital in northern Italy, an area severely hit by the epidemic. Results: Between 23 February and 14 May 2020, 4160 (52%) COVID-19 and 3778 (48%) non-COVID-19 patients were hospitalized. COVID-19 admissions peaked in the second half of March, a period characterized by an extremely high mortality rate (27.4%). The number of admissions in 2020 was similar to 2019, but COVID-19 patients gradually occupied all available beds. Comparison between COVID-19 and non-COVID-19 admissions in 2020 revealed significant differences concerning all age classes and gender. Specifically, COVID-19 patients were older, predominantly male, and exhibited more comorbidities. Overall, admissions for non-communicable diseases (NCDs) in 2020 vs. 2019 dropped by approximately one third. Statistically significant reductions were observed for acute myocardial infarction (−78, −33.9%), cerebrovascular disease (−235, −41.5%), and cancer (−368, −31.9%). While the first two appeared equally distributed between COVID-19 and non-COVID-19 patients, chronic NCDs were statistically significantly more frequent in the former, except cancer, which was less frequent in COVID-19 patients. Conclusions: Prevention of collateral damage to patients with other diseases should be an integral part of epidemic response plans. Prospective cohort studies are needed to understand the long-term impact.

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Tracheo-bronchial foreign bodies: our experience at a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20161848 ◽

2016 ◽

Author(s):

Shashidhar S. Suligavi ◽

Mallikarjun N. Patil ◽

S. S. Doddamani ◽

Chandrashekarayya S. Hiremath ◽

Afshan Fathima

Keyword(s):

Foreign Body ◽

Early Diagnosis ◽

Foreign Bodies ◽

Tertiary Care ◽

Case Series ◽

Team Work ◽

Care Hospital ◽

Retrospective Case ◽

Presenting Symptoms ◽

Case Series Study

Background:Tracheo- bronchial foreign bodies have always posed a challenge to the ENT surgeon as they present with varied symptomatology ranging from a simple cough and fever to more grave respiratory distress. It requires a strong suspicion, early diagnosis and timely intervention to reduce the overall morbidity and mortality .This study was undertaken to highlight our experiences in handling cases of tracheo- bronchial foreign bodies (FB) at our setup.Methods:It is a retrospective case series study conducted in S. Nijalingappa Medical College between January 2011 and January 2015. Results:Most commonly affected were children between 1year to 3years of age. Chronic cough and wheeze were the commonest presenting symptoms. Vegetative foreign body was found to be the commonest variety of foreign body. The mortality rate in our study was 4.7% (n=3).Conclusions:A good clinical acumen, team work, early diagnosis and timely intervention are all needed to reduce the overall mortality and morbidity associated with tracheo- bronchial foreign bodies.

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Effect of Placenta Previa on fetal & maternal morbidity / mortality

Annals of King Edward Medical University ◽

10.21649/akemu.v11i3.997 ◽

2016 ◽

Vol 11 (3) ◽

Author(s):

Bushra Sehr Zaman ◽

Asma Zubair ◽

Sher Zaman Bhatti ◽

Muhammad Zubair Saeed Malik

Keyword(s):

Risk Factors ◽

Early Diagnosis ◽

Maternal Morbidity ◽

Placenta Previa ◽

Case Series ◽

Antenatal Clinic ◽

Case Series Study ◽

Severe Hemorrhage ◽

Year 2000 ◽

Series Study

Objective: To see the effect of placenta previa on fetal and maternal mortality/ morbidity. This was a case series study. Study was conducted in Gynecology unit BV Hospital Bahawalpur during year 2000 to 2003. All the patients presenting with or with out painless bleeding in antenatal clinic & proved to be due placenta previa were included in the study. Patients presenting with pain less bleeding in the antenatal clinic due to other reasons were excluded from the study. In all the patients` history along with the risk factors clinical and sonography finding, any intervention needed and final out come was recorded. SPSS was used for data collection & analysis. Results: Total 50 patients were studied Out of these 84% of patients were symptomatic a t admission the symptoms found were Bleeding, shock & Pain. Strong associations o f risk factors like Age, Parity, ERCP, Smoking and previous C. Section was found in our study. Severe hemorrhage, prematurity, stillbirths and ENND was associated with Placenta Previa. Conclusion: Placenta previa is not an uncommon but underestimated, under reported & preventable condition. Prevention is possible in case of Known risk factors. Early diagnosis is necessary as the delay in some cases may end up in disaster

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OUR SURGICAL EXPERIENCE IN ACUTE MESENTERIC ISCHEMIA- VARIOUS PATHOPHYSIOLGICAL TYPES – A CASE SERIES

10.36106/gjra/2000940 ◽

2021 ◽

pp. 25-29

Author(s):

B. Santhi ◽

A. Ramprasath ◽

R. Saradha

Keyword(s):

Abdominal Pain ◽

Early Diagnosis ◽

Elderly Patients ◽

Mesenteric Ischemia ◽

Hospital Admissions ◽

Case Series ◽

Arterial Occlusion ◽

Acute Mesenteric Ischemia ◽

Delayed Presentation ◽

Surgical Critical Care

BACKGROUND: Mesenteric ischemia is a frequently lethal condition resulting from critically reduced perfusion to the gastrointestinal tract. It accounts for 1-2% of hospital admissions for abdominal pain. Mortality due to mesenteric ischemia ranges from 24% to 96% with an average of 69%. AIM: The aim of this case series is to outline the clinical presentation and challenges in diagnosis of acute mesenteric ischemia and emphasize the importance of early diagnosis and intervention in reducing the mortality and morbidity. This article presents a series of 4 cases of the 3 major types of acute mesenteric ischemia – 2 cases of Acute Mesenteric Arterial Thrombosis(AMAT), one case of Acute Mesenteric Arterial Embolism(AMAE) and one case of Mesenteric Venous Thrombosis(MVT). MATERIALS AND METHODS: A total number of 4 patients who had undergone emergency laparotomy for acute mesenteric ischemia during the month of December 2020 in the Department of General Surgery, Government Kilpauk Medical College were studied. All 4 cases have been analysed during this study period of one month and followed up until discharge from the hospital. RESULTS: This case series consisted of 4 cases. Out of 4 cases, 3 were cases of Superior Mesenteric Arterial Occlusion due to thrombus and emboli and 1 was a case of Superior Mesenteric Vein Occlusion by thrombus. All 4 were male patients. All 4 patients presented with sudden onset of abdominal pain with or without vomiting. Abdominal distension, constipation and clinical features suggestive of bowel gangrene was not seen in all cases. Out of 4 cases, 2 cases were diagnosed early and taken up for immediate surgery and had a better outcome postoperatively with shorter hospital stay. Denitive diagnosis could not be made at time of admission for one case and was taken up for surgery late after the general condition of the patient deteriorated and extensive gangrene of the small bowel was seen during surgery. One case succumbed to septic shock after surgery following delayed presentation. This case series attempts to highlight that the key to successful management in acute mesenteric ischemia is a high index of suspicion leading to early diagnosis, aggressive resuscitation and early mesenteric revascularization. CONCLUSION: Despite the remarkable advances in in vascular surgical technique, vascular imaging, percutaneous intervention and surgical critical care, mesenteric ischemia remains a complex and often disheartening disease. Acute mesenteric ischemia is a life threatening vascular emergency that requires a high degree of clinical suspicion and early intervention to avoid a poor outcome. As Acute Mesenteric Ischemia often affects elderly patients, we have to consider the possibility of acute mesenteric ischemia in all elderly patients presenting with abdominal pain that is out of proportion to the ndings on physical examination

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Cardiovascular risk in patients receiving ranibizumab for exudative age-related macular degeneration: a nationwide self-controlled case-series study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316373 ◽

2020 ◽

pp. bjophthalmol-2020-316373

Author(s):

Ha-Lim Jeon ◽

Seong Jun Byun ◽

Nicole L Pratt ◽

Janet Sultana ◽

Sang Jun Park ◽

...

Keyword(s):

Cardiovascular Risk ◽

Macular Degeneration ◽

Case Series ◽

Haemorrhagic Stroke ◽

Incidence Rates ◽

Age Related Macular Degeneration ◽

Age Related ◽

Case Series Study ◽

Risk Patients ◽

Rate Ratios

AimsTo identify the association between ranibizumab and risk of stroke and acute myocardial infarction (AMI) in patients with exudative age-related macular degeneration (AMD).MethodsWe identified patients aged ≥45 years who received ranibizumab for exudative AMD from the Korean National Health Insurance database. Of these, we selected patients suffering stroke or AMI for the self-controlled case series. We estimated incidence rate ratios (IRR) for stroke or AMI by comparing incidence rates of ranibizumab-exposed periods to that of baseline using conditional Poisson regression. The risks of haemorrhagic and ischaemic strokes were also calculated separately.ResultsAmong 33 134 patients receiving ranibizumab, 2397 patients had stroke or AMI. The risk of stroke (IRR=0.83, 95% CI 0.75 to 0.91) was not increased during the overall exposed period; however, there was a marginally elevated risk in ≥57 days exposed period (IRR=1.14, 95% CI 1.001 to 1.31). When analysing by the types of stroke, no increased risks of haemorrhagic (IRR=1.01, 95% CI 0.80 to 1.26) and ischaemic stroke (IRR=0.78, 95% CI 0.71 to 0.86) were observed during the exposed period, although the risks of ischaemic and haemorrhagic stroke were slightly elevated during ≥57 days exposed period. We could not find an association between ranibizumab and AMI.ConclusionsRanibizumab intravitreal injections did not increase the overall risk of stroke or AMI. Although the cardiovascular risk in patient receiving ranibizumab seems to be low, continuous monthly use of ranibizumab for high-risk patients should be judged carefully.

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Olfactory and Oral Manifestations of COVID-19: Sex-Related Symptoms—A Potential Pathway to Early Diagnosis

Otolaryngology ◽

10.1177/0194599820934380 ◽

2020 ◽

Vol 163 (4) ◽

pp. 722-728 ◽

Cited By ~ 12

Author(s):

Ameen Biadsee ◽

Ameer Biadsee ◽

Firas Kassem ◽

Or Dagan ◽

Shchada Masarwa ◽

...

Keyword(s):

Early Diagnosis ◽

Nasal Congestion ◽

Case Series ◽

Initial Symptom ◽

Clinical Approach ◽

Runny Nose ◽

Number Of Patients ◽

Case Series Study ◽

Initial Symptoms ◽

Common Combination

Objective The coronavirus disease 2019 (COVID-19) pandemic poses a threat to global health. Early diagnosis is an essential key to limit the outbreak of the virus. Study Design Case series, study conducted between March 25, 2020, and April 15, 2020. Setting Ambulatory, nonhospitalized patients who were quarantined in a designated hotel for COVID-19 patients and were recruited by an advertisement at the hotel. Subjects and Methods In total, 140 patients participated in a web-based questionnaire assessing initial symptoms of common viral diseases, olfactory and taste functions, xerostomia, and orofacial pain. Results A total of 58 men and 70 women participated. Initial symptoms were cough (59.4%), weakness (47.7%), myalgia (46.9%), fever (42.2%), headache (40.6%), impaired sense of smell (38.3%), impaired sense of taste (32.8%), sore throat (26.6%), runny nose (26.6%), and nasal congestion (22.7%). All symptoms were more frequent among women; however, only runny nose was statistically significant ( P = .018). The most common combination of symptoms was cough and weakness (37.5%). A total of 25.8% reported olfactory and taste dysfunctions in the absence of other symptoms. In a comparison between the sexes, cough and runny nose were the most common combination in women ( P = .018). A total of 38.3% of patients reported olfactory dysfunction as an initial symptom. Anosmia and facial pain were more common among women ( P < .001 and P = .01, respectively), and 56% of patients reported xerostomia. Conclusion A considerable number of patients presented with olfactory and oral disorders. Interestingly, women presented with a different cluster of symptoms than men, which may suggest a new clinical approach to diagnosing COVID-19 disease.

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Clinico etiological study of adverse cutaneous drug reactions

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20193243 ◽

2019 ◽

Vol 5 (3) ◽

pp. 559

Author(s):

Peram Karunakar ◽

Garimella Venkateswara Rao ◽

Kilaru Krishna Rajesh

Keyword(s):

Hospital Admissions ◽

Case Series ◽

Maculopapular Rash ◽

Drug Reactions ◽

Drug Induced ◽

Case Series Study ◽

Acneiform Eruption ◽

Etiological Study ◽

Cutaneous Drug Reactions ◽

Relationship Of

Background: Adverse cutaneous drug reactions (ACDR) are the most frequent ADRs (30-45%) and are responsible for about 2% of hospital admissions and few can result in significant morbidity, health care costs, hospitalization, and death. To study different clinical patterns of ACDR, assess the cause and identify the offending drug and to study the relationship of ACDRs to age and sex among patients referred to the department of DVL, NRI General Hospital.Methods: This is a retrospective study of 70 cases of colorectal carcinoma analysing incidence, clinicopathological features and outcome after different therapies including surgery, radiotherapy and chemotherapy. It was a descriptive hospital-based case series study. All out-patients and in-patients referred to the department of DVL, NRIGH, Chinakakani and in whom a diagnosis of ACDR is made, form the subjects for this study. The study was conducted over a period of two years.Results: 100 patients with adverse cutaneous drug reactions were included in the study. 42 (42%) were males and 58 (58%) were females. The age group ranged from 6 to 80 years with a maximum (43) belonging to 21 to 40 years. Maculopapular rash was most common followed by urticarial drug reaction, FDE, acneiform eruptions, EMF, erythroderma, DRESS, SJS, SJS/TEN, TEN and drug-induced hyperpigmentation. NSAIDs were the commonest culprits followed by antibiotics, antiepileptics and ATT.Conclusions: The commonest ACDR was maculopapular rash followed by urticaria, FDE and acneiform eruption. Antimicrobials as a group were the most common offending agents followed by individual drugs like diclofenac (13%), isoniazid (11%), efavirenz (9) and prednisolone (8%).

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Clinical profile of patients with intussusception in a tertiary care institution in South India

International Surgery Journal ◽

10.18203/2349-2902.isj20205873 ◽

2020 ◽

Vol 8 (1) ◽

pp. 155

Author(s):

Diljith San ◽

Ranjit P. ◽

Arun M. Ainippully

Keyword(s):

Early Diagnosis ◽

South India ◽

Clinical Presentation ◽

Abdominal Mass ◽

Tertiary Care ◽

Case Series ◽

Clinical Profile ◽

Care Hospital ◽

Abdominal Colic ◽

Case Series Study

Background: Intussusception is a common abdominal emergency in children. It is the most common cause of intestinal obstruction in children less than 2 years. Awareness about the clinical presentation vomiting, abdominal pain, blood in stools, abdominal mass helps in early diagnosis. This study describes the demographics and clinical profile of patients with intussusception in a tertiary care institute in South India.Methods: This was a prospective case series study conducted in the pediatric surgery department in a tertiary care hospital in South India. Children upto 12 years with clinically and radiologically confirmed intussusception were enrolled over 12 months study period. Demographic and clinical data was collected and recorded.Results: Eighty two children with clinical and radiological picture suggestive of intussusception were studied. 57 patients (75%) were below 1 year of age. Male:female ratio was 1.7:1. The classical triad of abdominal colic, palpable abdominal mass and rectal bleeding was seen in 39 patients (50%). Most common signs were rectal bleed and abdominal mass.Conclusions: Awareness about the clinical presentation of intussusception helps in early diagnosis and prompt treatment of this common pediatric emergency and helps to prevent mortality.

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Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection

Nature Medicine ◽

10.1038/s41591-021-01630-0 ◽

2021 ◽

Author(s):

Martina Patone ◽

Xue W. Mei ◽

Lahiru Handunnetthi ◽

Sharon Dixon ◽

Francesco Zaccardi ◽

...

Keyword(s):

General Population ◽

Cardiac Arrhythmias ◽

Messenger Rna ◽

Case Series ◽

Positive Test ◽

Vaccine Trials ◽

Case Series Study ◽

Increased Risk ◽

Subgroup Analyses ◽

Series Study

AbstractAlthough myocarditis and pericarditis were not observed as adverse events in coronavirus disease 2019 (COVID-19) vaccine trials, there have been numerous reports of suspected cases following vaccination in the general population. We undertook a self-controlled case series study of people aged 16 or older vaccinated for COVID-19 in England between 1 December 2020 and 24 August 2021 to investigate hospital admission or death from myocarditis, pericarditis and cardiac arrhythmias in the 1–28 days following adenovirus (ChAdOx1, n = 20,615,911) or messenger RNA-based (BNT162b2, n = 16,993,389; mRNA-1273, n = 1,006,191) vaccines or a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive test (n = 3,028,867). We found increased risks of myocarditis associated with the first dose of ChAdOx1 and BNT162b2 vaccines and the first and second doses of the mRNA-1273 vaccine over the 1–28 days postvaccination period, and after a SARS-CoV-2 positive test. We estimated an extra two (95% confidence interval (CI) 0, 3), one (95% CI 0, 2) and six (95% CI 2, 8) myocarditis events per 1 million people vaccinated with ChAdOx1, BNT162b2 and mRNA-1273, respectively, in the 28 days following a first dose and an extra ten (95% CI 7, 11) myocarditis events per 1 million vaccinated in the 28 days after a second dose of mRNA-1273. This compares with an extra 40 (95% CI 38, 41) myocarditis events per 1 million patients in the 28 days following a SARS-CoV-2 positive test. We also observed increased risks of pericarditis and cardiac arrhythmias following a positive SARS-CoV-2 test. Similar associations were not observed with any of the COVID-19 vaccines, apart from an increased risk of arrhythmia following a second dose of mRNA-1273. Subgroup analyses by age showed the increased risk of myocarditis associated with the two mRNA vaccines was present only in those younger than 40.

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