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Volume 28, Number 5—May 2022

Severe Multisystem Inflammatory Symptoms in 2 Adults after Short Interval between COVID-19 and Subsequent Vaccination

Elizabeth R. Jenny-AvitalComments to Author  and Ruth A. Howe1
Author affiliations: Jacobi Medical Center, Bronx, New York, USA (E.R. Jenny-Avital); Albert Einstein College of Medicine, Bronx (R.A. Howe)

Main Article


Characteristics of 5 previously published MIS cases occurring after COVID-19 vaccine was administered within 1 month of infection, United States*

Case no. and search term VAERS ID Patient age, y/sex COVID-19 date Vaccine date, type† Description in VAERS Treatment and outcome
1. MIS 1396536 53/F 2021 May 7 2021 May 29, Pfizer-BioNTech 2021 May 31: febrile (101.3°F), initial GI symptoms, dyspnea; admitted June 1; hypotensive (63/48 mm Hg) requiring vasopressors; leukocytes 31.3 × 103 cells/µL, creatinine 4.6 mg/dL, bilirubin 5.5 mg/dL, EF 35% Immunoglobulin infusion for prolonged hypotension despite antibiotics; weaned from vasopressors, reduced EF, and renal failure resolved
2. MIS 1282200 40/M 2020 Dec 26 2021 Jan 25, Pfizer-BioNTech 2021 Jan 29: fever, headache, neck pain, weakness, fatigue, diarrhea, abdominal pain; admitted after 2 emergency department visits with elevated cardiac inflammatory markers (BNP and troponin) Steroids, with complete resolution
3. MIS 1154625 48/F 2021 Dec 31 2021 Jan 22, Moderna 2021 Feb 1: MIS with GI symptoms, rash, conjunctival injection, encephalopathy, elevated BNP Immunoglobulin infusion, steroids, aspirin, with good response
4. Acute heart failure and fever 1027010 45/M 2020 Dec 30 2021 Jan 22, Pfizer-BioNTech 2021 Jan 30: fever, hypotension, morbilliform rash, cariogenic shock, EF 35%, CRP >320, BNP 3,583, SARS-CoV-2 antibody-positive Intra-aortic balloon pump, antibiotics; resolution, with EF 67%
5. Myocarditis and fever 1088210, 1122743 46/F 2021 early Jan 2021 Feb 5‡ 2021 Feb 23: 5 d fever, sore throat, swelling in hands/feet, EF 35%, hypotension requiring vasopressor, CRP >300 mg/L, ferritin 3,054 mcg/L, severe thrombocytopenia Antibiotics, steroids, mechanical ventilation, ECMO, intra-aortic balloon pump support

*BNP, brain natriuretic peptide; COVID-19, coronavirus disease; CRP, C-reactive protein; ECMO, extracorporeal membrane oxygenation; EF, ejection fraction; FU, follow-up; GI, gastrointestinal; ID, identification; MIS, multisystem inflammatory syndrome; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; VAERS, Vaccine Adverse Event Reporting System. †Pfizer-BioNTech,; Moderna, ‡Vaccine type not available in VAERS report.

Main Article

1Current affiliation: University of Washington, Seattle, Washington, USA.

Page created: March 01, 2022
Page updated: April 19, 2022
Page reviewed: April 19, 2022
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.