The first report of myocarditis followed by AstraZeneca vaccination in Iran

Karo Servatyari, Amir Hassani

DOI: 10.22122/cdj.v10i2.675


BACKGROUND: Coronavirus disease 2019 (COVID-19) is an emerging disease caused by the coronavirus. The initiation of vaccination significantly reduced the incidence and mortality of these patients. Some studies reported myocarditis as a rare complication after messenger ribonucleic acid (mRNA)-based vaccines (such as Pfizer).

CASE REPORT: The patient was a 26-year-old man without any history of the underlying disease with typical chest pain which spread to the back and left arm; he was diagnosed with myocarditis after the second dose of the AstraZeneca vaccine. The mechanism of myocarditis after AstraZeneca is not known precisely. It seems to be due to the AstraZeneca vaccine using adenovirus as a vector of the spike (S) protein of the virus, and it causes the production of antibodies in the body, while adenovirus can be one of the causes of myocarditis. On the other hand, it may be due to spike protein-mediated toxicity, which causes an inflammatory reaction such as myocarditis after the virus protein enters the bloodstream and eventually accumulates in various tissues, including the heart.

CONCLUSION: Myocarditis is a rare complication of the AstraZeneca vaccine, and this study could not recommend neglecting this vaccine.


AstraZeneca; Vaccination; Myocarditis; COVID-19; Iran

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Hui DS, Azhar I, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020; 91: 264-6.

Alimohamadi Y, Sepandi M, Taghdir M, Hosamirudsari H. Determine the most common clinical symptoms in COVID-19 patients: a systematic review and meta-analysis. J Prev Med Hyg. 2020; 61(3): E304-E312.

Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical Characteristics of Covid-19 in New York City. N Engl J Med. 2020; 382(24): 2372-4.

Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008; 86(2): 140-6.

Goldberg TL. Possible side effects after getting a COVID-19 vaccine. J Evol Med. 2021; 9(6): 1-2.

Su JR, McNeil MM, Welsh KJ, Marquez PL, Ng C, Yan M, et al. Myopericarditis after vaccination, Vaccine Adverse Event Reporting System (VAERS), 1990-2018. Vaccine. 2021; 39(5): 839-45.

Dagan N, Barda N, Kepten E, Miron O, Perchik S, Katz MA, et al. BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting. N Engl J Med. 2021; 384(15): 1412-23.

Fung G, Luo H, Qiu Y, Yang D, McManus B. Myocarditis. Circ Res. 2016; 118(3): 496-514.

Vogel G, Couzin-Frankel J. Science. Israel reports link between rare cases of heart inflammation and COVID-19 vaccination in young men. Science [Online]. [cited 2021 Jun 1]; Available from: URL: Gretchen Vogel G, Jennifer Couzin-Frankel J. 2022.

Bowles NE, Ni J, Kearney DL, Pauschinger M, Schultheiss HP, McCarthy R, et al. Detection of viruses in myocardial tissues by polymerase chain reaction. evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol. 2003; 42(3): 466-72.

Blailock ZR, Rabin ER, Melnick JL. Adenovirus myocarditis in mice. An electron microscopic study. Exp Mol Pathol. 1968; 9(1): 84-96.

Andreoletti L, Leveque N, Boulagnon C, Brasselet C, Fornes P. Viral causes of human myocarditis. Arch Cardiovasc Dis. 2009; 102(6-7): 559-68.

Schneider J, Pease D, Navaratnarajah C, Chanakha H, Peter C, Daniel Y, et al. SARS-CoV-2 direct cardiac damage through spike-mediated cardiomyocyte fusion. Research Square 2020 [Online]. [cited 2020]; Available from: URL:

Bozkurt B, Kamat I, Hotez PJ. Myocarditis with COVID-19 mRNA Vaccines. Circulation. 2021; 144(6): 471-84.


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