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Myocarditis After Immunization with mRNA Covid-19 Vaccines in US Military (jamanetwork.com)
65 points by walterbell on July 3, 2021 | hide | past | favorite | 77 comments


According to the article: Chances to get Myocarditis with mRNA: 20:1.000.000 of which 2/3 cleared in a week. This is the military so mostly younger male who seem to be most at risk for this side effect. To provide perspective: Chances to get heart injury from Covid infection 1:100 and 6:10 in severe hospitalized cases.


I had mild Covid in the second half of December and I still have occassional heart arrhythmias and random muscle twitching out of it - six months later.

Both of these have improved over time, but I am now on a heart medication (weakish, Concor) that I wasn't before, to address the arrhythmias. I wonder what the long term damage might be and whether Covid actually took a few years off my life expectancy.

I would certainly have preferred getting my shots before contracting Covid.


Somebody close to me is also experiencing random muscle twitching and had an episode of Afib.

They had a long-lasting CMV infection a year prior.

Is there evidence that viruses can cause arrhythmias and muscle twitching?


It even looks like one of the most common causes. Look for "viral cardiomyopathy" or similar online.

IIRC, inflammatory response from the immune system causes it, so it can happen with vaccines as well. I am not a physician so I won't write conjectures or anything.

As a 26 yo, I got vaccinated anyway, here are my reasons if that can help others decide: I think the risks are still low, and I preffer a controlled, well-known (as millions take the same) injection to getting infected with some random pathogen. Moreover, it's not only my personal risk factor that I need to weight against, but the one of every other person I interact with. It's also a bit of duty towards society, and not wanting to actively participate in the epidemic as a viral carrier.


Thank you.


Muscle twitching (fasciculations) are super common. Stress makes mine worse. So do things like caffeine and lack of sleep. Perhaps they're not a direct effect of covid, but more of the stress that comes with the whole situation?


Covid has a ton of neuromuscular manifestations.

https://www.openaccessjournals.com/articles/neurological-and...

Interestingly, the cardiologist who took care of me had covid too, and he had muscle twitching lingering afterwards just like me.


All CMV infections are long lasting. As a herpesvirus, infection is lifelong.


>I still have occassional heart arrhythmias and random muscle twitching out of it

What kind of proximate cause would lead to this effect?


Does anybody know? This is a new disease and most of our scientific efforts were concentrated on helping seriously people not die in the last year. These smaller effects can wait for further research.

Or are you doubting the causality? I had a slightly elevated blood pressure, so I had EKGs every 6 months since approx. 2001. Never did I have any extra systoles. Zero.

But on the second day of my Covid infection, I started feeling strong palpitations that I never experienced before, and a subsequent EKG holter showed a shit-ton of arrhythmia episodes, fortunately not of the really serious kind. I had the luck to be examined at the best Czech cardio center (IKEM) and they told me that they have a load of post-Covid patients with similar manifestations, and that they put them on Concor first as a protocol. Helped me as well.

As for muscle twitching, the timing was the same and it is not a symptom you can miss. Pretty strong at some times, too. It is getting better, fortunately. Exercise helps a lot, though training hard can make it worse again for a day or so.


The two symptoms do seem similar, from this layman's perspective. Perhaps they are both the result of one process.


Assuming your statistics are accurate, it's not an apples-to-apples comparison. You're comparing a risk factor of Covid in the general population to a study done on 20-somethings who are strong and healthy enough to pass basic training.

It's a fact that hospitilization and comorbidities go up almost exponentially with age

https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investi...


military so mostly younger male who seem to be most at risk for this side effect

I think they meant that being a military man usually means a daily heavy load on the heart while strong and healthy. A hundred push-ups after a cross-country run may or may not be worse for ones heart than getting up from a chair too quickly at the age of 70. Also, one of power training rules is to skip days with inflammation. These 0.002% of guys could simply ignore this rule for some reason and face pretty known consequences. So it’s apples-to-oranges, but with a huge offset.


What's lost here is that Myocarditis is a relatively common inflammatory response to both viruses like covid and vaccines like those for covid, smallpox, measles, and other diseases. It's still extremely rare. And it almost always resolves itself. If it doesn't, there are treatments. We've vaccinated 200 million + people in this country for covid, and thus far no one has died from heart inflammation as a result, as far as we know. It would be hard to cover up if young men were turning up in the hospital with heart symptoms at an alarming rate.


how would you know since OSHA has stopped registering any side effects following the vaccinations?

> Are adverse reactions to the COVID-19 vaccine recordable on the OSHA recordkeeping log?

> DOL and OSHA, as well as other federal agencies, are working diligently to encourage COVID-19 vaccinations. OSHA does not wish to have any appearance of discouraging workers from receiving COVID-19 vaccination, and also does not wish to disincentivize employers' vaccination efforts. As a result, OSHA will not enforce 29 CFR 1904's recording requirements to require any employers to record worker side effects from COVID-19 vaccination through May 2022. We will reevaluate the agency's position at that time to determine the best course of action moving forward.


Yes, how will we ever know since the workplace safety regulator doesn't do it? Could there be another government agency recording side effect reports?


To make the other comments point more explicitly, OSHA is not the one that determines if a drug has a side effect, the FDA is. So, this means nothing about whether the vaccines are having side effects recorded at a wider scale, OSHA is just not going to track them. OSHA's efforts were probably redundant in the first place. He do see that the FDA is still adding side effects when that data comes in, like for example with myocarditis. [0]

[0] https://www.healthline.com/health-news/fda-to-add-warning-on...


I'm not a fan of how the US has chosen to willfully minimize breakthrough cases, by categorizing them in very narrow terms. But the lack of side effects essentially speaks for itself, through the dramatic decrease in hospitalization rates in western europe, the US, and Israel. There is no way that some frequent side-effect would slip through all these countries' monitoring systems, or go unreported by the reputable press in those countries. This is the very reason the J&J vax was temporarily halted, and the AZ vax was stopped in most of Europe.

Widespread evidence of deadly side effects could not be suppressed.


Doesn't have to be deadly to change the calculation of a patient you're looking to get informed consent from.

But, medical people have long struggled to balance what they consider an informed patient, so, they paternalize.


I'd like to see a real count of: 1. how many people a year poison themselves with fake cures they find on YouTube, 2. how many fail to take prescribed medicine because they read something on Reddit, 3. how many die in the hands of medical professionals who misdiagnose or incorrectly prescribe.

"Paternalism" is only an attitude because doctors have to deal with tons of gullible people who are fed small amounts of truth they're not capable of comprehending, and large amounts of misinformation by people interested in selling them bleach, copper bracelets, and other "holistic cures". Put yourself in a doctor's shoes for a second. Paternalism is the only adequate response to a public stuffed to the gills with conspiracy thinking.


How would we know? Because OSHA is at _best_ a minor player in looking for vaccine side effects. I personally had no idea they were even doing that. That's the FDA/CDC/HHS's job. VAERS isn't going anywhere.


Chances to get diagnosed with Myocarditis with mRNA 20:1.000.000. The actual incidence is probably a bit higher; I suspect double-digit percentages of the youthful population don't know where their heart is and probably wouldn't report chest pain to a doctor.

Note that 95% of the cases being picked up here are in the military, presumably because they have better physical screening or something. The vaccine doesn't know they are in the military.


What are the chances of thinking you have myocarditis after reading alarming stuff on facebook?

I had chest pains a couple weeks after my second shot, had an EKG and asked about this. No myocarditis. I had torn a rib. Can you imagine how many people have phantom pains that don't get an EKG, but post to "confirm" they had symptoms? It's bad enough trying to get all these people to just get a goddamn vaccine without scaring them with shit that has basically no chance of happening, has no major long-term consequences if it does happen, and that practically everyone who eats a subway sandwich will have symptoms of.


I stopped looking up my "medical" symptoms online. Every time I Google something I go to curious to cancer.

The internet is not good for hypochondriacs.


Same, same here. It's going to take the vax-deniers about a decade to get to where they can shrug it off, though. If ever.


You're not doing it right. Despite this meme, online info makes self-diagnosis much easier.

The hard part is matching symptoms with your health history and eliminating the improbable/impossible causes/diseases. Which is really hard, even for trained doctors.


eh, I didn't mention I got nose bleeds from 12-48 hours after the second shot. Never had them before in my life.

I did look it up. I didn't like what I saw. But I decided to just ignore that information, take my goddamn vax status and go to a fucking bar.

[edit] I'm still here.


Ha, I have a similar story with strage red spots appearing on my back the day after vacciantion. Turns out it was from sitting on a bench.


That is what makes this study so relevant: US military personal has comparatively good access to doctors so chances for discovery are relatively good. The general population is both older and less male so this study gives a fairly good estimate for a relatively rare side effect which would not have been found nor quantified in a phase-3 trial with 40.000 participants.


Exactly, I would expect the severity of the side effects to be on a slope, with only the most severe cases being actually detected.

Athletes will notice a 10% reduction in heart functionality, the average person won’t.

Big question is, how large is the effect really, and are there 2nd order effects?


> Chances to get heart injury from Covid infection 1:100

Not true. At this point over a billion people on Earth had Covid. (And that's a low estimate.)

There aren't 10 million people with new heart injuries in 2020.


Where do you get this from ? Confirmed cases are in the 200m range, so you assume that the actual number is 5+ times more somehow?


confirmed cases is already a filter of those who were tested in the first place. I case you dont know, in many places it is still very hard to get a test until you have severe symptoms.


Many people are asymptomatic. A 5x number is likely low.

The only way to really know, would have been have worldwide, forced testing of every single person, weekly.

EG billions of test per week.

There were no tests at the start, not enough worldwide testing ability for the first 6 months, and once capacity existed, generally only people who felt sick were tested.

And that's in rich nations.


That's completely false. And don't "rich nations" this, as if your political view makes a point. We know that the asymptomatic rate for covid-19 is about 20% for adults, 40-50% for children, because we actually did massive testing of exposed people. Millions of tests were performed in the US, enough to get the positivity rate in most states down to 3-4%. There were not masses of 5x the positivity rate escaping these tests. And if you think everyone had it before the testing started, you're wrong, because the hospital records would have shown it.


You can't comprehend that richer nations would have better testing and would therefore have a better idea of how many cases they have...

And you think hospitals would have records of patients testing positive for a disease we had no knowledge of let alone means of testing before either of those came into place...


I quite well comprehend that richer nations have better testing. Those are the test results we have to go on (not Cameroon or North Korea - those would be blank guesses). The numbers are static across all nations that did serious population testing, so we actually do know the asymptomatic rates, and they are not 5x the diagnosed rates. They may well be 5x the positivity rate in poor countries that don't do much testing, but that still doesn't change the asymptomatic rate for people who have the virus.

Second point: Hospitals were recording symptoms of covid even prior to widely available testing, and as soon as the virus spiked their ICU beds were full. This has been the case in every country in the world. They didn't need to test patients. Those patients were dying in the hallway, and on ventilators. The spike was clear and obvious in each country when it arrived.

And in each country, the percentage of people testing positive who had no symptoms was roughly the same. So the argument that there have been 5x as many people as reported who had covid - and had no symptoms - is totally false.


Actual infections 5x the number of cases detected through testing in rich, developed countries with relatively widespread tests seems pretty plausible, I think there's some evidence the UK was close to that despite testing pretty heavily compared to the rest of the world e.g. https://www.news-medical.net/news/20210215/Only-2525-of-SARS... (I seem to recall the BBC reported on this at the time, but finding their old Covid-19 coverage again is basically impossible.)

Remember, fully asymptomatic infections aren't the only problem, there are also infections that technically have symptoms but they're too vague, commonplace and non-specific to lead to people getting tested.


Sounds plausible but are there any sources on these mass testing efforts and their methods?



A half of people I know, who self-reported covid-like symptoms from mild to very severe (n=20) had their tests negative. This is Moscow, Russia. They are not counted in official statistics.


We dont know at all actually because the virus has variants with different R profiles and symptoms too.


Norway lacked test capacity like everyone else early during the pandemic. We did antibody tests later to see what we had missed.

Turns out in spite of all asymptomatic cases etc the guesstimates were fairly good.

Now Norway is an extremely rich country and healthcare is (generally) excellent here, but if asymptomatic cases were really widespread we should have seen some non trivial percentage showing up in the antibody tests that we weren't aware of earlier.


Norway has low population density so you cannot really extrapolate to countries where people live in much denser areas with more chance of exposure.


Doesn't work like that. The main way respitory diseases spread is via socializing (ie talking face-to-face indoors).

No matter the population density, rural or urban, people socialize at roughly the same rate nowadays.


Of course it matters. If you have millions of people taking public transport every day vs people driving in individual cars, makes a huge difference in exposure.


>There aren't 10 million people with new heart injuries in 2020.

Are you sure about that, and how do you figure? Covid-19 related deaths alone are 4M and that's only tracked deaths. We don't yet know the fallout and long term effects from non-fatal Covid-19. Research on temporary and permanent damage including "Long Covid" has only begun.

But with the data available right now, I have no problem imagining 10M Covid-19 related heart injuries globally.

E.g. there are studies, right now small scale (N=100), that suggest 4/5th of patients had "cardiac involvement" and 3/5th had "ongoing myocardial inflammation" after recovery from Covid-19 [1] (this doesn't yet mean permanent heart damage, nor is the small sample conclusive, but I think it's an indicator that we should pay careful attention to this area).

[1] https://jamanetwork.com/journals/jamacardiology/fullarticle/...


Myocarditis is usually transient particularly post infection. These figures are roughly accurate especially considering that the symptoms are quite often mild as they also were via vaccination. There’s no real surprise here: aetiology of the myocarditis during covid is basically identical to that via vaccine, so the good news is that it’s at a lower rate, it just stands out more because the general symptoms of vaccination are so much lower


The second number should take into account the population and probablility of getting COVID, so it should be:

(probablilty of contracting COVID) * (probablity of heart injury in the military from COVID if someone contracts COVID)


I think this is missing the point slightly.

The vaccine/viral infection -> exercise -> myocarditis link is a well known (to the medical community) link in other vaccines/viruses, including flu.

Therefore the "burden of proof" should not be to show that there is a link here too, but to show that there isn't despite it being a common thing in so many other viruses.

Therefore, the fact that people are not given advice not to exercise heavily following vaccination, especially in professions where daily heavy exercise is the norm like in the military, is causing unnecessary morbidity.

To come and say "yeah but it's still small" is not "putting things in perspective", since this is morbidity that is likely entirely preventable and unnecessary.


One thing I find interesting is if the stated probability is correct, e.g 1:50,000, then the probability of having a heart condition as the result of an mRNA vaccine is statistically much greater than winning any of the Vaccine Lotteries.

I wonder if anyone has considered the ethical implications of the gamification of vaccination in light of this, and if governments should be held responsible if someone took the vaccine to win a lottery but instead wound up injured.


Not a fair comparison: there are way more people that are going to be vaccinated than to be contaminated. Also, I assume those stats are for people with symptoms ?


Risk is much lower than what you state for COVID since we dont test everyone who is carrying it and has no symptoms whatsoever.


The article doesn't explicitly make these claims, they are your own interpretations.


Thank you for this


interesting tidbit which to me, a layman, sounds like the myocarditis is the immune system's doing :

"For all but 3 patients, the second dose of vaccine preceded their myocarditis presentations. Among the 3 patients presenting after an initial vaccine dose, all had confirmed COVID-19 infection more than 2 months prior to vaccination."

That naturally leads to a speculation - the long lasting post-covid myocarditis as a side-effect/manifestation of the acquired immunity (instead of say the direct viral damage during the actual illness period). Similar to when chronic fatigue syndrome was associated with something like post-flu increase of B-cells hanging around for months and was successfully treated with immunosuppressants ( https://www.discovermagazine.com/health/are-b-cells-to-blame... )

It is kind of fascinating to me from a generic systems POV that a lot of damage is kind of "self-inflicted", like the most deaths in the Spanish flu, especially in the 2nd wave, resulted from the immune system [over]reaction (and thus killed a lot of otherwise healthy adult individuals, not just the "weak"/children/elderly who would typically be the direct virus victims), not the virus itself. To me it parallels for example another large complex system - society - which similarly self-inflicts a lot of damage in order to fight societal ills.


My Garmin (Vivosmart 4) band tracks "stress" and "body battery" metrics, which are based on your Heart Rate Variability. For the first couple of days after my first mRNA shot there were no anomalies at all, but then out of nowhere my stress levels went through the roof (and my body battery completely flatlined) in a way that I've never seen before. This lasted for 6 full days, now everything seems to have returned to baseline..

I didn't feel anything about the whole ordeal though, apart from some sore muscles in the first days. Crazy interesting to quantify the amount of stuff going on in the background without you being aware of it.

EDIT: Specifically, during these 5 nights my stress level was reportedly _unmeasurable_ for about 50% of the time. Unmeasurable is common when you are physically active (making the PPG data too noisy to properly calculate normalized RR intervals) but very rare during sleep, so this probably indicated a very high amount of irregular/ectopic heartbeats.


My wife has Garmin watch as well and had her Moderna shot yesterday. Even though obvious symptoms are very mild (muscle soreness), her "body battery" went all the way down to 0 during the night. It is the worst "body battery" result in her history. She is staying in bed today.

Interestingly, we both actually had mild Covid in December and her Garmin didn't show such a "body battery" dip back then.


I always wondered what the body does during the two weeks after the second vaccination. I mean, I'm aware of https://en.wikipedia.org/wiki/Somatic_hypermutation, but I guess there's a lot more going on in the body and immune system. Always fascinating.


When receiving the vaccination in Austria, I was told to avoid physical activity or sports for three days. The nurse told that a befriended doctor was treating a couple of patients, all of them young males, with myocarditis after the vaccination. Does anybody else have a source for that? The article unfortunately doesn't mention this. But maybe in the US military, and among young fit males in general, such an exercise pause isn't taken.


>to avoid physical activity or sports for three days.

similar advice in Russia is to avoid alcohol - main Russian heart/health stressor :) - post-vaccine, originally for 42 days, later, after massive outpour of public displeasure to say the least, the recommended period was decreased to 6 days.


Vaccines take 5-15 years to fully test. We have no idea what long term consequences will be yet.


Just because the normal process isn’t parallelized like it was done for these vaccines, plus natural exposure to the pathogen usually takes a very long time to play out. As this vaccine researcher at children’s hospital of Pennsylvania notes, all reactions to vaccines that have ever been recorded were within 2 months of application. https://www.chop.edu/news/long-term-side-effects-covid-19-va...


Would that be realistic to wait that long right in the middle of a global pandemic?


Is it be realistic to take a novel vaccine with unknown long term effects from indemnified big pharma companies?


If there is some long term disease that manifests from all this, I tell you what, people aren't going to care about "indemnified" big pharma. People will want blood.


I'm sure they've game theorized possible outcomes and will mitigate the blowback. But yea, I don't trust any of it.


160+ million people in the Us have had at least 1 vaccine shot, so I guess the answer to your question is yes.


I had my second dosis of the BNT162b2 last Monday and the only side effect was some pain in my shoulder, or at least that’s what I thought until I briefly checked my hear rate and I realized that 24 hours after the second dosis it climbed more than 25% lasting 48 hours. My average rest rate is 58-62 and at that time it was more than 85. I thought that maybe something was wrong when my walking heart rate for several minutes was higher than 130 when it should range between 95-105.

Obviously my antibodies were doing its job and everything now it’s back to normal. I did not suffer any other side effects like fever, headache, chest pain or tiredness.


> 24 hours after the second dosis it climbed more than 25% lasting 48 hours

Is this an uncommon reaction of the body during an immune response?


I looked for information and there are a lot of people reporting the same reaction, but it’s not in the vaccine side effects description as “normal”.


I wouldn't even call it a side effect.

It's part of a normal immune response. Don't you notice your heart rate increase when you catch a flu?


When somebody catch a flu there are a list of symptoms like fever, aches… but this time I had nothing except the annoying pain of the jab. I realized almost 72 later when my heart rate app raised an alarm because I was not training but I was above 135 bpm. I was surprised because I though the immune response of my body was without symptoms, but no, the immune system was doing its job.


Myocarditis is also linked to Covid exposure, due to the immune system response trying to clear the virus out of the heart.

I am curious how many of these individuals may have been exposed to Covid-19 before, even if they were asymptomatic and had never been tested. This may never be known.

If they were exposed to Covid-19, and still had viral particles in the heart, the vaccine could cause a major immune system ramp to go after those remnants.

And that could lead to myocarditis.


Interesting that they keep such close track of this when at the same time hundreds of soldiers have been living next to burn pits burning the most toxic substances. Then years later denying that the burning of these substances caused the cancer these soldiers are suffering from.


I have a friend who has (slowly clearing) myocarditis for close to a year now. But as a sequela of long COVID. I would be interested to know how likely that is.

Does anyone have an official stats on the the common sequelae of long COVID and their likeliness, each?


Anecdotally I have two friends who have the same. One got so bad they were hospitalized for quite awhile and had to take close to a year off of work while lingering in a very precarious state of recovery. Both in their 30s.




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