Myocarditis After COVID-19 Vaccination: Risk–Benefit Estimates and Incidence Over Time

The incidence of myocarditis after COVID-19 vaccination has become clearer over time.

A health care worker prepares a Moderna COVID-19 vaccine at the vaccination centre Hall Victor Hugo in Luxembourg on Jan. 21, 2021. Jean-Christophe Verhaegen/AFP via Getty Images

Presentations, studies, and other data showing risk–benefit estimates and rates of myocarditis following COVID-19 vaccination.

Key:

CDC = U.S. Centers for Disease Control and Prevention

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FDA = U.S. Food and Drug Administration

US = American researchers from outside the government

Risk–Benefit Estimates

June 23, 2021 (pdf) and July 6, 2021 (CDC)

Males 12–17 per million second Pfizer doses

Risks: 56–69 myocarditis cases

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Benefits: 5,700 COVID-19 cases, 215 hospitalizations, and two deaths prevented

Males 18–24 per million second doses

Risks: 45–56 myocarditis cases

Benefits: 12,000 COVID-19 cases, 530 hospitalizations, and three deaths prevented

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Aug. 10, 2021 (CDC)

Males 18–29 per million second doses

Risks: 22–27 myocarditis cases

Benefits: 300 hospitalizations and three deaths prevented

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Sept. 8, 2021 (US)

Males 12–15 without medical comorbidities after second Pfizer doses:

Risks: 162.2 cardiac adverse events per million

Benefits: 15 hospitalizations per million prevented

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Males 16–17 without medical comorbidities after second Pfizer doses

Risks: 94 cardiac adverse events per million

Benefits: 21 hospitalizations per million prevented

Oct. 26, 2021 (pdf) (FDA)

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Males 5–11 per million Pfizer doses

Risks: 89–179 excess myocarditis cases, 78–156 excess myocarditis hospitalizations

Benefits: 2,639–57,857 prevented COVID-19 cases, 21–254 prevented COVID-19 hospitalizations, 0–3 prevented COVID-19 deaths

Males 12–15 per million Pfizer doses

Risks: 179 excess myocarditis cases, 156 excess myocarditis hospitalizations

Benefits: 77,649 prevented COVID-19 cases, 318 prevented COVID-19 hospitalizations, three prevented COVID-19 deaths

Males 16–17 per million Pfizer doses

Risks: 196 excess myocarditis cases, 63 excess myocarditis hospitalizations

Benefits: 92,691 prevented COVID-19 cases, 813 prevented COVID-19 hospitalizations, 13 prevented COVID-19 deaths

Females 5–11 per million Pfizer doses

Risks: 16–32 excess myocarditis cases, 14–28 excess myocarditis hospitalizations

Benefits: 45,063 prevented COVID-19 cases, 172 prevented COVID-19 hospitalizations, one prevented COVID-19 death

Females 12–15 per million Pfizer doses

Risks: 32 excess myocarditis cases, 28 excess myocarditis hospitalizations

Benefits: 82,495 prevented COVID-19 cases, 466 prevented COVID-19 hospitalizations, one prevented COVID-19 death

Females 16–17 per million Pfizer doses

Risks: 36 excess myocarditis cases, 31 excess myocarditis hospitalizations

Benefits: 109,796 prevented COVID-19 cases, 1,144 prevented COVID-19 hospitalizations, seven prevented COVID-19 deaths

In one scenario (scenario 3), excess hospitalizations and ICU stays are higher than prevented hospitalizations and ICU stays.

Nov. 1, 2021 (England)

12–17 over 16 weeks of vaccination

Risks: 160 cases of myocarditis

Benefits: Up to 4,590 hospital admissions and 36 deaths prevented

April 26, 2022 (FDA)

Males 16–17 per million Pfizer doses

Risks: 98–196 myocarditis cases

Benefits: 13,577 COVID-19 cases, 127 COVID-19 hospitalizations, and one death prevented

In two of three scenarios, excess hospitalizations are higher than prevented hospitalizations.

Aug. 11, 2022 (Australia)

Males 12–19 per million doses

Risks: 146 myocarditis cases

Benefits: 11,029–110,288 symptomatic cases and 1–11 deaths prevented

Dec. 5, 2022 (US)

18–29

Per COVID-19 hospitalization prevented, 18.5 serious adverse events, including 1.5–4.6 myopericarditis cases in males

June 15, 2023 (FDA)

Males 18–25 per million Moderna doses

Risks: 68–241 myocarditis cases, 58–207 myocarditis hospitalizations

Benefits: 3,903-219,958 COVID-19 cases, 635–5,957 COVID-19 hospitalizations, 7–63 COVID-19 deaths prevented

Incidence

Incidence of myocarditis and/or pericarditis following COVID-19 vaccination. Incidence based on health care records. Some rates exclude pericarditis. “Reported cases” is used if based on reports. Some reports excluded for not meeting case definition.

May 31, 2021 (pdf) (Israel)

Males 16-19 after second Pfizer dose

One case per 6,637 doses

Males 20-24 after second Pfizer dose

One case per 9,208 doses

June 23, 2021 (pdf) and July 6, 2021 (CDC)

Males 12–17 after second Pfizer dose

62.8 reported cases per million

Males 18–24 after second dose

50.5 reported cases per million

Sept. 3, 2021 (CDC, etc.)

12–39 after first dose

104.2 cases per one million person years

12–39 after second dose

569.5 cases per one million person years

Oct. 6, 2021 (Israel)

Males 16–29 after first Pfizer dose

Pfizer: 106.9 per million

Males 30 and older after first Pfizer dose

Pfizer: 21 per million

Oct. 6, 2021 (Israel)

Males 16–19 after second Pfizer dose

Pfizer: 150 per million

Males 20–24 after second Pfizer dose

106 per million

Males 25–29 after second Pfizer dose

69 per million

Males 30–39 after second Pfizer dose

36 per million

Nov. 2, 2021 (Denmark)

Males 12–17 per million doses

97 cases, or 1 in 10,000 doses

Females 12–17 per million doses

16 cases, or 1 in 63,000 doses

Nov. 28, 2021 (Hong Kong)

Males 12–17 after second Pfizer dose

373 per million

Females 12–17

47 per million

Dec. 14, 2021 (England)

Under 40 after second dose

Pfizer: Excess of three per million

Moderna: Excess of five per million

After positive test: 10 per million

Dec. 16, 2021 (Nordic)

12–39

Pfizer: 16 per million

Moderna: 57 per million

Dec. 25, 2021 (UK)

Males under 40 after second dose

Pfizer: 12 per million

AstraZeneca: 14 per million

Moderna: 101 per million

After positive test: 7 per million

Males under 40 after third Pfizer dose

13 per million

Dec. 27, 2021 (US)

Males 12–39 after second dose

195.4 per million

Jan. 25, 2022 (CDC)

Males 12–15 after second Pfizer dose

70.7 reported cases per million

Expected: 0.5 per million

Males 16–17 after second Pfizer dose

105.8 reported cases per million

Expected: 1.3 per million

Males 18–24 after second dose

Pfizer: 52.4 reported cases per million

Moderna: 56.3 reported cases per million

Expected: 1.7 per million

Males 25–29 after second dose

Pfizer: 17.2 reported cases per million

Moderna: 24.1 reported cases per million

Expected: 1.4 per million

Jan. 26, 2022 (Israel)

Males 12–15 after second dose

80 per million (1 per 12,361)

Feb. 23, 2022 (Singapore)

Males 12–19

48 reported cases per million

Feb. 25, 2022 (Hong Kong)

Males 12–17 after second Pfizer dose

390 per million (1 in 2,563)

Females 12-17 after second Pfizer dose

49 per million (1 in 20,121)

No new cases after introduction of single dose policy

April 20, 2022 (Nordic)

Males 16–24 after second dose

Pfizer then Pfizer: 55 excess per million

Pfizer then Moderna: 274 excess per million

Moderna then Moderna: 183 excess per million

Males 25–39 after second dose

Pfizer then Pfizer: 5.9 excess per million

Pfizer then Moderna: 113 per million

Moderna then Moderna: 80 excess per million

June 11, 2022 (FDA)

Males 18–25 after second dose

Pfizer: 170 per million person days

Moderna: 21 per million person days

June 23, 2022 (pdf) (CDC)

Males 12–15 after second dose

Pfizer: 46.4 per million

Males 16–17 after second dose

Pfizer: 75.9 per million

June 25, 2022 (France)

Males 12–17 after second dose

Pfizer: 19 excess cases per million (1 case per 52,300)

Males 18–24 after second dose

Pfizer: 47 excess cases per million (1 case per 21,100)

Moderna: 170 excess cases per million (1 case per 5,900)

Males 25–29 after second dose

Pfizer: (1 case per 47,000)

Moderna: (1 case per 9,400)

Females 18–24 after second dose

Pfizer: 6.3 excess cases per million (1 case per 159,000)

Moderna: 53 excess cases per million (1 case per 18,700)

June 28, 2022 (Australia)

Males 12–17 after first dose

44 reported per million

Males 12–17 after second dose

242 reported per million

Females 12–17 after second dose

43 reported per million

July 14, 2022 (CDC)

5–11 after Pfizer dose

2.7 per million

July 20, 2022 (US)

18–39 after second dose

7.84 incidence rate ratio (compared to baseline)

18–39 after third dose

5.11 incidence rate ratio (compared to baseline)

July 26, 2022 (Denmark)

5–11 after Pfizer dose

4.8 per million

Background rate: 1 per million

12–17 after Pfizer dose

57 per million

Background rate: 17 per million

July 28, 2022 (Italy)

Males 12–39 after first dose

Pfizer: None

Moderna: 38 excess per million

Males 12–39 after second dose

Pfizer: 10 excess per million

Moderna: 88 excess per million

July 30, 2022 (Canada)

Males 18–29 after second dose

Pfizer: 31 reported per million

Moderna: 162 reported per million

Males 30–39 after dose 2

Pfizer: 9 reported per million

Moderna: 34 reported per million

Females 18–29 after dose 2

Pfizer: 7 reported cases per million

Moderna: 26 reported cases per million

Sept. 6, 2022 (Israel)

Males 16–19 after second Pfizer dose

148.9 per million

Males 16–19 after third Pfizer dose

64 per million

Males 20–24 after second Pfizer dose

108 per million

Males 20–24 after third Pfizer dose

54 per million

Males 25–29 after second Pfizer dose

83 per million

Females 20–24 after second Pfizer dose

20 per million

Oct. 4, 2022 (CDC)

Males 12–15 after second Pfizer dose

150.5 per million

Males 16–17 after second Pfizer dose

137.1 per million

Males 16–17 after third Pfizer dose

188 per million

Males 18–29 after second dose

Pfizer: 81.4 per million

Moderna: 97 per million

Males 18–29 after third dose

Pfizer: 36.4 per million

Moderna: 64 per million

Females 12–15 after second Pfizer dose

24.5 per 100,000

Females 16–17 after third Pfizer dose

36.4 per 100,000

Oct. 30, 2022 (Japan)

Males 10–19 after Moderna second dose

41 times as many reported as expected

Males 20–29 after Moderna second dose

16.8 times as many reported as expected

Nov. 7, 2022 (Canada)

Males 18–29 after second dose

Pfizer: 89.7 per million

Moderna: 310 per million

Males 30–39 after second dose

Pfizer: 28.4 per million

Moderna: 94.3 per million

Females 18–29 after second dose

Pfizer: 9.6 per million

Moderna: 68.5 per million

Females 30–39 after second dose

Pfizer: 10 per million

Moderna: 41.7 per million

Nov. 24, 2022 (Europe)

Under 30

Pfizer: 32.2 excess cases per million

Moderna: 33.7 excess cases per million

Feb. 8, 2023 (Taiwan)

Males 12–17 after first Pfizer dose

43 reported per million

Males 12–17 after second Pfizer dose

126.7 reported per million

Males 18–24 after second dose

Pfizer: 29.8 reported per million

Moderna: 93.8 reported per million

Males 25–29 after first dose

Pfizer: 3 reported per million

Moderna: 22.7 reported per million

Males 25–29 after second dose

Pfizer: 19 reported per million

Moderna: 78.5 reported per million

Feb. 27, 2023 (Canada)

Males 12–15 after second Pfizer dose

84 reported per million

Males 16–17 after first Pfizer dose

77 reported per million

Males 16–17 after second Pfizer dose

157 reported per million

March 24, 2023 (Canada)

Males 18–29 after second dose

Pfizer: 53.2 per million

Moderna: 224 per million

Males 18–29 after third dose

Pfizer: 18.6 per million

Moderna: 39 per million

March 28, 2023 (Thailand)

Males 12–17 after second Pfizer dose

44 reported per million

April 15, 2023 (Malaysia)

Males 12–17 after first Pfizer dose

7 per million

Males 12–17 after second Pfizer dose

9.5 per million

April 21, 2023 (CDC, FDA)

Males 12–15 after second Pfizer dose

48.3 reported per million

Males 16–17 after second Pfizer dose

84 reported per million

June 13, 2023 (South Korea)

Under 19 after third dose

Pfizer: 82 reported per million

Moderna: 31 reported per million