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Cardiac sequelae in athletes following COVID-19 vaccination: evidence and misinformation
  1. Joelle Julius Nicolaas Daems,
  2. Juliette C van Hattum,
  3. Sjoerd M Verwijs,
  4. Nick R Bijsterveld,
  5. Maarten Groenink,
  6. Arthur A M Wilde,
  7. Yigal M Pinto,
  8. Harald T Jorstad
  1. Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
  1. Correspondence to Joelle Julius Nicolaas Daems, Department of Cardiology, Amsterdam UMC, Amsterdam, Noord Holland, The Netherlands; jjndaems{at}

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The recognition of myocarditis as a rare side effect of SARS-CoV-2 mRNA vaccination by the US Food and Drug Administration and European Medicines Agency has led to global debate regarding vaccine safety, particularly within the world of sports. A plethora of speculative reports on social media attribute sudden cardiac arrest/death (SCA/D) in athletes to mRNA vaccination. We, therefore, aim to provide: (1) a comprehensive overview of current literature on SARS-CoV-2 vaccination safety in athletes; (2) a theoretical overview of potential COVID-19 mRNA vaccination-associated myocarditis (C-VAM) pathogeneses; (3) performance considerations and (4) a critical appraisal of circulating reports on vaccine-induced adverse cardiac events in athletes.

Safety of COVID-19 mRNA vaccine in athletes

A subgroup analysis in individuals under 40 years of age estimated an excess 2 and 8 cases of myocarditis per 1 million first doses, and an excess 3 and 15 cases per 1 million second doses of the BNT162b2 (BioNTech, Pfizer) and mRNA-1273 (Moderna) vaccine, respectively. This contrasts with 10 extra cases of myocarditis per 1 million positive SARS-CoV-2 tests (figure 1).1 However, no confirmed cases of athletes with cardiac complications following mRNA vaccination have been reported to date. A PubMed search (15 February 2023) using the terms ‘vaccine’, ‘(peri)myocarditis’, ‘SARS-CoV-2’ and ‘athlete’ (online supplemental appendix A) yielded nine results. None of these contained original data except one case report of a woman athlete who developed pericarditis after a Bentall procedure and mRNA COVID-19 vaccine administration. Although the interval between vaccination and the onset of her symptoms was peculiar, the a priori chance of …

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  • Correction notice This article has been corrected since it published. The abstract has been removed from the online version only.

  • Contributors HTJ conceived the main conceptual idea. JJND, JCvH and SMV contributed to the design of the manuscript. JJND wrote the manuscript with input from all authors in consultation with JCvH, SMV, NRB, MG and HTJ. All authors discussed the findings and commented on the manuscript. YM Pinto and AM Wilde supervised the project.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.