Heart failure & cardiomyopathies

Prognostic Factors Associated with Fatal Outcomes in COVID-19 Vaccine-Related Myocarditis

ESC Heart FailPublished retrospective analysis of a pharmacovigilance database

Authors' conclusion

Older age was associated with higher odds of reported fatal outcomes among VRM reports in JADER. Female sex, delayed onset, and comorbidities were more common among reports with fatal outcomes. These exploratory findings require validation in clinically adjudicated studies.

Study context

Population
COVID-19 vaccine-related myocarditis reports in the Japanese Adverse Drug Event Report databasereports including myocarditis among 31,022 reports listing COVID-19 vaccines as suspected drug, outcome data available for 863 reports
Participants
1,041 participants
Exposure
Death vs survival groups based on recorded outcome information
  • Deathn = 97
Outcome
Myocarditis reporting with COVID-19 vaccines
Methodological detailsJapanese Adverse Drug Event Report database, 2021 to 2024
  • Japanese Adverse Drug Event Report database
  • 2021 to 2024

Main finding

As reported in the abstract

Reporting odds ratio [ROR]

31.3, 95% CI 29.0-33.8

Observational data: associations, not effects.

Further findings

Time from vaccination to myocarditis onset

Median time
2 (1-4) days
Most events occurring within 7 days

Characteristics of vaccine-related myocarditis (VRM) reports

Men
77.8%
≤39 years old
68.6%

Death recorded (of 863 reports with outcome data)

Death
97 reports (11.2% [95% CI, 9.3%-13.5%])

Factors associated with reported fatal outcomes

Age ≥70 years independently associated with reported fatal outcomes (multivariable logistic regression), OR
8.67, 95% CI 4.41-17.3; P < 0.001
Reported fatal outcomes more frequent in women, patients aged ≥70 years, those with delayed onset (≥8 days after COVID-19 vaccination), and those with ≥1 comorbidities

Original publication

Prognostic Factors Associated with Fatal Outcomes in COVID-19 Vaccine-Related Myocarditis. ESC Heart Fail. Published 16 September 2026. doi:10.1093/eschf/xvag239

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