14 year old girl dies unexpectedly two days after her third dose of a Pfizer covid shot.

“the patient was diagnosed with post-vaccination pneumonia, myopericarditis, hepatitis, nephritis, gastroenteritis, cystitis, and myositis”

From Legal Medicine (Tokyo, Japan)

Abstract

A 14-year-old Japanese girl died unexpectedly 2 days after receiving the third dose of the BNT1262b2 mRNA COVID-19 vaccine. Autopsy findings showed congestive edema of the lungs, T-cell lymphocytic and macrophage infiltration in the lungs, pericardium, and myocardium of the left atria and left ventricle, liver, kidneys, stomach, duodenum, bladder, and diaphragm. Since there was no preceding infection, allergy, or drug toxicity exposure, the patient was diagnosed with post-vaccination pneumonia, myopericarditis, hepatitis, nephritis, gastroenteritis, cystitis, and myositis. Although neither type of inflammation is fatal by itself, arrhythmia is reported to be the most common cause of death in patients with atrial myopericarditis. In the present case, arrhythmia of atrial origin was assumed as the cause of cardiac failure and death. In sudden post-vaccination deaths, aggressive autopsy systemic search and histological examination involving extensive sectioning of the heart, including the atrium, are indispensable.

Keywords: Systemic inflammation, Myopericarditis, COVID-19, Vaccines, Sudden death, Autopsy

Introduction

Coronavirus disease 2019 (COVID-19) vaccines are available worldwide. Since their introduction, post-vaccination deaths have been reported, and their association with the vaccine has been forensically examined [1], [2]. Post-vaccination myocarditis and pericarditis have been increasingly reported, with male adolescents reported to have a higher incidence of pericarditis with a good prognosis, while middle-aged and older patients are more likely to have severe myocarditis. In this study, we report an autopsy case of a 14-year-old girl who died unexpectedly 2 days after receiving the third dose of BNT1262b2 mRNA COVID-19 vaccine.

Case report

A 14-year-old Japanese girl received a third dose of the BNT1262b2 mRNA COVID-19 vaccine/Pfizer (Comirnaty®) on 10th August 2022. Despite her history of orthostatic dysregulation, she was healthy by nature and was active in her middle school athletic team. The day after vaccination, she developed a fever of 37.9 °C, which resolved by the same evening. Her sister, who had slept with her that night, reported that she woke up briefly because she was having difficulty in breathing, talked with her sister, and went to bed soon after. The following morning, her mother noticed that she was not breathing and had a pale appearance, and she immediately called an ambulance. The patient was in cardiopulmonary arrest when the ambulance crew arrived at their house and attempts to administer advanced life support were unsuccessful. She died 45 h after the third vaccination. After the first dose of vaccine on 12th September 2021, she had arm pain without fever. The day after the second dose on 3rd October 2021, she missed school because she had a fever of less than 38 °C. All three vaccines were made by Pfizer. An autopsy was performed the following day to evaluate the cause of sudden death.

2.1. Autopsy findings

The deceased patient was 154 cm tall and weighed 43 kg. The patient’s body showed normal development and nutrition relative to her age. No superficial injuries were observed, except for injection marks from emergency medical treatment. No petechial hemorrhage was observed in the conjunctiva. Her heart weighed 192 g (normal weight, 241.92 ± 42.88 g) [3] and contained dark-red liquid blood (21 g on the left and 110 g on the right side). The heart showed no degeneration or scarring on the grossly superficial surface or cross-sections. The left lung weighed 424 g (normal weight, 349.78 ± 143.69 g) [3], while the right lung weighed 471 g (normal weight, 396.28 ± 190.63 g) [3]. In the cross-section, both lungs showed severe pulmonary edema and congestion.

A COVID-19 antigen quantification test performed using a nasopharyngeal swab taken before autopsy yielded negative results. The serum collected at autopsy tested negative for adenovirus, cytomegalovirus, influenza virus (A, B), respiratory syncytial virus, Epstein-Barr virus, enterovirus (70, 71), parvovirus, and human immunodeficiency virus. Quantitative testing for the COVID-19 antigen using nasopharyngeal swabs yielded negative results. The results of polymerase chain reaction tests performed for COVID-19 using swabs from the lung, heart, liver, kidney, stomach, duodenum, diaphragm, and cerebrum after formalin fixation were also negative. Blood at autopsy was tested for drug toxicity using LC-MS/MS, and the results were negative.

2.2. Histological findings

The autopsied organs were examined histologically, focusing particularly on the resected heart, anterior and posterior walls of the left and right atria and ventricles, atrial septum, ventricular septum, sinus node, and atrioventricular node. Tissue samples were fixed in phosphate-buffered formalin and embedded in paraffin. Paraffin sections of 5 µm thickness were then stained with hematoxylin and eosin. Lymphocyte cellular infiltrates, including eosinophils, were observed in the lungs, pericardium of both atria and adjacent myocardium, liver, kidneys, stomach, duodenum, and diaphragm (Fig. 1 ), and mild cellular infiltration was also observed in the pericardium of the right ventricle. The brain showed congestion. In the hippocampus a slight lymphocytic infiltration was observed. Immunostaining with an anti-CD3 antibody (Dako 1:200) (Fig. 1) and anti-CD68 antibody (Dako 1:200) (Fig. 1) revealed that most of the infiltrating cells were T cells and macrophages.