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Mody Shehab discusses his struggle recovering from COVID-19 and how he was hospitalized with heart inflammation days after receiving Pfizer vaccine. NorthJersey.com

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Three days after Mody Shehab, a healthy 31-year-old, received his first dose of the Pfizer vaccine for COVID-19, he developed such severe chest pain he thought he was having a heart attack. He rushed to the emergency room. Doctors performed an emergency heart procedure.

The Saddle River man had an inflammation of his heart muscle and heart membrane, a rare potential adverse event from the Pfizer and Moderna vaccines that has prompted the federal Centers for Disease Control and Prevention to alert clinicians. While not definitively linked to the vaccine, the few cases reported warrant more investigation, the CDC’s COVID-19 Vaccine Safety Technical Work Group said on May 17.  

“I never had a heart problem in my life,” said Shehab, who was diagnosed with myocarditis and pericarditis and spent three days in the hospital after an emergency cardiac catheterization. He attributed the frightening episode to the vaccine, because of its timing, and reported it to the CDC’s Vaccine Adverse Event Reporting System (VAERS), an online data collection site to which anyone can submit a report. 

Myocarditis, an inflammation of the heart muscle usually caused by a virus, and pericarditis, an inflammation of the membrane surrounding the heart, weaken the heart muscle and the electrical impulses that keep the heart pumping regularly. When severe, the result can be heart failure, abnormal heartbeat or sudden death.  

The CDC said “relatively few” cases of myocarditis have followed a COVID vaccination. They occurred predominantly in adolescents and young adults, more often in males than females and usually within four days of vaccination, and were more common after the second dose. Most appear to be mild, the agency said.

While the number of reports did not appear to exceed the normal rate of myocarditis, members of the work group "felt that information about reports of myocarditis should be communicated to providers," the CDC said.  

The group recommended further investigation and collaboration among infectious disease specialists, cardiologists and rheumatologists (who specialize in inflammatory illnesses) to develop guidance about how to diagnose, treat and manage the condition. Information about the potential adverse event should be shared, so clinicians can recognize it early and treat it appropriately, the work group said.

How the vaccine safety monitoring system works

The CDC’s action shows how the nation’s system for monitoring vaccine safety works in real time.  

Reports of individual adverse events that may be related to the vaccine are collected in a variety of ways from patients and medical providers. They are scanned and screened for patterns to see if further digging is warranted. When announced to the public, more cases may be identified, even before scientific conclusions are drawn.  

Then, if it is warranted, teams of researchers review medical records, assess the cases' statistical significance and try to determine whether there’s a scientific basis to link them to the vaccine. Recommendations to health care providers or new guidelines on the use of the vaccine may follow. 

This was the process followed when the government recommended a temporary pause in the use of the Johnson & Johnson COVID vaccine in April. 

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Shehab’s case and others like it are “a perfect example of the system working as it is supposed to work,”  said Dr. Stanley Weiss, an infectious disease specialist and epidemiologist at Rutgers Medical School and the university’s school of public health. Through the amassing and assessing of individual reports, scientific conclusions can guide vaccine policy.

Additional information is expected soon about the issue from expert groups advising the CDC, as well as the World Health Organization and Israel. Weiss is involved in one of the groups working to standardize the definition of myocarditis so that cases in vaccinated patients or COVID patients can be readily compared.  

Meanwhile, experts emphasize that vaccination is still recommended. An unvaccinated person faces more risks from infection with COVID-19 than from a potential adverse reaction to the vaccine.  

COVID vaccine benefits vs. risks

“The benefits of COVID-19 vaccination enormously outweigh the rare, possible risk of heart-related complications, including inflammation of the heart muscle, or myocarditis,” the American Heart Association/American Stroke Association said in a statement. “We strongly urge all adults and children ages 12 and older in the U.S. to receive a COVID vaccine as soon as they can receive it.” 

COVID-19 can be fatal and has “potential long-term health effects that are still revealing themselves, including myocarditis,” the statement said. And a correlation between vaccination and myocarditis has yet to be established, it noted. 

A Rutgers pediatrician and epidemiologist said he would not hesitate to have his child vaccinated, if she were eligible.  

“We know this is not a benign illness, even though children are not likely to die from it,” said Lawrence Kleinman, a professor of pediatrics and an epidemiologist at Rutgers Robert Wood Johnson Medical School.

“Some proportion of kids who get COVID and a fair number of young adults who get COVID will have long-haul symptoms,” he said, adding that it’s too soon to know whether there will be long-term developmental effects. 

“We don’t want people to get sick,” he said. The vaccination “appears very effective at stopping people from getting sick. The question is: Are the side effects worse than the disease? At this point, we don’t have any evidence that they are.” 

Kleinman is leading two national collaborative research projects on the risk of myocarditis with COVID in young people with and without the vaccine. Two questions must be answered, he said: Is there an association between the COVID vaccines and myocarditis? And if there is, is the risk greater than the risk of myocarditis from COVID itself?  

As the research evolves on multiple fronts, “the public is seeing the sausage get made, at some level,” he said. 

Adverse COVID shot reaction

Shehab, a new father who was laid off from his job as a retail manager during the pandemic, feels fine now. “It’s as if it never happened,” he said last week, after a follow-up visit with his cardiologist. 

No damage to his heart occurred, and his prognosis is good, the cardiologist said. Shehab plans to launch an online food show in a few months.

But when he arrived at the Valley Hospital emergency room late on March 31, “he presented as if he was having a heart attack,” said Dr. Robert Baklajian, the cardiologist on call that night. “His EKG [electrocardiogram] was abnormal, simulating a heart attack. His heart enzymes — troponin — did rise.” Magnetic-resonance images of Shehab’s heart confirmed an inflammation. 

Shehab had received his first dose of the vaccine three days earlier. That timing, and the sudden onset of such symptoms in a healthy young person, “can’t be overlooked,” Baklajian said.  

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Shehab said he'd been severely ill with COVID for three months late last year and spent five days in the hospital. His primary symptoms were a high fever, nausea and diarrhea. He lost 25 pounds and feared he would die. After he recovered and his baby daughter was born on Jan. 4, he wanted to do the right thing and get vaccinated, he said.

His reaction to the shot was intense.

On day one, he felt chills. On day two, he said, "I got the sweats, like someone was dumping a bucket of water on me.” He began to feel a few chest pains and couldn’t sleep. On day three, all his complaints worsened.

“I was so uncomfortable,” he said. He paced. Then his neck began to feel numb and his shoulder and fingers began to tingle. Although it seemed crazy at the time, he wondered if he was having a heart attack. 

He drove himself to the hospital. That's when the abnormalities in his EKG triggered an urgent response. A medical team swarmed around him and told him they were prepping him for surgery within the hour. 

Baklajian was summoned in the middle of the night, he recalled. Shehab "was taken to the cardiac catheterization lab and his arteries were open," Baklajian said.

“It raises a lot of questions,” the cardiologist said. “Unfortunately, I think we’re learning about the COVID infection throughout the whole year.” 

Shehab decided not to get a second dose of the vaccine.

Lindy Washburn is a senior health care reporter for NorthJersey.com. To keep up-to-date about how changes in the medical world affect the health of you and your family, please subscribe or activate your digital account today.

Email: washburn@northjersey.com 

Twitter: @lindywa 

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