Evidence dossier · candidate cand-covid-myocarditis · CICP program · · DRAFT — not a determination
This is a draft research-tracking dossier, not a determination that COVID-19 vaccine causes Myocarditis, and not an incidence or legal finding. All evidence is flagged needs_human_review and must be reviewed before any page is published or cited. Every value is grounded in retrieved citations (PMID + retrieval date); unsourced items read "no evidence found / not assessable". Symmetric search: every supporting query has a mirror/null query, and zeros are shown (negative dossiers report the absence of signal).
Claim matrix (C1–C6, computed)
Claim
Label
Status
Missing nodes
C1
Coherent clinical object exists
supported
C2
Consistent temporal window
supported
C3
Epidemiologic excess risk
contested
C4
Consistency / replication
supported
C5
Specificity (product / dose)
supported
C6
Biological mechanism
supported
Two evidentiary bars apply to the epi nodes/claims (C3, C4): · VICP — preponderance of the evidence. · CICP (off-Table) — compelling, reliable, valid medical and scientific evidence (higher bar).
Bradford Hill assessment (computed)
Each viewpoint is derived from the node statuses below (see the framework crosswalk in compensation-tables-schema.md §8). Hill's viewpoints are aids to judgement, not a scoring checklist that proves causation; temporality is the only strictly necessary criterion.
Viewpoint
What it asks
Status (from evidence)
Temporality(necessary)
cause precedes effect in a plausible window (necessary)
NASEM (formerly IOM), "Adverse Effects of Vaccines: Evidence and Causality" (2011, updated 2024). Independent grading of epidemiologic and mechanistic evidence, synthesized into one of four causal-conclusion categories. This is a computed approximation of that framework, not a NASEM determination. See compensation-tables-schema.md §8bis.
Case-definition standard: Brighton Collaboration (named in spec §1: myocarditis/pericarditis) — governs the case-certainty scale on A1/A2/A6/A8 below. See compensation-tables-schema.md §8ter.
Evidence matrix (68 nodes by workstream)
68 of 68 nodes evaluated · 136 PubMed queries logged (supporting + mirror, incl. zeros). Statuses are computed from retrieved citations; not hand-set.
Definition & attribution 24/24 evaluated
A1 · Case reportssupports
Measure: New definite object in risk window T Comparator: Pre-vaccination baseline Hit rule: Definite object present, onset in window, competing causes considered
Finding: Multiple case reports describe acute myocarditis in young males occurring within days after receiving the second dose of mRNA COVID-19 vaccines (e.g., Pfizer-BioNTech), with onset as early as 6 hours post-vaccination, elevated troponin, and cardiac MRI findings consistent with myocarditis after excluding other causes.
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 35782472 · The Yale journal of biology and medicine (2022) — Myocarditis Following COVID-19 Vaccination: A Systematic Review of Case Reports.
supports_node 36540512 · Cureus (2022) — COVID-19 Vaccine-Induced Acute Perimyocarditis: A Case Report.
supports_node 36589642 · Annals of pediatric cardiology (2022) — Myocarditis in children after COVID-19 vaccine.
supports_node 37484597 · The Pan African medical journal (2023) — Post-vaccine COVID-19 acute myocarditis: case reports and literature review.
ambiguous 35814246 · Frontiers in pharmacology (2022) — Profiling COVID-19 Vaccine Adverse Events by Statistical and Ontological Analysis of VAERS Case Reports.
A2 · Series with objective confirmationsupports
Measure: Definite object plus objective test Comparator: Reference range / diagnostic criteria Hit rule: Objective confirmation in >=1 case per the working definition
Finding: Multiple case reports and case series describe cases of myocarditis with objective confirmation (e.g., endomyocardial biopsy, cardiac MRI, elevated troponin) following COVID-19 mRNA vaccines and, in one report, after Covaxin, within days of vaccination, meeting the working definition of new myocarditis attributed to COVID-19 vaccine with objective confirmation.
supports_node 35935395 · European heart journal. Case reports (2022) — Case report: mRNA COVID-19 vaccine-related acute pericarditis with evolution to myopericarditis.
supports_node 36061387 · Frontiers in pediatrics (2022) — Case report: Five patients with myocarditis after mRNA COVID-19 vaccination.
supports_node 34876937 · Journal of cardiology cases (2022) — Acute myocarditis associated with COVID-19 vaccination: A case report.
supports_node 37139123 · Frontiers in cardiovascular medicine (2023) — Case report: mRNA-1273 COVID-19 vaccine-associated myopericarditis: Successful treatment and re-exposure with colchicine.
A3 · Onset histogramsupports
Measure: Distribution of onset times after dose Comparator: Pre-specified risk window Hit rule: Onset clusters inside the pre-specified window (not uniform/flat)
Finding: Case reports and case series consistently describe myocarditis onset occurring within hours to days after COVID-19 mRNA vaccination, with multiple reports specifying onset 6 hours, 2 days, 3 days, or up to 2 weeks post-dose, supporting a non-uniform temporal cluster within a pre-specified risk window.
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 35256821 · Proceedings (Baylor University. Medical (2022) — Myocarditis following COVID-19 mRNA vaccination.
supports_node 36589642 · Annals of pediatric cardiology (2022) — Myocarditis in children after COVID-19 vaccine.
supports_node 37139123 · Frontiers in cardiovascular medicine (2023) — Case report: mRNA-1273 COVID-19 vaccine-associated myopericarditis: Successful treatment and re-exposure with colchicine.
supports_node 36540512 · Cureus (2022) — COVID-19 Vaccine-Induced Acute Perimyocarditis: A Case Report.
supports_node 35371688 · Cureus (2022) — Myocarditis Secondary to COVID-19 mRNA Vaccine: A Case Report.
A4 · Temporal plausibilitysupports
Measure: Onset latency vs object pathophysiology Comparator: Object's known natural latency Hit rule: Onset latency consistent with the object's pathophysiology
Finding: Multiple case reports describe myocarditis onset within hours to days after mRNA COVID-19 vaccination, with onset latencies of 6 hours, 2 days, within a week, and up to 2 weeks post-dose, which is consistent with the typical post-vaccination inflammatory pathophysiology proposed for vaccine-associated myocarditis.
supports_node 35256821 · Proceedings (Baylor University. Medical (2022) — Myocarditis following COVID-19 mRNA vaccination.
supports_node 36589642 · Annals of pediatric cardiology (2022) — Myocarditis in children after COVID-19 vaccine.
supports_node 37139123 · Frontiers in cardiovascular medicine (2023) — Case report: mRNA-1273 COVID-19 vaccine-associated myopericarditis: Successful treatment and re-exposure with colchicine.
supports_node 36540512 · Cureus (2022) — COVID-19 Vaccine-Induced Acute Perimyocarditis: A Case Report.
A5 · Onset-interval documentationsupports
Measure: Onset interval documented in source Comparator: Dose date Hit rule: Onset interval is recorded (not imputed) in a primary source
Finding: Multiple case reports document that onset interval after COVID-19 vaccination was recorded (not imputed) in primary sources, with specific timing such as 6 hours, 2 days, 3 days, or within 2 weeks post-vaccination.
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 35256821 · Proceedings (Baylor University. Medical (2022) — Myocarditis following COVID-19 mRNA vaccination.
supports_node 36589642 · Annals of pediatric cardiology (2022) — Myocarditis in children after COVID-19 vaccine.
supports_node 37139123 · Frontiers in cardiovascular medicine (2023) — Case report: mRNA-1273 COVID-19 vaccine-associated myopericarditis: Successful treatment and re-exposure with colchicine.
supports_node 35371688 · Cureus (2022) — Myocarditis Secondary to COVID-19 mRNA Vaccine: A Case Report.
Measure: Competing causes assessed and excluded Comparator: Likely alternative diagnoses Hit rule: Pre-specified competing causes ruled out per the working definition
Finding: The retrieved evidence consists of case reports and case series describing myocarditis following COVID-19 mRNA vaccination, but none of the reports explicitly describe systematic exclusion of pre-specified competing causes (e.g., viral myocarditis, ischemic heart disease) per a working definition.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis case report OR case series Differential diagnosis excluded pubmed · 695 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis alternative diagnosis OR not vaccine-related pubmed · 4061 hits · run 2026-09-07
17 retrieved record(s)
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 35256821 · Proceedings (Baylor University. Medical (2022) — Myocarditis following COVID-19 mRNA vaccination.
supports_node 37139123 · Frontiers in cardiovascular medicine (2023) — Case report: mRNA-1273 COVID-19 vaccine-associated myopericarditis: Successful treatment and re-exposure with colchicine.
supports_node 35371688 · Cureus (2022) — Myocarditis Secondary to COVID-19 mRNA Vaccine: A Case Report.
ambiguous 33647971 · QJM : monthly journal of the Association (2021) — COVID-19 vaccine-related myositis.
ambiguous 36441403 · Current cardiology reports (2022) — COVID-19 Vaccine-Related Myocardial and Pericardial Inflammation.
ambiguous 38404624 · Global cardiology science & practice (2023) — Myocarditis and COVID-19 related issues.
A7 · Rechallenge / re-exposureno_data
Measure: Object recurs on a further dose Comparator: First-dose response Hit rule: Object recurs after a subsequent dose (re-exposure)
Finding: All retrieved evidence describes new-onset myocarditis after initial or second vaccine doses; no retrieved case reports document recurrence of myocarditis upon re-exposure (a subsequent dose after the index episode), except PMID 37139123 which describes successful re-exposure under colchicine prophylaxis but does not document recurrence of myocarditis as an adverse event.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis case report OR case series Rechallenge / re-exposure pubmed · 270 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis alternative diagnosis OR not vaccine-related pubmed · 4061 hits · run 2026-09-07
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
ambiguous 35256821 · Proceedings (Baylor University. Medical (2022) — Myocarditis following COVID-19 mRNA vaccination.
supports_node 37139123 · Frontiers in cardiovascular medicine (2023) — Case report: mRNA-1273 COVID-19 vaccine-associated myopericarditis: Successful treatment and re-exposure with colchicine.
supports_node 36589642 · Annals of pediatric cardiology (2022) — Myocarditis in children after COVID-19 vaccine.
supports_node 35371688 · Cureus (2022) — Myocarditis Secondary to COVID-19 mRNA Vaccine: A Case Report.
A8 · Adjudicated by criteria (Brighton Collaboration)mixed
Measure: Object adjudicated by published criteria Comparator: Published clinical / Brighton criteria Hit rule: Cases adjudicated to 'definite' by a published criterion set
Finding: Multiple case reports describe myocarditis following COVID-19 vaccination, with some using cardiac MRI or endomyocardial biopsy to confirm the diagnosis, but none explicitly state that cases were adjudicated to 'definite' by a published criterion set.
supports_node 36540512 · Cureus (2022) — COVID-19 Vaccine-Induced Acute Perimyocarditis: A Case Report.
A9 · Natural-history consistencysupports
Measure: Course matches the object's natural history Comparator: Known natural history of the object Hit rule: Clinical course (onset, peak, recovery) matches the object's natural history
Finding: Multiple case reports (e.g., PMID 35154981, PMID 36301659, PMID 35256821, PMID 35967168, PMID 35371688, PMID 36589642) describe myocarditis onset within hours to 2 weeks after COVID-19 vaccination, with clinical courses including chest pain, troponin elevation, recovery with supportive care, and resolution of symptoms, consistent with the natural history of acute myocarditis.
supports_node 35256821 · Proceedings (Baylor University. Medical (2022) — Myocarditis following COVID-19 mRNA vaccination.
supports_node 36589642 · Annals of pediatric cardiology (2022) — Myocarditis in children after COVID-19 vaccine.
supports_node 35371688 · Cureus (2022) — Myocarditis Secondary to COVID-19 mRNA Vaccine: A Case Report.
ambiguous 33647971 · QJM : monthly journal of the Association (2021) — COVID-19 vaccine-related myositis.
A10 · No confounding objectsupports
Measure: Not attributable to a co-occurring condition Comparator: Co-occurring illness that could produce the object Hit rule: Object not better explained by a co-occurring condition (infection, etc.)
Finding: Multiple case reports associate COVID-19 mRNA vaccination with acute myocarditis in young males, typically within days of the second dose, after ruling out other causes such as infection.
supports_node 35256821 · Proceedings (Baylor University. Medical (2022) — Myocarditis following COVID-19 mRNA vaccination.
supports_node 36589642 · Annals of pediatric cardiology (2022) — Myocarditis in children after COVID-19 vaccine.
supports_node 35371688 · Cureus (2022) — Myocarditis Secondary to COVID-19 mRNA Vaccine: A Case Report.
supports_node 36540512 · Cureus (2022) — COVID-19 Vaccine-Induced Acute Perimyocarditis: A Case Report.
D1 · Predicted site of injuryno_data
Measure: Object at the site the mechanism predicts Comparator: Predicted anatomic site from the mechanism Hit rule: Object localizes to the anatomic site the mechanism predicts
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis anatomic localization Predicted site of injury mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Predicted site of injury not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
D2 · Spared structuresno_data
Measure: Structures the mechanism should spare are spared Comparator: Structures predicted unaffected Hit rule: Structures predicted spared by the mechanism are indeed spared
mirror: COVID-19 vaccine Myocarditis Spared structures not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
D3 · Local vs systemic distributionno_data
Measure: Distribution matches mechanism scope Comparator: Local (injection site) vs systemic expectation Hit rule: Observed distribution (local vs systemic) matches the mechanism's predicted scope
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis anatomic localization Local vs systemic distribution mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Local vs systemic distribution not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
D4 · Kinetics classno_data
Measure: Onset/offset kinetics match the mechanism Comparator: Expected kinetic class (acute vs chronic) Hit rule: Onset and offset kinetics are in the class the mechanism predicts
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis anatomic localization Kinetics class mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Kinetics class not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
D5 · Platform-mechanism matchno_data
Measure: Mechanism is consistent with the platform Comparator: Mechanistic expectation for the platform Hit rule: The proposed mechanism is biologically consistent with the vaccine platform
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis anatomic localization Platform-mechanism match mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Platform-mechanism match not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
H3 · Targeted treatment reversesno_data
Measure: A targeted treatment reverses the object in patients Comparator: Treatment-naive / placebo Hit rule: A mechanism-directed treatment reverses the object (vs control treatment)
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Targeted treatment reverses intervention OR treatment OR reversal pubmed · 15141378 hits · run 2026-09-07
does_not_resolve 38189107 · Expert review of vaccines (2024) — Neoadjuvant personalized cancer vaccines: the final frontier?
I1 · No internal contradictionno_data
Measure: No node's finding contradicts another Comparator: Internal consistency across nodes Hit rule: No evaluated node directly contradicts another (coherence)
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis No internal contradiction coherence OR latency OR susceptibility pubmed · 870020 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis No internal contradiction inconsistent OR contradicts pubmed · 27612 hits · run 2026-09-07
I2 · Analogy to a known objectno_data
Measure: Object analogous to a well-established analog Comparator: Established analog's profile Hit rule: The object's profile matches a well-established analog on key features
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Analogy to a known object coherence OR latency OR susceptibility pubmed · 870020 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Analogy to a known object inconsistent OR contradicts pubmed · 27612 hits · run 2026-09-07
I5 · Latency coherenceno_data
Measure: Observed latency matches the mechanism's latency Comparator: Mechanism-predicted latency Hit rule: Observed onset latency is coherent with the mechanism's predicted latency
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Latency coherence coherence OR latency OR susceptibility pubmed · 870020 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Latency coherence inconsistent OR contradicts pubmed · 27612 hits · run 2026-09-07
J1 · Pre-specificationno_data
Measure: Window/hit-rule pre-specified before data Comparator: Pre-specified vs post-hoc Hit rule: The risk window, object, and hit rule were pre-specified before data were seen
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Pre-specification pre-specified OR adjudicated pubmed · 13548 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Pre-specification post-hoc OR hypothesis-generating only pubmed · 1698 hits · run 2026-09-07
3 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
does_not_resolve 35412949 · Human vaccines & immunotherapeutics (2022) — Explaining COVID-19 postvaccination-related immune thrombotic thrombocytopenia: a hypothesis-generating in-silico approach.
J2 · Contrary-evidence logno_data
Measure: Contrary evidence is logged, not omitted Comparator: Support-only dossier Hit rule: Contrary / null / refuting findings are logged and shown alongside support
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Contrary-evidence log pre-specified OR adjudicated pubmed · 13548 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Contrary-evidence log post-hoc OR hypothesis-generating only pubmed · 1698 hits · run 2026-09-07
3 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
does_not_resolve 35412949 · Human vaccines & immunotherapeutics (2022) — Explaining COVID-19 postvaccination-related immune thrombotic thrombocytopenia: a hypothesis-generating in-silico approach.
J3 · No temporality-only claimno_data
Measure: Claim not based on temporality alone Comparator: Sequence-only evidence Hit rule: The claim is not supported by temporal sequence alone (independent evidence exists)
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis No temporality-only claim pre-specified OR adjudicated pubmed · 13549 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis No temporality-only claim post-hoc OR hypothesis-generating only pubmed · 1699 hits · run 2026-09-07
3 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
does_not_resolve 35412949 · Human vaccines & immunotherapeutics (2022) — Explaining COVID-19 postvaccination-related immune thrombotic thrombocytopenia: a hypothesis-generating in-silico approach.
J4 · Passive-surveillance roleno_data
Measure: Passive-surveillance findings bounded correctly Comparator: Active-surveillance confirmation Hit rule: Passive-surveillance signals are framed as hypothesis-generating, not confirmatory
Finding: No evidence retrieved directly addresses passive-surveillance signals for myocarditis after COVID-19 vaccination. The retrieved studies focus on immune checkpoint inhibitor-related adverse events, cerebral microbleeds and thrombolysis, and hypothesis-generating in-silico analysis of vaccine-induced thrombosis, respectively. None report passive-surveillance findings for myocarditis.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Passive-surveillance role pre-specified OR adjudicated pubmed · 13548 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Passive-surveillance role post-hoc OR hypothesis-generating only pubmed · 1698 hits · run 2026-09-07
3 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
does_not_resolve 35412949 · Human vaccines & immunotherapeutics (2022) — Explaining COVID-19 postvaccination-related immune thrombotic thrombocytopenia: a hypothesis-generating in-silico approach.
J5 · Dose mappingno_data
Measure: Dose/lot exposure mapped to the object Comparator: Unmapped exposure Hit rule: Dose / lot exposure is mapped to the object where the mechanism predicts it
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Dose mapping pre-specified OR adjudicated pubmed · 13548 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Dose mapping post-hoc OR hypothesis-generating only pubmed · 1698 hits · run 2026-09-07
2 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
does_not_resolve 35412949 · Human vaccines & immunotherapeutics (2022) — Explaining COVID-19 postvaccination-related immune thrombotic thrombocytopenia: a hypothesis-generating in-silico approach.
Epidemiologic chassis 13/13 evaluated
B1 · Excess vs baselineno_data
Measure: RR/IRR vs unexposed or prior window Comparator: Unvaccinated person-time or pre-vaccination window Hit rule: RR/IRR > 1 with CI excluding 1 after pre-specified confounders
Finding: No retrieved evidence directly estimates the relative risk or incidence rate ratio of myocarditis following COVID-19 vaccination using a self-controlled case series design with a pre-specified risk window and confounder adjustment as required by the hit rule for this node.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Excess vs baseline incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no association OR null OR no increased risk Excess vs baseline pubmed · 89011 hits · run 2026-09-07
20 retrieved record(s)
does_not_resolve 29961876 · Nephrology, dialysis, transplantation : (2019) — Risk of acute kidney injury following community prescription of antibiotics: self-controlled case series.
refutes_node 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
ambiguous 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
ambiguous 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 42661284 · Expert review of vaccines (2026) — Stroke risk following BNT162b2 vaccination: a systematic review and meta-analysis of self-controlled case series studies.
does_not_resolve 36813998 · Eye (London, England) (2023) — Risk of retinal vein occlusion following COVID-19 vaccination: a self-controlled case series.
B2 · SCCSno_data
Measure: Self-controlled case series risk ratio Comparator: Individuals' own risk intervals (no-event) Hit rule: SCCS risk ratio > 1 in the post-vaccination window, CI excluding 1
Finding: No retrieved SCCS study directly reports a risk ratio for myocarditis after COVID-19 vaccination with a confidence interval excluding 1. The retrieved evidence includes SCCS studies on Guillain-Barré syndrome, arrhythmias, myasthenia gravis, retinal vein occlusion, and glucocorticoid use, but none provide a SCCS risk ratio for the specific pairwise exposure-outcome (COVID-19 vaccine -> myocarditis) with a post-vaccination window and CI excluding 1.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis SCCS incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no association OR null OR no increased risk SCCS pubmed · 89115 hits · run 2026-09-07
18 retrieved record(s)
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 33748963 · British journal of haematology (2021) — Glucocorticoid use and risk of first and recurrent venous thromboembolism: self-controlled case-series and cohort study.
does_not_resolve 36813998 · Eye (London, England) (2023) — Risk of retinal vein occlusion following COVID-19 vaccination: a self-controlled case series.
ambiguous 37806668 · Human vaccines & immunotherapeutics (2023) — Response to Dr. Somovilla del Saz's letter to the editor regarding "Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-a
ambiguous 35504917 · Signal transduction and targeted therapy (2022) — COVID-19 vaccine development: milestones, lessons and prospects.
B3 · Cohort / risk-intervalno_data
Measure: Incidence rate ratio in defined window Comparator: Pre-specified risk vs comparison interval Hit rule: IRR > 1 in the pre-specified window, CI excluding 1, stratified by age/sex
Finding: The retrieved evidence does not provide a cohort or risk-interval study reporting an incidence rate ratio (IRR) for myocarditis following COVID-19 vaccination, stratified by age and sex, with a pre-specified window and confidence interval excluding 1. Most retrieved studies address myocarditis as a general narrative review topic or examine other outcomes (e.g., Guillain-Barré syndrome, arrhythmias, retinal vein occlusion), and none perform a formal epidemiologic analysis meeting the node's hit rule.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Cohort / risk-interval incidence risk cohort OR self-controlled case series pubmed · 946 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no association OR null OR no increased risk Cohort / risk-interval pubmed · 88619 hits · run 2026-09-07
18 retrieved record(s)
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
does_not_resolve 33748963 · British journal of haematology (2021) — Glucocorticoid use and risk of first and recurrent venous thromboembolism: self-controlled case-series and cohort study.
does_not_resolve 36813998 · Eye (London, England) (2023) — Risk of retinal vein occlusion following COVID-19 vaccination: a self-controlled case series.
does_not_resolve 37806668 · Human vaccines & immunotherapeutics (2023) — Response to Dr. Somovilla del Saz's letter to the editor regarding "Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-a
ambiguous 35504917 · Signal transduction and targeted therapy (2022) — COVID-19 vaccine development: milestones, lessons and prospects.
does_not_resolve 37014337 · JAMA (2023) — Diagnosis and Treatment of Acute Myocarditis: A Review.
B4 · Meta-analysis / poolingno_data
Measure: Pooled effect across studies Comparator: Pooled estimate with heterogeneity Hit rule: Pooled estimate > 1 (or < 1) with quantified heterogeneity (I2)
Finding: No meta-analysis or pooled estimate of myocarditis risk after COVID-19 vaccination was identified in the retrieved evidence; one meta-analysis of self-controlled case series studies reported no significant association with all-cause or cardiac-related mortality, but did not specifically address myocarditis.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Meta-analysis / pooling incidence risk cohort OR self-controlled case series pubmed · 947 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no association OR null OR no increased risk Meta-analysis / pooling pubmed · 112446 hits · run 2026-09-07
19 retrieved record(s)
does_not_resolve 29961876 · Nephrology, dialysis, transplantation : (2019) — Risk of acute kidney injury following community prescription of antibiotics: self-controlled case series.
refutes_node 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 37534766 · Human vaccines & immunotherapeutics (2023) — Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-analysis of self-controlled case series studies.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 42661284 · Expert review of vaccines (2026) — Stroke risk following BNT162b2 vaccination: a systematic review and meta-analysis of self-controlled case series studies.
B5 · Negative-control outcomesno_data
Measure: No excess for outcomes the vaccine should not cause Comparator: Negative-control outcomes (unaffected by mechanism) Hit rule: Null for negative-control outcomes while target outcome is positive (specificity)
Finding: The retrieved evidence includes general discussion of COVID-19 vaccine-associated myocarditis in review articles and surveillance data, but no self-controlled case series or controlled study quantifying excess risk for myocarditis specifically as a negative-control outcome is provided; the only directly relevant study (PMID 36813998) found no increased risk of retinal vein occlusion, an unrelated outcome.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Negative-control outcomes incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no association OR null OR no increased risk Negative-control outcomes pubmed · 88822 hits · run 2026-09-07
18 retrieved record(s)
does_not_resolve 29961876 · Nephrology, dialysis, transplantation : (2019) — Risk of acute kidney injury following community prescription of antibiotics: self-controlled case series.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 33748963 · British journal of haematology (2021) — Glucocorticoid use and risk of first and recurrent venous thromboembolism: self-controlled case-series and cohort study.
does_not_resolve 36813998 · Eye (London, England) (2023) — Risk of retinal vein occlusion following COVID-19 vaccination: a self-controlled case series.
does_not_resolve 37806668 · Human vaccines & immunotherapeutics (2023) — Response to Dr. Somovilla del Saz's letter to the editor regarding "Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-a
ambiguous 35504917 · Signal transduction and targeted therapy (2022) — COVID-19 vaccine development: milestones, lessons and prospects.
B6 · Other-antigen comparisonno_data
Measure: Risk vs a different-antigen comparator Comparator: Comparator product with a different antigen Hit rule: Risk specific to the target antigen, not shared with the comparator antigen
Finding: No retrieved evidence directly addresses the risk of myocarditis after COVID-19 vaccination compared with a different-antigen comparator. The available studies focus on other adverse events (e.g., Guillain-Barré syndrome, arrhythmias, retinal vein occlusion) or on myocarditis in other contexts (e.g., SARS-CoV-2 infection, review articles), but none provide a head-to-head antigen comparison for myocarditis risk.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Other-antigen comparison incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no association OR null OR no increased risk Other-antigen comparison pubmed · 88584 hits · run 2026-09-07
18 retrieved record(s)
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
ambiguous 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 33748963 · British journal of haematology (2021) — Glucocorticoid use and risk of first and recurrent venous thromboembolism: self-controlled case-series and cohort study.
does_not_resolve 36813998 · Eye (London, England) (2023) — Risk of retinal vein occlusion following COVID-19 vaccination: a self-controlled case series.
does_not_resolve 37806668 · Human vaccines & immunotherapeutics (2023) — Response to Dr. Somovilla del Saz's letter to the editor regarding "Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-a
ambiguous 35504917 · Signal transduction and targeted therapy (2022) — COVID-19 vaccine development: milestones, lessons and prospects.
B7 · Absolute riskno_data
Measure: Per-100k risk in window Comparator: Absolute incidence per 100k Hit rule: Absolute risk reported and stable across the window (not an artifact of rarity)
Finding: No retrieved evidence directly reports absolute risk (per-100k) of myocarditis following COVID-19 vaccination within a specified risk window, or provides stable estimates across a window that are not artifacts of rarity.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Absolute risk incidence risk cohort OR self-controlled case series pubmed · 956 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no association OR null OR no increased risk Absolute risk pubmed · 111841 hits · run 2026-09-07
18 retrieved record(s)
does_not_resolve 29961876 · Nephrology, dialysis, transplantation : (2019) — Risk of acute kidney injury following community prescription of antibiotics: self-controlled case series.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
ambiguous 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 33748963 · British journal of haematology (2021) — Glucocorticoid use and risk of first and recurrent venous thromboembolism: self-controlled case-series and cohort study.
does_not_resolve 36813998 · Eye (London, England) (2023) — Risk of retinal vein occlusion following COVID-19 vaccination: a self-controlled case series.
does_not_resolve 37806668 · Human vaccines & immunotherapeutics (2023) — Response to Dr. Somovilla del Saz's letter to the editor regarding "Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-a
does_not_resolve 35504917 · Signal transduction and targeted therapy (2022) — COVID-19 vaccine development: milestones, lessons and prospects.
B8 · Platform splitno_data
Measure: Risk by vaccine platform / product Comparator: Platform (mRNA vs viral vector, etc.) Hit rule: Risk attributable to a specific platform, not to 'a vaccine' generally
Finding: No retrieved evidence specifically addresses the risk of myocarditis attributable to a specific COVID-19 vaccine platform (e.g., mRNA vs. viral vector vs. protein subunit) using a self-controlled case series design or other controlled epidemiologic method. The retrieved studies either examine other adverse events (e.g., Guillain-Barré syndrome, arrhythmias, retinal vein occlusion) or discuss myocarditis in a general, non-platform-specific manner (e.g., narrative reviews or unspecified vaccine type). One review (PMID 35504917) mentions that 'viral vector or mRNA vaccines may be associated with complications like ... myocarditis' but does not provide platform-specific risk estimates or controlled analyses.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Platform split incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no association OR null OR no increased risk Platform split pubmed · 88649 hits · run 2026-09-07
19 retrieved record(s)
does_not_resolve 29961876 · Nephrology, dialysis, transplantation : (2019) — Risk of acute kidney injury following community prescription of antibiotics: self-controlled case series.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 33748963 · British journal of haematology (2021) — Glucocorticoid use and risk of first and recurrent venous thromboembolism: self-controlled case-series and cohort study.
does_not_resolve 36813998 · Eye (London, England) (2023) — Risk of retinal vein occlusion following COVID-19 vaccination: a self-controlled case series.
does_not_resolve 37806668 · Human vaccines & immunotherapeutics (2023) — Response to Dr. Somovilla del Saz's letter to the editor regarding "Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-a
does_not_resolve 35504917 · Signal transduction and targeted therapy (2022) — COVID-19 vaccine development: milestones, lessons and prospects.
B9 · Host-structure stratificationno_data
Measure: Risk by age / sex / host structure Comparator: Unstratified estimate Hit rule: Risk concentrated in a defined host subgroup (e.g. young males), stable across sources
Finding: The retrieved evidence does not include any study that examines risk of myocarditis stratified by age, sex, or other host-structure subgroups after COVID-19 vaccination; most studies address mortality, arrhythmias, Guillain-Barré syndrome, or general safety, and none provide stable subgroup risk estimates for myocarditis.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Host-structure stratification incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no association OR null OR no increased risk Host-structure stratification pubmed · 88582 hits · run 2026-09-07
19 retrieved record(s)
does_not_resolve 29961876 · Nephrology, dialysis, transplantation : (2019) — Risk of acute kidney injury following community prescription of antibiotics: self-controlled case series.
refutes_node 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
supports_node 37534766 · Human vaccines & immunotherapeutics (2023) — Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-analysis of self-controlled case series studies.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
does_not_resolve 42661284 · Expert review of vaccines (2026) — Stroke risk following BNT162b2 vaccination: a systematic review and meta-analysis of self-controlled case series studies.
ambiguous 35504917 · Signal transduction and targeted therapy (2022) — COVID-19 vaccine development: milestones, lessons and prospects.
B10 · Formulation / component changeno_data
Measure: Risk tracks a formulation change Comparator: Pre- vs post-change formulation Hit rule: Risk change tracks a documented formulation / component change over time
Finding: No retrieved evidence directly evaluates whether COVID-19 vaccine-associated myocarditis risk tracks a documented formulation or component change over time.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Formulation / component change incidence risk cohort OR self-controlled case series pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no association OR null OR no increased risk Formulation / component change pubmed · 88744 hits · run 2026-09-07
17 retrieved record(s)
does_not_resolve 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 38089855 · European heart journal open (2023) — Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study.
ambiguous 37534766 · Human vaccines & immunotherapeutics (2023) — Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-analysis of self-controlled case series studies.
does_not_resolve 37223097 · Frontiers in immunology (2023) — Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study.
refutes_node 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 42661284 · Expert review of vaccines (2026) — Stroke risk following BNT162b2 vaccination: a systematic review and meta-analysis of self-controlled case series studies.
ambiguous 35504917 · Signal transduction and targeted therapy (2022) — COVID-19 vaccine development: milestones, lessons and prospects.
H2 · Formulation natural experimentno_data
Measure: Risk shifts with a formulation change in the field Comparator: Pre- vs post-change formulation Hit rule: Observed risk tracks a real-world formulation change (natural experiment)
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Formulation natural experiment intervention OR treatment OR reversal pubmed · 15141378 hits · run 2026-09-07
Measure: Risk signal appears/disappears across a pause or policy change Comparator: Pre- vs post-pause period Hit rule: The signal appears or disappears coherently with a rollout / pause (H4)
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Policy / pause signal intervention OR treatment OR reversal pubmed · 15141378 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Policy / pause signal no effect intervention pubmed · 0 hits (0 hits — negative) · run 2026-09-07
1 retrieved record(s)
does_not_resolve 16553322 · Revista do Instituto de Medicina Tropica (2005) — Study of antiretroviral mutants in HIV patients with treatment failures and the effect of risk factors in the virological failures.
I3 · Infection coherenceno_data
Measure: Pattern is coherent with or distinct from infection Comparator: Infection-matched comparison Hit rule: The post-vaccine pattern is coherent with (or clearly distinct from) the infection pattern
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Infection coherence coherence OR latency OR susceptibility pubmed · 870020 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Infection coherence inconsistent OR contradicts pubmed · 27612 hits · run 2026-09-07
Mediator & biological gradient 24/24 evaluated
C1n · Dose strength gradientno_data
Measure: Risk vs dose strength (dose size) Comparator: Lower dose strength Hit rule: Monotonic dose-response in dose strength (larger dose -> higher risk)
Finding: The retrieved evidence does not contain studies that evaluate monotonic dose-response by dose strength (e.g., comparing standard vs. higher/lower antigen dose or booster dose levels) for COVID-19 vaccine-associated myocarditis. Several retrieved papers discuss increased risk after the second dose compared to the first, which is a dose-number gradient, not a dose-strength gradient, and no study tests a monotonic relationship across multiple dose-strength levels.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Dose strength gradient dose-response OR dose effect pubmed · 1299132 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no dose effect OR no dose-response Dose strength gradient pubmed · 437 hits · run 2026-09-07
10 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
does_not_resolve 36090988 · Frontiers in immunology (2022) — A comprehensive analysis of the efficacy and effectiveness of COVID-19 vaccines.
supports_node 38350768 · Vaccine (2024) — COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals.
does_not_resolve 34477808 · JAMA (2021) — Surveillance for Adverse Events After COVID-19 mRNA Vaccination.
supports_node 36988252 · Immunity, inflammation and disease (2023) — Adverse events following COVID-19 mRNA vaccines: A systematic review of cardiovascular complication, thrombosis, and thrombocytopenia.
supports_node 41370400 · Science translational medicine (2025) — Inhibition of CXCL10 and IFN-γ ameliorates myocarditis in preclinical models of SARS-CoV-2 mRNA vaccination.
supports_node 34907393 · Nature medicine (2022) — Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection.
C2n · Dose number gradientsupports
Measure: Risk vs dose number (1st vs 2nd vs 3rd) Comparator: First dose Hit rule: Risk increases (or shows a defined pattern) with dose number
Finding: Multiple studies report that myocarditis after COVID-19 mRNA vaccination is more common after the second dose than after the first or third doses, consistent with a dose-number gradient.
supporting: COVID-19 vaccine Myocarditis Dose number gradient dose-response OR dose effect pubmed · 1299132 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no dose effect OR no dose-response Dose number gradient pubmed · 881 hits · run 2026-09-07
11 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
does_not_resolve 28000606 · Diseases of aquatic organisms (2016) — Development of Streptococcus agalactiae vaccines for tilapia.
supports_node 38350768 · Vaccine (2024) — COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals.
does_not_resolve 34477808 · JAMA (2021) — Surveillance for Adverse Events After COVID-19 mRNA Vaccination.
supports_node 36988252 · Immunity, inflammation and disease (2023) — Adverse events following COVID-19 mRNA vaccines: A systematic review of cardiovascular complication, thrombosis, and thrombocytopenia.
supports_node 41370400 · Science translational medicine (2025) — Inhibition of CXCL10 and IFN-γ ameliorates myocarditis in preclinical models of SARS-CoV-2 mRNA vaccination.
supports_node 34907393 · Nature medicine (2022) — Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection.
C3n · Measured-exposure tertilesmixed
Measure: Risk vs measured exposure tertile Comparator: Lowest-exposure tertile Hit rule: Risk ordered by measured-exposure tertile (high > mid > low)
Finding: The retrieved evidence includes multiple studies and reviews confirming that myocarditis is a rare adverse event following COVID-19 mRNA vaccination, with higher risk observed in young males after the second dose, consistent with a dose-response relationship by exposure (dose/tertile), but no retrieved study directly reports risk stratified by measured-exposure tertiles (high, mid, low) as defined for this node.
supporting: COVID-19 vaccine Myocarditis Measured-exposure tertiles dose-response OR dose effect pubmed · 1299132 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no dose effect OR no dose-response Measured-exposure tertiles pubmed · 326 hits · run 2026-09-07
10 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
supports_node 38350768 · Vaccine (2024) — COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals.
ambiguous 34477808 · JAMA (2021) — Surveillance for Adverse Events After COVID-19 mRNA Vaccination.
supports_node 41370400 · Science translational medicine (2025) — Inhibition of CXCL10 and IFN-γ ameliorates myocarditis in preclinical models of SARS-CoV-2 mRNA vaccination.
supports_node 36988252 · Immunity, inflammation and disease (2023) — Adverse events following COVID-19 mRNA vaccines: A systematic review of cardiovascular complication, thrombosis, and thrombocytopenia.
supports_node 34907393 · Nature medicine (2022) — Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection.
supports_node 37868673 · Journal of community hospital internal m (2023) — Covid- 19 Vaccine-induced Myocarditis.
C4n · Organoid concentration curveno_data
Measure: Effect vs antigen concentration in organoid Comparator: Vehicle / zero antigen Hit rule: Dose-dependent effect across a graded concentration curve
Finding: The retrieved evidence includes epidemiological studies on myocarditis following COVID-19 mRNA vaccination (e.g., PMID 34281357, 38350768, 34907393, 37868673, 38293564, 35289493) and mechanistic in vitro/human data suggesting immune mediators (PMID 41370400), but no study specifically reports a dose-dependent effect of antigen concentration in an organoid model. The node requires an organoid concentration-response curve, and no such data were found.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Organoid concentration curve dose-response OR dose effect pubmed · 1299132 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no dose effect OR no dose-response Organoid concentration curve pubmed · 337 hits · run 2026-09-07
10 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
supports_node 38350768 · Vaccine (2024) — COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals.
does_not_resolve 34477808 · JAMA (2021) — Surveillance for Adverse Events After COVID-19 mRNA Vaccination.
ambiguous 36988252 · Immunity, inflammation and disease (2023) — Adverse events following COVID-19 mRNA vaccines: A systematic review of cardiovascular complication, thrombosis, and thrombocytopenia.
supports_node 41370400 · Science translational medicine (2025) — Inhibition of CXCL10 and IFN-γ ameliorates myocarditis in preclinical models of SARS-CoV-2 mRNA vaccination.
supports_node 34907393 · Nature medicine (2022) — Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection.
ambiguous 37868673 · Journal of community hospital internal m (2023) — Covid- 19 Vaccine-induced Myocarditis.
C5n · EC50 vs Cmax coherenceno_data
Measure: Measured exposure reaches effect threshold Comparator: Pharmacokinetic Cmax vs EC50 Hit rule: Achieved exposure (Cmax/tissue) plausibly reaches the in-vitro EC50
Finding: Epidemiological studies and case series report that myocarditis occurs as a rare adverse event following COVID-19 mRNA vaccination, particularly in young males after the second dose, with onset typically within days and elevated troponin and abnormal ECG findings; however, no retrieved study reports measured Cmax/tissue concentrations relative to an in-vitro EC50 for this association.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis EC50 vs Cmax coherence dose-response OR dose effect pubmed · 1299132 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis no dose effect OR no dose-response EC50 vs Cmax coherence pubmed · 326 hits · run 2026-09-07
11 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
does_not_resolve 28000606 · Diseases of aquatic organisms (2016) — Development of Streptococcus agalactiae vaccines for tilapia.
supports_node 38350768 · Vaccine (2024) — COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals.
refutes_node 34477808 · JAMA (2021) — Surveillance for Adverse Events After COVID-19 mRNA Vaccination.
ambiguous 36988252 · Immunity, inflammation and disease (2023) — Adverse events following COVID-19 mRNA vaccines: A systematic review of cardiovascular complication, thrombosis, and thrombocytopenia.
supports_node 41370400 · Science translational medicine (2025) — Inhibition of CXCL10 and IFN-γ ameliorates myocarditis in preclinical models of SARS-CoV-2 mRNA vaccination.
supports_node 34907393 · Nature medicine (2022) — Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection.
E1 · Mediator identified in casessupports
Measure: Mediator present in affected tissue/cells Comparator: Unaffected tissue / control Hit rule: The hypothesized mediator is detected in the affected compartment and not (or less) in control
Finding: The study in PMID 41370400 identifies increased CXCL10 and IFN-γ in human plasma after mRNA vaccination and shows that neutralization of these mediators ameliorates myocarditis in preclinical models, supporting CXCL10 and IFN-γ as mediators detected in affected tissue.
supporting: COVID-19 vaccine Myocarditis mechanism Mediator identified in cases in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Mediator identified in cases not associated mechanism pubmed · 4 hits · run 2026-09-07
3 retrieved record(s)
ambiguous 41370400 · Science translational medicine (2025) — Inhibition of CXCL10 and IFN-γ ameliorates myocarditis in preclinical models of SARS-CoV-2 mRNA vaccination.
does_not_resolve 37716365 · The Lancet. Respiratory medicine (2023) — Efficacy of a bivalent (D614 + B.1.351) SARS-CoV-2 recombinant protein vaccine with AS03 adjuvant in adults: a phase 3, parallel, randomised, modified double-bl
does_not_resolve 34998242 · EBioMedicine (2022) — Lack of evidence of significant homology of SARS-CoV-2 spike sequences to myocarditis-associated antigens.
E2 · Mediator in healthy vaccineesno_data
Measure: Mediator detectable after vaccination Comparator: Pre-vaccination baseline Hit rule: Mediator appears after vaccination and tracks the exposure window
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis mechanism Mediator in healthy vaccinees in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Mediator in healthy vaccinees not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
E3 · Infection contrastno_data
Measure: Mediator absent/low after natural infection Comparator: Recovered natural infection Hit rule: Mediator signal is specific to vaccination vs a comparable natural-infection control
Finding: The retrieved evidence indicates that the incidence of myocarditis after COVID-19 vaccination (1–10 per million) is substantially lower than after COVID-19 infection (40 per million), and that vaccine-related cases are generally milder and more transient. However, none of the retrieved studies directly compare a mediator signal specific to vaccination versus a natural infection control, or assess mediator absence/low after natural infection as specified in the hit rule.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis mechanism Infection contrast in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Infection contrast not associated mechanism pubmed · 40 hits · run 2026-09-07
10 retrieved record(s)
does_not_resolve 37014337 · JAMA (2023) — Diagnosis and Treatment of Acute Myocarditis: A Review.
supports_node 36441403 · Current cardiology reports (2022) — COVID-19 Vaccine-Related Myocardial and Pericardial Inflammation.
ambiguous 36419861 · American journal of cardiovascular disea (2022) — Myocarditis presentation following COVID-19 virus infection versus COVID-19 vaccination.
supports_node 35153093 · Vaccine (2022) — Myocarditis following mRNA Covid-19 vaccination: A pooled analysis.
supports_node 36006062 · Tomography (Ann Arbor, Mich.) (2022) — Myocarditis Following COVID-19 Vaccination: Cardiac Imaging Findings in 118 Studies.
supports_node 35612967 · Journal of magnetic resonance imaging : (2022) — Cardiac MRI Findings in COVID-19 Vaccine-Related Myocarditis: A Pooled Analysis of 468 Patients.
supports_node 34704459 · AJR. American journal of roentgenology (2022) — Cardiac MRI Findings of Myocarditis After COVID-19 mRNA Vaccination in Adolescents.
E4 · Transfer to recipientno_data
Measure: Phenotype/mediator transferred to a recipient system Comparator: Control transfer Hit rule: The effect / mediator transfers to a naive recipient system
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis mechanism Transfer to recipient in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Transfer to recipient not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
E5 · Transfer specificityno_data
Measure: Transfer requires the specific mediator Comparator: Transfer with mediator present Hit rule: Transfer effect is lost when the specific mediator is removed
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis mechanism Transfer specificity in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Transfer specificity not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
E6 · Depletion / knockdownno_data
Measure: Removing the mediator reduces the effect Comparator: Non-targeted knockdown Hit rule: Knockdown / depletion of the mediator reduces the phenotype
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis mechanism Depletion / knockdown in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-07
Measure: Adding the mediator restores the effect Comparator: Add-back of a control protein Hit rule: Adding back the mediator (not a control) restores the phenotype
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis mechanism Add-back rescue in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Add-back rescue not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
E8 · Neutralizationsupports
Measure: Neutralizing the mediator blocks the effect Comparator: Isotype control Hit rule: Neutralization of the mediator (not an isotype control) blocks the phenotype
Finding: Neutralization of CXCL10 and IFN-γ ameliorates myocarditis in preclinical models of SARS-CoV-2 mRNA vaccination, indicating that these mediators are required for the phenotype and that their neutralization blocks the effect.
supporting: COVID-19 vaccine Myocarditis mechanism Neutralization in vitro OR patient-derived pubmed · 29240 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Neutralization not associated mechanism pubmed · 21 hits · run 2026-09-07
9 retrieved record(s)
supports_node 41370400 · Science translational medicine (2025) — Inhibition of CXCL10 and IFN-γ ameliorates myocarditis in preclinical models of SARS-CoV-2 mRNA vaccination.
does_not_resolve 38141632 · The Lancet. Infectious diseases (2024) — Immunogenicity and safety of a booster dose of a self-amplifying RNA COVID-19 vaccine (ARCT-154) versus BNT162b2 mRNA COVID-19 vaccine: a double-blind, multicen
refutes_node 35544369 · The New England journal of medicine (2022) — Evaluation of mRNA-1273 Covid-19 Vaccine in Children 6 to 11 Years of Age.
does_not_resolve 38839044 · Human vaccines & immunotherapeutics (2024) — Clinical development of SpikoGen®, an Advax-CpG55.2 adjuvanted recombinant spike protein vaccine.
refutes_node 38615382 · International immunopharmacology (2024) — Comparative safety profile of bivalent and original COVID-19 mRNA vaccines regarding myocarditis/pericarditis: A pharmacovigilance study.
refutes_node 40195167 · Expert review of vaccines (2025) — Safety profile of self-amplifying mRNA SARS-CoV-2 vaccine ARCT-154 in adults: a pooled phase 1/2/3 randomized clinical study.
ambiguous 35543726 · Innere Medizin (Heidelberg, Germany) (2022) — [Vaccines against coronavirus disease 2019 (COVID-19) : Efficacy comparison, safety aspects, and current challenges].
ambiguous 34788497 · Microbial biotechnology (2022) — mRNA vaccines against COVID-19: a showcase for the importance of microbial biotechnology.
E9 · Isotype controlno_data
Measure: Isotype control does not reproduce the effect Comparator: Active antibody Hit rule: An isotype control fails to reproduce the block/activation
Finding: No evidence was found that describes an isotype control experiment or any control that fails to reproduce an effect related to COVID-19 vaccine and myocarditis. The retrieved evidence includes a report of a direct antiglobulin test that was negative with standard anti-IgG reagents but positive with a reagent detecting all IgG isotypes, but this is about autoimmune hemolytic anemia, not myocarditis, and does not involve an isotype control reproducing or failing to reproduce a block or activation.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis mechanism Isotype control in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Isotype control not associated mechanism pubmed · 5 hits · run 2026-09-07
2 retrieved record(s)
supports_node 35763290 · Expert review of vaccines (2022) — Reactogenicity and immunogenicity of BNT162b2 or mRNA-1273 COVID-19 booster vaccinations after two doses of BNT162b2 among healthcare workers in Japan: a prospe
does_not_resolve 34549821 · Transfusion (2021) — Severe autoimmune hemolytic anemia following receipt of SARS-CoV-2 mRNA vaccine.
F1 · Full product reproducesno_data
Measure: Full vaccine product reproduces the effect Comparator: No-product control Hit rule: The full product (not a subcomponent) reproduces the effect
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Full product reproduces component OR antigen OR vector pubmed · 2045214 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Full product reproduces no effect component isolation pubmed · 0 hits (0 hits — negative) · run 2026-09-07
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
does_not_resolve 40276512 · Frontiers in immunology (2025) — Development of a novel adenovirus type 4 vector as a promising respiratory vaccine vehicle.
F2 · Empty vector / particleno_data
Measure: Vector/particle without antigen reproduces (or not) Comparator: Full product Hit rule: Effect attributed to (or excluded from) the vector/particle backbone alone
Finding: Retrieved evidence discusses virus-vectored influenza vaccines, live bacterial vaccine vectors, measles vaccine, adenovirus-vectored influenza vaccines, viral vector-based cancer vaccines, and Newcastle Disease Virus as a vaccine vector, but none of the abstracts report on myocarditis or any adverse cardiac event attributed to the vector/particle backbone of a COVID-19 vaccine.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Empty vector / particle component OR antigen OR vector pubmed · 2045214 hits · run 2026-09-07
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F4 · Irrelevant cargono_data
Measure: Irrelevant cargo does not reproduce the effect Comparator: Vector with the target antigen Hit rule: Irrelevant cargo fails to reproduce the effect (specificity)
Finding: Retrieved evidence describes virus-vectored influenza vaccines, live bacterial vaccine vectors, measles vaccine, adenovirus-vectored influenza vaccines, viral vector-based cancer vaccines, and Newcastle disease virus as a vaccine vector; none of these sources address COVID-19 vaccine-induced myocarditis or the specificity of irrelevant cargo failing to reproduce the effect.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Irrelevant cargo component OR antigen OR vector pubmed · 2045214 hits · run 2026-09-07
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F5 · Infection preparationno_data
Measure: Infection preparation vs product comparison Comparator: Product-derived preparation Hit rule: Effect compares correctly between infection and product preparations
Finding: No evidence found: The retrieved abstracts discuss viral-vectored influenza vaccines, live bacterial vaccine vectors, measles vaccine, adenovirus-vectored influenza vaccines, viral vector-based cancer vaccines, and Newcastle disease virus vaccine vectors. None of these address myocarditis following COVID-19 vaccination or any comparison between infection and product preparations relevant to myocarditis.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Infection preparation component OR antigen OR vector pubmed · 2045216 hits · run 2026-09-07
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F6 · Cytokine / adjuvant mixno_data
Measure: Cytokine/adjuvant mix alone reproduces (or not) Comparator: Individual components Hit rule: The effect is (or is not) reproducible by the cytokine/adjuvant mix alone
Finding: The retrieved evidence discusses viral and bacterial vaccine vectors as platforms for expressing heterologous antigens, but none of the abstracts mention myocarditis, cytokine/adjuvant mixes, or any test of whether a cytokine/adjuvant mix alone reproduces adverse events.
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Cytokine / adjuvant mix component OR antigen OR vector pubmed · 2045214 hits · run 2026-09-07
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F7 · Component combinationno_data
Measure: Defined component combination reproduces the effect Comparator: Single components Hit rule: A defined combination reproduces the effect that single components do not
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Component combination component OR antigen OR vector pubmed · 2045216 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Component combination no effect component isolation pubmed · 1 hits · run 2026-09-07
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
does_not_resolve 40276512 · Frontiers in immunology (2025) — Development of a novel adenovirus type 4 vector as a promising respiratory vaccine vehicle.
does_not_resolve 34833382 · Medicina (Kaunas, Lithuania) (2021) — Vaccine-Associated Thrombocytopenia and Thrombosis: Venous Endotheliopathy Leading to Venous Combined Micro-Macrothrombosis.
G1 · 2D human cellsno_data
Measure: Effect reproduced in 2D human cell culture Comparator: Untreated / control cells Hit rule: Effect reproduced in 2D primary human cells
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis 2D human cells animal OR organoid OR cell model pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis 2D human cells not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-07
G2 · Organoid / chipno_data
Measure: Effect reproduced in organoid / organ-on-chip Comparator: Unexposed organoid Hit rule: Effect reproduced in a 3D organoid / organ-on-chip system
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Organoid / chip animal OR organoid OR cell model pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Organoid / chip not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-07
H1 · Block in vitro / in vivono_data
Measure: Blocking the mediator/mechanism prevents the effect Comparator: Control intervention Hit rule: Blocking the mechanism prevents or reverses the effect (not with a control intervention)
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Block in vitro / in vivo intervention OR treatment OR reversal pubmed · 15141378 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Block in vitro / in vivo no effect intervention pubmed · 0 hits (0 hits — negative) · run 2026-09-07
1 retrieved record(s)
does_not_resolve 16553322 · Revista do Instituto de Medicina Tropica (2005) — Study of antiretroviral mutants in HIV patients with treatment failures and the effect of risk factors in the virological failures.
Clinical / animal / host 7/7 evaluated
E10 · Host-line dependenceno_data
Measure: Effect depends on host line/cell type Comparator: Susceptible host line Hit rule: Effect is restricted to a defined host line / genotype, not universal
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis mechanism Host-line dependence in vitro OR patient-derived pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Host-line dependence not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-07
G3 · Animal, clinical routeno_data
Measure: Effect in animal via the clinical route of administration Comparator: Vehicle, same route Hit rule: Effect reproduced in an animal using the clinical route of administration
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Animal, clinical route animal OR organoid OR cell model pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Animal, clinical route not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-07
G4 · Susceptible animalmixed
Measure: Effect in a susceptible animal model Comparator: Non-susceptible model Hit rule: Effect in a defined susceptible animal model
Finding: The 2026 study proposes a multi-hit model implicating lipid nanoparticle persistence in the heart as a key pathogenic contributor to myocarditis after mRNA vaccination, supported by preclinical evidence; the 2023 study evaluated SARS-CoV-2 mRNA-vaccine effects in murine models of myocarditis but does not provide direct evidence for a defined susceptible animal model establishing vaccine-attributable myocarditis.
supporting: COVID-19 vaccine Myocarditis Susceptible animal animal OR organoid OR cell model pubmed · 1818476 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Susceptible animal not reproduced model pubmed · 3 hits · run 2026-09-07
2 retrieved record(s)
ambiguous 36902442 · International journal of molecular scien (2023) — Effect of SARS-CoV-2 mRNA-Vaccine on the Induction of Myocarditis in Different Murine Animal Models.
does_not_resolve 42261850 · Mediators of inflammation (2026) — Myocarditis After mRNA Vaccination: A Metabolic-Innate Immune Cascade Centered on Lipid Nanoparticles.
G5 · Replication across labsno_data
Measure: Effect replicated in an independent lab Comparator: Original result Hit rule: The key effect is replicated in an independent laboratory
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Replication across labs animal OR organoid OR cell model pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Replication across labs not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-07
G6 · Blinded scoringno_data
Measure: Outcomes scored blinded Comparator: Unblinded reference Hit rule: Primary outcomes scored by a blinded assessor
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Blinded scoring animal OR organoid OR cell model pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Blinded scoring not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-07
G7 · Experimental time coursesupports
Measure: Effect follows a defined experimental time course Comparator: No-exposure time course Hit rule: The effect's onset/offset follows a defined experimental time course
Finding: Retrospective study of 44 VAMP patients required symptom onset ≤25 days after last vaccine dose, confirming a defined experimental time course of effect onset within a pre-specified risk window.
supporting: COVID-19 vaccine Myocarditis Experimental time course animal OR organoid OR cell model pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Experimental time course not reproduced model pubmed · 1 hits · run 2026-09-07
1 retrieved record(s)
supports_node 36913155 · The international journal of cardiovascu (2023) — Short term outcome of myocarditis and pericarditis following COVID-19 vaccines: a cardiac magnetic resonance imaging study.
I4 · Susceptibility traitno_data
Measure: A host trait / marker defines susceptibility Comparator: Trait-negative hosts Hit rule: A defined host trait / marker enriches for susceptibility
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myocarditis Susceptibility trait coherence OR latency OR susceptibility pubmed · 870020 hits · run 2026-09-07
mirror: COVID-19 vaccine Myocarditis Susceptibility trait inconsistent OR contradicts pubmed · 27612 hits · run 2026-09-07
How this was built
Per node: a supporting and a mirror PubMed query built from the node's measure / population / comparator / hit_rule; top hits fetched (title + abstract); each record classified (supports / refutes / ambiguous) by xAI with a heuristic fallback; a per-node synthesis is generated strictly from the retrieved PMIDs; the node status is then rolled up to C1–C6. Full query provenance is shown per node above. Reproduce the build: python -m evidence_run. Data: data/evidence_run/state.json.