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COVID-19 vaccine → Myopericarditis

Evidence dossier · candidate cand-covid-myopericarditis · CICP program · · DRAFT — not a determination
This is a draft research-tracking dossier, not a determination that COVID-19 vaccine causes Myopericarditis, 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)

ClaimLabelStatusMissing nodes
C1Coherent clinical object existssupported
C2Consistent temporal windowsupported
C3Epidemiologic excess riskcontested
C4Consistency / replicationcontested
C5Specificity (product / dose)supported
C6Biological mechanisminsufficient_datamissing: E1

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.

ViewpointWhat it asksStatus (from evidence)
Temporality (necessary)cause precedes effect in a plausible window (necessary)met · via A3 A4 A5
Strengthsize/precision of the associationnot established
Consistencyreproduced across settings/designsnot established
Specificitytied to a specific product/dose/outcomemet · via C2n
Biological gradientdose-responsemet · via C2n
Plausibilitya named biological mechanismmet · via E3
Coherencefits known biology/natural historymet · via A9 A10
Experimentintervention changes risknot established
Analogyprecedent for the patternnot established

NASEM weight-of-evidence synthesis (computed)

TrackWeightBasis
EpidemiologicLIMITEDvia B1, B2, B3, B4, B5, B8
MechanisticINTERMEDIATEvia A9, A10, C1n, C2n, C3n, C4n, C5n · missing: D1 D2 D3 D4 D5 E1 E2 E4 E5 E6 E7 E8 E9 E10 F1 F2 …
Synthesized conclusionInadequate to accept or reject

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 and case series describe new-onset myopericarditis or myocarditis occurring within days after COVID-19 mRNA vaccination, typically in young males, with onset in a defined risk window (2 days to 3 weeks), and after consideration of competing causes.
Cited: PMID 36301659 PMID 35128370 PMID 37139123 PMID 35371688 PMID 36540512 PMID 35935395 PMID 36441403 PMID 37775180
supporting: COVID-19 vaccine Myopericarditis case report OR case series Case reports
pubmed · 66213 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis alternative diagnosis OR not vaccine-related
pubmed · 4055 hits · run 2026-09-07
19 retrieved record(s)
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 35128370 · CJC open (2022) — COVID-19 Vaccination-Induced Myopericarditis: An Imager's Perspective.
supports_node 35004093 · Cureus (2022) — COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis.
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.
supports_node 36540512 · Cureus (2022) — COVID-19 Vaccine-Induced Acute Perimyocarditis: A Case Report.
supports_node 37484868 · Vaccine: X (2023) — Myocarditis following COVID-19 mRNA vaccinations: Twin and sibling case series.
supports_node 35935395 · European heart journal. Case reports (2022) — Case report: mRNA COVID-19 vaccine-related acute pericarditis with evolution to myopericarditis.
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 objective confirmation of myopericarditis after COVID-19 vaccination using cardiac magnetic resonance imaging, elevated cardiac biomarkers, echocardiography, or biopsy, with onset typically within days after vaccination.
Cited: PMID 35128370 PMID 35004093 PMID 37139123 PMID 36301659 PMID 35321100 PMID 35371688 PMID 36038960 PMID 36441403 PMID 37775180
supporting: COVID-19 vaccine Myopericarditis case report OR case series Series with objective confirmation
pubmed · 5700 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis alternative diagnosis OR not vaccine-related
pubmed · 4055 hits · run 2026-09-07
18 retrieved record(s)
supports_node 35128370 · CJC open (2022) — COVID-19 Vaccination-Induced Myopericarditis: An Imager's Perspective.
supports_node 35004093 · Cureus (2022) — COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis.
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 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 35321100 · Frontiers in cardiovascular medicine (2022) — Case Report: Two Case Reports of Acute Myopericarditis After mRNA COVID-19 Vaccine.
supports_node 35371688 · Cureus (2022) — Myocarditis Secondary to COVID-19 mRNA Vaccine: A Case Report.
supports_node 36038960 · Journal of Korean medical science (2022) — A Case Report for Acute Myopericarditis After NVX-CoV2373 (Novavax(®)) COVID-19 Vaccination.
ambiguous 33647971 · QJM : monthly journal of the Association (2021) — COVID-19 vaccine-related myositis.
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: Retrieved case reports and case series show that myopericarditis onset after COVID-19 mRNA vaccination clusters within days (24–72 hours to ~3 days) after dose, notably after the second dose, with a median onset of 3 days in one case series, and within 2 days to 2 weeks in individual reports, consistent with a non-uniform onset distribution within a pre-specified risk window.
Cited: PMID PMID 36301659 PMID PMID 35371688 PMID PMID 35321100 PMID PMID 35128370 PMID PMID 35935395
supporting: COVID-19 vaccine Myopericarditis case report OR case series Onset histogram
pubmed · 61 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis alternative diagnosis OR not vaccine-related
pubmed · 4055 hits · run 2026-09-07
22 retrieved record(s)
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
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 35004093 · Cureus (2022) — COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis.
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.
ambiguous 37692656 · Cureus (2023) — Takotsubo Cardiomyopathy Following COVID-19 Vaccine Booster Dose: A Case Report.
supports_node 37484868 · Vaccine: X (2023) — Myocarditis following COVID-19 mRNA vaccinations: Twin and sibling case series.
supports_node 35935395 · European heart journal. Case reports (2022) — Case report: mRNA COVID-19 vaccine-related acute pericarditis with evolution to myopericarditis.
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: Retrieved case reports and case series show that COVID-19 mRNA vaccine-associated myopericarditis typically presents with symptom onset within 2–7 days after vaccination, with a median of 3 days after the second dose, which is consistent with the expected latency for a post-vaccination immune-mediated inflammatory response.
Cited: PMID 36301659 PMID 35128370 PMID 35321100 PMID 35935395 PMID 37775180
supporting: COVID-19 vaccine Myopericarditis case report OR case series Temporal plausibility
pubmed · 90 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis alternative diagnosis OR not vaccine-related
pubmed · 4055 hits · run 2026-09-07
21 retrieved record(s)
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 35128370 · CJC open (2022) — COVID-19 Vaccination-Induced Myopericarditis: An Imager's Perspective.
supports_node 35004093 · Cureus (2022) — COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis.
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 35321100 · Frontiers in cardiovascular medicine (2022) — Case Report: Two Case Reports of Acute Myopericarditis After mRNA 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.
ambiguous 37692656 · Cureus (2023) — Takotsubo Cardiomyopathy Following COVID-19 Vaccine Booster Dose: 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: The retrieved evidence includes multiple case reports and series that explicitly document the onset interval between COVID-19 vaccination and myopericarditis symptoms, e.g., onset within days (2 days, 24-72 hours, 3 days, 2 weeks) in primary sources, often specifying the exact number of days post-vaccination.
Cited: PMID 36301659 PMID 35128370 PMID 35321100 PMID 35371688 PMID 35529098 PMID 35935395
supporting: COVID-19 vaccine Myopericarditis case report OR case series Onset-interval documentation
pubmed · 59 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis alternative diagnosis OR not vaccine-related
pubmed · 4055 hits · run 2026-09-07
22 retrieved record(s)
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 35128370 · CJC open (2022) — COVID-19 Vaccination-Induced Myopericarditis: An Imager's Perspective.
supports_node 35004093 · Cureus (2022) — COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis.
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 35321100 · Frontiers in cardiovascular medicine (2022) — Case Report: Two Case Reports of Acute Myopericarditis After mRNA 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.
does_not_resolve 37692656 · Cureus (2023) — Takotsubo Cardiomyopathy Following COVID-19 Vaccine Booster Dose: A Case Report.
A6 · Differential diagnosis excludedno_data
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 includes multiple case series and reviews describing COVID-19 vaccine-associated myopericarditis, but none of the studies explicitly report that pre-specified competing causes (e.g., viral or other etiologies) were systematically assessed and excluded per the working definition.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis case report OR case series Differential diagnosis excluded
pubmed · 486 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis alternative diagnosis OR not vaccine-related
pubmed · 4055 hits · run 2026-09-07
13 retrieved record(s)
supports_node 35128370 · CJC open (2022) — COVID-19 Vaccination-Induced Myopericarditis: An Imager's Perspective.
supports_node 37139123 · Frontiers in cardiovascular medicine (2023) — Case report: mRNA-1273 COVID-19 vaccine-associated myopericarditis: Successful treatment and re-exposure with colchicine.
does_not_resolve 41306776 · Frontiers in pharmacology (2025) — HPV vaccine-related thyroid adverse events: temporal patterns and reporting trends.
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.
supports_node 37775180 · Clinical medicine (London, England) (2023) — SARS-CoV-2 vaccines and myocarditis.
ambiguous 40902666 · Journal of the American Academy of Derma (2026) — Drug and vaccine-associated pemphigoid in patients aged 50 years and older: A pharmacovigilance study.
does_not_resolve 30000765 · (2006) — Human Papillomavirus Vaccines.
A7 · Rechallenge / re-exposuresupports
Measure: Object recurs on a further dose
Comparator: First-dose response
Hit rule: Object recurs after a subsequent dose (re-exposure)
Finding: A single case report (PMID 37139123) describes successful re-exposure to an mRNA COVID-19 vaccine (second and third doses) in a patient who had myopericarditis after the first dose, with no recurrence of myopericarditis when prophylactic colchicine was used. Other retrieved case reports describe myopericarditis after a first or second dose but do not provide evidence of recurrence on re-exposure.
Cited: PMID 37139123
supporting: COVID-19 vaccine Myopericarditis case report OR case series Rechallenge / re-exposure
pubmed · 61 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis alternative diagnosis OR not vaccine-related
pubmed · 4055 hits · run 2026-09-07
22 retrieved record(s)
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 35004093 · Cureus (2022) — COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis.
supports_node 35371688 · Cureus (2022) — Myocarditis Secondary to COVID-19 mRNA Vaccine: A Case Report.
supports_node 36038960 · Journal of Korean medical science (2022) — A Case Report for Acute Myopericarditis After NVX-CoV2373 (Novavax(®)) COVID-19 Vaccination.
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 36540512 · Cureus (2022) — COVID-19 Vaccine-Induced Acute Perimyocarditis: A Case Report.
ambiguous 34588400 · Circulation journal : official journal o (2022) — Myopericarditis After COVID-19 mRNA Vaccination.
supports_node 35935395 · European heart journal. Case reports (2022) — Case report: mRNA COVID-19 vaccine-related acute pericarditis with evolution to myopericarditis.
A8 · Adjudicated by criteria (Brighton Collaboration)supports
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 myopericarditis occurring shortly after COVID-19 vaccination, with cases adjudicated by cardiac magnetic resonance imaging, elevated biomarkers, and clinical criteria meeting published definitions of myocarditis or myopericarditis.
Cited: PMID 35128370 PMID 37139123 PMID 35321100 PMID 36301659 PMID 35371688 PMID 36038960 PMID 36540512 PMID 35935395
supporting: COVID-19 vaccine Myopericarditis case report OR case series Adjudicated by criteria
pubmed · 98 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis alternative diagnosis OR not vaccine-related
pubmed · 4055 hits · run 2026-09-07
21 retrieved record(s)
supports_node 35128370 · CJC open (2022) — COVID-19 Vaccination-Induced Myopericarditis: An Imager's Perspective.
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 35004093 · Cureus (2022) — COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis.
supports_node 35321100 · Frontiers in cardiovascular medicine (2022) — Case Report: Two Case Reports of Acute Myopericarditis After mRNA COVID-19 Vaccine.
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 35371688 · Cureus (2022) — Myocarditis Secondary to COVID-19 mRNA Vaccine: A Case Report.
supports_node 36038960 · Journal of Korean medical science (2022) — A Case Report for Acute Myopericarditis After NVX-CoV2373 (Novavax(®)) COVID-19 Vaccination.
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 and series describe onset of myopericarditis within days (median 3 days) after mRNA COVID-19 vaccination, predominantly in young males, with elevated troponins, cardiac imaging findings consistent with myocarditis, and a generally benign clinical course with symptom resolution, matching the natural history of acute myopericarditis.
Cited: PMID 36301659 PMID 35128370 PMID 35004093 PMID 37139123 PMID 35371688 PMID 36540512 PMID 36441403 PMID 37775180
supporting: COVID-19 vaccine Myopericarditis case report OR case series Natural-history consistency
pubmed · 162 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis alternative diagnosis OR not vaccine-related
pubmed · 4055 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 35128370 · CJC open (2022) — COVID-19 Vaccination-Induced Myopericarditis: An Imager's Perspective.
supports_node 35004093 · Cureus (2022) — COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis.
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.
supports_node 36540512 · Cureus (2022) — COVID-19 Vaccine-Induced Acute Perimyocarditis: 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.
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 and case series describe myopericarditis following COVID-19 vaccination, with onset typically within days after the second dose, predominantly in young males, and with evidence of cardiac inflammation documented by cardiac MRI or biopsy, often after excluding other causes.
Cited: PMID 35128370 PMID 37139123 PMID 35004093 PMID 35371688 PMID 36038960 PMID 36301659 PMID 36540512 PMID 34588400 PMID 35935395 PMID 37692656 PMID 35082004 PMID 33647971 PMID 36441403 PMID 37775180
supporting: COVID-19 vaccine Myopericarditis case report OR case series No confounding object
pubmed · 78 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis alternative diagnosis OR not vaccine-related
pubmed · 4055 hits · run 2026-09-07
21 retrieved record(s)
supports_node 35128370 · CJC open (2022) — COVID-19 Vaccination-Induced Myopericarditis: An Imager's Perspective.
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 35004093 · Cureus (2022) — COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis.
supports_node 35371688 · Cureus (2022) — Myocarditis Secondary to COVID-19 mRNA Vaccine: A Case Report.
supports_node 36038960 · Journal of Korean medical science (2022) — A Case Report for Acute Myopericarditis After NVX-CoV2373 (Novavax(®)) COVID-19 Vaccination.
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 36540512 · Cureus (2022) — COVID-19 Vaccine-Induced Acute Perimyocarditis: A Case Report.
ambiguous 34588400 · Circulation journal : official journal o (2022) — Myopericarditis After COVID-19 mRNA Vaccination.
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 Myopericarditis anatomic localization Predicted site of injury mechanism
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis anatomic localization Spared structures mechanism
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 Myopericarditis anatomic localization Local vs systemic distribution mechanism
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 Myopericarditis anatomic localization Kinetics class mechanism
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 Myopericarditis anatomic localization Platform-mechanism match mechanism
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 Myopericarditis Targeted treatment reverses intervention OR treatment OR reversal
pubmed · 15141378 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Targeted treatment reverses no effect intervention
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
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 Myopericarditis No internal contradiction coherence OR latency OR susceptibility
pubmed · 870020 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis No internal contradiction inconsistent OR contradicts
pubmed · 27612 hits · run 2026-09-07
1 retrieved record(s)
does_not_resolve 25187623 · Reproduction (Cambridge, England) (2014) — Epigenetics and life-long consequences of an adverse nutritional and diabetic intrauterine environment.
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 Myopericarditis Analogy to a known object coherence OR latency OR susceptibility
pubmed · 870020 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Analogy to a known object inconsistent OR contradicts
pubmed · 27612 hits · run 2026-09-07
1 retrieved record(s)
does_not_resolve 25187623 · Reproduction (Cambridge, England) (2014) — Epigenetics and life-long consequences of an adverse nutritional and diabetic intrauterine environment.
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 Myopericarditis Latency coherence coherence OR latency OR susceptibility
pubmed · 870020 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 Myopericarditis Pre-specification pre-specified OR adjudicated
pubmed · 13548 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 42474879 · Biological trace element research (2026) — Cadmium Exposure and Osteoporosis: A Spatially Contextualized Adverse Outcome Pathway Integrating Epidemiology, Toxicogenomics and Transcriptomics.
does_not_resolve 42569385 · Frontiers in medicine (2026) — Antibiotic-associated adverse events in bone and joint infections: a FAERS pharmacovigilance study.
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 Myopericarditis Contrary-evidence log pre-specified OR adjudicated
pubmed · 13548 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Contrary-evidence log 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 42474879 · Biological trace element research (2026) — Cadmium Exposure and Osteoporosis: A Spatially Contextualized Adverse Outcome Pathway Integrating Epidemiology, Toxicogenomics and Transcriptomics.
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 Myopericarditis No temporality-only claim pre-specified OR adjudicated
pubmed · 13548 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis No temporality-only claim 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 26296519 · Neurology (2015) — Cerebral microbleeds and postthrombolysis intracerebral hemorrhage risk Updated meta-analysis.
does_not_resolve 38983297 · Radiology case reports (2024) — Identification of perineural invasion at imaging staging as a novel potential risk factor in rectal cancer: A case report.
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 found
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Passive-surveillance role pre-specified OR adjudicated
pubmed · 13548 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Passive-surveillance role 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 42569385 · Frontiers in medicine (2026) — Antibiotic-associated adverse events in bone and joint infections: a FAERS pharmacovigilance study.
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 retrieved evidence addresses dose/lot exposure mapping for myopericarditis following COVID-19 vaccination.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Dose mapping pre-specified OR adjudicated
pubmed · 13548 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Dose mapping post-hoc OR hypothesis-generating only
pubmed · 1698 hits · run 2026-09-07
4 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 42569385 · Frontiers in medicine (2026) — Antibiotic-associated adverse events in bone and joint infections: a FAERS pharmacovigilance study.
does_not_resolve 26296519 · Neurology (2015) — Cerebral microbleeds and postthrombolysis intracerebral hemorrhage risk Updated meta-analysis.
does_not_resolve 38983297 · Radiology case reports (2024) — Identification of perineural invasion at imaging staging as a novel potential risk factor in rectal cancer: A case report.

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: Two case reports describe myocarditis within days after mRNA COVID-19 vaccination, but no controlled epidemiological study (e.g., self-controlled case series or cohort) among the retrieved evidence provides an RR or IRR with a confidence interval excluding 1 for the association between COVID-19 vaccine and myopericarditis.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Excess vs baseline incidence risk cohort OR self-controlled case series
pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no association OR null OR no increased risk Excess vs baseline
pubmed · 88532 hits · run 2026-09-07
9 retrieved record(s)
does_not_resolve 30172612 · American journal of infection control (2019) — Antibiotic exposure and risk of community-associated Clostridium difficile infection: A self-controlled case series analysis.
does_not_resolve 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: 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 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
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.
supports_node 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
does_not_resolve 34489307 · Gut (2022) — Non-alcoholic fatty liver disease and incident major adverse cardiovascular events: results from a nationwide histology cohort.
does_not_resolve 40794640 · European heart journal (2026) — Cardiovascular benefit of continuous positive airway pressure according to high-risk obstructive sleep apnoea: a multi-trial analysis.
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: One SCCS study (PMID 40664645) reported a relative risk estimate for myo/pericarditis after XBB.1.5-containing COVID-19 mRNA vaccines, but the abstract does not provide the risk ratio or confidence interval, and no other SCCS studies in the retrieved list directly address myopericarditis risk after COVID-19 vaccination with a risk ratio >1 and CI excluding 1.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis SCCS incidence risk cohort OR self-controlled case series
pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no association OR null OR no increased risk SCCS
pubmed · 88640 hits · run 2026-09-07
13 retrieved record(s)
refutes_node 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 33773635 · The Lancet. Public health (2021) — Periods of altered risk for non-fatal drug overdose: a self-controlled case series.
does_not_resolve 40818314 · Vaccine (2025) — COVID-19 vaccination and the risk of abnormal uterine bleeding: A nationwide 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.
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 36226469 · Epilepsia (2022) — Association between the risk of seizure and COVID-19 vaccinations: A self-controlled case-series study.
supports_node 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
B3 · Cohort / risk-intervalmixed
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: Two self-controlled case series studies (PMID 40664645 and 36469338) assessed myopericarditis risk after COVID-19 mRNA vaccination; the former found an elevated relative incidence in the risk window, and the latter meta-analysis confirmed increased risk in adolescents and young adults. Case reports (PMID 35289493, 37139123, 36301659, 36540512) document individual cases, but the node requires IRR >1 with CI excluding 1, stratified by age/sex—only the SCCS studies approach this standard, but neither explicitly provides IRR estimates with age/sex-stratified CIs for this pair.
Cited: PMID 40664645 PMID 36469338 PMID 35289493 PMID 37139123 PMID 36301659 PMID 36540512
supporting: COVID-19 vaccine Myopericarditis Cohort / risk-interval incidence risk cohort OR self-controlled case series
pubmed · 946 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no association OR null OR no increased risk Cohort / risk-interval
pubmed · 88140 hits · run 2026-09-07
13 retrieved record(s)
does_not_resolve 33773635 · The Lancet. Public health (2021) — Periods of altered risk for non-fatal drug overdose: a self-controlled case series.
does_not_resolve 40818314 · Vaccine (2025) — COVID-19 vaccination and the risk of abnormal uterine bleeding: A nationwide 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 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
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 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
supports_node 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
supports_node 37139123 · Frontiers in cardiovascular medicine (2023) — Case report: mRNA-1273 COVID-19 vaccine-associated myopericarditis: Successful treatment and re-exposure with colchicine.
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: PMID 40664645 (2025) reports a relative risk estimate for myo/pericarditis following XBB.1.5-containing COVID-19 mRNA vaccines in a self-controlled case series, but does not provide the numerical pooled estimate or heterogeneity measure needed for this node. PMID 35289493 (2023) is a narrative review describing myopericarditis after mRNA vaccination but is not a meta-analysis with pooled estimates and quantified heterogeneity. No retrieved study provides a pooled effect estimate with I² for myopericarditis after COVID-19 vaccination.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Meta-analysis / pooling incidence risk cohort OR self-controlled case series
pubmed · 946 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no association OR null OR no increased risk Meta-analysis / pooling
pubmed · 111971 hits · run 2026-09-07
13 retrieved record(s)
does_not_resolve 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 33773635 · The Lancet. Public health (2021) — Periods of altered risk for non-fatal drug overdose: a self-controlled case series.
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 40818314 · Vaccine (2025) — COVID-19 vaccination and the risk of abnormal uterine bleeding: A nationwide 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 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 36226469 · Epilepsia (2022) — Association between the risk of seizure and COVID-19 vaccinations: A self-controlled case-series study.
does_not_resolve 35489031 · Journal of clinical psychopharmacology (2022) — Prescription Stimulants and the Risk of Psychosis: A Systematic Review of Observational 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: No retrieved evidence addresses negative-control outcomes for myopericarditis after COVID-19 vaccination; the only relevant study (PMID 35289493) is a descriptive review of case reports, not an epidemiologic assessment of excess risk in a negative-control context.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Negative-control outcomes incidence risk cohort OR self-controlled case series
pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no association OR null OR no increased risk Negative-control outcomes
pubmed · 88343 hits · run 2026-09-07
9 retrieved record(s)
does_not_resolve 30172612 · American journal of infection control (2019) — Antibiotic exposure and risk of community-associated Clostridium difficile infection: A self-controlled case series analysis.
refutes_node 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 33773635 · The Lancet. Public health (2021) — Periods of altered risk for non-fatal drug overdose: a self-controlled case series.
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 40818314 · Vaccine (2025) — COVID-19 vaccination and the risk of abnormal uterine bleeding: A nationwide 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 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
supports_node 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
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: The retrieved evidence includes case reports and review articles describing myopericarditis following COVID-19 mRNA vaccination, but no study provides a direct risk comparison against a different-antigen comparator (e.g., another vaccine) as required for Node B6. The SCCS studies focus on mortality, arrhythmias, or other vaccines (e.g., Clostridium difficile, Guillain-Barré syndrome) and do not address this specific comparison.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Other-antigen comparison incidence risk cohort OR self-controlled case series
pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no association OR null OR no increased risk Other-antigen comparison
pubmed · 88105 hits · run 2026-09-07
12 retrieved record(s)
does_not_resolve 30172612 · American journal of infection control (2019) — Antibiotic exposure and risk of community-associated Clostridium difficile infection: A self-controlled case series analysis.
refutes_node 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: 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 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
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.
supports_node 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
ambiguous 41317434 · Vaccine (2026) — Revaccination of individuals with cardiac adverse events following COVID-19 vaccination: A Canadian Immunization Research Network study.
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: A 2023 review (PMID 35289493) notes that myopericarditis can occur as an adverse effect of COVID-19 mRNA vaccination, but does not report an absolute risk per 100,000 within a defined risk window. No retrieved study provides a stable per-100k absolute risk estimate for this outcome.
Cited: PMID 35289493
supporting: COVID-19 vaccine Myopericarditis Absolute risk incidence risk cohort OR self-controlled case series
pubmed · 948 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no association OR null OR no increased risk Absolute risk
pubmed · 111370 hits · run 2026-09-07
12 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 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
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 29211679 · The New England journal of medicine (2017) — Contemporary Hormonal Contraception and the Risk of Breast Cancer.
does_not_resolve 23484825 · The New England journal of medicine (2013) — Risk of ischemic heart disease in women after radiotherapy for breast cancer.
supports_node 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
does_not_resolve 26950145 · Nutrients (2016) — An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity.
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: PMID 40664645 2025 reports that myopericarditis was assessed as an adverse event following XBB.1.5-containing COVID-19 mRNA vaccination using a self-controlled case series design, but no specific risk estimate or attribution by platform is provided in the abstract. Two additional references (PMID 35289493 2023; PMID 41317434 2026) describe myopericarditis as a rare adverse event of mRNA COVID-19 vaccines, with the latter focusing on revaccination safety. None of the retrieved evidence isolates attributable risk to a specific platform in a manner that directly addresses the node's hit rule.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Platform split incidence risk cohort OR self-controlled case series
pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no association OR null OR no increased risk Platform split
pubmed · 88170 hits · run 2026-09-07
11 retrieved record(s)
refutes_node 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: 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 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
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 36226469 · Epilepsia (2022) — Association between the risk of seizure and COVID-19 vaccinations: 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 35489031 · Journal of clinical psychopharmacology (2022) — Prescription Stimulants and the Risk of Psychosis: A Systematic Review of Observational Studies.
ambiguous 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
B9 · Host-structure stratificationsupports
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 includes case reports and a systematic review indicating that myopericarditis after COVID-19 mRNA vaccination is concentrated in adolescent and young adult males, typically within days of the second dose (PMID 35289493, PMID 36301659, PMID 36540512, PMID 36469338).
Cited: PMID 35289493 PMID 36301659 PMID 36540512 PMID 36469338
supporting: COVID-19 vaccine Myopericarditis Host-structure stratification incidence risk cohort OR self-controlled case series
pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no association OR null OR no increased risk Host-structure stratification
pubmed · 88103 hits · run 2026-09-07
14 retrieved record(s)
does_not_resolve 30172612 · American journal of infection control (2019) — Antibiotic exposure and risk of community-associated Clostridium difficile infection: A self-controlled case series analysis.
does_not_resolve 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 33773635 · The Lancet. Public health (2021) — Periods of altered risk for non-fatal drug overdose: a self-controlled case series.
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 40818314 · Vaccine (2025) — COVID-19 vaccination and the risk of abnormal uterine bleeding: A nationwide 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 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 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
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 examines whether the risk of myopericarditis after COVID-19 vaccination tracks a documented formulation or component change over time.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Formulation / component change incidence risk cohort OR self-controlled case series
pubmed · 945 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no association OR null OR no increased risk Formulation / component change
pubmed · 88265 hits · run 2026-09-07
11 retrieved record(s)
does_not_resolve 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 33773635 · The Lancet. Public health (2021) — Periods of altered risk for non-fatal drug overdose: a self-controlled case series.
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 40818314 · Vaccine (2025) — COVID-19 vaccination and the risk of abnormal uterine bleeding: A nationwide 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 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 36226469 · Epilepsia (2022) — Association between the risk of seizure and COVID-19 vaccinations: A self-controlled case-series study.
does_not_resolve 35489031 · Journal of clinical psychopharmacology (2022) — Prescription Stimulants and the Risk of Psychosis: A Systematic Review of Observational Studies.
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 Myopericarditis Formulation natural experiment intervention OR treatment OR reversal
pubmed · 15141378 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Formulation natural experiment no effect intervention
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
H4 · Policy / pause signalno_data
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 Myopericarditis Policy / pause signal intervention OR treatment OR reversal
pubmed · 15141378 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Policy / pause signal no effect intervention
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
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 Myopericarditis Infection coherence coherence OR latency OR susceptibility
pubmed · 870020 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Infection coherence inconsistent OR contradicts
pubmed · 27612 hits · run 2026-09-07
1 retrieved record(s)
does_not_resolve 25187623 · Reproduction (Cambridge, England) (2014) — Epigenetics and life-long consequences of an adverse nutritional and diabetic intrauterine environment.

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 contains case reports and systematic reviews describing myopericarditis following COVID-19 vaccination, but no study directly examines or reports a monotonic dose-response gradient in risk by dose strength (larger dose vs. smaller dose).
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Dose strength gradient dose-response OR dose effect
pubmed · 1299132 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no dose effect OR no dose-response Dose strength gradient
pubmed · 178 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 36090988 · Frontiers in immunology (2022) — A comprehensive analysis of the efficacy and effectiveness of COVID-19 vaccines.
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 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
supports_node 36038960 · Journal of Korean medical science (2022) — A Case Report for Acute Myopericarditis After NVX-CoV2373 (Novavax(®)) COVID-19 Vaccination.
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 35421376 · The Lancet. Respiratory medicine (2022) — Myopericarditis following COVID-19 vaccination and non-COVID-19 vaccination: a systematic review and meta-analysis.
ambiguous 37692656 · Cureus (2023) — Takotsubo Cardiomyopathy Following COVID-19 Vaccine Booster Dose: A Case Report.
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 systematic reviews and meta-analyses report that the risk of myopericarditis following COVID-19 mRNA vaccination is higher after the second dose compared to the first dose, particularly in adolescent males, with onset typically within 1–5 days post-vaccination.
Cited: PMID 36988252 PMID 35289493 PMID 35421376 PMID 35317093 PMID 39229736 PMID 36469338 PMID 35529098 PMID 37246067
supporting: COVID-19 vaccine Myopericarditis Dose number gradient dose-response OR dose effect
pubmed · 1299132 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no dose effect OR no dose-response Dose number gradient
pubmed · 622 hits · run 2026-09-07
12 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 36988252 · Immunity, inflammation and disease (2023) — Adverse events following COVID-19 mRNA vaccines: A systematic review of cardiovascular complication, thrombosis, and thrombocytopenia.
supports_node 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
ambiguous 37692656 · Cureus (2023) — Takotsubo Cardiomyopathy Following COVID-19 Vaccine Booster Dose: A Case Report.
supports_node 35421376 · The Lancet. Respiratory medicine (2022) — Myopericarditis following COVID-19 vaccination and non-COVID-19 vaccination: a systematic review and meta-analysis.
supports_node 35317093 · Journal of medical cases (2022) — Transient Myopericarditis Following Vaccination for COVID-19.
supports_node 39229736 · Singapore medical journal (2024) — Myopericarditis following COVID-19 vaccination in children: a systematic review and meta-analysis.
C3n · Measured-exposure tertilesno_data
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 does not contain any data on adverse event risk ordered by measured-exposure tertiles for COVID-19 vaccine and myopericarditis; all included studies report on incidence, case series, or systematic reviews of post-vaccination myopericarditis without stratifying risk by tertiles of measured exposure.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Measured-exposure tertiles dose-response OR dose effect
pubmed · 1299132 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no dose effect OR no dose-response Measured-exposure tertiles
pubmed · 67 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.
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 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
supports_node 36038960 · Journal of Korean medical science (2022) — A Case Report for Acute Myopericarditis After NVX-CoV2373 (Novavax(®)) COVID-19 Vaccination.
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 35421376 · The Lancet. Respiratory medicine (2022) — Myopericarditis following COVID-19 vaccination and non-COVID-19 vaccination: a systematic review and meta-analysis.
does_not_resolve 37692656 · Cureus (2023) — Takotsubo Cardiomyopathy Following COVID-19 Vaccine Booster Dose: A Case Report.
supports_node 35082004 · Cardiology in the young (2022) — A paediatric case of myopericarditis post-COVID-19 mRNA vaccine.
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 on myopericarditis following COVID-19 vaccination includes multiple case reports and systematic reviews, but none provide data on a dose-dependent effect across a graded antigen concentration curve in organoids. The studies focus on clinical incidence, timing, and patient demographics, not on in vitro concentration-response relationships.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Organoid concentration curve dose-response OR dose effect
pubmed · 1299132 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no dose effect OR no dose-response Organoid concentration curve
pubmed · 78 hits · run 2026-09-07
12 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 36988252 · Immunity, inflammation and disease (2023) — Adverse events following COVID-19 mRNA vaccines: A systematic review of cardiovascular complication, thrombosis, and thrombocytopenia.
supports_node 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
supports_node 36038960 · Journal of Korean medical science (2022) — A Case Report for Acute Myopericarditis After NVX-CoV2373 (Novavax(®)) COVID-19 Vaccination.
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
supports_node 35421376 · The Lancet. Respiratory medicine (2022) — Myopericarditis following COVID-19 vaccination and non-COVID-19 vaccination: a systematic review and meta-analysis.
ambiguous 37692656 · Cureus (2023) — Takotsubo Cardiomyopathy Following COVID-19 Vaccine Booster Dose: A Case Report.
supports_node 35082004 · Cardiology in the young (2022) — A paediatric case of myopericarditis post-COVID-19 mRNA vaccine.
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: Multiple systematic reviews and meta-analyses confirm that myopericarditis occurs as a rare adverse event after COVID-19 mRNA vaccination, particularly in adolescent and young adult males within days of the second dose, with incidence rates reported (e.g., 40.6 cases per million in males ≤30 years). However, the retrieved evidence does not provide any data on measured Cmax/tissue exposure or EC50 thresholds for the COVID-19 vaccine, and thus does not address the in-vitro EC50 vs Cmax coherence node.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis EC50 vs Cmax coherence dose-response OR dose effect
pubmed · 1299132 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis no dose effect OR no dose-response EC50 vs Cmax coherence
pubmed · 67 hits · run 2026-09-07
12 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 36988252 · Immunity, inflammation and disease (2023) — Adverse events following COVID-19 mRNA vaccines: A systematic review of cardiovascular complication, thrombosis, and thrombocytopenia.
supports_node 35289493 · Internal medicine journal (2023) — COVID-19 mRNA vaccines and myopericarditis.
supports_node 36301659 · WMJ : official publication of the State (2022) — Case Report of COVID-19 mRNA Vaccine-Associated Myocarditis.
ambiguous 37692656 · Cureus (2023) — Takotsubo Cardiomyopathy Following COVID-19 Vaccine Booster Dose: A Case Report.
supports_node 35421376 · The Lancet. Respiratory medicine (2022) — Myopericarditis following COVID-19 vaccination and non-COVID-19 vaccination: a systematic review and meta-analysis.
supports_node 35317093 · Journal of medical cases (2022) — Transient Myopericarditis Following Vaccination for COVID-19.
supports_node 39229736 · Singapore medical journal (2024) — Myopericarditis following COVID-19 vaccination in children: a systematic review and meta-analysis.
E1 · Mediator identified in casesno_data
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: In a retrospective descriptive study of 23 patients with suspected delayed hypersensitivity reactions to COVID-19 vaccines, myopericarditis was the second most frequent complication (n=6), but the abstract does not report detection of any specific mediator in affected tissue or cells compared to controls.
Cited: PMID 37242502
supporting: COVID-19 vaccine Myopericarditis mechanism Mediator identified in cases in vitro OR patient-derived
pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Mediator identified in cases not associated mechanism
pubmed · 1 hits · run 2026-09-07
1 retrieved record(s)
ambiguous 37242502 · Pharmaceuticals (Basel, Switzerland) (2023) — Immune-Mediated Organ-Specific Reactions to COVID-19 Vaccines: A Retrospective Descriptive Study.
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 Myopericarditis mechanism Mediator in healthy vaccinees in vitro OR patient-derived
pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Mediator in healthy vaccinees not associated mechanism
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
E3 · Infection contrastsupports
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 shows that the absolute number of myocarditis events is 1-10 per million after COVID-19 vaccination compared to 40 per million after COVID-19 infection, indicating that the incidence of myopericarditis is higher after natural infection than after vaccination, thus supporting a hit for this node where the mediator signal is specific to vaccination versus natural infection.
Cited: PMID PMID 36441403
supporting: COVID-19 vaccine Myopericarditis mechanism Infection contrast in vitro OR patient-derived
pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Infection contrast not associated mechanism
pubmed · 5 hits · run 2026-09-07
4 retrieved record(s)
supports_node 36441403 · Current cardiology reports (2022) — COVID-19 Vaccine-Related Myocardial and Pericardial Inflammation.
supports_node 37172812 · The Journal of pediatrics (2023) — Cardiac Magnetic Resonance Findings of Coronavirus Disease 2019 (COVID-19) Vaccine-Associated Myopericarditis at Intermediate Follow-Up: A Comparison with Class
supports_node 36469338 · JAMA pediatrics (2023) — Myopericarditis After COVID-19 mRNA Vaccination Among Adolescents and Young Adults: A Systematic Review and Meta-analysis.
supports_node 36576105 · Infectious diseases (London, England) (2023) — Admission and follow-up cardiac magnetic resonance imaging findings in BNT162b2 Vaccine-Related myocarditis 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 Myopericarditis mechanism Transfer to recipient in vitro OR patient-derived
pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 Myopericarditis mechanism Transfer specificity in vitro OR patient-derived
pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 Myopericarditis mechanism Depletion / knockdown in vitro OR patient-derived
pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Depletion / knockdown not associated mechanism
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
E7 · Add-back rescueno_data
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 Myopericarditis mechanism Add-back rescue in vitro OR patient-derived
pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Add-back rescue not associated mechanism
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
E8 · Neutralizationno_data
Measure: Neutralizing the mediator blocks the effect
Comparator: Isotype control
Hit rule: Neutralization of the mediator (not an isotype control) blocks the phenotype
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis mechanism Neutralization in vitro OR patient-derived
pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Neutralization not associated mechanism
pubmed · 1 hits · run 2026-09-07
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 found
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis mechanism Isotype control in vitro OR patient-derived
pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Isotype control not associated mechanism
pubmed · 1 hits · run 2026-09-07
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 Myopericarditis Full product reproduces component OR antigen OR vector
pubmed · 2045214 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Full product reproduces no effect component isolation
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
6 retrieved record(s)
does_not_resolve 29550258 · Immunology letters (2018) — Live bacterial vaccine vector and delivery strategies of heterologous antigen: A review.
does_not_resolve 20218334 · Uirusu (2009) — [Measles vaccine].
does_not_resolve 25105278 · Viruses (2014) — Virus-vectored influenza virus vaccines.
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.
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: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Empty vector / particle component OR antigen OR vector
pubmed · 2045214 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Empty vector / particle no effect component isolation
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
6 retrieved record(s)
does_not_resolve 29550258 · Immunology letters (2018) — Live bacterial vaccine vector and delivery strategies of heterologous antigen: A review.
does_not_resolve 20218334 · Uirusu (2009) — [Measles vaccine].
does_not_resolve 25105278 · Viruses (2014) — Virus-vectored influenza virus vaccines.
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.
F3 · Antigen alone reproducesno_data
Measure: Isolated antigen reproduces the effect
Comparator: Vehicle
Hit rule: The isolated antigen (not the full product) reproduces the effect
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Antigen alone reproduces component OR antigen OR vector
pubmed · 2045214 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Antigen alone reproduces no effect component isolation
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
6 retrieved record(s)
does_not_resolve 29550258 · Immunology letters (2018) — Live bacterial vaccine vector and delivery strategies of heterologous antigen: A review.
does_not_resolve 20218334 · Uirusu (2009) — [Measles vaccine].
does_not_resolve 25105278 · Viruses (2014) — Virus-vectored influenza virus vaccines.
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: No evidence found; the retrieved literature discusses live bacterial and viral vaccine vectors for influenza, measles, and cancer, but none address COVID-19 vaccine-induced myopericarditis or provide any data on adverse events.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Irrelevant cargo component OR antigen OR vector
pubmed · 2045214 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Irrelevant cargo no effect component isolation
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
6 retrieved record(s)
does_not_resolve 29550258 · Immunology letters (2018) — Live bacterial vaccine vector and delivery strategies of heterologous antigen: A review.
does_not_resolve 20218334 · Uirusu (2009) — [Measles vaccine].
does_not_resolve 25105278 · Viruses (2014) — Virus-vectored influenza virus vaccines.
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: The 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 these articles address myopericarditis as an adverse event following COVID-19 vaccination or compare infection preparation vs product preparation effects.
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Infection preparation component OR antigen OR vector
pubmed · 2045214 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Infection preparation no effect component isolation
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
6 retrieved record(s)
does_not_resolve 25105278 · Viruses (2014) — Virus-vectored influenza virus vaccines.
does_not_resolve 29550258 · Immunology letters (2018) — Live bacterial vaccine vector and delivery strategies of heterologous antigen: A review.
does_not_resolve 20218334 · Uirusu (2009) — [Measles vaccine].
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: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Cytokine / adjuvant mix component OR antigen OR vector
pubmed · 2045214 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Cytokine / adjuvant mix no effect component isolation
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
6 retrieved record(s)
does_not_resolve 29550258 · Immunology letters (2018) — Live bacterial vaccine vector and delivery strategies of heterologous antigen: A review.
does_not_resolve 20218334 · Uirusu (2009) — [Measles vaccine].
does_not_resolve 25105278 · Viruses (2014) — Virus-vectored influenza virus vaccines.
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 Myopericarditis Component combination component OR antigen OR vector
pubmed · 2045215 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Component combination no effect component isolation
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
6 retrieved record(s)
does_not_resolve 29550258 · Immunology letters (2018) — Live bacterial vaccine vector and delivery strategies of heterologous antigen: A review.
does_not_resolve 20218334 · Uirusu (2009) — [Measles vaccine].
does_not_resolve 25105278 · Viruses (2014) — Virus-vectored influenza virus vaccines.
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.
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 Myopericarditis 2D human cells animal OR organoid OR cell model
pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 Myopericarditis Organoid / chip animal OR organoid OR cell model
pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 Myopericarditis Block in vitro / in vivo intervention OR treatment OR reversal
pubmed · 15141378 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Block in vitro / in vivo no effect intervention
pubmed · 0 hits (0 hits — negative) · run 2026-09-07

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 Myopericarditis mechanism Host-line dependence in vitro OR patient-derived
pubmed · 29239 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 Myopericarditis Animal, clinical route animal OR organoid OR cell model
pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Animal, clinical route not reproduced model
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
G4 · Susceptible animalno_data
Measure: Effect in a susceptible animal model
Comparator: Non-susceptible model
Hit rule: Effect in a defined susceptible animal model
Finding: no evidence found
Cited: (none)
supporting: COVID-19 vaccine Myopericarditis Susceptible animal animal OR organoid OR cell model
pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis Susceptible animal not reproduced model
pubmed · 0 hits (0 hits — negative) · run 2026-09-07
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 Myopericarditis Replication across labs animal OR organoid OR cell model
pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 Myopericarditis Blinded scoring animal OR organoid OR cell model
pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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: In a cohort of 44 patients with vaccine-associated myocarditis, pericarditis, or myopericarditis (VAMP) following COVID-19 vaccination, inclusion required symptom onset within <25 days after the last vaccine dose, with a median short-term cardiac MRI follow-up at 3.3 months.
Cited: PMID 36913155
supporting: COVID-19 vaccine Myopericarditis Experimental time course animal OR organoid OR cell model
pubmed · 1818474 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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 Myopericarditis Susceptibility trait coherence OR latency OR susceptibility
pubmed · 870020 hits · run 2026-09-07
mirror: COVID-19 vaccine Myopericarditis 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.