text: Myocarditis With COVID 19 mRNA Vaccines Myocarditis has been recognized as a rare complication of coronavirus disease 2019 COVID 19 mRNA vaccinations especially in young adult and adolescent males According to the US Centers for Disease Control and Prevention myocarditis pericarditis rates are 12 6 cases per million doses of second dose mRNA vaccine among individuals 12 to 39 years of age In reported cases patients with myocarditis invariably presented with chest pain usually 2 to 3 days after a second dose of mRNA vaccination and had elevated cardiac troponin levels ECG was abnormal with ST elevations in most and cardiac MRI was suggestive of myocarditis in all tested patients There was no evidence of acute COVID 19 or other viral infections In 1 case a cardiomyopathy gene panel was negative but autoantibody levels against certain self antigens and frequency of natural killer cells were increased Although the mechanisms for development of myocarditis are not clear molecular mimicry between the spike protein of severe acute respiratory syndrome coronavirus 2 SARS CoV 2 and self antigens trigger of preexisting dysregulated immune pathways in certain individuals immune response to mRNA and activation of immunologic pathways and dysregulated cytokine expression have been proposed The reasons for male predominance in myocarditis cases are unknown but possible explanations relate to sex hormone differences in immune response and myocarditis and also underdiagnosis of cardiac disease in women Almost all patients had resolution of symptoms and signs and improvement in diagnostic markers and imaging with or without treatment Despite rare cases of myocarditis the benefit risk assessment for COVID 19 vaccination shows a favorable balance for all age and sex groups therefore COVID 19 vaccination is recommended for everyone 12 years of age 