To the Editor.—We would like to share our ideas on “Autopsy Histopathologic Cardiac Findings in 2 Adolescents Following the Second COVID-19 Vaccine Dose.”1  In reaction to Gill et al,2  who first reported the 2 incidents, Paddock et al1  wrote a letter to the editor regarding cases of post–COVID-19 vaccination deaths that showed alternative causes of death. Gill et al2  primarily noted that these postvaccine problematic cases have myocardial injury that is distinct from conventional myocarditis and resemble a catecholamine-mediated stress (toxic) cardiomyopathy more than anything else. We agree that the COVID-19 vaccine can cause clinical problems and death in the worst cases. However, not all cardiac problems in a vaccine recipient are due to the vaccine. There is a chance of a concurrent medical problem. Other medical causes should be ruled out. For example, in a tropical country, other concurrent tropical viral coinfections are possible3  and might be the cause of cardiac problems in a post–COVID-19 vaccine recipient.4  A good clinical history and careful examination to rule out other possible concurrent causes of cardiac problems following the COVID-19 vaccine are recommended.4 

1.
Paddock
CD,
Reagan-Steiner
S,
Su
JR,
et al
Autopsy histopathologic cardiac findings in 2 adolescents following the second COVID-19 vaccine dose
.
Arch Pathol Lab Med
.
2022
;
146
(8)
:
921
923
.
2.
Gill
JR,
Tashjian
R,
Duncanson
E.
Autopsy histopathologic cardiac findings in 2 adolescents following the second COVID-19 vaccine dose
.
Arch Pathol Lab Med
.
2022
;
146
(8)
:
925
929
.
3.
Kebayoon
A,
Wiwanitkit
V.
Dengue after COVID-19 vaccination: possible and might be missed
.
Clin Appl Thromb Hemost
.
2021
;
27
:
10760296211047229
.
4.
Mungmunpuntipantip
R,
Wiwanitkit
V.
mRNA COVID-19 vaccination and myocarditis
.
Pediatr Emerg Care
.
2022
;
38
(2)
:
e503
.

Competing Interests

The authors have no relevant financial interest in the products or companies described in this article.