On February 28, a woman aged 45 years with a history of smallpox vaccination
had sharp left shoulder pain and chest pain 2 days after vaccination. Her
symptoms resolved after treatment with a nonsteroidal anti-inflammatory medication.
Approximately 2 weeks before vaccination, she had onset of influenza-like
illness (ILI) with fever, chill, myalgias, malaise, and cough, which were
resolving at the time of vaccination after 1 week away from work. On March
3, she complained again of exertional chest pain and was hospitalized the
following day with dyspnea and exertional chest pain that radiated to her
neck. An echocardiogram on March 5 demonstrated a small pericardial effusion,
left ventricular wall motion abnormality, and a mild decrease in left ventricular
function. Cardiac catheterization found no evidence of coronary artery narrowing.
Viral myocarditis judged to be associated with the antecedent ILI was diagnosed.
On March 6, the patient was discharged after 2 days of hospitalization.