Updates regarding medical exemption and vaccination with COVID-19 vaccines following myocarditis (with or without pericarditis)

Advisory Alert

January 18, 2022

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To: Local Health System Partners


Medical exemption updates regarding myocarditis and pericarditis based on updated NACI statement

In follow up to an Advisory Alert issued on January 4, 2022, and additional Advisory Alerts issued on December 17, 2021, September 22, 2021, and September 17, 2021,  this Advisory Alert provides an update on medical exemptions regarding myocarditis and pericarditis.

Medical Exemptions for individuals who have pre-existing Condition(s) of myocarditis

The National Advisory Committee on Immunization (NACI), recommends that individuals with a history of myocarditis unrelated to mRNA COVID-19 vaccination should consult their primary care provider for considerations and recommendations. NACI advises that individuals previously diagnosed with myocarditis, whose diagnosis is considered remote and are no longer followed clinically by a medical professional for cardiac issues, should receive the COVID-19 vaccine.

The Ontario Ministry of Health advises that individuals who have been diagnosed with myocarditis prior to initiating an mRNA COVID-19 vaccine series qualifies for medical exemption only if a discussion with appropriate physician or nurse practitioner has occurred regarding potential options for immunization with an mRNA COVID-19 vaccine or alternative; and if the physician or nurse practitioner has determined that the individual is unable to receive any COVID-19 vaccine.

Medical exemption for individuals who experienced myocarditis/pericarditis following mRNA COVID-19 vaccination

A medical exemption may be issued if myocarditis/pericarditis was diagnosed after medical evaluation. Until more information is available, and as a precautionary measure individual with a diagnosed episode of myocarditis/pericarditis within 6 weeks of receiving of a previous dose of an mRNA COVID-19 vaccine should defer further doses of the vaccine. This includes any person who had an abnormal cardiac investigation including electrocardiogram (ECG), elevated troponins, echocardiogram or cardiac MRI after a dose of an mRNA vaccine. This is a precaution based on recommendations issued by NACI.  Please note that NACI, Public Health Ontario, and the Ontario Ministry of Health are following this closely and will update this recommendation as more evidence becomes available.

Where there is uncertainty that an individual has experienced myocarditis after immunization, a discussion regarding potential options for reimmunization with the same or alternate COVID-19 vaccine, including a risk-benefit analysis for the individual should occur. The individual qualifies for a medical exemption if the physician or nurse practitioner has determined that the individual is unable to receive any COVID-19 vaccine.

Individuals with a history compatible with pericarditis and who either had no cardiac workup or had normal cardiac investigations, can be re(immunized) once they are symptom free and at least 90 days has passed since vaccination.

Some people with confirmed myocarditis and/or pericarditis may choose to receive another dose of vaccine after discussing the risks and benefits with their health care provider. After the discussion has occurred and (re)immunization has been agreed upon, the individual should be offered the Pfizer-BioNTech 30 mcg vaccine due to the lower reported rate of myocarditis and/or pericarditis following the Pfizer-BioNTech 30mcg vaccine compared to the Moderna 100 mcg vaccine as previously advised.

Contraindications and precautions that may require medical exemptions

Except for the noted above changes, previous guidance on evaluating all other contraindications or precautions to COVID-19 vaccination that may warrant a medical exemption has not changed.

Please refer to the Ministry of Health’s Medical Exemptions to COVID-19 Vaccination (PDF) document for guidance to assist in evaluating contraindications or precautions to COVID-19 vaccination that may warrant a medical exemption.

Additional information

For more information on the COVID-19 vaccines, as well as for specific answers to your frequently asked questions visit our FAQ web page or call Public Health Sudbury & Districts at 705.522.9200 (toll-free 1.866.522.9200).


Original Signed By

Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer

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This item was last modified on January 18, 2022