Latest Autopsy Study on mRNA Vaccine Recipients From Germany: What It Means and Doesn’t Mean


A newly published autopsy study of vaccinees — by respected German pathologists— has been heralded by the antivaccine community as the definitive proof that mRNA vaccines can kill. While there is some element of truth in that, the German autopsy study has been put out of context. But having said that, it may also be time to consider personalized vaccination, given what the German autopsy and other autopsy studies have found.

What the study did and found

The study, “Autopsy-based histopathological characterization of myocarditis after anti-SARS-CoV-2-vaccination,” was published in Clinical Research in Cardiology, led by Peter Schirmacher, MD, Ph.D., professor of pathology, acting chairman of the German Society of Pathology, director of the Institute of Pathology at Heidelberg University Hospital, and president of the German Association for the Study of the Liver.

In this study, German scientists reviewed 35 autopsy cases of people who died within 20 days of vaccination (against Covid-19). But in 10 of the cases, autopsies revealed that the cause of death was unrelated to the vaccine and mostly due to pre-existing diseases. 

Of the remaining 25 cases, only 5 had autopsy findings indicating myocarditis as the likely or possible cause of death. None of these 5 cases had Covid-19, with their nasopharyngeal swabs negative for SARS-CoV-2. Details of their sex, age, vaccine type, etc. are described in the table below. Specifically, all died within a week of receiving an mRNA vaccine.
Case characteristics of the 5 autopsied cases showing myocarditis as the likely/possible cause of death.Photo bySchwab et al. (2022).

Histological analyses then showed that inflammatory cells had infiltrated the myocardium (heart muscles), mainly on the right side of the heart. As blood first enters the heart from the right atrium, the authors suspect that accidental vaccine injection into the blood vessel may have contributed to or caused the myocarditis. 

Further inspection revealed that the inflammatory cells were mainly lymphocytes, particularly CD4 helper T-cells, and macrophages (figure 1). (Lymphocytes comprise CD4 helper T-cells, CD8 killer T-cells, and antibody-producing B-cells. Macrophages are another type of immune cell that engulf dead cells or foreign materials, including viruses.) Myocyte (muscle cell) damage was seen in 3 out of 5 cases.
Photo bySchwab et al. (2022).
Figure 1. A) Lymphocyte infiltrations (purple dots) associated with damaged myocardiocytes (heart muscle cells). B) The infiltrate was mainly composed of CD4 helper T-cells (brown dots).

All cases lacked pathological signs of pre-existing heart diseases, indicating that no other causes of death, other than the vaccine, can explain the fatal myocarditis. Aside from one case with low levels of human herpesvirus 6 (HHV6) genetic material, all cases tested negative for 12 other infectious agents capable of causing myocarditis. 

This German study also evaluated autopsied controls, which prior autopsy studies of vaccinated individuals don’t usually do. The control group was cardiac tissues from three independent pre-pandemic cohorts (covering the years 2005/2006, 2010/2011, and 2015/2016). And the study found no similar autopsy findings in the control group, suggesting that the myocardial pathology in the mRNA vaccine group is rather novel. 

“During the last 20 years of autopsy service at Heidelberg University Hospital, we did not observe comparable myocardial inflammatory infiltration,” the authors wrote. “This was validated by histological re-evaluation of age- and sex-matched cohorts from three independent periods, which did not reveal a single case showing a comparable cardiac pathology.”

What the study doesn’t mean

First, this study is not meant to infer the incidence of mRNA vaccine-induced myocarditis, even though 5 out of 35 autopsied cases showed evidence of mRNA vaccine-associated myocarditis. It’s important to note that such fatal cases of myocarditis represent the extreme minority that we’ll only see when we have a sample size by the billions

As the authors wrote, “the nature of our autopsy study necessitates that the data are descriptive in quality and does not allow any epidemiological conclusions in terms of incidence or risk estimation.”

In a meta-analysis of 23 studies of 854 young patients (90% males) with mRNA vaccine-associated myocarditis, 0% died and 0% needed mechanical support. But 93% of patients were hospitalized and 23% were admitted to ICU. So, mRNA vaccine-induced myocarditis can be severe but rarely ever fatal, with a fatality rate close to 0%. In contrast, virus-induced myocarditis, including Covid-19, has a fatality rate of about 10% (Figure 2).
Photo byLai et al. (2022).
Figure 2. Illustration of the design of a study comparing the prognosis of myocarditis after mRNA vaccine vs. Covid-19. As evident in the rightmost panel, the cumulative incidence of heart failure and mortality in Covid-19 myocarditis is about 10% higher than in vaccine myocarditis. Source: Lai et al. (2022); Hong Kong. 

However, the German study has been put into the context of dangerous mRNA vaccines that must be avoided, and that even mild myocarditis can be fatal, in several news articles and videos. One such video has already garnered a million views in less than two weeks. 

While it’s true that the German autopsy found that the myocardial damage doesn’t appear severe enough to cause heart contractile failure — and that the patients likely died as a result of cardiac arrest or ventricular fibrillation (irregular heart rhythm) — it doesn’t change the fact that fatal myocarditis, even if it’s defined as mild tissue damage, is exceedingly rare.

In my two previous autopsy articles where I reviewed over 120 peer-reviewed papers, I arrived at the calculation that:

  • The rate of post-vaccine deaths (i.e., deaths occurring shortly after vaccination) regardless of its causation is 24 in a million vaccinees.
  • The rate of suspected post-vaccine deaths (i.e., deaths where the suspected cause of death is the vaccine) is 0.5 in a million vaccines.
  • The rate of causal post-vaccine deaths (i.e., deaths where the cause of death is likely the vaccine) is 0.05 in a million vaccinees. 

So, this new German autopsy study doesn’t mean that the mRNA vaccine is putting a permanent stop to people’s heartbeats everywhere. It only does so in the extreme minority, which seems to happen more frequently owing to mass vaccinations on a global scale. 

What the study means

Since Covid is known to cause myocarditis too, the German authors speculate that the CD4 T-cell-mediated autoimmunity likely stems from immune reactions against the spike protein, especially in people susceptible to CD4 T-cell-related autoimmune conditions.

But the authors also suspect that the immune reactions may also be directed against the mRNA or other constituents of the mRNA vaccine formula, such as the lipid nanoparticles. This is because vaccine-induced myocarditis has not been seen with viral-vectored DNA vaccines.

However, The Gift Of Fire has a more convincing theory: “A stronger vaccine gives a better response against covid, but also a higher chance of myocarditis.” Novavax subunit vaccine is the strongest or most effective vaccine, followed by Moderna and Pfizer mRNA vaccines, and then only DNA and inactivated vaccines. And the risk of myocarditis is greatest with Novavax, then only Moderna and Pfizer. 

That said, the German autopsy study also tells us another thing: mRNA vaccine-induced myocarditis can be severe and fatal. This finding may bolster policy changes in the concept of personalized vaccination, particularly in the choice of boosters, given that majority of the world has received at least two doses of Covid-19 vaccines. 

For instance, young men are at the highest risk of mRNA vaccine-induced myocarditis but are at low risk of severe Covid-19. So, it would be unwise to administer Novavax subunit or Moderna mRNA vaccines to young men when alternative and safer vaccines are available, especially under circumstances of low Covid-19 transmission. 

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