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How can I check the status of my medical exam results?

The way to check the status of your medical exam results depends on how you applied.

If you applied online

If you applied to immigrate through Express Entry or to sponsor your spouse, partner or dependent children

You can check the status of your results in your application status tracker.

Sign in to your application status tracker .

If you applied to any other program

You can check the status of your results in your IRCC secure account.

Sign in to your IRCC secure account .

• If you don’t already have an account ,  you can create one and link it to your existing application.
• Make sure you link your account to the application that needed a medical exam.
• Find out which applications you can link to an IRCC secure account .

The status of medical exam results in your account may show an inaccurate validity date.

If you applied on paper

You can check the status of your application, including your medical exam results, using the  check your application status tool .

When to check the status of your results

You may not see the status of your results updated right away.

• Your results usually show up in your account within 30 days of the date you booked your exam.
• It may take longer (for example, if we need more information from you).

You may not see the status of your results updated in your account until we finish processing your immigration application. We need time to

• process your application
• link the results to your application

Check the application processing time .

To avoid more delays, you must

• go back to see the physician
• complete the requirement before we can assess your medical exam

Don’t complete a new medical exam unless we instruct you to do so.

Your panel physician can explain how long it will take to complete additional testing or treatment.

When to contact us

Use the  web form to tell us if

• we asked you for a medical exam after you applied
• it’s been over 3 weeks since you had your exam
• your results do not show up in your account

Did you find what you were looking for?

If not, tell us why:

You will not receive a reply. Telephone numbers and email addresses will be removed. Maximum 300 characters

Thank you for your feedback

Answers others found useful

• If you return my application, will I get a refund?
• How do I fill out and validate IRCC application forms with 2D barcodes?
• Why won’t my application form let me save my information or digitally sign it?
• How can I check if my application has been received?
• What happens after I send in my application?
• What is a UCI?
• What is an application number?
• How can I find a doctor to provide my medical exam?
• How can I get my citizenship application processed urgently?
• How can I get help with my application?

Glossary term

• Medical examination
• Medical inadmissibility

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I-693, Report of Immigration Medical Examination and Vaccination Record

ALERT: Effective April 4, 2024, any Form I-693 that was properly completed and signed by a civil surgeon on or after Nov. 1, 2023, does not expire, and can be used indefinitely as evidence to show that the applicant is not inadmissible on health-related grounds. For more information, see the Policy Alert . 

ALERT:  Urgent Message for USCIS Designated Civil Surgeons:

The Centers for Disease Control and Prevention (CDC) recently updated the  Tuberculosis Technical Instructions for Civil Surgeons . Civil Surgeons must now register for access to eMedical, an electronic health processing system. Using eMedical will help the CDC maintain public health security and transition to electronic submission of immigration medical examinations.  Civil Surgeons should have received emailed instructions to register; it is important that you follow these instructions and register immediately . If you did not receive the emails with instructions from the CDC and eMedical, please email  [email protected] .

If you are applying for adjustment status to become a lawful permanent resident, use this form to establish that you are not inadmissible to the United States on public health grounds.

A list of those health grounds can be found in section 212(a)(1) of the Immigration and Nationality Act. For more information on the validity of Form I-693, see the  USCIS Policy Manual Volume 8, Part B, Chapter 4.

Forms and Document Downloads

Form I-693 (PDF, 664.86 KB)

Instructions for Form I-693 (PDF, 453.66 KB)

Form Details

03/09/23 . If the civil surgeon signs your form on or after May 31, 2023, you must use the 03/09/23 edition. You can find the edition date at the bottom of the page on the form and instructions.

Dates are listed in mm/dd/yy format.

If you complete and print this form to mail it, make sure that the form edition date and page numbers are visible at the bottom of all pages and that all pages are from the same form edition. If any of the form’s pages are missing or are from a different form edition, we may reject your form.

If you need help downloading and printing forms, read our instructions . 

After completing your immigration medical examination, the civil surgeon must give you, the applicant, the completed Form I-693 in a sealed envelope. Do not accept it if it is not in a sealed envelope. We will return the form to you if it is not in a sealed envelope, or if the envelope has been opened or altered.

You (not the civil surgeon) must submit your Form I-693 to USCIS. If you are applying for adjustment of status, you may submit Form I-693:

• By mail with your Form I-485, Application to Register for Permanent Residence or Adjust Status , to the location specified for your Form I-485 (see the  Direct Filing Addresses for Form I-485 );
• By mail after filing your Form I-485 at the location specified in your most recent communication with us (for example, a Request for Evidence letter from us); or
• In person at an interview in a USCIS field office (if an interview is required).

Other applicants: Follow the instructions on or included with the application, or the instructions given to you by the office requesting the immigration medical examination.

Save time by submitting Form I-693, Report of Immigration Medical Examination and Vaccination Record, with  Form I-485, Application to Register Permanent Residence or Adjust Status . We generally consider a completed Form I-693 to retain its evidentiary value for 2 years after the date the civil surgeon signed it. We have removed the requirement that the applicant submit their underlying immigration benefit application no more than 60 days after the civil surgeon’s signature on Form I-693.

You are not required to submit your Form I-693 at the same time you file Form I-485. While some applicants intend to bring their completed Form I-693 to their interview, some applications may not require an interview. We make decisions to waive interviews on a case-by-case basis.

Filing Form I-485 and Form I-693 at the same time may eliminate the need for us to issue a Request for Evidence (RFE) to obtain your Form I-693. This may also help avoid adjudication delays if we decide that you do not need to be interviewed.

You can find the filing fee for Form I-693 by visiting our Fee Schedule page.  

Fees for immigration medical examinations are established by the civil surgeon. Fees may vary by physician.

Filing Tips:  Review our  Tips for Filing Forms by Mail  page for information on how to ensure we will accept your form.

Don’t forget to sign your form.  We will reject any unsigned form.

To ensure your immigration medical examination results are still valid when we adjudicate your associated benefit application, you should schedule the immigration medical examination as close as possible to the time you file for adjustment of status, respond to a Request for Evidence, or attend an interview (if applicable).

Be sure to provide enough time for any laboratory testing or additional testing required under the Technical Instructions for Civil Surgeons from the Centers for Disease Control and Prevention.

• Immigration Medical Examinations
• USCIS Policy Manual Guidance on Review of Medical Examination Documentation

Civil Surgeons

• Find a Civil Surgeon (Doctor)
• Designated Civil Surgeons

Vaccination

• Vaccination Requirements

Related Forms

• I-485, Application to Register Permanent Residence or Adjust Status
• I-539, Application To Extend/Change Nonimmigrant Status

Language selection

• Français fr

Submission of immigration medical examinations (IMEs)

This section contains policy, procedures and guidance used by IRCC staff. It is posted on the department’s website as a courtesy to stakeholders.

Electronic immigration medical examinations (eMedical)

Panel physicians complete the immigration medical examination (IME) and enter the results into the eMedical system (an online application that provides a paperless process for electronic recording, transmission and storage of the IME results). Once the IME is submitted in eMedical, the results are automatically transferred to the Global Case Management System (GCMS) for assessment.

Note: Panel physicians are unable to submit an incomplete IME through eMedical.

Guidelines for record management using eMedical

• Panel physicians are encouraged to give a copy of the IME to the client, unless it would be injurious to the client’s physical or mental health.
• Panel physicians are required to keep copies and records of files for at least 2 years in compliance with their local regulatory and licensing requirements.
• Once the IME has been submitted through eMedical, there is no way for the panel physician to retrieve it to make a copy.

Paper-based immigration medical examinations

In exceptional cases where the panel physician does not have access to eMedical, submission of paper-based IMEs is accepted. Panel physicians send the original copy of the IME by mail to the responsible regional medical office (RMO). The RMO manually enters the IME results into the GCMS.

Guidelines for paper-based immigration medical examination record management

• Original documents must never be given to the client for delivery to the RMO.
• Panel physicians should retain tracking numbers for the shipments of IMEs for 6 months.

Page details

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• Physician Fee Schedule
• Local Coverage Determination
• Medically Unlikely Edits

Electronic Health Records

An Electronic Health Record (EHR) is an electronic version of a patients medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports   The EHR automates access to information and has the potential to streamline the clinician's workflow.  The EHR also has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.

EHRs are the next step in the continued progress of healthcare that can strengthen the relationship between patients and clinicians.  The data, and the timeliness and availability of it, will enable providers to make better decisions and provide better care.  

For example, the EHR can improve patient care by:

• Reducing the incidence of medical error by improving the accuracy and clarity of medical records.
• Making the health information available, reducing duplication of tests, reducing delays in treatment, and patients well informed to take better decisions.
• Reducing medical error by improving the accuracy and clarity of medical records.

For information about the Medicare & Medicaid EHR Incentive Programs, please see the link in the "Related Links Inside CMS" section below.

For industry resources on EHR, please see the links in the "Related Links Outside CMS" section below.

Related Links

• HHS/Office of National Coordinator Health IT Web Site
• Health Level Seven (HL7)
• Promoting Interoperability (PI)

• Finding your eMedical and INZ health case reference numbers

We may ask you for your eMedical reference number (NZER) or INZ health case reference number (NZHR) when you apply for a visa using Immigration Online.

Acceptable standard of health criteria for visa approvals

• Evidence you are in good health
• Who needs an X-ray or medical examination
• Getting an X-ray or medical examination
• Find a radiologist or doctor near you
• Identity documents for x-rays and medical examinations
• What we do with your x-ray and examination results
• Countries with a low incidence of tuberculosis
• Countries with a high risk of HIV
• Working holiday visa medical requirements
• Medical and x-ray certificates for existing Essential Skills Work Visa applications
• Getting public health care in New Zealand
• Medical waivers for visa applications

About eMedical

We may request you to have a medical examination when we are processing your visa application. ​eMedical is an electronic health processing system that is used by approved panel physicians to send us the results of your medical examination.

eMedical reference number (NZER)

When you visit a panel physician to have a medical examination, the panel physician creates an eMedical case for you. This generates an eMedical reference number (NZER). Your NZER is used to identify you in the eMedical system.

Immigration New Zealand health case reference number (NZHR)

If you are applying for a Visitor Visa or an Accredited Employer Work Visa (AEWV) and we require you to have a medical examination, we will create a case in eMedical for you. We will then provide you with an INZ health case reference number (NZHR). You must provide your NZHR to the panel physician when you book your medical examination.

If you are applying for another type of visa, your NZHR will be created after you provide us with your medical examination. You do not need to provide your NZHR to the panel physician.

Where to find your NZER or NZHR

You can find your NZER and NZHR in the following documents.

eMedical information sheet

When you visit a panel physician you can request an eMedical information sheet from their clinic. You can find your NZER in the 'Client visa details' section of this document. If you are applying for a Visitor Visa or an AEWV and we have asked you to get a medical examination, you can also find your NZHR in the 'Client visa details' section of this document.

eMedical email notification

When you visit a panel physician you can choose to receive automatic emails from eMedical. These emails will go to the email address that you provided to your panel physician. You can find your NZER in the body of these emails. If you are applying for a Visitor Visa or an AEWV and we have asked you to get a medical examination, you can also find your NZHR in the body of these emails.

Letter from INZ

If you are applying for a Visitor Visa or an AEWV, and we send you a letter notifying you that you need to get a medical examination, your NZHR will be in this letter. You can view this letter by logging in to your Immigration Online account. You can find your NZHR under the heading 'INZ Health case reference'. Your NZER will not be in this letter.

If you do not have your NZER or NZHR

If you do not have your NZER or NZHR you may be able to contact the panel physician's clinic where you had your medical examination. They may be able to provide you with your NZER or NZHR, or a copy of your eMedical information sheet.

Approved panel physicians

Appointments at Mayo Clinic

• Consumer health
• Personal health records and patient portals

Personal health records and patient portals are powerful tools for managing your health.

If you're like most people, you have a number of health concerns and may visit multiple doctors and pharmacies. Keeping track of it all can be a challenge. With a personal health record, you can gather — and manage — all that information in one easily accessible location.

What is a personal health record?

A personal health record is simply a collection of information about your health. If you have a shot record or a folder of medical papers, you already have a basic personal health record.

And you've probably encountered the big drawback of paper records: You rarely have them with you when you need them.

Electronic personal health records (PHRs) remedy that problem by making your information accessible to you anytime via web-enabled devices, such as computers, smartphones and tablets.

What information goes into a PHR?

In general, your PHR needs to include anything that helps you and your doctors manage your health — starting with the basics:

• Your doctor's names and phone numbers
• Allergies, including drug allergies
• Your medications, including dosages
• List and dates of illnesses and surgeries
• Chronic health problems, such as high blood pressure
• Living will or advance directives
• Family history
• Immunization history

You can also add information about what you're doing to stay healthy and prevent disease, such as:

• Home blood pressure readings
• Exercise and dietary habits
• Health goals, such as stopping smoking or losing weight

PHRs, EHRs and patient portals

PHRs are not the same as electronic health records (EHRs), also called electronic medical records (EMRs), which are owned and maintained by doctors' offices, hospitals or health insurance plans.

EHRs typically contain the same basic information you would put in a PHR , such as your date of birth, medication list and drug allergies. But EHRs contain more extensive information because they're used by health care providers to store visit notes, test results and much more.

A PHR that is tied to an EHR is called a patient portal. In some but not all cases you can add information, such as home blood pressure readings, to your record via a patient portal. If that's the case, you may not want to create a separate, standalone PHR .

However, you may want to consider having at least some basic information on hand in case of emergency, including advance directives, which outline your decisions about health care, such as whether to use life-support machines.

You could use an app such as the Health app for iPhones, which includes Medical ID, which makes critical information available via the lock screen for use by first responders in an emergency. Medical ID can display medical conditions, allergies, medications, blood type and emergency contacts. You can also use it to indicate if you're registered to be organ donor.

It is important to make sure any apps you use are secure so that your information is kept private. Make sure any app you use requires you to enter a password and that your phone has a firewall or encryption software. Research all apps before you download them to your phone and enter your personal information.

Similar apps are available for other smartphones as well. Or you could go low tech and keep a card in your wallet or wear a medical alert bracelet.

What are the benefits of a PHR?

Having a PHR can be a lifesaver, literally. In an emergency you can quickly give first responders vital information, such as diseases you're being treated for, medications you take, drug allergies, and contact information for your doctor.

If you see multiple doctors and they don't use the same EHR system, a PHR is a good way to keep all of your health information in one place.

A PHR also empowers you to manage your health between visits. For example, a PHR enables you to:

• Track and assess your health. Record and track your progress toward your health goals, such as lowering your cholesterol level.
• Make the most of doctor visits. Be ready with questions for your doctor and information you want to share, such as blood pressure readings since your last visit.
• Manage your health between visits. Upload and analyze data from home-monitoring devices such as a blood pressure cuff. And remind yourself of your doctor's instructions from your last appointment.
• Get organized. Track appointments, vaccinations, medications and preventive or screening services, such as mammograms. In fact, studies have shown when parents use personal health records for their children, the children are more likely to get their preventive well-child checkups on time.

Are there drawbacks to PHRs?

Building a complete health record takes some time. You have to collect and enter all your health information. Only a minority of doctors, hospitals, pharmacies and insurance companies can send information electronically to a PHR that isn't part of a patient portal.

In most cases, you will have to update your PHR manually each time you see the doctor, fill a prescription, have a test or go to the hospital.

Even if you use a patient portal, you still need to review the information that's added to it. The process of transferring health data electronically isn't always perfect and mistakes can happen.

Will my information be kept private?

Perhaps the most common concerns about PHRs are about privacy and security. To address these issues, reputable PHR systems follow industry best practices, such as making their privacy policies public and submitting to monitoring by independent organizations. In addition, federal laws have been put in place to protect the security of personal health information.

How do I get started?

If your primary care doctor offers a patient portal, use it. The staff at the front desk should be able to tell you how to register for it. (If your doctor doesn't offer one, ask if one will be available in the future.) Then start taking advantage of its features. Most portals offer the following:

• Appointment reminders
• Medication list
• Appointment summaries, sometimes with associated educational material
• Secure messaging with your provider
• Test results

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• Individuals' right under HIPAA to access their health information. U.S. Department of Health and Human Services. https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html. Accessed Dec. 12, 2019.
• What are the benefits of personal health records? HealthIT.gov. https://www.healthit.gov/faq/what-are-benefitspersonal-health-records. Accessed Dec. 12, 2019.
• What are the differences between electronic medical records, electronic health records, and personal health records? HealthIT.gov. https://www.healthit.gov/faq/what-are-differences-between-electronic-medical-recordselectronic-health-records-and-personal. Accessed Dec. 12, 2019.
• Device software functions including mobile medical applications. U.S. Food and Drug Administration. https://www.fda.gov/medical-devices/digital-health/device-software-functions-including-mobile-medicalapplications. Accessed Dec. 12, 2019.
• How can you protect and secure health information when using a mobile device? HealthIT.gov. https://www.healthit.gov/topic/privacy-security-and-hipaa/how-can-you-protect-and-secure-health-information-whenusing-mobile-device. Accessed Dec. 12, 2019.
• Empower your patients with health records on iPhone. Apple. https://www.apple.com/healthcare/health-records/. Accessed Dec. 12, 2019.
• McBride S, et al., eds. Personal health records and patient portals. In: Nursing Informatics for the Advanced Practice Nurse: Patient, Quality, Outcomes, and Interprofessionalism. 2nd ed. Springer; 2019.
• Grossman LV, et al. Interventions to increase patient portal use in vulnerable populations: A systematic review. Journal of the American Medical Informatics Associations: JAMIA. 2019; doi:10.1093/jamia/ocz023.
• Abd-Alrazaq AA, et al. Factors that affect the use of electronic personal health records among patients: A systematic review. International Journal of Medical Informatics. 2019; doi:10.1016/j.ijmedinf.2019.03.014.
• Mobile devices and health. New England Journal of Medicine. 2019; doi:10.1056/NEJMra1806949.

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Immigration Tips

Canada Immigration Medical Exam Report

One of the final requirements for Canada’s immigration process is a medical exam report. Every applicant for permanent residence must undergo a medical exam before an immigration officer can approve their application. Medical exams play an important role in determining whether a candidate is  admissible to Canada .

Medical inadmissibility can prevent an applicant from coming to Canada as a permanent resident, student, or temporary worker. There are two types of medical issues that could result in refusal:

• You, or any of your dependent family members, pose a danger to the health or safety of the general public;
• You, or any of your dependent family members, have a condition that would cause excessive strain or demand on Canadian health or social services.

*Excessive demand is defined as a condition where the expected cost of treatment would exceed five times the annual average health and social services costs for an individual in Canada.

Whether an applicant fulfills the health requirements is determined by a Medical Certificate or Medical Report based on a medical exam conducted by an authorized medical practitioner. Therefore, the medical report is an important immigration document that can have a significant impact on your chances of successfully immigrating to Canada.

Who should undergo Canada’s immigration medical exam?

Along with the principal applicant, all dependants,  including those who are not accompanying the principal applicant to Canada , should undergo the immigration medical exam and obtain the medical report. An applicant’s eligibility depends on all his or her dependants fulfilling the health requirement.

To become eligible for permanent residence in Canada, the applicant and all dependants must not suffer from a condition that puts public health at risk or places excessive strain on the Canadian health system. This requirement comes into effect from the time the applicant files the application for Canadian permanent residence.

Certain foreign nationals applying to work or study in Canada may also require a medical exam. The best way to find out if a medical exam is required is by visiting IRCC’s dedicated page .

When to obtain the medical report

Depending on the  immigration program  they are applying to, applicants have two options for undergoing the medical exam.

• Contact a qualified physician and complete the exam before submitting the immigration application. In this case, the applicant must include a copy of the upfront medication notification (IMM 1017B) with their application as proof the medical exam was completed. This option is available to Express Entry applicants.
• Initiate the process after submitting an application. Alternatively, an applicant may need to wait to receive instructions for getting the medical exam. In this case, the applicant must complete the exam and submit the report within the deadline provided with the instructions.

Who is an IRCC authorized panel physician?

The medical exam for Canadian immigration must be with an  IRCC approved panel physician . In exceptional cases, IRCC may grant a dispensation and temporarily permit a non-panel physician to conduct the exam. However, the dispensation is very rarely granted to physicians outside Canada. This option is available primarily to immigration applicants who are physically present in Canada.

What to expect during a medical exam Canadian immigration

According to the  government of Canada , an immigration medical exam will typically require any or all of the below:

• review of past medical history
• medical assessment of records respecting the applicant
• physical examination
• mental examination
• laboratory test
• diagnostic test
• urinalysis – applicants age 5 and older
• chest x-ray (posterior-anterior view) – applicants age 11 and older
• syphilis – applicants age 15 and older
• HIV – applicants age 15 and older

Canadian immigration medical exam cost

The cost of a medical exam for Canadian immigration will vary depending on the panel physician visited. Applicants are responsible for paying all fees involved with the medical exam.

Contents of a medical exam report

Your medical report will contain the following details:

• Summary of personal details
• Your consent to the medical exam
• Medical history questions
• Physical exam report
• Lab test report
• Chest X Ray report and findings
• Reports covering urinalysis, HIV test, Syphilis test, and other medical reports
• Other relevant information

In most cases, the panel physician will submit the report electronically directly to IRCC. IRCC only accepts paper-based reports when the physician does not have access to the ‘eMedical’ electronic submission facility.

It is important to note that the medical report is the property of IRCC and that you must specifically make a request to your panel physician if you wish to retain a copy for your records.

How long is a Canadian immigration medical report valid for?

If you clear the medical exam and are not disqualified on health grounds, then this positive report will be valid for a period of 12 months from the date of the medical assessment. This validity period is the same whether the examination was done in Canada or a foreign country.

If the validity period has expired — more than 12 months have passed since you underwent the medical exam — then you and your dependents will have to undergo the examination again in order to continue to remain eligible. This is one reason why doing the exam after the file has begun processing may be beneficial. An upfront test may lapse if the processing period exceeds 12 months.

Are you interested in immigrating to Canada? Discover your options with our free online assessment!

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What Is eMedical? And What Are Its Benefits?

Jan 5, 2022

eMedical is a web-based application that is used for recording and transmitting immigration medical cases between the Panel Physicians and the Immigration Refugee & Citizenship Canada (IRCC). Other countries such as Australia and New Zealand also use the eMedical system. In Canada, only Panel Physicians who are approved and empanelled by the IRCC are given access to eMedical. eMedical consists of various modules including physical medical measurement such as height, weight, vision, blood pressure, etc. Other modules include blood test records and results, urine analysis, as well as chest x-ray examination, and a section to add specialist reports if necessary.

eMedical eliminates any paper-based medical examination process between Panel Physician clinics and the IRCC which means information and files will be transmitted and submitted electronically and instantly, hence avoiding any delays in paper-based submission. eMedical is an easier, faster, and more reliable system to record, process and transmit immigration medical cases. In addition, using eMedical allows photos to be taken electronically, therefore, clients don’t need to take and bring any photos to the clinic. Using eMedical systems, all confidential and private information of clients are transmitted electronically through highly cyber secure and protected systems and servers hence preventing data from being lost or jeopardized.

Once a medical report is processed and submitted to the IRCC, Panel Physicians can’t make any changes to the file. However, if clients are interested in obtaining a copy of their medical report, they can order it through the Panel Physician clinic. Please note, immigration medical reports will only be sent to clients once those reports are first submitted to the IRCC. Immigration Medical Exam reports are expected to be submitted to the IRCC within 10 days of the medical exam. On the day of the medical exam, once all the client’s information is entered into eMedical, an information sheet is created, printed and handed to clients to retain as a proof and reference of completion of their medical exam.

Our clinic, the Immigration Medical Centre located in Oakville is 100% eMedical, which means all immigration, work permit, visa extension, and refugee medical exams are processed through eMedical, which is faster, easier and more reliable and efficient than paper-based system. To save even more of our clients’ time, our Immigration Medical Centre clinic and associated x-ray radiology clinic are both located in one building. Therefore all tests are completed in one day, (within 90 minutes), and in one building.

To book your medical exam appointment for your immigration, visa extension, work permit, or refugee applications, please either book online by visiting us at www.immigrationmedicalcentre.ca , or call us at 416-822-3326 .

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How to check eMedical results?

• Thread starter Flo85
• Start date May 4, 2014

Star Member

Hello everyone, I went 1,5 weeks ago for an upfront medical examination and am just wondering if I can see somewhere the results of that examination online? I went to a cic approved eMedical panel doctor in Mississauga and just want to know if I have passed the examination. Thank you very much in advance. Flo  

You don't get the results, or get to know if you "passed". However, if there's anything that you "have" to know (they find something bad), they will let you know about it. If you're healthy, then don't even worry about it.  

aminata2010

You paid for your medical..so you can ask the dr for results..the dr I went to automatically provided me with my results.  

aminata2010 said: You paid for your medical..so you can ask the dr for results..the dr I went to automatically provided me with my results. Click to expand...

I just assumed since it's my money i am paying...i have the rights to my medical records if i request it..and at least here ( usa)you have the right to request them.  

Hero Member

I'd too, received a copy of my medical examination by an email from the panel doctor here in Kuwait.  

aminata2010 said: I just assumed since it's my money i am paying...i have the rights to my medical records if i request it..and at least here ( usa)you have the right to request them. Click to expand...

Avadava said: It doesn't matter what the panel physician says about your results. In the end, it is the CIC doctors that make decision on your medical exam. The CIC Health branch decides if you passed or not. Of course, the panel physician can tell you if you are healthy or not, but that doesn't mean anything. The doctor who performed my medical exam told me I am healthy, but nevertheless, 9 days later I got a letter from CIC asking me to go back for further tests. They saw something on my lungs, had to take an additional X-ray and a sputum test. One month after I sent it the additional tests, I ordered GCMS notes and found out I had passed my medical. They suspected inactive TB, but after the additional tests, they figured out it was nothing. The best way to find out if you passed your medical is to order the GCMS notes after your application reaches the VO. Click to expand...

aminata2010 said: I never stated it matter..I stated that I have the right to know my results if I am paying for the medical. Click to expand...

If you want to know your results go check the GCMS notes.  

Full Member

Need Help in EE as Immigration DR asked for further Medical checkup I saw an article about Medical Inadmissibility . I am scared because as I had Brain surgery to get a tumor removed in the year 2017 and post that I got all the treatment done in my home country and now I am fully fit. But My Immigration doctor asked me to see an Oncologist for further investigation. I am fully fit and I have all the fitness documents about my health from my Neuro-Surgeon and my Oncologist from India. In that case, will my case get rejected? Can you assist? Has any one in the forum faced the same situation, I am very confused. what is the success rate for such cases?  

Champion Member

skrba said: Need Help in EE as Immigration DR asked for further Medical checkup I saw an article about Medical Inadmissibility . I am scared because as I had Brain surgery to get a tumor removed in the year 2017 and post that I got all the treatment done in my home country and now I am fully fit. But My Immigration doctor asked me to see an Oncologist for further investigation. I am fully fit and I have all the fitness documents about my health from my Neuro-Surgeon and my Oncologist from India. In that case, will my case get rejected? Can you assist? Has any one in the forum faced the same situation, I am very confused. what is the success rate for such cases? Click to expand...

Thankyou Krissh and bdidol, Appreciate your kind words ... let's hope for the best. I will keep this thread posted about my case.  

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Understanding Your Medical Test Results

What Positive, Negative, and Relative Values Mean

Positive and Negative Tests

• Factors That Affect Results

Relative Value Tests

• At-Home Tests

There are two basic kinds of medical test results:

• Tests that give "yes" or "no" answers (usually for diagnostic purposes)
• Tests that give relative results (to measure high or low values compared to a "normal" range)

Thousands of medical tests are done to make diagnoses, measure the progression of a disease or condition, or monitor the effectiveness of treatment. But they all have some basic truths about what they mean and how they are best interpreted.

This article provides information about medical test results and the kinds of questions you'll want answered to better understand what they mean.

When you are given a medical test that yields a positive or negative result, you will need to know what the results mean and whether the result is trustworthy.

Positive and negative tests are typically used for diagnostic purposes to ascertain whether a disease or condition is present (positive) or not (negative). In layperson's terms:

• Positive means whatever the test was looking for was found.
• Negative means whatever the test was looking for was not found.
• Inconclusive means "unsure." The test result was not positive or negative and will likely need to be repeated.

There are also false-positive results which means your test shows you have a disease or condition, but you don't actually have it, and false-negative results in which a test shows you don't have a disease or condition, but you really do. Certain tests have limitations and may be less accurate than others.

For example, you may be given an HIV test , and it comes back negative. Because the test detects proteins produced in response to the disease, rather than the disease itself, it may not be able to make an accurate diagnosis if you are tested too soon after HIV exposure.

Other tests have low specificity. This means the test may be able to detect certain organisms, but are less able to tell one strain of the organism from another.

Factors That Affect Medical Results

The accuracy of certain test results may be affected by factors such as:

• Consuming certain foods or drinks
• Taking certain medicines or supplements
• Exercising hard before your test
• Having a menstrual period at the time of your test

If your test results are not what you expect, you may want to ask to be tested again. There are many ways mistakes can occur, usually because of errors in collecting, storing, or processing lab samples.

Once you have been diagnosed, further testing for that condition will usually yield relative results that will be important to you.

When you are given a medical test that yields relative results, usually in the form of a number (value), you will want to know what those results mean and how they compare to previous results.

These values can determine whether a treatment is working or a disease or condition is progressing. The range of values can sometimes vary based on age, sex, and other factors.

By definition, a relative value test is one that measures specific components of blood, urine, or other lab samples and compares those values to what would be expected in a normal, healthy population.

A complete blood test (CBC) is a prime example of a relative value test. Anything within the range of values is considered normal. Anything above or below the range of values is abnormal.

Abnormal values don't necessarily have diagnostic value but may indicate a developing concern. What is often more important is how values trend between tests, as this can indicate that a treatment is working or failing or if a disease is progressing or resolving.

Common Healthy Results for Medical Tests

Examples of healthy relative value results include:

• Blood pressure: less than 120/80mm Hg (millimeters of mercury)
• Blood glucose (fasting): less than 100mg/dL (milligrams per deciliter)

Cholesterol results, also called a lipid panel, include several types of cholesterol and a blood fat called triglycerides. Healthy relative value results include:

• Total cholesterol: less than 200mg/dL
• HDL cholesterol: 70 to 130mg/dL
• LDL cholesterol: greater than 40mg/dL
• Triglycerides: less than 150mg/dL

Questions to Ask Your Healthcare Provider

Questions to ask your healthcare provider about relative tests include:

• What is normal, and are your results normal?
• If your results are not normal, are better results higher, lower, bigger, or smaller than the results of your test?
• What does your healthcare provider recommend you do to bring them into the normal range?
• How accurate is this test?

Ask for copies of your test results . You might ask for written documentation about where your healthcare provider thinks those relative values should be for you. You might even consider tracking them over time as a way to manage your health.

What to Know About At-Home Tests

At-home medical tests are kits you can buy online, at a pharmacy, or grocery store. The kits provide everything you need to collect a sample of body fluid or cells at home.

You may be able to read the results at home or you may need to send the sample to a lab to test for, screen, or monitor certain diseases and conditions.

Common at-home tests include:

• Pregnancy tests
• Blood sugar tests (to monitor and manage diabetes)
• Fecal occult blood test (screens for colon cancer)
• Tests that check for signs of infectious diseases, such as hepatitis, HIV, and COVID-19
• Genetic tests that may show if you are at higher risk for certain diseases

At-home tests should never replace testing that your healthcare provider orders. Ask your provider or pharmacist to recommend test kits, and talk with your provider about your results, even if they're normal.

Medical tests are done to make diagnoses, measure the progression of a disease or condition, or monitor the effectiveness of treatment. Test results may be positive, negative, inconclusive, or a relative number.

Several factors can affect test results. It's important to talk to your healthcare provider about your test results to make sure you understand the results and what they mean for your health and possible treatments.

Medline Plus. How to understand your lab results .

nam: aidsmap. False negative results on HIV tests .

Plebani M. Diagnostic errors and laboratory medicine - causes and strategies .  EJIFCC . 2015;26(1):7–14.

American Heart Association. High blood pressure .

American Diabetes Association. Blood glucose and A1C diagnosis .

Johns Hopkins Medicine. Lipid panel .

Medline Plus. At-home medical tests .

By Trisha Torrey  Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system. 

NHRA - National Hot Rod Association

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Veteran crew chief John Stewart joins Josh Hart's R+L Carriers Top Fuel team

Mark Dawson joins NHRA as Northeast Division Director

Unofficial Mission Foods points standings

John Force moving forward in recovery process

Travis Shumake announces partnership with CAS for Norwalk event

NHRA racers Shumake, Nataas, Handras visit Goodyear race tire plant in Ohio

John Force improving, faces long road ahead; Brittany to sit out Norwalk race

Funny Car champ Matt Hagan nominated for ESPYS Best Driver Award

Defending champ Alexander to fly Schaeffler colors this weekend in Norwalk

Funny Car racer Chris King excited to compete this weekend in Norwalk

Right2Breathe, Cleveland Clinic to provide free lung screening Health Expo at Norwalk event

Seventy-day countdown begins to the 70th nhra u.s. nationals.

In Memoriam

Joe Morrison set for nitro Funny Car debut in Norwalk

John Force remains in ICU at Virginia hospital

Pluchino claims JHG Mountain Motor title in Richmond

John Force suffers engine explosion, crash in first round at Virginia Nationals

Pro Stock rookie Sienna Wildgust joins Elite Motorsports team roster

Bo Butner returns to Pro Stock, taking on double duty at Virginia Nationals

Pro Stock Motorcycle champ Geno Scali set to return for final seven events of 2024

Doug Kalitta throws first pitch, readies for curveballs in Richmond heat

Historic NHRA Gatornationals set to open 2025 NHRA season on March 6-9

Racers, fans geared up for exciting new format at PlayNHRA Virginia Nationals

Dodge brand extends NHRA partnership with Tony Stewart Racing

PlayNHRA named title sponsor of Virginia Nationals at Virginia Motorsports Park

Wilson wins fourth title to highlight JDRL Western Conference Finals in Dallas

Hot summertime racing, even hotter features highlight new National Dragster

Cornwell Tools backs Brittany Force for two Norwalk events

Watch the NHRA Jr. Drag Racing League Western Conference Finals on NHRA.tv

DHDR developmental driver Madi Turley enjoys Bristol experience

Four days after his crash at more than 300 miles per hour, drag racing champion John Force has moved from the trauma intensive care unit to the neuro intensive care unit, where the medical team can focus on his head injury, which is their primary concern.   The move was a welcome positive for his family members, who have maintained a daily presence at the hospital all week.   With the unanimous support of her family, team, and sponsors, Brittany Force is not planning to compete this week at the Summit Racing Equipment NHRA Nationals in Norwalk, where she would have driven the Cornwell Tools Chevrolet Top Fuel dragster. Instead, she will remain at the hospital with her family in solidarity for her father.   Austin Prock will compete this weekend with the same courageous, fighting spirit that John has embodied and instilled in his teams over the years, and his AAA Chevrolet Camaro SS team will proudly carry the torch for the entire John Force Racing organization and sponsors this weekend.   The Force family is grateful for the team of medical professionals who are caring for John and for the overwhelming number of heartfelt messages of prayer, support, and concern. Thank you for continuing to respect the privacy of the family and John Force Racing team members.

• Introduction
• Conclusions
• Article Information

The reports to the Vaccine Adverse Event Reporting System met the case definition of myocarditis (reported cases). Among individuals older than 40 years of age, there were no more than 8 reports of myocarditis for any individual age after receiving either vaccine. For the BNT162b2 vaccine, there were 114 246 837 first vaccination doses and 95 532 396 second vaccination doses; and for the mRNA-1273 vaccine, there were 78 158 611 and 66 163 001, respectively. The y-axis range differs between panels A and B.

The reports to the Vaccine Adverse Event Reporting System met the case definition of myocarditis (reported cases). Among recipients of either vaccine, there were only 13 reports or less of myocarditis beyond 10 days for any individual time from vaccination to symptom onset. The y-axis range differs between panels A and B.

A, For the BNT162b2 vaccine, there were 138 reported cases of myocarditis with known date for symptom onset and dose after 114 246 837 first vaccination doses and 888 reported cases after 95 532 396 second vaccination doses.

B, For the mRNA-1273 vaccine, there were 116 reported cases of myocarditis with known date for symptom onset and dose after 78 158 611 first vaccination doses and 311 reported cases after 66 163 001 second vaccination doses.

eMethods. Medical Dictionary for Regulatory Activities Preferred Terms, Definitions of Myocarditis and Pericarditis, Myocarditis medical review form

eFigure. Flow diagram of cases of myocarditis and pericarditis reported to Vaccine Adverse Event Reporting System (VAERS) after receiving mRNA-based COVID-19 vaccine, United States, December 14, 2020-August 31, 2021.

eTable 1. Characteristics of all myocarditis cases reported to Vaccine Adverse Event Reporting System (VAERS) after mRNA-based COVID-19 vaccination, United States, December 14, 2020–August 31, 2021.

eTable 2. Characteristics of all pericarditis cases reported to Vaccine Adverse Event Reporting System (VAERS) after mRNA-based COVID-19 vaccination, United States, December 14, 2020–August 31, 2021.

eTable 3. Characteristics of myocarditis cases reported to Vaccine Adverse Event Reporting System after mRNA-based COVID-19 vaccination by case definition status.

• Myocarditis and Pericarditis After Vaccination for COVID-19 JAMA Research Letter September 28, 2021 This study investigates the incidence of myocarditis and pericarditis emergency department or inpatient hospital encounters before COVID-19 vaccine availability (January 2019–January 2021) and during a COVID-19 vaccination period (February-May 2021) in a large US health care system. George A. Diaz, MD; Guilford T. Parsons, MD, MS; Sara K. Gering, BS, BSN; Audrey R. Meier, MPH; Ian V. Hutchinson, PhD, DSc; Ari Robicsek, MD
• Myocarditis Following a Third BNT162b2 Vaccination Dose in Military Recruits in Israel JAMA Research Letter April 26, 2022 This study assessed whether a third vaccine dose was associated with the risk of myocarditis among military personnel in Israel. Limor Friedensohn, MD; Dan Levin, MD; Maggie Fadlon-Derai, MHA; Liron Gershovitz, MD; Noam Fink, MD; Elon Glassberg, MD; Barak Gordon, MD
• Myocarditis Cases After mRNA-Based COVID-19 Vaccination in the US—Reply JAMA Comment & Response May 24, 2022 Matthew E. Oster, MD, MPH; David K. Shay, MD, MPH; Tom T. Shimabukuro, MD, MPH, MBA
• Myocarditis Cases After mRNA-Based COVID-19 Vaccination in the US JAMA Comment & Response May 24, 2022 Sheila R. Weiss, PhD
• JAMA Network Articles of the Year 2022 JAMA Medical News & Perspectives December 27, 2022 This Medical News article is our annual roundup of the top-viewed articles from all JAMA Network journals. Melissa Suran, PhD, MSJ
• Diagnosis and Treatment of Acute Myocarditis—A Review JAMA Review April 4, 2023 This Review summarizes current evidence regarding the diagnosis and treatment of acute myocarditis. Enrico Ammirati, MD, PhD; Javid J. Moslehi, MD
• Patient Information: Acute Myocarditis JAMA JAMA Patient Page August 8, 2023 This JAMA Patient Page describes acute myocarditis and its symptoms, causes, diagnosis, and treatment. Kristin Walter, MD, MS
• Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military JAMA Cardiology Brief Report October 1, 2021 This case series describes myocarditis presenting after COVID-19 vaccination within the Military Health System. Jay Montgomery, MD; Margaret Ryan, MD, MPH; Renata Engler, MD; Donna Hoffman, MSN; Bruce McClenathan, MD; Limone Collins, MD; David Loran, DNP; David Hrncir, MD; Kelsie Herring, MD; Michael Platzer, MD; Nehkonti Adams, MD; Aliye Sanou, MD; Leslie T. Cooper Jr, MD
• Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination JAMA Cardiology Brief Report October 1, 2021 This study describes 4 patients who presented with acute myocarditis after mRNA COVID-19 vaccination. Han W. Kim, MD; Elizabeth R. Jenista, PhD; David C. Wendell, PhD; Clerio F. Azevedo, MD; Michael J. Campbell, MD; Stephen N. Darty, BS; Michele A. Parker, MS; Raymond J. Kim, MD
• Association of Myocarditis With BNT162b2 Vaccination in Children JAMA Cardiology Brief Report December 1, 2021 This case series reviews comprehensive cardiac imaging in children with myocarditis after COVID-19 vaccine. Audrey Dionne, MD; Francesca Sperotto, MD; Stephanie Chamberlain; Annette L. Baker, MSN, CPNP; Andrew J. Powell, MD; Ashwin Prakash, MD; Daniel A. Castellanos, MD; Susan F. Saleeb, MD; Sarah D. de Ferranti, MD, MPH; Jane W. Newburger, MD, MPH; Kevin G. Friedman, MD

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Oster ME , Shay DK , Su JR, et al. Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021. JAMA. 2022;327(4):331–340. doi:10.1001/jama.2021.24110

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Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021

• 1 US Centers for Disease Control and Prevention, Atlanta, Georgia
• 2 School of Medicine, Emory University, Atlanta, Georgia
• 3 Children’s Healthcare of Atlanta, Atlanta, Georgia
• 4 Vanderbilt University Medical Center, Nashville, Tennessee
• 5 Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
• 6 Boston Medical Center, Boston, Massachusetts
• 7 Duke University, Durham, North Carolina
• 8 US Food and Drug Administration, Silver Spring, Maryland
• Research Letter Myocarditis and Pericarditis After Vaccination for COVID-19 George A. Diaz, MD; Guilford T. Parsons, MD, MS; Sara K. Gering, BS, BSN; Audrey R. Meier, MPH; Ian V. Hutchinson, PhD, DSc; Ari Robicsek, MD JAMA
• Research Letter Myocarditis Following a Third BNT162b2 Vaccination Dose in Military Recruits in Israel Limor Friedensohn, MD; Dan Levin, MD; Maggie Fadlon-Derai, MHA; Liron Gershovitz, MD; Noam Fink, MD; Elon Glassberg, MD; Barak Gordon, MD JAMA
• Comment & Response Myocarditis Cases After mRNA-Based COVID-19 Vaccination in the US—Reply Matthew E. Oster, MD, MPH; David K. Shay, MD, MPH; Tom T. Shimabukuro, MD, MPH, MBA JAMA
• Comment & Response Myocarditis Cases After mRNA-Based COVID-19 Vaccination in the US Sheila R. Weiss, PhD JAMA
• Medical News & Perspectives JAMA Network Articles of the Year 2022 Melissa Suran, PhD, MSJ JAMA
• Review Diagnosis and Treatment of Acute Myocarditis—A Review Enrico Ammirati, MD, PhD; Javid J. Moslehi, MD JAMA
• JAMA Patient Page Patient Information: Acute Myocarditis Kristin Walter, MD, MS JAMA
• Brief Report Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military Jay Montgomery, MD; Margaret Ryan, MD, MPH; Renata Engler, MD; Donna Hoffman, MSN; Bruce McClenathan, MD; Limone Collins, MD; David Loran, DNP; David Hrncir, MD; Kelsie Herring, MD; Michael Platzer, MD; Nehkonti Adams, MD; Aliye Sanou, MD; Leslie T. Cooper Jr, MD JAMA Cardiology
• Brief Report Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination Han W. Kim, MD; Elizabeth R. Jenista, PhD; David C. Wendell, PhD; Clerio F. Azevedo, MD; Michael J. Campbell, MD; Stephen N. Darty, BS; Michele A. Parker, MS; Raymond J. Kim, MD JAMA Cardiology
• Brief Report Association of Myocarditis With BNT162b2 Vaccination in Children Audrey Dionne, MD; Francesca Sperotto, MD; Stephanie Chamberlain; Annette L. Baker, MSN, CPNP; Andrew J. Powell, MD; Ashwin Prakash, MD; Daniel A. Castellanos, MD; Susan F. Saleeb, MD; Sarah D. de Ferranti, MD, MPH; Jane W. Newburger, MD, MPH; Kevin G. Friedman, MD JAMA Cardiology

Question   What is the risk of myocarditis after mRNA-based COVID-19 vaccination in the US?

Findings   In this descriptive study of 1626 cases of myocarditis in a national passive reporting system, the crude reporting rates within 7 days after vaccination exceeded the expected rates across multiple age and sex strata. The rates of myocarditis cases were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively).

Meaning   Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men.

Importance   Vaccination against COVID-19 provides clear public health benefits, but vaccination also carries potential risks. The risks and outcomes of myocarditis after COVID-19 vaccination are unclear.

Objective   To describe reports of myocarditis and the reporting rates after mRNA-based COVID-19 vaccination in the US.

Design, Setting, and Participants   Descriptive study of reports of myocarditis to the Vaccine Adverse Event Reporting System (VAERS) that occurred after mRNA-based COVID-19 vaccine administration between December 2020 and August 2021 in 192 405 448 individuals older than 12 years of age in the US; data were processed by VAERS as of September 30, 2021.

Exposures   Vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna).

Main Outcomes and Measures   Reports of myocarditis to VAERS were adjudicated and summarized for all age groups. Crude reporting rates were calculated across age and sex strata. Expected rates of myocarditis by age and sex were calculated using 2017-2019 claims data. For persons younger than 30 years of age, medical record reviews and clinician interviews were conducted to describe clinical presentation, diagnostic test results, treatment, and early outcomes.

Results   Among 192 405 448 persons receiving a total of 354 100 845 mRNA-based COVID-19 vaccines during the study period, there were 1991 reports of myocarditis to VAERS and 1626 of these reports met the case definition of myocarditis. Of those with myocarditis, the median age was 21 years (IQR, 16-31 years) and the median time to symptom onset was 2 days (IQR, 1-3 days). Males comprised 82% of the myocarditis cases for whom sex was reported. The crude reporting rates for cases of myocarditis within 7 days after COVID-19 vaccination exceeded the expected rates of myocarditis across multiple age and sex strata. The rates of myocarditis were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively). There were 826 cases of myocarditis among those younger than 30 years of age who had detailed clinical information available; of these cases, 792 of 809 (98%) had elevated troponin levels, 569 of 794 (72%) had abnormal electrocardiogram results, and 223 of 312 (72%) had abnormal cardiac magnetic resonance imaging results. Approximately 96% of persons (784/813) were hospitalized and 87% (577/661) of these had resolution of presenting symptoms by hospital discharge. The most common treatment was nonsteroidal anti-inflammatory drugs (589/676; 87%).

Conclusions and Relevance   Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men. This risk should be considered in the context of the benefits of COVID-19 vaccination.

Myocarditis is an inflammatory condition of the heart muscle that has a bimodal peak incidence during infancy and adolescence or young adulthood. 1 - 4 The clinical presentation and course of myocarditis is variable, with some patients not requiring treatment and others experiencing severe heart failure that requires subsequent heart transplantation or leads to death. 5 Onset of myocarditis typically follows an inciting process, often a viral illness; however, no antecedent cause is identified in many cases. 6 It has been hypothesized that vaccination can serve as a trigger for myocarditis; however, only the smallpox vaccine has previously been causally associated with myocarditis based on reports among US military personnel, with cases typically occurring 7 to 12 days after vaccination. 7

With the implementation of a large-scale, national COVID-19 vaccination program starting in December 2020, the US Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration began monitoring for a number of adverse events of special interest, including myocarditis and pericarditis, in the Vaccine Adverse Event Reporting System (VAERS), a long-standing national spontaneous reporting (passive surveillance) system. 8 As the reports of myocarditis after COVID-19 vaccination were reported to VAERS, the Clinical Immunization Safety Assessment Project, 9 a collaboration between the CDC and medical research centers, which includes physicians treating infectious diseases and other specialists (eg, cardiologists), consulted on several of the cases. In addition, reports from several countries raised concerns that mRNA-based COVID-19 vaccines may be associated with acute myocarditis. 10 - 15

Given this concern, the aims were to describe reports and confirmed cases of myocarditis initially reported to VAERS after mRNA-based COVID-19 vaccination and to provide estimates of the risk of myocarditis after mRNA-based COVID-19 vaccination based on age, sex, and vaccine type.

VAERS is a US spontaneous reporting (passive surveillance) system that functions as an early warning system for potential vaccine adverse events. 8 Co-administered by the CDC and the US Food and Drug Administration, VAERS accepts reports of all adverse events after vaccination from patients, parents, clinicians, vaccine manufacturers, and others regardless of whether the events could plausibly be associated with receipt of the vaccine. Reports to VAERS include information about the vaccinated person, the vaccine or vaccines administered, and the adverse events experienced by the vaccinated person. The reports to VAERS are then reviewed by third-party professional coders who have been trained in the assignment of Medical Dictionary for Regulatory Activities preferred terms. 16 The coders then assign appropriate terms based on the information available in the reports.

This activity was reviewed by the CDC and was conducted to be consistent with applicable federal law and CDC policy. The activities herein were confirmed to be nonresearch under the Common Rule in accordance with institutional procedures and therefore were not subject to institutional review board requirements. Informed consent was not obtained for this secondary use of existing information; see 45 CFR part 46.102(l)(2), 21 CFR part 56, 42 USC §241(d), 5 USC §552a, and 44 USC §3501 et seq.

The exposure of concern was vaccination with one of the mRNA-based COVID-19 vaccines: the BNT162b2 vaccine (Pfizer-BioNTech) or the mRNA-1273 vaccine (Moderna). During the analytic period, persons aged 12 years or older were eligible for the BNT162b2 vaccine and persons aged 18 years or older were eligible for the mRNA-1273 vaccine. The number of COVID-19 vaccine doses administered during the analytic period was obtained through the CDC’s COVID-19 Data Tracker. 17

The primary outcome was the occurrence of myocarditis and the secondary outcome was pericarditis. Reports to VAERS with these outcomes were initially characterized using the Medical Dictionary for Regulatory Activities preferred terms of myocarditis or pericarditis (specific terms are listed in the eMethods in the Supplement ). After initial review of reports of myocarditis to VAERS and review of the patient’s medical records (when available), the reports were further reviewed by CDC physicians and public health professionals to verify that they met the CDC’s case definition for probable or confirmed myocarditis (descriptions previously published and included in the eMethods in the Supplement ). 18 The CDC’s case definition of probable myocarditis requires the presence of new concerning symptoms, abnormal cardiac test results, and no other identifiable cause of the symptoms and findings. Confirmed cases of myocarditis further require histopathological confirmation of myocarditis or cardiac magnetic resonance imaging (MRI) findings consistent with myocarditis.

Deaths were included only if the individual had met the case definition for confirmed myocarditis and there was no other identifiable cause of death. Individual cases not involving death were included only if the person had met the case definition for probable myocarditis or confirmed myocarditis.

We characterized reports of myocarditis or pericarditis after COVID-19 vaccination that met the CDC’s case definition and were received by VAERS between December 14, 2020 (when COVID-19 vaccines were first publicly available in the US), and August 31, 2021, by age, sex, race, ethnicity, and vaccine type; data were processed by VAERS as of September 30, 2021. Race and ethnicity were optional fixed categories available by self-identification at the time of vaccination or by the individual filing a VAERS report. Race and ethnicity were included to provide the most complete baseline description possible for individual reports; however, further analyses were not stratified by race and ethnicity due to the high percentage of missing data. Reports of pericarditis with evidence of potential myocardial involvement were included in the review of reports of myocarditis. The eFigure in the Supplement outlines the categorization of the reports of myocarditis and pericarditis reviewed.

Further analyses were conducted only for myocarditis because of the preponderance of those reports to VAERS, in Clinical Immunization Safety Assessment Project consultations, and in published articles. 10 - 12 , 19 - 21 Crude reporting rates for myocarditis during a 7-day risk interval were calculated using the number of reports of myocarditis to VAERS per million doses of COVID-19 vaccine administered during the analytic period and stratified by age, sex, vaccination dose (first, second, or unknown), and vaccine type. Expected rates of myocarditis by age and sex were calculated using 2017-2019 data from the IBM MarketScan Commercial Research Database. This database contains individual-level, deidentified, inpatient and outpatient medical and prescription drug claims, and enrollment information submitted to IBM Watson Health by large employers and health plans. The data were accessed using version 4.0 of the IBM MarketScan Treatment Pathways analytic platform. Age- and sex-specific rates were calculated by determining the number of individuals with myocarditis ( International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes B33.20, B33.22, B33.24, I40.0, I40.1, I40.8, I40.9, or I51.4) 22 identified during an inpatient encounter in 2017-2019 relative to the number of individuals of similar age and sex who were continually enrolled during the year in which the myocarditis-related hospitalization occurred; individuals with any diagnosis of myocarditis prior to that year were excluded. Given the limitations of the IBM MarketScan Commercial Research Database to capture enrollees aged 65 years or older, an expected rate for myocarditis was not calculated for this population. A 95% CI was calculated using Poisson distribution in SAS version 9.4 (SAS Institute Inc) for each expected rate of myocarditis and for each observed rate in a strata with at least 1 case.

In cases of probable or confirmed myocarditis among those younger than 30 years of age, their clinical course was then summarized to the extent possible based on medical review and clinician interviews. This clinical course included presenting symptoms, diagnostic test results, treatment, and early outcomes (abstraction form appears in the eMethods in the Supplement ). 23

When applicable, missing data were delineated in the results or the numbers with complete data were listed. No assumptions or imputations were made regarding missing data. Any percentages that were calculated included only those cases of myocarditis with adequate data to calculate the percentages.

Between December 14, 2020, and August 31, 2021, 192 405 448 individuals older than 12 years of age received a total of 354 100 845 mRNA-based COVID-19 vaccines. VAERS received 1991 reports of myocarditis (391 of which also included pericarditis) after receipt of at least 1 dose of mRNA-based COVID-19 vaccine (eTable 1 in the Supplement ) and 684 reports of pericarditis without the presence of myocarditis (eTable 2 in the Supplement ).

Of the 1991 reports of myocarditis, 1626 met the CDC’s case definition for probable or confirmed myocarditis ( Table 1 ). There were 208 reports that did not meet the CDC’s case definition for myocarditis and 157 reports that required more information to perform adjudication (eTable 3 in the Supplement ). Of the 1626 reports that met the CDC’s case definition for myocarditis, 1195 (73%) were younger than 30 years of age, 543 (33%) were younger than 18 years of age, and the median age was 21 years (IQR, 16-31 years) ( Figure 1 ). Of the reports of myocarditis with dose information, 82% (1265/1538) occurred after the second vaccination dose. Of those with a reported dose and time to symptom onset, the median time from vaccination to symptom onset was 3 days (IQR, 1-8 days) after the first vaccination dose and 74% (187/254) of myocarditis events occurred within 7 days. After the second vaccination dose, the median time to symptom onset was 2 days (IQR, 1-3 days) and 90% (1081/1199) of myocarditis events occurred within 7 days ( Figure 2 ).

Males comprised 82% (1334/1625) of the cases of myocarditis for whom sex was reported. The largest proportions of cases of myocarditis were among White persons (non-Hispanic or ethnicity not reported; 69% [914/1330]) and Hispanic persons (of all races; 17% [228/1330]). Among persons younger than 30 years of age, there were no confirmed cases of myocarditis in those who died after mRNA-based COVID-19 vaccination without another identifiable cause and there was 1 probable case of myocarditis but there was insufficient information available for a thorough investigation. At the time of data review, there were 2 reports of death in persons younger than 30 years of age with potential myocarditis that remain under investigation and are not included in the case counts.

Symptom onset of myocarditis was within 7 days after vaccination for 947 reports of individuals who received the BNT162b2 vaccine and for 382 reports of individuals who received the mRNA-1273 vaccine. The rates of myocarditis varied by vaccine type, sex, age, and first or second vaccination dose ( Table 2 ). The reporting rates of myocarditis were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.73 [95% CI, 61.68-81.11] per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.86 [95% CI, 91.65-122.27] per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.43 [95% CI, 45.56-60.33] per million doses of the BNT162b2 vaccine and 56.31 [95% CI, 47.08-67.34] per million doses of the mRNA-1273 vaccine). The lower estimate of the 95% CI for reporting rates of myocarditis in adolescent males and young men exceeded the upper bound of the expected rates after the first vaccination dose with the BNT162b2 vaccine in those aged 12 to 24 years, after the second vaccination dose with the BNT162b2 vaccine in those aged 12 to 49 years, after the first vaccination dose with the mRNA-1273 vaccine in those aged 18 to 39 years, and after the second vaccination dose with the mRNA-1273 vaccine in those aged 18 to 49 years.

The reporting rates of myocarditis in females were lower than those in males across all age strata younger than 50 years of age. The reporting rates of myocarditis were highest after the second vaccination dose in adolescent females aged 12 to 15 years (6.35 [95% CI, 4.05-9.96] per million doses of the BNT162b2 vaccine), in adolescent females aged 16 to 17 years (10.98 [95% CI, 7.16-16.84] per million doses of the BNT162b2 vaccine), in young women aged 18 to 24 years (6.87 [95% CI, 4.27-11.05] per million doses of the mRNA-1273 vaccine), and in women aged 25 to 29 years (8.22 [95% CI, 5.03-13.41] per million doses of the mRNA-1273 vaccine). The lower estimate of the 95% CI for reporting rates of myocarditis in females exceeded the upper bound of the expected rates after the second vaccination dose with the BNT162b2 vaccine in those aged 12 to 29 years and after the second vaccination dose with the mRNA-1273 vaccine in those aged 18 to 29 years.

Among the 1372 reports of myocarditis in persons younger than 30 years of age, 1305 were able to be adjudicated, with 92% (1195/1305) meeting the CDC’s case definition. Of these, chart abstractions or medical interviews were completed for 69% (826/1195) ( Table 3 ). The symptoms commonly reported in the verified cases of myocarditis in persons younger than 30 years of age included chest pain, pressure, or discomfort (727/817; 89%) and dyspnea or shortness of breath (242/817; 30%). Troponin levels were elevated in 98% (792/809) of the cases of myocarditis. The electrocardiogram result was abnormal in 72% (569/794) of cases of myocarditis. Of the patients who had received a cardiac MRI, 72% (223/312) had abnormal findings consistent with myocarditis. The echocardiogram results were available for 721 cases of myocarditis; of these, 84 (12%) demonstrated a notable decreased left ventricular ejection fraction (<50%). Among the 676 cases for whom treatment data were available, 589 (87%) received nonsteroidal anti-inflammatory drugs. Intravenous immunoglobulin and glucocorticoids were each used in 12% of the cases of myocarditis (78/676 and 81/676, respectively). Intensive therapies such as vasoactive medications (12 cases of myocarditis) and intubation or mechanical ventilation (2 cases) were rare. There were no verified cases of myocarditis requiring a heart transplant, extracorporeal membrane oxygenation, or a ventricular assist device. Of the 96% (784/813) of cases of myocarditis who were hospitalized, 98% (747/762) were discharged from the hospital at time of review. In 87% (577/661) of discharged cases of myocarditis, there was resolution of the presenting symptoms by hospital discharge.

In this review of reports to VAERS between December 2020 and August 2021, myocarditis was identified as a rare but serious adverse event that can occur after mRNA-based COVID-19 vaccination, particularly in adolescent males and young men. However, this increased risk must be weighed against the benefits of COVID-19 vaccination. 18

Compared with cases of non–vaccine-associated myocarditis, the reports of myocarditis to VAERS after mRNA-based COVID-19 vaccination were similar in demographic characteristics but different in their acute clinical course. First, the greater frequency noted among vaccine recipients aged 12 to 29 years vs those aged 30 years or older was similar to the age distribution seen in typical cases of myocarditis. 2 , 4 This pattern may explain why cases of myocarditis were not discovered until months after initial Emergency Use Authorization of the vaccines in the US (ie, until the vaccines were widely available to younger persons). Second, the sex distribution in cases of myocarditis after COVID-19 vaccination was similar to that seen in typical cases of myocarditis; there is a strong male predominance for both conditions. 2 , 4

However, the onset of myocarditis symptoms after exposure to a potential immunological trigger was shorter for COVID-19 vaccine–associated cases of myocarditis than is typical for myocarditis cases diagnosed after a viral illness. 24 - 26 Cases of myocarditis reported after COVID-19 vaccination were typically diagnosed within days of vaccination, whereas cases of typical viral myocarditis can often have indolent courses with symptoms sometimes present for weeks to months after a trigger if the cause is ever identified. 1 The major presenting symptoms appeared to resolve faster in cases of myocarditis after COVID-19 vaccination than in typical viral cases of myocarditis. Even though almost all individuals with cases of myocarditis were hospitalized and clinically monitored, they typically experienced symptomatic recovery after receiving only pain management. In contrast, typical viral cases of myocarditis can have a more variable clinical course. For example, up to 6% of typical viral myocarditis cases in adolescents require a heart transplant or result in mortality. 27

In the current study, the initial evaluation and treatment of COVID-19 vaccine–associated myocarditis cases was similar to that of typical myocarditis cases. 28 - 31 Initial evaluation usually included measurement of troponin level, electrocardiography, and echocardiography. 1 Cardiac MRI was often used for diagnostic purposes and also for possible prognostic purposes. 32 , 33 Supportive care was a mainstay of treatment, with specific cardiac or intensive care therapies as indicated by the patient’s clinical status.

Long-term outcome data are not yet available for COVID-19 vaccine–associated myocarditis cases. The CDC has started active follow-up surveillance in adolescents and young adults to assess the health and functional status and cardiac outcomes at 3 to 6 months in probable and confirmed cases of myocarditis reported to VAERS after COVID-19 vaccination. 34 For patients with myocarditis, the American Heart Association and the American College of Cardiology guidelines advise that patients should be instructed to refrain from competitive sports for 3 to 6 months, and that documentation of a normal electrocardiogram result, ambulatory rhythm monitoring, and an exercise test should be obtained prior to resumption of sports. 35 The use of cardiac MRI is unclear, but it may be useful in evaluating the progression or resolution of myocarditis in those with abnormalities on the baseline cardiac MRI. 36 Further doses of mRNA-based COVID-19 vaccines should be deferred, but may be considered in select circumstances. 37

This study has several limitations. First, although clinicians are required to report serious adverse events after COVID-19 vaccination, including all events leading to hospitalization, VAERS is a passive reporting system. As such, the reports of myocarditis to VAERS may be incomplete, and the quality of the information reported is variable. Missing data for sex, vaccination dose number, and race and ethnicity were not uncommon in the reports received; history of prior SARS-CoV-2 infection also was not known. Furthermore, as a passive system, VAERS data are subject to reporting biases in that both underreporting and overreporting are possible. 38 Given the high verification rate of reports of myocarditis to VAERS after mRNA-based COVID-19 vaccination, underreporting is more likely. Therefore, the actual rates of myocarditis per million doses of vaccine are likely higher than estimated.

Second, efforts by CDC investigators to obtain medical records or interview physicians were not always successful despite the special allowance for sharing information with the CDC under the Health Insurance Portability and Accountability Act of 1996. 39 This challenge limited the ability to perform case adjudication and complete investigations for some reports of myocarditis, although efforts are still ongoing when feasible.

Third, the data from vaccination administration were limited to what is reported to the CDC and thus may be incomplete, particularly with regard to demographics.

Fourth, calculation of expected rates from the IBM MarketScan Commercial Research Database relied on administrative data via the use of ICD-10 codes and there was no opportunity for clinical review. Furthermore, these data had limited information regarding the Medicare population; thus expected rates for those older than 65 years of age were not calculated. However, it is expected that the rates in those older than 65 years of age would not be higher than the rates in those aged 50 to 64 years. 4

Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men. This risk should be considered in the context of the benefits of COVID-19 vaccination.

Corresponding Author: Matthew E. Oster, MD, MPH, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333 ( [email protected] ).

Correction: This article was corrected March 21, 2022, to change “pericarditis” to “myocarditis” in the first row, first column of eTable 1 in the Supplement.

Accepted for Publication: December 16, 2021.

Author Contributions: Drs Oster and Su had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Oster, Shay, Su, Creech, Edwards, Dendy, Schlaudecker, Woo, Shimabukuro.

Acquisition, analysis, or interpretation of data: Oster, Shay, Su, Gee, Creech, Broder, Edwards, Soslow, Schlaudecker, Lang, Barnett, Ruberg, Smith, Campbell, Lopes, Sperling, Baumblatt, Thompson, Marquez, Strid, Woo, Pugsley, Reagan-Steiner, DeStefano, Shimabukuro.

Drafting of the manuscript: Oster, Shay, Su, Gee, Creech, Marquez, Strid, Woo, Shimabukuro.

Critical revision of the manuscript for important intellectual content: Oster, Shay, Su, Creech, Broder, Edwards, Soslow, Dendy, Schlaudecker, Lang, Barnett, Ruberg, Smith, Campbell, Lopes, Sperling, Baumblatt, Thompson, Pugsley, Reagan-Steiner, DeStefano, Shimabukuro.

Statistical analysis: Oster, Su, Marquez, Strid, Woo, Shimabukuro.

Obtained funding: Edwards, DeStefano.

Administrative, technical, or material support: Oster, Gee, Creech, Broder, Edwards, Soslow, Schlaudecker, Smith, Baumblatt, Thompson, Reagan-Steiner, DeStefano.

Supervision: Su, Edwards, Soslow, Dendy, Schlaudecker, Campbell, Sperling, DeStefano, Shimabukuro.

Conflict of Interest Disclosures: Dr Creech reported receiving grants from the National Institutes of Health for the Moderna and Janssen clinical trials and receiving personal fees from Astellas and Horizon. Dr Edwards reported receiving grants from the National Institutes of Health; receiving personal fees from BioNet, IBM, X-4 Pharma, Seqirus, Roche, Pfizer, Merck, Moderna, and Sanofi; and receiving compensation for being the associate editor of Clinical Infectious Diseases . Dr Soslow reported receiving personal fees from Esperare. Dr Schlaudecker reported receiving grants from Pfizer and receiving personal fees from Sanofi Pasteur. Drs Barnett, Ruberg, and Smith reported receiving grants from Pfizer. Dr Lopes reported receiving personal fees from Bayer, Boehringer Ingleheim, Bristol Myers Squibb, Daiichi Sankyo, GlaxoSmithKline, Medtronic, Merck, Pfizer, Portola, and Sanofi and receiving grants from Bristol Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi. No other disclosures were reported.

Funding/Support: This work was supported by contracts 200-2012-53709 (Boston Medical Center), 200-2012-53661 (Cincinnati Children’s Hospital Medical Center), 200-2012-53663 (Duke University), and 200-2012-50430 (Vanderbilt University Medical Center) with the US Centers for Disease Control and Prevention (CDC) Clinical Immunization Safety Assessment Project.

Role of the Funder/Sponsor: The CDC provided funding via the Clinical Immunization Safety Assessment Project to Drs Creech, Edwards, Soslow, Dendy, Schlaudecker, Lang, Barnett, Ruberg, Smith, Campbell, and Lopes. The authors affiliated with the CDC along with the other coauthors conducted the investigations; performed collection, management, analysis, and interpretation of the data; were involved in the preparation, review, and approval of the manuscript; and made the decision to submit the manuscript for publication.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the CDC or the US Food and Drug Administration. Mention of a product or company name is for identification purposes only and does not constitute endorsement by the CDC or the US Food and Drug Administration.

Additional Contributions: We thank the following CDC staff who contributed to this article without compensation outside their normal salaries (in alphabetical order and contribution specified in parenthesis at end of each list of names): Nickolas Agathis, MD, MPH, Stephen R. Benoit, MD, MPH, Beau B. Bruce, MD, PhD, Abigail L. Carlson, MD, MPH, Meredith G. Dixon, MD, Jonathan Duffy, MD, MPH, Charles Duke, MD, MPH, Charles Edge, MSN, MS, Robyn Neblett Fanfair, MD, MPH, Nathan W. Furukawa, MD, MPH, Gavin Grant, MD, MPH, Grace Marx, MD, MPH, Maureen J. Miller, MD, MPH, Pedro Moro, MD, MPH, Meredith Oakley, DVM, MPH, Kia Padgett, MPH, BSN, RN, Janice Perez-Padilla, MPH, BSN, RN, Robert Perry, MD, MPH, Nimia Reyes, MD, MPH, Ernest E. Smith, MD, MPH&TM, David Sniadack, MD, MPH, Pamela Tucker, MD, Edward C. Weiss, MD, MPH, Erin Whitehouse, PhD, MPH, RN, Pascale M. Wortley, MD, MPH, and Rachael Zacks, MD (for clinical investigations and interviews); Amelia Jazwa, MSPH, Tara Johnson, MPH, MS, and Jamila Shields, MPH (for project coordination); Charles Licata, PhD, and Bicheng Zhang, MS (for data acquisition and organization); Charles E. Rose, PhD (for statistical consultation); and Scott D. Grosse, PhD (for calculation of expected rates of myocarditis). We also thank the clinical staff who cared for these patients and reported the adverse events to the Vaccine Adverse Event Reporting System.

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She Needed an Emergency Abortion. Doctors in Idaho Put Her on a Plane.

In states that have banned abortion, hospitals have struggled to treat pregnant women facing health risks. A Supreme Court decision this week did not help.

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By Kate Zernike

Kate Zernike writes about abortion and politics.

Nicole Miller had gone to the emergency room in Boise, Idaho, after waking up with heavy bleeding in her 20th week of pregnancy. By afternoon, she was still leaking amniotic fluid and hemorrhaging and, now in a panic, struggling to understand why the doctor was telling her that she needed to leave the state to be treated.

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Israeli authorities say 68 people, 19 sick and injured children plus their companions, have been allowed out of the Gaza Strip and into Egypt in the first medical evacuation since May, when the territory’s sole travel crossing was shut down.

Scuffles between Israeli police and demonstrators broke out in Jerusalem on Thursday as thousands gathered to protest against Prime Minister Benjamin Netanyahu’s government and demand the return of hostages being held by Hamas in Gaza. (27 June 2024)

Palestinian parents say goodbye to their sick son before leaving the Gaza Strip to get treatment abroad through the Kerem Shalom crossing, in Khan Younis, southern Gaza Strip, Thursday, June 27, 2024. Twenty one patients in the Gaza Strip evacuated the war-torn enclave in an initiative led by the World Health Organization for the children to receive life-saving treatment elsewhere. (AP Photo/Abdel Kareem Hana)

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A Palestinian man reacts as he says goodbye to his sick daughter before leaving the Gaza Strip to get treatment abroad through the Kerem Shalom crossing, in Khan Younis, southern Gaza Strip, Thursday, June 27, 2024. 21 patients in the Gaza Strip evacuated the war-torn enclave in an initiative led by the World Health Organization for the children to receive life-saving treatment elsewhere. (AP Photo/Abdel Kareem Hana)

Palestinian children with chronic diseases say goodbye to their relatives as they leave the Gaza Strip for treatment abroad through the Kerem Shalom crossing, in Khan Younis, southern Gaza Strip, Thursday, June 27, 2024. 21 patients in the Gaza Strip evacuated the war-torn enclave in an initiative led by the World Health Organization for the children to receive life-saving treatment elsewhere. (AP Photo/Abdel Kareem Hana)

Palestinian children with chronic diseases sit with their relatives before they leave the Gaza Strip for treatment abroad through the Kerem Shalom crossing, in Khan Younis, southern Gaza Strip, Thursday, June 27, 2024. 21 patients in the Gaza Strip evacuated the war-torn enclave in an initiative led by the World Health Organization for the children to receive life-saving treatment elsewhere. (AP Photo/Abdel Kareem Hana)

A Palestinian woman says goodbye to her sick son before leaving the Gaza Strip to get treatment abroad through the Kerem Shalom crossing, in Khan Younis, southern Gaza Strip, Thursday, June 27, 2024. 21 patients in the Gaza Strip evacuated the war-torn enclave in an initiative led by the World Health Organization for the children to receive life-saving treatment elsewhere. (AP Photo/Abdel Kareem Hana)

Palestinian children with chronic diseases stand next to their mother as they wait to leave the Gaza Strip for treatment abroad through the Kerem Shalom crossing, in Khan Younis, southern Gaza Strip, Thursday, June 27, 2024. 21 patients in the Gaza Strip evacuated the war-torn enclave in an initiative led by the World Health Organization for the children to receive life-saving treatment elsewhere. (AP Photo/Abdel Kareem Hana)

An amputee Palestinian child sits in an ambulance with his relatives as he waits to leave the Gaza Strip for treatment abroad through the Kerem Shalom crossing, in Khan Younis, southern Gaza Strip, Thursday, June 27, 2024. 21 patients in the Gaza Strip evacuated the war-torn enclave in an initiative led by the World Health Organization for the children to receive life-saving treatment elsewhere. (AP Photo/Abdel Kareem Hana)

Israeli army tanks are seen in Wadi Gaza, central Gaza Strip, Wednesday, June 26, 2024. (AP Photo/Abdel Kareem Hana)

KHAN YOUNIS, Gaza Strip (AP) — Israeli authorities say 68 people — 19 sick or wounded children plus their companions — have been allowed out of the Gaza Strip and into Egypt in the first medical evacuation since early May, when the territory’s sole travel crossing was shut down after Israel captured it.

The nearly nine-month Israel-Hamas war has devastated Gaza’s health sector and forced most of its hospitals to shut down. Health officials say thousands of people need medical treatment abroad, including hundreds of urgent cases.

The Israeli military body responsible for Palestinian civilian affairs, known by its acronym COGAT, said Thursday that the evacuation was carried out in coordination with officials from the United States, Egypt and the international community.

The children and their companions left Gaza via the Kerem Shalom cargo crossing, and the patients were to travel to Egypt and farther abroad for medical treatment.

Family members bade a tearful goodbye to the kids at Nasser Hospital in the southern Gaza town of Khan Younis. Many of the families appeared anxious — most relatives had to stay behind, and even those allowed to accompany the patients did not know their final destination.

Nour Abu Zahri wept as he kissed his young daughter goodbye. The girl has severe burns on her head from an Israeli airstrike. He said he didn’t get clearance to leave Gaza with her, although her mother did.

“It’s been almost 10 months, and there is no solution for the hospitals here,” he said.

Kamela Abukweik burst into tears after her son got on the bus heading to the crossing with her mother. Neither she nor her husband were cleared to leave.

“He has tumors spread all over his body and we don’t know what the reason is. And he constantly has a fever,” she said. “I still don’t know where he is going.”

The Rafah crossing between Gaza and Egypt, the only one available for people to travel in or out, shut down after Israeli forces captured it during their operation in the city early last month. Egypt has refused to reopen its side of the crossing until the Gaza side is returned to Palestinian control.

Six of the children were transferred to Nasser Hospital from Al-Ahli Hospital in Gaza City earlier this week. Five have cancer and one suffers from metabolic syndrome. That evacuation was organized by the World Health Organization, which could not immediately be reached for comment.

At a press conference at Nasser Hospital on Thursday, Dr. Mohammed Zaqout, the head of Gaza’s hospitals, said the evacuation was being conducted in coordination with the WHO and three American charities.

Zaqout said over 25,000 patients in Gaza require treatment abroad, including some 980 children with cancer, a quarter of whom need “urgent and immediate evacuation.”

He said the cases included in Thursday’s evacuation are “a drop in the ocean” and that the complicated route through Kerem Shalom and into Egypt cannot serve as an alternative to the Rafah crossing.

Zaqout said 21 children had originally been scheduled to leave Thursday, but one arrived at the hospital too late to make the departure. It was not immediately clear what prevented the other child from joining the evacuation.

Physicians for Human Rights Israel and Gisha, an Israeli human rights organization, petitioned Israel’s Supreme Court to create a “permanent mechanism” to allow people needing medical treatment to evacuate Gaza.

Adi Lustigman, an attorney with Physicians for Human Rights Israel, said that before May 7, when the Israeli military launched their ground operation in Rafah and took control of the crossing, approximately 50 Palestinian patients per day crossed into Egypt for medical treatment abroad.

The fact that fewer than 70 people left the territory Thursday “after two months the crossing has been closed is beyond tragic,” said Tania Hary executive director of Gisha. “Our sense of it is that it’s just unsustainable in terms of a response.”

She called on the Israeli military to reopen Rafah Crossing and allow patients to exit the Erez Crossing in the northern part of the territory, which had previously been the main crossing for Palestinians entering Israel.

Israel’s Supreme Court will hold a hearing on the petition Monday.

In a post on the social media platform X, the World Health Organization regional director for the Eastern Mediterranean, Hanan Balkhy, welcomed news of the children’s evacuation, but noted that “more than 10,000 patients still require medical care outside the Strip. Of the 13,872 people who have applied for medical evacuation since 7 October, only 35% have been evacuated.”

“Medical evacuation corridors must be urgently established for the sustained, organized, safe, and timely passage of critically ill patients from Gaza via all possible routes,” she said.

Israel’s offensive against Hamas, which runs the Gaza Strip, has killed over 37,700 Palestinians, according to Gaza’s Health Ministry, which does not differentiate between civilians and fighters in its count. Thousands of women and children are among the dead.

The war began with Hamas’ surprise attack into Israel on Oct. 7 , in which militants killed some 1,200 people and took another 250 hostage.

On Thursday, the Israeli military ordered new evacuations from Gaza City neighborhoods that were heavily bombed and largely emptied early in the war. The latest orders apply to Shijaiyah and other neighborhoods where residents reported heavy bombing on Thursday.

First responders with Gaza’s Civil Defense said airstrikes hit five homes, killing at least three people and wounding another six. It said rescuers were still digging through the rubble for survivors.

Gaza City was heavily bombed in the opening weeks of the war. Israel ordered the evacuation of all of northern Gaza, including the territory’s largest city, later that month. Hundreds of thousands of people have remained in the north, even as Israeli troops have surrounded and largely isolated it.

Shijaiyah residents in a messaging group shared video showing large numbers of people fleeing the neighborhood on foot with their belongings in their arms.

International criticism has been growing over Israel’s campaign against Hamas as Palestinians face severe and widespread hunger . The eight-month war has largely cut off the flow of food, medicine and basic goods to Gaza, and people there are now totally dependent on aid. The top United Nations court has concluded there is a “plausible risk of genocide” in Gaza — a charge Israel strongly denies.

Shurafa reported from Deir al-Balah, Gaza Strip and Chehayeb from Beirut. Associated Press writer Melanie Lidman in Tel Aviv, Israel contributed.

Follow AP’s war coverage at https://apnews.com/hub/israel-hamas-war