We describe a fatal case of multisystem inflammatory syndrome in an adult with onset 22 days after a second dose of mRNA coronavirus disease vaccine. Serologic and clinical findings indicated severe acute respiratory syndrome coronavirus 2 infection occurred before vaccination. The immunopathology of this syndrome, regardless of vaccination status, remains poorly understood.
Keywords: COVID-19; MIS-A; SARS-CoV-2; coronavirus disease; multisystem inflammatory syndrome in adults; respiratory infections; severe acute respiratory syndrome coronavirus 2; vaccine-preventable diseases; vaccines; viruses.