Thursday 31 March 2022

UK Government plans to launch new Digital ID Technology in April

Source:

https://dailyexpose.uk/2022/03/31/uk-gov-digital-identity-launch-april-22/

The UK government is pushing ahead with its nationwide digital ID plans, despite half of the responses to its public consultation on digital identity opposing the idea.

On April 6, 2022, new digital identity document verification technology (IDVT) that enables data sharing between public bodies and businesses for the purpose of identity verification will be introduced. It will be made available to UK employers, landlords, and letting agents who can use it to digitally carry out pre-employment criminal record checks, right to work checks, and right to rent checks.

The introduction of this digital IDVT is part of the government’s far-reaching digital ID plans which were announced in March. The government has framed these digital ID plans as a way for UK citizens to “easily and quickly prove their identity using digital methods instead of having to rely on traditional physical documents.”

Under these digital ID plans, UK citizens will be able to “create a digital identity with a trusted organisation” which can be used “in-person or online” and “via a phone app or website.” These trusted organisations will then be given a “legal gateway” to “carry out verification checks against official data held by public bodies to help validate a person’s identity.” The government will also allow the “trust” generated by a single successful digital identity check to be passed to other organisations “where appropriate.”

The trusted organisations that provide these digital identity solutions will need to get accredited and certified under legislation that the government plans to introduce. Once accredited and certified, they’ll be “given a trust mark to demonstrate their compliance and will be defined as being a trust-marked organisation.”

A new interim governing body, the Office for Digital Identities and Attributes (ODIA), will be set up in the Department for Digital, Culture, Media, and Sport (DCMS) and it will have the power to issue these trust marks. The ODIA will also publish a publicly viewable list of trust-marked organisations.

Other companies that rely on the digital identity solutions provided by trust-marked organizations won’t need to be certified but may be subject to “flow-down conditions” such as agreements to not share the information they receive.

Before announcing these digital ID plans, the government sought views and feedback on its proposed approach to digital identity via a public consultation.

50% of the responses to this consultation were “against digital identity in principle” but the government didn’t include these responses in its statistical analysis of responses to the consultation because they “did not engage with the questions.” However, the government insisted that “outside the context of producing the statistical analysis, we have taken these responses into account as part of this consultation exercise.”

The government also admitted that some respondents feared that “digital identities are going to be made mandatory for all people” but dismissed these concerns as “false” and said it will seek feedback on how to “encourage more inclusive digital identities.”

“As set out in the consultation, there are no plans to make digital identities mandatory, but we recognise they are an emerging technology and people may not be fully aware of the privacy and security benefits,” the government said. “Therefore we will take steps to increase understanding amongst potential users and engage with civil society groups to receive their expert feedback on how to increase inclusion, now and into the future.”

The government added that it’s “committed to ensuring” that “people will still be able to use available paper documentation.”

The government’s digital ID framework has completed alpha testing. The next steps are a beta publication followed by beta testing before the framework is formalized in legislation.

The government cited “positive feedback received about the ability to conduct right to work and right to rent checks remotely during the COVID-19 pandemic” as one of its reasons for initiating its review of digital ID technology.

During the COVID-19 pandemic, the UK government embraced vaccine passports – a technology that shares many similarities with digital ID by requiring citizens to use a digital pass.

These vaccine passports were used to scoop up large amounts of data from UK citizens, some of which was shared with private companies.

Vaccine passports are one of many examples of the UK government using or proposing the use of technology to surveil its citizens. Other examples include it secretly surveilling millions of COVID vaccine recipients via their phones, proposing a social credit style app to encourage healthy eating, and proposing the increased use of surveillance drones to “protect” women.

Despite its history of surveillance, the government insists that this digital ID technology will have “strong security and privacy standards.”

The government’s digital ID plans were announced in the same month that the UK government’s Online Safety Bill began its legislative journey. This bill mandates the implementation of identity and age verification technology on many large online platforms.

This current attempt to introduce digital ID comes almost a decade after the UK government launched its 2013 digital ID project “Verify” which was blasted by the National Audit Office and internal Parliamentary committees for “failing the public” and missing all of its performance targets.


Harbinger Second Chapter

 Second Chapter from Harbinger Entertainment with 107Daily.com



Wednesday 30 March 2022

CONSPIRATORS' HIERARCHY: THE STORY OF THE COMMITTEE OF 300 by Dr. John Coleman 10

10th Part

FREEDOM HOUSE Officials: Leo Churn and Carl Gershman. Purpose: To spread 
socialist disinformation among Ameri-can blue collar workers, spread dissension and 
dissatisfaction. Now that these objectives have been largely realized, Gershman has been 
drafted by Lawrence Eagleburger to CEDC, a newly created body to stop a united 
Germany from expanding its trade into the Danube Basin.  
COMMITTEE FOR A DEMOCRATIC MAJORITY Officials: Ben Wattenburg, Jean 
Kirkpatrick, Elmo Zumwa and Midge Dector. Purpose: To provide a connecting link 
between the educated socialist class and minority groups with the intent of setting up a 
solid block of voters who can be counted on to vote for leftwing candidates at election 
time. It was really a Fabianist operation from start to finish.  
FOREIGN POLICY RESEARCH INSTITUTE Officials: Robert Strausz Hupe. 
Purpose: To undermine and eventually end NASA space program.  
SOCIAL DEMOCRATS U.S.A. Officials: Bayard Rustin, Lane Kirkland, Jay 
Lovestone, Carl Gershman, Howard Samuel, Sidney Hook. Purpose: To spread radical 
socialism, especially among minority groups, and forge links between similar 
organizations in socialist countries. Lovestone was for decades the leading advisor to 
U.S. presidents on Soviet affairs and a strong direct link with Moscow.  
INSTITUTE FOR SOCIAL RELATIONS Officials: Harland Cleveland, Willis 
Harmon. Purpose: Change the way America thinks.  
THE CITIZENS LEAGUE Officials: Barry Commoner. Purpose: To bring "common 
cause" legal suits against vari-ous government agencies, especially in the defense 
industries.  
WAR RESISTERS LEAGUE Officials: Noam Chomsky and David McReynolds. 
Purpose: To organize resistance to the Vietnam War among leftwing groups, students and 
the Hollywood "in crowd."  
THE DEMOCRATIC SOCIALIST ORGANIZING COMMITTEE OF THE 
INSTITUTE FOR DEMOCRATIC SOCIALISM
Officials: Frank Zeider, Arthur 
Redier and David McReynolds. Purpose: A clearing house for leftwing socialist ideas and 
activities in the U.S and Europe.  
ANTI-DEFAMATION LEAGUE FACT FINDING DIVISION Officials: IRWIN 
SUALL
, also known as John Graham. Purpose: A joint FBI-British intelligence operation 
designed to single out rightwing groups and their leaders and put them out of business 
before they grow too large and too influential.  
INTERNATIONAL ASSOCIATION OF MACHINISTS Purpose: A labor oriented 
front for the Socialist International and a hot-bed of organized labor unrest polarizing 
workers and management.  
AMALGAMATED CLOTHING WORKERS Officials: Murray Findley, IRWIN 
SUALL and Jacob Scheinkman. Purpose: Much the same as the Machinists Union, to so-
cialize and polarize workers in the garment trade.  
A. PHILIP RANDOLPH INSTITUTE Officials: Bayard Rustin. Purpose: To provide a 
means of coordinating organizations with a common purpose, an example of which 
would be the spread of socialist ideas among college students and workers.  
CAMBRIDGE POLICY STUDIES INSTITUTE Officials: Gar Apelrovitz. Purpose: 
To expand on the work being done at the Institute for Policy Studies. Founded in 
February 1969 by international socialist, Gar Apelrovitz, former assistant to Senator 
Gaylord Nelson. Apelrovitz wrote the controversial book ATOMIC DI-PLOMACY for 
the Club of Rome which work was financed by the German Marshall Fund. It 
concentrates on research and action projects, with a stated goal of fundamentally 
changing American society, i. .e., to create a Fabianist United States in preparation of the 
coming One World Government.  
ECONOMIC COMMITTEE OF THE NORTH ATLANTIC INSTITUTE Officials: 
Dr. Aurellio Peccei. Purpose: NATO think-tank on global economic issues.  
CENTER FOR THE STUDY OF DEMOCRATIC INSTITUTIONS Officials: 
Founder Robert Hutchins of the Committee of 300, Harry Ashmore, Frank Kelly and a 
large group of "Fellows." Purpose: To spread ideas that will bring on social reforms of 
the liberal kind with democracy as an ideology. One of its activities is to draft a new 
constitution for the U.S. which will be strongly monarchical and socialistic as found in 
Denmark. The Center is an "Olympian" stronghold. Located in Santa Barbara, it is 
housed in what is affectionately called "the Parthenon." Former Representative John 
Rarick called it "an outfit loaded with Communists." By 1973 work on a new United 
States Constitution was in its thirty-fifth draft which proposes an amendment 
guaranteeing "environmental right," the thrust of which is to reduce the industrial base of 
the U.S. to a mere whisper of what it was in 1969. In other words, this institution is 
carrying out Club of Rome zero-growth post-industrial policies laid down by the 
Committee of 300. Some of its other aims are control of economic cycles, welfare, 
regulation of business and national public works, con- trol of pollution. Speaking on 
behalf of the Committee of 300, Ashmore says the function of the CSDI is to find ways 
and means of making our political system work more effectively. "We must change 
education and we must consider a new U.S Constitution and a Constitution for the 
world," Ashmore says.  
Further goals enunciated by Ashmore are as follows:  
(1) Membership of the U.N. must be made universal. (2) The U.N. must be strengthened. 
(3) South East Asia must be neutralized. (For neutralized, read "Communized.") (4) Cold 
War must be ended. (5) Racial discrimination must be abolished. (6) Developing nations 
must be assisted. (Meaning assisted to destruct.) (7) No military solutions to problems. 
(Pity they didn't tell George Bush that before the Gulf War.) (8) National solutions are 
not adequate. (9) Coexistence is necessary.  
HARVARD PSYCHOLOGICAL CLINIC Officials: Dr. Kurt Lewin and staff of 15 
new-science scientists. Purpose: To create a climate where the Committee of 300 can take 
unlimited power over the U.S.  
INSTITUTE FOR SOCIAL RESEARCH Officials: Dr. Kurt Lewin and staff of 20 
new-science scientists. Purpose: To devise a whole new set of social programs to steer 
America away from industry.  
SCIENCE POLICY RESEARCH UNIT Officials: Leland Bradford, Kenneth Dam, 
Ronald Lippert. Purpose: A "Future Shocks" research institution at Sussex University in 
England and part of the Tavistock network.  
SYSTEMS DEVELOPMENT CORPORATION Officials: Sheldon Arenberg and a staff 
of hundreds, too numerous to mention here. Purpose: To coordinate all elements of the 
intelligence communities of the U.S.A. and Britain. It analyzes what "play- ers" have to 
be assigned the role of a national entity; for example, Spain would come under a supine 
watered-down Catholic Church, the U.N. under the Secretary General and so forth. It 
developed the system of "X RAY 2" where think tank personnel, military installations 
and law enforcement centers are all linked to the Pentagon through a nation-wide 
network of Teletypes and computers: To apply surveillance techniques on a nation-wide 
scale. Arenberg says his ideas are non-military, but his techniques are mainly those he 
learned from the military. He was responsible for the New York State Identification and 
Intelligence System, a typical George Orwell "1984" project, which is completely illegal 
under our Constitution. The NYSIIS system is in the process of being adopted 
nationwide. It is what Brzezinsk referred to as the ability to almost instantaneously 
retrieve data about any person. NYSIIS shares data with all law enforcement and govern-
ment agencies in the state. It provides storage and rapid retrieval of individual records, 
criminal and social. It is a TYPICAL Committee of 300 project. There is a crying need 
for a full investigation to be conducted into just what it is that Systems Development 
Corporation is doing, but that is beyond the scope of this book. One thing is sure, SDC is 
not there to preserve freedom and liberty guaranteed by the U.S. Constitution. How 
convenient that it should be located in Santa Barbara in easy reach of Robert Hutchins 
"Parthenon." Some publications put out by these Club of Rome institutions are as 
follows:  
"Center Magazine" "Counterspy" "Coventry" "Covert Action Information Bulletin" 
"Dissent" "Human Relations" "Industrial Research" "Inquiry" "Mother Jones" "One" 
"Progressive" "Raconteur" "The New Republic" "Working Papers for a New Society"  
These are by no means all of the publications issued under the auspices of the Club of 
Rome. There are many hundreds more, in fact each of the foundations puts out its own 
publication. Given the number of foundations run by the Tavistock Institute and the Club 
of Rome, a partial listing is all we can include here. Some of the more important 
foundations and think tanks are in the following list, which includes Army think tanks. 
The American public would be astounded if it only knew how deeply the Army is 
involved in "new war tactics" research with Committee of 300 "think tanks." Americans 
are not aware that in 1946 the Club of Rome was ordered by the Committee of 300 to 
further the progress of think tanks which it said offered a new means of spreading the 
Committee's philosophy. The impact of these think tanks upon our military, just since 
1959 when they suddenly proliferated, is truly astounding. There is no doubt that they 
will play an even greater role in the daily affairs of this nation as we come to the close of 
the 20th century.  

Italian Translation by Google Translate

Funzionari della FREEDOM HOUSE: Leo Churn e Carl Gershman. Scopo: diffondere
disinformazione socialista tra i colletti blu americani, diffuso dissenso e
insoddisfazione. Ora che questi obiettivi sono stati ampiamente realizzati, Gershman lo è stato
redatto da Lawrence Eagleburger al CEDC, un organismo di nuova creazione per fermare un'unione
La Germania dall'espansione del suo commercio nel bacino del Danubio.
COMITATO PER LA MAGGIORANZA DEMOCRATICA Funzionari: Ben Wattenburg, Jean
Kirkpatrick, Elmo Zumwa e Midge Dector. Scopo: fornire un collegamento di collegamento
tra la classe socialista colta e le minoranze con l'intento di costituire a
solido blocco di elettori su cui si può contare per votare per i candidati di sinistra alle elezioni
volta. È stata davvero un'operazione fabianista dall'inizio alla fine.
ISTITUTO DI RICERCA DI POLITICA ESTERA Funzionari: Robert Strausz Hupe.
Scopo: minare ed eventualmente porre fine al programma spaziale della NASA.
I Socialdemocratici U.S.A. Funzionari: Bayard Rustin, Lane Kirkland, Jay
Lovestone, Carl Gershman, Howard Samuel, Sidney Hook. Scopo: diffondere radicalmente
socialismo, soprattutto tra i gruppi minoritari, e stringono legami tra simili
organizzazioni nei paesi socialisti. Lovestone è stato per decenni il principale consulente di
Presidenti degli Stati Uniti sugli affari sovietici e un forte legame diretto con Mosca.
ISTITUTO PER LE RELAZIONI SOCIALI Funzionari: Harland Cleveland, Willis
Armonia. Scopo: cambiare il modo di pensare dell'America.
LA CITIZENS LEAGUE Ufficiali: Barry Commoner. Scopo: portare "comune
cause" legali contro vari enti governativi, soprattutto nella difesa
industrie.
WAR RESISTERS LEAGUE Funzionari: Noam Chomsky e David McReynolds.
Scopo: organizzare la resistenza alla guerra del Vietnam tra gruppi di sinistra, studenti e
l'Hollywood "in mezzo alla folla".
IL COMITATO ORGANIZZATIVO SOCIALISTA DEMOCRATICA DEL
ISTITUTO PER IL SOCIALISMO DEMOCRATICA Funzionari: Frank Zeider, Arthur
Redier e David McReynolds. Scopo: una stanza di smistamento per le idee socialiste di sinistra e
attività negli Stati Uniti e in Europa.
DIVISIONE FACT FINDING LEAGUE ANTI-DEFAMAZIONE Funzionari: IRWIN
SUALL, noto anche come John Graham. Scopo: un'operazione congiunta dell'FBI e dell'intelligence britannica
progettato per individuare i gruppi di destra e i loro leader e metterli fuori mercato
prima che diventino troppo grandi e troppo influenti.
ASSOCIAZIONE INTERNAZIONALE DEI MACCHINISTI Scopo: Un lavoro orientato
fronte dell'Internazionale socialista e focolaio di disordini sindacali organizzati che polarizzano
lavoratori e dirigenti.
LAVORATORI DI ABBIGLIAMENTO AMALGAMATI Funzionari: Murray Findley, IRWIN
SUALL e Jacob Scheinkman. Scopo: più o meno lo stesso dell'Unione dei macchinisti, per così-
Socializzare e polarizzare i lavoratori nel commercio dell'abbigliamento.
A. PHILIP RANDOLPH INSTITUTE Funzionari: Bayard Rustin. Scopo: fornire a
mezzi per coordinare organizzazioni con uno scopo comune, di cui un esempio
sarebbe la diffusione di idee socialiste tra studenti universitari e lavoratori.
ISTITUTO PER STUDI SULLA POLITICA DI CAMBRIDGE Funzionari: Gar Apelrovitz. Scopo:
Per ampliare il lavoro svolto presso l'Institute for Policy Studies. Fondato nel
Febbraio 1969 dal socialista internazionale Gar Apelrovitz, ex assistente del senatore
Gaylord Nelson. Apelrovitz ha scritto il controverso libro ATOMIC DI-PLOMACY per
il Club di Roma il cui lavoro è stato finanziato dal Fondo Marshall tedesco. Esso
si concentra su progetti di ricerca e azione, con un obiettivo dichiarato di fondamentalmente
cambiare la società americana, i. .e., per creare gli Stati Uniti fabianisti in preparazione del
prossimo governo mondiale.
COMITATO ECONOMICO DELL'ISTITUTO ATLANTICO DEL NORD Funzionari:
Dott. Aurellio Peccei. Scopo: gruppo di riflessione della NATO sulle questioni economiche globali.
CENTRO STUDIO DELLE ISTITUZIONI DEMOCRATICA Funzionari:
Il fondatore Robert Hutchins del Comitato dei 300, Harry Ashmore, Frank Kelly e a
folto gruppo di "Fellow". Scopo: Diffondere idee che porteranno a riforme sociali di
il tipo liberale con la democrazia come ideologia. Una delle sue attività è quella di redigere un nuovo
costituzione per gli Stati Uniti che sarà fortemente monarchica e socialista come si trova in
Danimarca. Il Centro è una roccaforte "olimpionica". Situato a Santa Barbara, lo è
ospitato in quello che viene affettuosamente chiamato "il Partenone". L'ex rappresentante John
Rarick lo definì "un vestito carico di comunisti". Nel 1973 lavoro su un nuovo United
La Costituzione degli Stati era nella sua trentacinquesima bozza che propone un emendamento
garantire il "diritto ambientale", la cui spinta è ridurre la base industriale di
negli Stati Uniti a un semplice sussurro di ciò che era nel 1969. In altre parole, questa istituzione è
attuare le politiche post-industriali a crescita zero del Club di Roma previste dal
Comitato dei 300. Alcuni dei suoi altri obiettivi sono il controllo dei cicli economici, il benessere,
regolazione delle imprese e dei lavori pubblici nazionali, controllo dell'inquinamento. Continuando a parlare
a nome del Comitato dei 300, Ashmore afferma che la funzione del CSDI è trovare modi
e mezzi per far funzionare più efficacemente il nostro sistema politico. "Noi deve cambiare
istruzione e dobbiamo considerare una nuova Costituzione degli Stati Uniti e una Costituzione per il
mondo", dice Ashmore.
Ulteriori obiettivi enunciati da Ashmore sono i seguenti:
(1) L'appartenenza all'ONU deve essere resa universale. (2) Le Nazioni Unite devono essere rafforzate.
(3) Il sud-est asiatico deve essere neutralizzato. (Per neutralizzato, leggi "Communizzato.") (4) Freddo
La guerra deve finire. (5) La discriminazione razziale deve essere abolita. (6) Nazioni in via di sviluppo
deve essere assistito. (Significato assistito alla distruzione.) (7) Nessuna soluzione militare ai problemi.

(Peccato che non l'abbiano detto a George Bush prima della Guerra del Golfo.) (8) Le soluzioni nazionali lo sono
non adeguato. (9) La convivenza è necessaria.
HARVARD PSYCHOLOGICAL CLINIC Funzionari: Dr. Kurt Lewin e personale di 15 persone
scienziati della nuova scienza. Scopo: creare un clima in cui il Comitato dei 300 possa prendere
potere illimitato sugli Stati Uniti
ISTITUTO PER LA RICERCA SOCIALE Funzionari: Dr. Kurt Lewin e personale di 20 persone
scienziati della nuova scienza. Scopo: ideare una serie completamente nuova di programmi sociali da guidare
L'America lontana dall'industria.
UNITÀ DI RICERCA SULLA POLITICA SCIENTIFICA Funzionari: Leland Bradford, Kenneth Dam,
Ronald Lippert. Scopo: un istituto di ricerca "Future Shocks" presso la Sussex University di
Inghilterra e parte della rete Tavistock.
SYSTEMS DEVELOPMENT CORPORATION Funzionari: Sheldon Arenberg e uno staff
di centinaia, troppo numerosi per essere menzionati qui. Scopo: coordinare tutti gli elementi del
comunità di intelligence degli Stati Uniti e della Gran Bretagna. Analizza cosa devono fare i "giocatori".
essere assegnato il ruolo di ente nazionale; per esempio, la Spagna verrebbe supina
annacquata Chiesa cattolica, l'ONU sotto il Segretario Generale e così via. Esso
ha sviluppato il sistema di "X RAY 2" in cui personale di think tank, installazioni militari
e i centri delle forze dell'ordine sono tutti collegati al Pentagono attraverso una rete nazionale
rete di telescriventi e computer: applicare tecniche di sorveglianza a livello nazionale
scala. Arenberg dice che le sue idee non sono militari, ma le sue tecniche sono principalmente quelle che lui
appreso dai militari. Era responsabile dell'identificazione dello Stato di New York e
Intelligence System, un tipico progetto di George Orwell "1984", che è completamente illegale
secondo la nostra Costituzione. Il sistema NYSIIS è in fase di adozione
a livello nazionale. È ciò che Brzezinsk chiamava la capacità di fare quasi istantaneamente
recuperare dati su qualsiasi persona. NYSIIS condivide i dati con tutte le forze dell'ordine e le autorità
agenzie di mento nello stato. Fornisce l'archiviazione e il rapido recupero di singoli record,
criminale e sociale. È un TIPICO Comitato di 300 progetti. C'è un bisogno disperato
per un'indagine completa da condurre proprio su cos'è lo sviluppo di sistemi
Corporation sta facendo, ma questo va oltre lo scopo di questo libro. Una cosa è certa, la DSC lo è
non lì per preservare la libertà e la libertà garantite dalla Costituzione degli Stati Uniti. Come
conveniente che dovrebbe essere situato a Santa Barbara, a poca distanza da Robert Hutchins
"Partenone." Alcune pubblicazioni emesse da queste istituzioni del Club di Roma sono come
segue:
"Center Magazine" "Counterspy" "Coventry" "Bollettino informativo sulle azioni segrete"
"Dissenso" "Relazioni umane" "Ricerca industriale" "Inchiesta" "Madre Jones" "Uno"
"Progressista" "Raconteur" "The New Republic" "Carte di lavoro per una nuova società"
Queste non sono affatto tutte le pubblicazioni emesse sotto gli auspici del Club di
Roma. Ce ne sono molte altre centinaia, infatti ognuna delle fondazioni mette fuori la sua
pubblicazione. Dato il numero di fondazioni gestite dal Tavistock Institute e dal Club
di Roma, un elenco parziale è tutto ciò che possiamo includere qui. Alcuni dei più importanti
le fondazioni e i think tank sono nell'elenco seguente, che include i think tank dell'esercito.
Il pubblico americano sarebbe sbalordito se solo sapesse quanto è profondo l'esercito
coinvolto nella ricerca di "nuove tattiche di guerra" con un Comitato di 300 "think tank". americani
Non sono a conoscenza che nel 1946 il Club di Roma fu ordinato dal Comitato dei 300 a
ulteriormente il progresso dei gruppi di riflessione che ha affermato offriva un nuovo mezzo per diffondere il
La filosofia del Comitato. L'impatto di questi think tank sul nostro esercito, proprio da allora
Il 1959, quando improvvisamente proliferarono, è davvero sbalorditivo. Non c'è dubbio che loro
giocherà un ruolo ancora più importante negli affari quotidiani di questa nazione alla fine
il 20° secolo.


Persistent Cardiac MRI Findings in a Cohort of Adolescents with post COVID-19 mRNA vaccine myopericarditis

Source:

https://www.jpeds.com/article/S0022-3476(22)00282-7/fulltext#%20

Persistent Cardiac MRI Findings in a Cohort of Adolescents with post COVID-19 mRNA vaccine myopericarditis

Abbreviations:

Late gadolinium enhancement (LGE), Coronavirus disease of 2019 (COVID-19), Nonsteroidal anti-inflammatory drugs (NSAIDs), Intravenous immunoglobulin (IVIG), Left ventricle (LV), Left ventricular ejection fraction (LVEF), Global Longitudinal Strain (GLS)
Myopericarditis, , has emerged as an important adverse event following COVID-19 mRNA vaccination, particularly in adolescents []. Patients typically exhibit chest pain and an elevated serum troponin level in the days following the COVID-19 mRNA vaccine. They usually are hemodynamically stable, and symptoms and cardiac biomarkers normalize within a few days []. cardiac magnetic resonance studies, when performed early, frequently demonstrate abnormalities such as edema and late gadolinium enhancement (LGE), meeting Lake Louise Criteria for diagnosing myocarditis noninvasively [,]. In classical myocarditis LGE can be predictive of a poor outcome []. Little is known about the prognostic value or expected evolution of these CMR abnormalities associated with post-COVID-19 mRNA vaccine myopericarditis. In this case series we report the evolution of CMR imaging compared with initial, acute phase, CMR in our cohort of patients with myopericarditis post COVID-19 mRNA vaccine.

Methods

This case review includes patients younger than 18 years of age presenting to Seattle Children’s Hospital with chest pain and elevated serum troponin level from April 1, 2021 to January 7, 2022 within one week of receiving the second dose of the Pfizer COVID-19 mRNA vaccine. Institutional Review Board approval was obtained. All patients were evaluated by a pediatric cardiologist, underwent ECG and echocardiogram, and were admitted for observation with telemetry, serial troponin measurements, and repeat cardiac testing as needed. All patients underwent CMR within 1 week of initial presentation and had repeat CMR imaging at 3-8 months follow up. CMR was performed on a 1.5 T Siemens scanner. CMR analysis was performed using CVI42 (version 5.11.4, Circle Cardiovascular Imaging Inc., Alberta Canada). Patients were excluded if they did not undergo CMR or did not have a follow up CMR. Initial and follow up CMR data for each patient were reviewed and compared using paired Student t-test. Statistical significance was defined as a p < 0.05. Statistical analysis was performed using SPSS 27 (SPSS Inc., Chicago, IL).

Results

A total of 35 patients with the diagnosis of myopericarditis associated with Pfizer COVID-19 mRNA vaccine are followed at our institution. Twelve patients were excluded as they never had CMR due to delayed presentation after initial symptoms resolved or admission to other centers. Six patients were excluded as they did not have a follow up CMR, either because they followed up out of state or a study is still pending. One patient was excluded as initial CMR was performed 3 weeks after presentation. Sixteen patients who had both acute phase and follow-up CMR available for review comprised the final cohort. This group had a median age of 15 years (range, 12-17), were mostly male (n=15, 94%), white and non-Hispanic (n= 14, 88%). One patient was Asian and one patient was American Indian. Median time to presentation from the second dose of the Pfizer COVID-19 mRNA vaccine was 3 days (range 2-4 days). All patients had chest pain. The most common other presenting symptoms were fever (n=6, 37.5%) and shortness of breath (n=6, 37.5%). All patients had elevated serum troponin levels (median 9.15 ng/mL, range 0.65-18.5, normal < 0.05 ng/mL). Twelve patients had c- reactive protein (CRP) measured with median value 3.45 mg/dL, range 0-6.5 mg/dL, normal < 0.08 mg/dL.
Ten (62.5%) patients had an abnormal electrocardiogram (ECG), with the most common finding being diffuse ST segment elevation. All patients had an echocardiogram on admission; 14/16 patients had normal left ventricular (LV) systolic function; two patients demonstrated mildly reduced LV systolic function with no dilation. Left ventricular ejection fraction (LVEF) for these two patients was 45% and 53% (normal > 55%). Median left LVEF was 59% (range 45-69%). No patients had pericardial effusion.
The initial CMRs were performed within 1 week of presentation (median 2, range 0-7 days). All were abnormal; all showed evidence of edema by T2 imaging and 15/16 had LGE in a patchy subepicardial to transmural pattern with predilection for the inferior LV free wall. Distribution of LGE can be seen in Figure 1. LV regional wall motion abnormalities were noted in 2 patients. CMR median LVEF% was 54%, range 46-63%. CMR LVEF was mildly decreased in 7 patients. CMR global longitudinal strain (GLS%) measurements were abnormal in 12 patients (median -16.1%, range -13.2% to -18.1%, normal <-18%).
Figure thumbnail gr1
Figure 1Distribution of Late Gadolinium Enhancement (LGE) in American Heart Association Myocardial Segments[]. Figure shows segment with number of patients and percent of cohort.
All patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs): 75% (n=12) received scheduled dosing (mostly, 10 mg/kg ibuprofen every 8 hours) with the remaining 4 receiving NSAIDs as needed for pain. The median time from vaccination to NSAID initiation was 2.5 days (range 0-4 days) and from symptom onset to NSAID initiation was 1 day (range 0-4 days). The two patients who presented with echocardiographic LV dysfunction were treated with intravenous immunoglobulin (IVIG) plus a corticosteroid per our institutional pathway for treatment of myocarditis[]. One additional patient received IVIG without corticosteroids. Median hospital length of stay was 2 days (range 1-4 days) with no ICU admission and no significant morbidity or mortality. All patients had resolution of chest pain and down-trending serum troponin level prior to discharge.
All patients underwent follow up CMR at 3-8 months after their initial study (median 3.7 months, range 2.8-8.1 months). The results are compared in Table I. Follow up CMR LVEF (57.7 ±2.8%) was significantly improved from initial (54.5 ± 5.5%, p < 0.05), and none of the patients had regional wall motion abnormalities. LVEF by echocardiogram was normal for all patients at the time of follow up. Eleven patients (68.8%) had persistent LGE, although there was a significant decrease in the quantifiable LGE% (8.16± 5.74%) from the initial study (13.77± 8.53%, p <0.05). Cardiac edema resolved in all but one patient. GLS% remained abnormal in most patients (75%, mean -16.4 ± 2.1%) at follow up without significant change from the initial study (-16.0 ± 1.7, p = 0.6). Examples of initial and follow up CMR images are shown in Figure 2. The patient who received IVIG alone and one patient who received IVIG plus corticosteroid had resolution of LGE, and the other had persistence of LGE.
Table 1Covid Vaccine-Associated Myopericarditis Findings in 16 patients
Initial (Mean±SD)Follow up (Mean±SD)P value
Echocardiographic LVEF %59.4±6.062.6±2.8<0.05
Electrocardiogram

Abnormal

Normal
10 (62.5%)

6 (37.5%)
Peak Serum Troponin (ng/mL)9.0± 5.2
CMR LVEF %54.5 ± 5.557.7 ±2.7<0.05
CMR LGE % (n=15*)13.5± 8.37.7 ± 5.7<0.001
CMR global longitudinal strain % (n=15*)-16.0 ± 1.7-16.4 ± 2.10.5
*Initial source images were not available for reanalysis for one patient.
LVEF% = LV ejection fraction
LGE %= percentage of late gadolinium enhancem
ent
CMR = Cardiac MRI
Figure thumbnail gr2
Figure 2CMR images from 3 days after admission of a 16-year-old male who presented to emergency room with chest pain and elevated troponin 3 days after receiving Pfizer COVID-19 mRNA vaccine. Initial CMR. 1a and 1b. subepicardial to midmyocardial LGE in inferior and inferolateral LV wall from base to apex (arrows). 1c shows T2 hyper-intensity in similar segments, consistent with edema. 1d, 1e and 1f. Follow up CMR 4.4 months later. LGE still persistent but decreased from 26% to 19.84% (arrows), LVEF remained stable at 58%. There is improved T2 hyperintensity.
Eight patients (5 of whom had persistent LGE) underwent 24-hour cardiac rhythm monitoring, all of which studies were normal. Six patients, all with persistent LGE, underwent exercise tests, all of which were normal. Four patients complained of intermittent chest pain at follow up with no identifiable abnormality on evaluation; no therapy or intervention was required. No patient received heart failure medication.

DISCUSSION

We previously reported 15 patients with clinically suspected SARS-CoV-2 mRNA vaccine induced myopericarditis. All patients had an abnormal CMR, with edema and or LGE in addition to clinical symptoms and troponin elevation, and some had abnormal ECG or echocardiogram []. We have since established a clinical protocol for serial CMR performance in these patients consistent with the 2021 American Heart Association (AHA) statement that stressed the risk of sudden cardiac death, particularly with exercise, while active inflammation is present. []. our patients were restricted from exercise on discharge. Repeat CMR was performed within 3-6 months to guide next clinical decision-making steps; timing was modified in some individuals based on scanner accessibility and safety precautions during the COVID-19 pandemic. Although symptoms were transient and most patients appeared to respond to treatment (soley with NSAIDS), we demonstrated persistence of abnormal findings on CMR at follow up in most patients, albeit with improvement in extent of LGE.
CMR has increasingly been identified as an important diagnostic tool for myocarditis given its ability to identify subclinical injury and fibrosis by markers of LGE and edema. CMR also has been utilized in longitudinal follow up of patients with myocarditis to help therapeutic management, although exact screening protocols remain controversial[].
The presence of LGE is an indicator of cardiac injury and fibrosis and has been strongly associated with worse prognosis in patients with classical acute myocarditis. In a meta-analysis including 8 studies, Yang et al found that presence of LGE is a predictor of all cause death, cardiovascular death, cardiac transplant, rehospitalization, recurrent acute myocarditis and requirement for mechanical circulatory support[]. Similarly, Georgiopoulos et al found presence and extent of LGE to be a significant predictor of adverse cardiac outcomes in an 11 study meta-analysis[].
The persistence of LGE over time and its prognostic value is less well established. Malek et al found that in a cohort of 18 patients with myocarditis, nearly 70% had persistent CMR changes at a median follow-up time of 7 months[]. Dubey et al found similar findings in their cohort of 12 pediatric patients, with persistence of LGE in all patients despite resolution of edema[]. Prognostic meaning of LGE in vaccine associated myopericarditis requires further study.
Strain analysis by CMR also has been shown to have prognostic utility in myocarditis even in the setting of normal LV function[]. Strain testing can be performed without use of contrast material and can be particularly useful in situations where contrast administration is challenging or contraindicated. Notably, in our cohort, though there was significant reduction in LGE at follow up, abnormal strain persisted for the majority of patients at follow up.
This study has certain limitations. Patients who did not seek medical attention during acute illness or did not present with significant symptoms and require hospitalization were not captured, and their disease course may be different. Incomplete CMR data on other patients precludes extrapolation of our CMR findings to all who experienced mRNA vaccine-related myopericarditis. In addition, follow-up CMR timeframes varied from patient to patient making it difficult to predict the timing of CMR changes over time. the total number of patients reported is small, limiting ability to draw conclusions about the effect of treatment modalities or to generalize regarding outcomes of vaccine-associated myopericarditis.
In a cohort of adolescents with COVID-19 mRNA vaccine-related myopericarditis, a large portion have persistent LGE abnormalities, raising concerns for potential longer-term effects. Despite these persistent abnormalities, all patients had rapid clinical improvement and normalization of echocardiographic measures of systolic function. For patients with short acute illness, no dysfunction demonstrated by echocardiogram at presentation and resolution of symptoms at follow up, return to sports was guided by normalization of CMR alone. In patients with persistent CMR abnormalities we performed exercise stress testing prior to sports clearance per myocarditis recommendations[]. We plan to repeat CMR at 1 year post-vaccine for our cohort to assess for resolution or continued CMR changes.
The CDC notes that even though the absolute risk for myopericarditis following mRNA COVID-19 vaccine is small, the relative risk is higher for particular groups, including males 12-39 years of age. Some studies have suggested that increasing the interval between the first and second dose may reduce the incidence of myopericarditis in this population [] . These data led to an extension in CDC recommended dosing interval between dose 1 and dose 2 to 8 weeks. Further follow up assessment and larger multicenter studies are needed to determine the ultimate clinical significance of persistent CMR abnormalities in patients with post COVID-19 vaccine myopericarditis

Uncited reference

[], [].

REFERENCES

  1. Gargano JW, Wallace M, Hadler SC, Langley G, Su JR, Oster ME, et al. Morbidity and Mortality Weekly Report Use of mRNA COVID-19 Vaccine After Reports of Myocarditis Among Vaccine Recipients: Update from the Advisory Committee on Immunization Practices-United States, June 2021 2021;70. https://doi.org/10.1161/CIR.0000000000000239?url_.

    • Kohli U.
    • Desai L.
    • Chowdhury D.
    • Harahsheh A.S.
    • Yonts A.B.
    • Ansong A.
    • et al.
    mRNA Coronavirus-19 Vaccine–Associated Myopericarditis in Adolescents: A Survey Study.
    The Journal of Pediatrics. 2021;https://doi.org/10.1016/j.jpeds.2021.12.025
    • Truong D.T.
    • Dionne A.
    • Muniz J.C.
    • McHugh K.E.
    • Portman M.A.
    • Lambert L.M.
    • et al.
    Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults.
    Circulation. 2021;https://doi.org/10.1161/circulationaha.121.056583
    • Schauer J.
    • Buddhe S.
    • Colyer J.
    • Sagiv E.
    • Law Y.
    • Mallenahalli Chikkabyrappa S.
    • et al.
    Myopericarditis After the Pfizer Messenger Ribonucleic Acid Coronavirus Disease Vaccine in Adolescents.
    Journal of Pediatrics. 2021; 238317-320https://doi.org/10.1016/j.jpeds.2021.06.083
    • Yang F.
    • Wang J.
    • Li W.
    • Xu Y.
    • Wan K.
    • Zeng R.
    • et al.
    The prognostic value of late gadolinium enhancement in myocarditis and clinically suspected myocarditis: systematic review and meta-analysis.
    European Radiology. 2020; 302616-2626https://doi.org/10.1007/s00330-019-06643-5
    • Law Y.M.
    • Lal A.K.
    • Chen S.
    • Čiháková D.
    • Cooper L.T.
    • Deshpande S.
    • et al.
    Diagnosis and Management of Myocarditis in Children: A Scientific Statement from the American Heart Association.
    Circulation. 2021; (E123–35)https://doi.org/10.1161/CIR.0000000000001001
    • Georgiopoulos G.
    • Figliozzi S.
    • Sanguineti F.
    • Aquaro G.D.
    • di Bella G.
    • Stamatelopoulos K.
    • et al.
    Prognostic Impact of Late Gadolinium Enhancement by Cardiovascular Magnetic Resonance in Myocarditis: A Systematic Review and Meta-Analysis.
    Circulation: Cardiovascular Imaging. 2021; 55-65https://doi.org/10.1161/CIRCIMAGING.120.011492
    • Małek Ł.A.
    • Kamińska H.
    • Barczuk-Falęcka M.
    • Ferreira V.M.
    • Wójcicka J.
    • Brzewski M.
    • et al.
    Children With Acute Myocarditis Often Have Persistent Subclinical Changes as Revealed by Cardiac Magnetic Resonance.
    Journal of Magnetic Resonance Imaging. 2020; 52488-496https://doi.org/10.1002/jmri.27036
    • Dubey S.
    • Agarwal A.
    • Nguyen S.
    • Adebo D.
    Persistence of Late Gadolinium Enhancement on Follow-Up CMR Imaging in Children with Acute Myocarditis.
    Pediatric Cardiology. 2020; 411777-1782https://doi.org/10.1007/s00246-020-02445-5
    • Chen Y.
    • Sun Z.
    • Xu L.
    • Liu J.
    • Li Y.
    • Zhang N.
    • et al.
    Diagnostic and Prognostic Value of Cardiac Magnetic Resonance Strain in Suspected Myocarditis With Preserved LV-EF: A Comparison Between Patients With Negative and Positive Late Gadolinium Enhancement Findings.
    Journal of Magnetic Resonance Imaging. 2021;https://doi.org/10.1002/jmri.27873
  2. Moulia D. Myocarditis and COVID-19 vaccine intervals: international data and policies. n.d.

    • Cerqueira M.D.
    • Weissman N.J.
    • Dilsizian V.
    • Jacobs A.K.
    • Kaul S.
    • Laskey W.K.
    • et al.
    Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the Heart.
    Circulation. 2002; 105539-542https://doi.org/10.1161/hc0402.102975