This paper is important. So, I’m copying some highlights here to maximise exposure on the Internet (the more different web pages reference it, the easier it will be to find when people search for myocarditis).

Abstract:

COVID-19 vaccines have been linked to myocarditis, which, in some circumstances, can be fatal. This systematic review aims to investigate potential causal links between COVID-19 vaccines and death from myocarditis using post-mortem analysis. We performed a systematic review of all published autopsy reports involving COVID-19 vaccination-induced myocarditis through 3 July 2023. All autopsy studies that include COVID-19 vaccine-induced myocarditis as a possible cause of death were included. Causality in each case was assessed by three independent physicians with cardiac pathology experience and expertise. We initially identified 1691 studies and, after screening for our inclusion criteria, included 14 papers that contained 28 autopsy cases. The cardiovascular system was the only organ system affected in 26 cases. In two cases, myocarditis was characterized as a consequence of multisystem inflammatory syndrome. The mean age of death was 44.4 years old. The mean and median number of days from the last COVID-19 vaccination until death were 6.2 and 3 days, respectively. We established that all 28 deaths were most likely causally linked to COVID-19 vaccination by an independent review of the clinical information presented in each paper. The temporal relationship, internal and external consistency seen among cases in this review with known COVID-19vaccine-induced myocarditis, its pathobiological mechanisms, and related excess death, complemented with autopsy confirmation, independent adjudication, and application of the Bradford Hill criteria to the overall epidemiology of vaccine myocarditis, suggests that there is a high likelihood of a causal link between COVID-19 vaccines and death from myocarditis.

Extracts:

Myocarditis development most commonly occurred after the second dose; however, additional cases occurred after the third dose, adding to the cumulative risk for individuals continuing with every 6-month injection schedules.15 Avolioet al. demonstrated the cardiac pericyte as one of the several cell lines that takeup mRNA, produce Spike protein, and express it on the cell surface inciting autoimmune attack.13Yonkeret al. found that children hospitalized with myocarditis had the presence of free Spike protein not neutralized by antibodies while those who were asymptomatic had appropriate neutralization of spike protein by anti-Spike antibodies.11A biodistribution study has shown that LNPs can travel to the heart as well as other vital organs.16Baumeieret al. found that among15 young individuals suffering from myocarditis who underwent cardiac biopsy, the myocardium stained forSARS-CoV-2 Spike protein and not nucleocapsid, effectively ruling out infection and leaving vaccination as the only possible source of Spike protein.17 Furthermore, they found a range of pathologies from inflammatory cardiomyopathy to active myocarditis and severe giant cell myocarditis.17 Detection of Spike protein and CD4+T-cell-dominated inflammation within cardiac tissue suggested vaccine-triggered autoimmune processes.17 Two prospective cohort studies, by Mansanguan et al.18 and Buerginet al.,19 suggested that the incidence of myocarditis or troponin elevation from COVID-19 vaccine dose numbers 2 and 3 could be as high as 2.3% and 2.8%, respectively. Because of the frequent occurrence of this problem in cardiovascular practice, the United Kingdom20and Australia21have issued clinical practice guidelines on the diagnosis and management of COVID-19 vaccine-induced myocarditis. Up to 16 June 2023, the Vaccine Adverse Event Reporting System (VAERS) included 1 569 668 adverse event reports associated with COVID-19 vaccines, including 35 487 deaths,27 229 myocarditis and pericarditis, and 20 184 heart reports 22Before the COVID-19 pandemic, Meissner reported that 86% of VAERS entries were completed by medical personnel or vaccine manufacturers and only 14% were made by the patient or their family.23Thus, VAERS has demonstrated a very strong crude signal for myocarditis as an accepted complication of COVID-19 vaccination; however, additional information can be gleaned from autopsy in cases of death that are suspected to be caused by COVID-19 immunization. In fact, Walachet al. stated that all deaths after COVID-19 vaccination should be investigated with an autopsy to better our understanding of the vaccine’s deleterious mechanisms on the human body.24Autopsies represent one of the most powerful diagnostic methods in medicine, ascertaining causes of death and elucidating the pathophysiological mechanisms of disease.25COVID-19 vaccines exhibit multiple mechanisms of injury to the cardiovascular system and are associated with a considerable number of adverse event reports, thus representing an exposure that may be causally linked to death in some myocarditis cases. This systematic review aims to investigate potential causal links between COVID-19 vaccines and death from myocarditis using post-mortem analysis.

We established that all 28 deaths were most likely causally linked to COVID-19 vaccination by independent review of the clinical information presented in each paper. Our data is consistent with the overall epidemiological literature[PubMed search for (COVID-19 vaccination) * (myocarditis)= 994 papers] concerning COVID-19 vaccine-induced myocarditis where the Bradford Hill criteria supports causality from an epidemiological perspective. This includes biological plausibility, temporal association, internal and external validity, coherence, analogy, and reproducibility with each successive report of myocarditis-related death after COVID-19 vaccination. Baumeieret al.’ findings that the myocardium stained for SARS-CoV-2 Spike protein and not nucleocapsid among 15 young individuals suffering from myocarditis indicated the sole cause of cardiac injury in post-vaccine myocarditis is highly likely to be COVID-19 vaccination, confirming our results (Figure4).17In addition, Baumeieret al. found Spikeprotein and CD4+T-cell-dominated inflammation, suggesting the COVID-19 vaccine as the single cause of autoimmune reaction processes seen in myocardial histology (Figure5).17 COVID-19 vaccination and SARS-CoV-2 infection before orafter one or more vaccine administrations may have contrib-uted to cardiac Spike protein injury and inflammation in caseswhere infection was not ruled out. The predominant mechanism of death is most likely a sudden arrhythmia suchas ventricular tachycardia or ventricularfibrillation. Relatively few cases had antecedent fulminant pump failure. These data are concerning when considered in light of young indi-viduals, particularly male athletes who have had suddendeath after vaccination without an autopsy. Polykretis andMcCullough have reported that, among professional and semi-professional European athletes <35 years old, compared with a stable period before the pandemic, the annualized rate of sudden death since the rollout of COVID-19 vaccines has increased 10-fold. 41 Cadegiani has postulated that a surge of catecholamines can be the trigger for COVID-19 vaccine-induced sudden death, 42 which could explain the occurrence during exercise and sports as well asduring the early morning waking hours from sleep wherethere is a surge of epinephrine and norepinephrine. 43 Our findings escalate concerns regarding COVID-19 vaccine-induced myocarditis and its mechanisms, particularlyin cases of sudden unexpected death in younger individuals where there is no other explanation. COVID-19 vaccine Spike protein is produced in the body for an uncontrolled duration and in unknown quantity resulting in deleterious effects, 4–13 especially on the heart,10,11,13–21explaining the cardiovascular deaths seen in our study without evidence of other organsystem involvement. MIS has been identified followingCOVID-19 vaccination in both children 44 and adults 45; how-ever, we found only two autopsy cases with this diagnosis.MIS may be caused by the systemic distribution of the LNPs containing mRNA after vaccine administration16and consequent systemic Spike protein expression on cell surfaces thatresults in extensive inflammation. Considering the averagetime of 6.2 days between vaccination and death, a temporallink between COVID-19 vaccination and death is corroboratedby the observation that SARS-CoV-2 mRNA Spike vaccinesequences can persist in the bloodstream for at least 28 days after vaccination.12 Ittiwutet al. have found that genetic susceptibility tosudden death may explain some of the variation.46 Polymorphisms in the SCN5A channel were associated with the highest rates of sudden death in their study.46The over-whelming predominance of men among COVID-19 vaccine-induced myocarditis cases15and with other vaccines including smallpox and influenza 47 suggests that androgen receptors or some other undiscovered interaction with male hormones may play a role in the manifestation of vaccine-induced myocarditis

Baseline susceptibility includes male gender, age 18–24, SCN5A polymorphisms, and athletic tendency with surges of catecholamines in routine sports activities and during sleep. Some batches/vials of mRNA may have more concentrated LNP–mRNA complexes or cDNA contaminants as suggested by Schmelinget al., who found that~4.2% of vials are responsible for>70% of serious adverseevents.48The LNPs loaded with mRNA are known to systemically circulate for 28 days or more; thus, there are many cycles of coronary flow and cardiac uptake of the LNP–mRNA complex.12,49 These data indicate that the mRNA sequences are long-lasting and durable within pericytes, cardiomyocytes, and other cell lines, providing the genetic instructions for the continuous production of Spike protein, which is expressed on cell surfaces and in the interstitial space, which can incite a deleterious autoimmune reaction. According to Mansanguanet al., 57% of myocarditis cases may beasymptomatic.18Among those with symptoms,>90% are hospitalized with clinical and diagnostic features including pain, heart failure, electrocardiogram (ECG) changes, positive troponin levels, and cardiac MRI imaging demonstrating patchy late gadolinium enhancement.50

If undetected, risks include sudden cardiac death during sports or sleep where ~65% cannot be resuscitated41 and are classified as sudden adult death syndrome (SADS). In such cases, it is important to document the brand, number of doses, inoculation dates, lot numbers, and, as our data indicate, procurement of an autopsy. Vaccines have played an important role in the advancement of immunology, leading to strategies of prevention, and lessening the burden of infectious diseases. Vaccines, while preventative, may fail as a treatment to end pandemics with highly prevalent infections. 51 Some immunizations as we have learned, including the COVID-19 vaccine, can have significant side effects. Myocarditis may be a significant contributor to overall deaths observed after COVID-19 vaccination. The studies analysed in this review are consistent with multiple studies that show excess mortality after vaccination, which may have occurred due to myocarditis that was not detected before sudden death. Pantazatos and Seligmann reported that all-cause mortality increased in most age groups up to 5 weeks after vaccination resulting in 146 000 to 187 000 vaccine-associated deaths in the United States by August 2021.52Skidmore elucidated that 278 000 Americans may have died from the COVID-19 vaccine by December2021.53 These findings were corroborated by Aarstad and Kvitastein, who reported that, among European countries, a higher COVID-19 vaccine uptake in 2021 was associated with increased all-cause mortality in the first 9 months of 2022 after accounting for alternative explanations.54 Excess deaths not caused by COVID-19 have been identified worldwide after the mass COVID-19 vaccination programmes began,55–60 indicating the presence of a novel detrimental exposure among populations. Pantazatos and Seligmann extrapolated that VAERS reports are underreported by a factor of 20.52 When this factor is applied to the 16 June 2023 VAERS death report count of 35 487,22the number of deaths in the UnitedStates and other countries that use VAERS becomes 709 740. Please note that this extrapolation is a general estimate and may not be accurate. Nonetheless, if the sizeable number of fatalities were to be confirmed, the COVID-19 vaccines would constitute the largest biological safety disaster in human history. Our paper has all the limitations of a small sample size derived from assembling case reports or series. These include selection bias of cases for autopsy, publication bias against disclosing more cases from academic medical centres and medical examiners for fear of reprisal, and unknown confounders such as undetected cardiotropic pathogens, alcohol abuse, and drug abuse, which are all threats to validity. In summary, we identified a series of myocarditis-related deaths following COVID-19 vaccination, confirmed with autopsies, to provide the medical community with a more comprehensive understanding of fatal COVID-19 vaccine-induced myocarditis. The temporal relationship, internal and external consistency seen among cases in this review with known COVID-19 vaccine-induced myocarditis, its pathobiological mechanisms, and related excess death, complemented with autopsy confirmation, independent adjudication, and application of the Bradford Hill criteria to the overall epidemiology of vaccine myocarditis, suggests that there is a high likelihood of a causal link between COVID-19 vaccines and death from myocarditis. This may also apply to some cases where sudden, unexpected death has occurred in a vaccinated person. If the COVID-19 vaccines remain on the market for public use, urgent investigation is required for the purpose of risk stratification and mitigation in order to reduce the population occurrence of fatal COVID-19 vaccine-induced myocarditis.