A study just published in December 2022 found that upon examining patients who developed long COVID-19, 39 percent of women met the criteria to be diagnosed with POTS, while only 7 percent of men . Stories about patients with persistent symptoms following infection with the coronavirus started surfacing in the news during the summer of 2020. Si vous ne souhaitez pas que nos partenaires et nousmmes utilisions des cookies et vos donnes personnelles pour ces motifs supplmentaires, cliquez sur Refuser tout. Provided by the Springer Nature SharedIt content-sharing initiative, Nature Cardiovascular Research (Nat Cardiovasc Res) By December 2020, the program had received a flood of referrals for patients exhibiting symptoms similar to those of POTS, after Chungs colleagues from comparable programs across the country were reporting that they, too, were receiving a large number of patient referrals dealing with POTS-like symptoms. Nat Cardiovasc Res 1, 11321133 (2022). Probably had it for years but no dx. 04 March 2023. My daughter had dizziness with first and second, in a delayed reaction that was probably inflammatory, but was okay with the third. Epub 2022 Jul 26. Fedorowski, A. et al. People could self-report pre-existing conditions when getting the vaccine or making a VAERS report, but it is not required in VAERS. Potential POTS association with COVID-19 vaccination weaker than with COVID-19 infection, https://doi.org/10.1038/s44161-022-00194-7. Early July I started experiencing dizziness, wooziness when I got up to let the dog out. Muscle Nerve. Further studies are also necessary to understand the pathophysiology underlying both POTS occurring after vaccine and POTS occurring after infection. The mRNA-based COVID-19 vaccines are effective at preventing infection . My GP put me on Oomneprazole(sp?). It's not clear yet whether patients are developing POTS after COVID-19 for some reason above and beyond why any other infections trigger POTS, or whether it's just that we're seeing a lot. Internet Explorer). POTS has been around forever and gets exacerbated by viral illness or in . The investigators found that the risk of developing POTS after vaccination is less than five cases per million doses. Res. Here's what you need to know about the different vaccines and the benefits of getting vaccinated. 285, 352366 (2019). However, reports of post-vaccination adverse events involving various cardiovascular and neurological manifestations, including POTS, have been mounting in the Vaccine Adverse Event Reporting System1. But all of this, he stressed, is pretty speculative.. Front Neurol. Sheldon, R. S. et al. Using a sequence-symmetry analysis in over 280,000 COVID-19 vaccination records, we compared the odds of POTS-related diagnosis after exposure to COVID-19 versus before exposure, and compared these results with those for common primary care diagnoses that are not POTS-related. The main analysis was repeated with the second vaccine dose as the index study exposure and using cluster bootstrapping. 1997;20:15611568. I am worried about NON POTS reactions in POTS patients. BMC Med. Sanada Y, Azuma J, Hirano Y, Hasegawa Y, Yamamoto T. Cureus. Kwan, A. et al. Moderna announced a free COVID vaccine program. mesurer votre utilisation de nos sites et applications. The likelihood of getting diagnosed with postural orthostatic tachycardia syndrome (POTS) increases after both COVID-19 and vaccination against SARS-CoV-2 infection, although COVID-19 itself poses a greater risk, observational data suggest. Kwan, the first and corresponding author of the study, told ABC 7 news reporter Denise Dador that in reviewing patient health records, he and his team found that a small percentage of patients who received the COVID-19 vaccine experienced POTS. Thus, there exists a biological probability of comparable systemic immune responses to COVID-19 vaccinations in comparison to those induced due to SARS-CoV-2 exposure. Complete your request online or contact us by phone. Although POTS was previously recognized as a condition that can develop after SARS-CoV-2 infection2, data on its potential development after vaccination have been scarce. The likelihood of getting diagnosed with postural orthostatic tachycardia syndrome (POTS) increases after both COVID-19 and vaccination against SARS-CoV-2 infection, although COVID-19 itself poses a greater risk, observational data suggest. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Johns Hopkins Postural Orthostatic Tachycardia Syndrome (POTS) Program. I became very ill and no success in controlling the symptoms until the cardiologist at Mayo diagnosed me with POTS and instructed me on the changes I needed to make to get the symptoms to subside. I hope this helps you with your decision-making. It doesnt quite bring it to the point of being able to tell an individual patient, This is what your specific odds of POTS are after a vaccination, but we believe this essentially brings some validity to the observation that POTS may occur after vaccination, though notably at a significantly lower rate than after [COVID-19 itself].. Moderna said people without insurance will be able to get its COVID vaccine at no cost after the U.S. government . Dr. Alan C. Kwan treats POTS patients at a specialized clinic at Cedars Sinai. We use cookies to enhance your experience. I apologize for the long post. ISSN 2731-0590 (online). -, Garg RK, Paliwal VK. If we can understand the relationship between COVID-19 and POTS, it will also help us understand the cause of POTS.. Potential POTS association with COVID-19 vaccination weaker than with COVID-19 infection. Am. Kwon, A. et al. Study shows COVID-19 rates were likely forty-times higher than CDC estimates during BA.4/BA.5 dominant period in the U.S. New cell-based assay shown to rapidly profile drug resistance to three widely used SARS-CoV-2 main protease inhibiting drugs, Rebounding of COVID-19 symptoms and viral load are common among untreated COVID-19 patients, 25% of COVID-19 patients have lasting reduction in lung function, I have had COVID twice. The rates of POTS after infection were so much higher that this shouldnt be taken as anything discouraging vaccination, he added. February 2022?heart rate still increases. Sign up for the Nature Briefing newsletter what matters in science, free to your inbox daily. Go to the Heart Rhythm Conditions Support Group. Thank you for visiting nature.com. A 2022 review notes that an estimated 2% to 14% of people who've had COVID-19 may experience POTS in the months after their illness. My heart rate had always been normal. A lot of people with chronic fatigue and heart palpitations end up in physiatry clinics because they are debilitated. He did suggest I speak with my cardiologist first(because of possible side effects). Toshniwal Paharia, Pooja Toshniwal Paharia. I now am ok diltiazem and that lowers my pulse and my breathing has normalized.. I looked and I looked and I failed. For POTS-related diagnoses, the post-infection risk was 5.35 (5.055.68) times higher after exposure to SARS-CoV-2 infection than after exposure to vaccination. Clin Auton Res. I appreciate reading this. The study, published in Nature Cardiovascular Research on Dec. 12, analyzed data from more than 280,000 patients who received a COVID-19 vaccine and more than 12,000 patients with a confirmed . J. This paper describes and analyses different methods for pharmacoepidemiological studies. Of course, it's been awhile since your post, so perhaps this information is too late. 2023 Cedars-Sinai. So sweet of you, thanks Sue, I did the same thing and also found this. Overall, the study findings showed a probable association between POTS incidence and SARS-CoV-2 vaccinations, with a 5.4-fold greater incidence of POTS post-COVID-19 than that post-SARS-CoV-2 vaccination. He emphasized that people should still get vaccinated. As we continue to navigate and mitigate the SARS-CoV-2 pandemic and long-term post-COVID-19 complications with the help of COVID-19 vaccines, the need to invest in POTS research to advance our understanding, diagnosis and management of POTS a common sequela of both SARS-CoV-2 infection and COVID-19 vaccination has never been more pressing. Studies have reported POTS as a potential post-acute coronavirus disease 2019 sequela (PASC). the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Get the most important science stories of the day, free in your inbox. Even without clear mechanisms to explain the findings, the medical community should be aware of the potential links between COVID-19 and vaccination and POTS, Kwan said. Recognized as a clinical syndrome that manifests with orthostatic intolerance and postural tachycardia, POTS is diagnosed based on clinical features, such as orthostatic dizziness, palpitations and presyncope, and a 10-minute stand test or a tilt table test that demonstrate a heart rate elevation of at least 30 beats per minute from supine to standing position, the authors explain, noting that it has emerged as one of the features of postacute COVID-19 syndromes. Since April 2021, some people have developed myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining outside the heart) after receiving the Pfizer-BioNTech or Moderna coronavirus vaccines in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). 2017 Nov;61(5):577-582. doi: 10.1016/j.jadohealth.2017.08.004. Experts speculate that COVID-19 antibodies may be targeting the autonomic nervous system, which can cause POTS after an infection. Postural orthostatic tachycardia syndrome (POTS) has been observed following SARS-CoV-2 infection. . "What is the relation between COVID-19 vaccination and new POTS-related diagnoses?". 2022 Aug;122(4):1081-1083. doi: 10.1007/s13760-022-02002-2. 2023 Feb 14;329(6):454-456. doi: 10.1001/jama.2023.0050. Eldokla, A. M. & Numan, M. T. Clin Auton. Publishers note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. No help. National Library of Medicine The authors declare that they have no conflict of interest. Johns Hopkins researchers continue study into brain stimulation reinforced with repetitive learning strategies to increase motor function after stroke. POTS is a clinical syndrome that manifests with orthostatic intolerance and postural tachycardia1. Unable to load your collection due to an error, Unable to load your delegates due to an error, Quantitative sudomotor axon reflex test revealed normal response in the forearm (. Kwan, who treats POTS patients in a specialized clinic at Cedars-Sinai, said he hopes his research will help connect POTS patients to a specialist for proper care. 12, 669010 (2021). Blitshteyn, S. et al. Si vous souhaitez personnaliser vos choix, cliquez sur Grer les paramtres de confidentialit. March 2022 Gallbladder removed, heart rate increasing, still have GI issues. A 501(c)(3) non-profit organization. -, Goodman BP, Khoury JA, Blair JE, Grill MF. There are three different COVID-19 vaccine options available in the U.S., and all are safe and provide powerful protection against severe illness and death from COVID-19. Clin Pediatr (Phila). Rare Side Effects of COVID Vaccines Myocarditis and the COVID-19 Vaccines. JAMA. The .gov means its official. Masks are required inside all of our care facilities. (no I dont). POTS is a clinical syndrome that manifests with orthostatic intolerance and postural tachycardia 1. Never got vaccinated. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients. An official website of the United States government. Bethesda, MD 20894, Web Policies But the condition isn't well understood, and many patients are dismissed as having anxiety, delaying diagnosis. To obtain I got the vaccine and since have been diagnosed with small fiber neuropathy. Apparent risks of postural orthostatic tachycardiac syndrome diagnoses after COVID-19 vaccination and SARS-CoV-2 infection. During these months I have had a Colonoscopy, Endoscopy, CT scans bloodwork, urinalysis, etc..Motegrity did not help nor did Nortriptyline. Vaccination efforts against COVID-19 have been instrumental in limiting transmission and preventing severe disease. afficher des publicits et des contenus personnaliss en fonction de vos profils de centres dintrt; mesurer lefficacit des publicits et contenus personnaliss; et. I will not be getting any further booster shots. 8600 Rockville Pike COVID-19 Dysautonomia. <3, I have had COVID twice. By continuing to browse this site you agree to our use of cookies. Article Similar results were obtained after sex stratification, except that EDS was reported rarely among men (five cases) compared to women (35 cases). Went to an electrophysiologist who confirmed I have POTS and said it is directly related to my GI problems which were definitely a result of the Covid 19 virus. permanently. The primary outcomes were the diagnosis-specific odds of a new diagnosis occurring post-exposure vs. pre-exposure and the odds of acquiring a post-exposure new POTS diagnosis vs. a new CPC diagnosis. Gastro finally calls me and says I have a pulled stomach muscle. I am a 57 year old female who just prior to Covid walked 18 miles per week and swam 4 -8 hours per week. News-Medical, viewed 04 March 2023, https://www.news-medical.net/news/20221214/What-is-the-relation-between-COVID-19-vaccination-and-new-POTS-related-diagnoses.aspx. Toshniwal Paharia, Pooja Toshniwal Paharia. 2023 Jan 26;15(1):e34236. I did have costochondritis for a few hours, an inflammation of connective tissue between the ribs, the last day, which may have been autoimmune. Most patients have trouble getting a diagnosis, which can take years, he said. The risks of POTS after COVID-19 vaccination and SARS-CoV-2 infection: its worth a shot, https://doi.org/10.1038/s44161-022-00180-z. But there are various treatments for POTS that have been effective for many patients.. 1 cause of, CBS 2 recently interviewed cardiovascular specialist Alan Kwan, MD, an investigator with the Smidt Heart Institute at Cedars-Sinai, about a recent study suggesting that a COVID-19 infection can increase the risk of developing new-onset diabetes by, ABC 7: Syndrome POTS in Rare Cases Can Be Associated With COVID Vaccine, As Well As Virus Itself, ABC 7 recently interviewed Cedars-Sinai cardiovascular specialist. This content is available for meeting attendees and/or Platinum Members. dvelopper et amliorer nos produits et services. The ER admitted me for severe dehydration and 24 hr observation. Vaccination Still Best Option for Protection, Asked about potential mechanisms to explain the findings, Kwan said POTS is typically thought of as an issue with the autonomic nervous system, which maybe damaged by COVID-19. Kwan reports no relevant conflicts of interest. For COVID-19-vaccinated individuals, POTS odds were higher 90days post-vaccination compared to those 90days prior to vaccination. Res. . Sign up for the Nature Briefing newsletter what matters in science, free to your inbox daily. Needless to say, after several years striking a tenuous health balance, I'm not anxious to an develop autoimmune condition / reaction. Google Scholar. Furthermore, manual adjudication of a subset of 50 events was performed. The symptoms of POTS include but are not limited to lightheadedness (occasionally with fainting), difficulty thinking and concentrating (brain fog), fatigue, intolerance of exercise, headache, blurry vision, palpitations, tremor and nausea. Connect with thousands of patients and caregivers for support, practical information, and answers. GI problems continue. COVID-19 was associated with greater odds of both POTS-associated diagnoses (OR 1.52; 95% CI 1.33-1.72) and common primary care diagnoses (OR 1.40; 95% CI 1.31-1.50). Interested in more discussions like this? After 20 hours I was not able to go from lying, sitting, standing. There does appear to be a small signal associating COVID-19 vaccines with POTS occurring after vaccine exposure within 90 days, Kwan told Dador. Federal government websites often end in .gov or .mil. To learn more, or to refer a patient, visit the Johns Hopkins Postural Orthostatic Tachycardia Syndrome (POTS) program website. However, they found that people diagnosed with COVID-19 are five times more likely to develop POTS after being infected than after getting vaccinated. This similarity in symptoms led doctors to start testing patients for POTS. 2021;69:205211. She is the highest ranking Australian medical doctor to admit to being COVID-19 vaccine injured (read more here):"This is an issue that I have witnessed first-hand with my wife who suffered a severe neurological reaction to her first Pfizer vaccine within . Front Immunol. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. We are able to more definitively say that we think that this is a real observation, he said. Can cause muscle twitching etc. We hope that large prospective studies utilizing the new ICD-10 diagnostic code specific for POTS, which has been implemented by the US Center for Disease Control and Prevention committee as of October 1, 2022, can be conducted in the future. Patients with lymphoid malignancies have impaired humoral immunity caused by the disease itself and its treatment, placing them at risk for severe coronavirus disease-19 (COVID-19) and reduced response to vaccination. Kwan told Dador research also showed that the COVID-19 vaccine actually offers substantial protection against POTS. Calked my Gastroenterologist for more and he does not like to use it long term. One of the remaining approvals was for severe allergic shock and one was for a type of skin swelling called angioedema. Find more COVID-19 testing locations on Maryland.gov. My daughter and I both have autoimmune conditions: I have lupus. Request for providers that treat COVID-19, although some of the providers in the system may treat COVID. J. Neurol. Please note that medical information found
. No other problems since Pfizer vaccine in March if 2021. Reports of Postural Orthostatic Tachycardia Syndrome After Human Papillomavirus Vaccination in the Vaccine Adverse Event Reporting System. I was very sick for about 4 months. Thus, we examined the extent to which new diagnoses of POTS are increased following COVID-19 vaccination in our health system, a large quaternary care system in Los Angeles. In general, the vaccines developed to combat COVID-19 safely and effectively reduce the risk of severe outcomes, although some rare side effectsmost notably, myocarditishave been reported following widespread rollout of the shots. Thank you for visiting nature.com. 2022;Epub ahead of print. When clinically indicated, usually for substantial or persistent symptoms, medication therapy, such as beta-blockers or ivabradine, were prescribed as tolerated for tachycardic response and midodrine for orthostatic intolerance, they add. Blitshteyn, S., Fedorowski, A. Overlapping Myocarditis and Postural Orthostatic Tachycardia Syndrome After COVID-19 Messenger RNA Vaccination: A Case Report. Dis. Whatever side of the covid/vaccine side you are on people actually died . HHS Vulnerability Disclosure, Help (2023) Efficacy of first dose of covid-19 vaccine versus no vaccination on symptoms of patients with long covid: target trial emulation based on ComPaRe e-cohort. In the SARS-CoV-2 population, for most conditions studied, post-infection rates were higher than post-vaccination rates (Fig. Google Scholar. Bookshelf Svetlana Blitshteyn. People could self-report pre-existing conditions when getting the vaccine or making a VAERS report, but it is not required in VAERS. Eight cases (25.8%) received one dose of the . 71, 235248 (2020). A case of transient POTS following COVID-19 vaccine Acta Neurol Belg. Stay up-to-date with breaking news, conference slides, and topical videos covering the spectrum of CVD. We found that most POTS-related diagnoses increased after COVID-19 vaccination to a greater degree than non-POTS-related diagnoses (Fig. Toshniwal Paharia, Pooja Toshniwal Paharia. Norovirus, the No. I had virtually no reaction to the first shot, and had fever and aches with the third, but no secondary autoimmune flare. Additionally, POTS odds (1.3, n=4,526) were higher than. After seeing my PCP and a cardiologist who both dx my with syncope, I went to the Cleveland Clinic Foundation and was diagnosed with POTs on June 16, 2021. POTs symptoms continued and got worse. A condition called POTS rose after covid, but patients can't find care. 69, 205211 (2021). Rev. Disclaimer. The Moderna and Pfizer BioNTech vaccines prevented COVID-19 infection in cancer patients, particularly in those whose treatment concluded more than six months before vaccination, say researchers at Stanford, Harvard and the VA. December 2, 2021 - By Krista Conger. As COVID-19 vaccines will continue to be necessary for the foreseeable future, pharmacovigilance regarding off-target effects will improve our ability to engage patients in a balanced discussion on the relative benefits versus the risks of vaccination. Concerning POTS-related diagnoses, post-COVID-19 risks were 5.4-fold greater compared to the risks post-SARS-CoV-2 vaccinations. And in a broader context, its important to raise awareness about POTS itself within cardiology because there are treatments, there are ways to help these patients feel better, Kwan said. a, Post-vaccination odds by diagnosis in all patients. Some researchers believe that coronavirus can be a trigger for POTS, as an increased number of people who recovered from COVID-19 are now experiencing POTS-like symptoms, such as brain fog, tachycardia (increased heart rate) and severe chronic fatigue. Fedorowski, A. J. Intern. "In an unexpected but important way, the COVID-19 pandemic brought a great deal of awareness to POTSboth to patients and providers," said Peng-Sheng Chen, MD, an expert on the condition who leads one of only a few POTS specialty clinics in the nation. There is some evidence that the coronavirus that causes COVID-19 may also trigger a condition called postural orthostatic tachycardia syndrome (POTS) in people with long-haul COVID-19. 9, 43 (2020). Kwan said his team was inspired to delve into POTS as a possible side effect based on anecdotal reports coming out of the specialized clinic at Cedars-Sinai that had been set up to manage the condition before the pandemic. In this interview, we speak to Ceri Wiggins, a Director at AstraZeneca, about the many applications of CRISPR and its role in discovering new COPD therapies. We recognized that pharmaco-epidemiology studies had previously used self-controlled designs, wherein patients serve as their own control3. Maharaj N, Swarath S, Seecheran R, Seecheran V, Panday A, Seecheran N. Cureus. Arana J, Mba-Jonas A, Jankosky C, Lewis P, Moro PL, Shimabukuro TT, Cano M. J Adolesc Health. All Rights Reserved. Correspondence to POTS can cause a rapid increase in heartbeat, fainting, dizziness and fatigue. This paper describes the patient experience of POTS, with 75% of participants reporting misdiagnosis and a median diagnostic delay of 2 years. A condition called POTS rose after covid, but patients can't find care A life-changing condition called POTS, which can cause fainting, irregular heartbeats and dizziness, particularly among young women, appears to be on the rise as a result of the coronavirus pandemic. Came back the next day and said I might have POTS. Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA. The study was supported, in part, by National Institutes of Health grants; a Doris Duke Charitable Foundation grant; the American Heart Association; the American Society of Nuclear Cardiology 2021 Institute for the Advancement of Nuclear Cardiology Research Award; the Smidt Heart Institute; and the Burns & Allen Chair in Cardiology Research, Cedars-Sinai Medical Center. Does anyone with POTS who had either COVID or one of the vaccines care to comment about their experiences? Nat. First, it undeniably establishes POTS and dysautonomia in general as adverse events after vaccination that should be recognized and investigated as other well-accepted post-vaccination syndromes, such as GuillainBarre syndrome and acute disseminated encephalomyelitis. ISSN 2731-0590 (online). Instead of getting eyerolls and no help they listened and tested. doi: 10.7759/cureus.34236. In this article, News-Medical talks to Sartorius about biosensing and bioprocessing in gene therapy, The Mayo clinic said they cant see me. 286, 434448 (2019). Despite these limitations, the study by Kwan et al.12 is of major importance to POTS research and patient care for several reasons. Alan C. Kwan, Joseph E. Ebinger, Susan Cheng, Jlia Arany, Victor Bazan, Roger Villuendas, Tetsuya Akaishi, Tamotsu Onodera, Tadashi Ishii, Shigeru Shibata, Kazuo Kobayashi, Hiromi Rakugi, Hannah E. Davis, Lisa McCorkell, Eric J. Topol, Benjamin A. Satterfield, Deepak L. Bhatt & Bernard J. Gersh, Prakash G. Kulkarni, Amul Sakharkar & Tanushree Banerjee, Mateusz Soliski, Agnieszka Pawlak, Jan J. ebrowski, Miguel A. Fernndez-Rojas, Marco A. Luna-Ruiz Esparza, Jonathan Alcntar-Fernndez, Nature Cardiovascular Research You are using a browser version with limited support for CSS. In October 2020, Chung launched a clinic specifically for patients who were once infected with SARS-CoV-2 the virus that causes COVID-19 and who now experience severe fatigue; orthostatic tachycardia, dizziness or intolerance to standing; chronic muscle pain; headache; and nausea, vomiting or irritable bowel syndrome. 2022;43:340. Second, the general awareness and diagnostic vigilance of POTS and access to adequate diagnostic modalities are decisive for POTS incidence reliability. Despite the good research around POTS and the evidence around autonomic nerve damage, says Chung, symptoms may be diagnosed as psychological. Most (62%) received the shot from Pfizer/BioNTech, 31% the one from Moderna, 7% the Janssen vaccine from Johnson & Johnson, and less than 0.1% a mix of other shots. doi: 10.1146/annurev-med-041818-011630. FOIA In the present study, researchers performed a sequence-symmetry analysis to investigate the relationship between SARS-CoV-2 vaccinations and novel POTS-associated diagnoses by evaluating the odds of POTS diagnosis 90days before the initial vaccination/infection (background interval) vs. 90days following the vaccination/infection (subsequent interval). Similar findings were observed after repeating the analysis and considering the second vaccination as the index vaccination. A.C.K. Side effects and immune reactivity would naturally be worse with Moderna. He got his start in journalism at. Following up on this information, we developed the initial question about POTS after COVID-19 vaccination. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. New POTS diagnoses within 90days of exposure were identified based on the international classification of diseases (ICD)-9,10 codes or phecode grouping and expressed as a rate per 100,000 exposures. Fourth, the rate of new-onset POTS diagnoses is more than five times higher following natural SARS-CoV-2 infection than after COVID-19 vaccination. Diagnosed with pots earlier this year, this is not some new found side effect, this was reported on back in mid 2021 by those that were vaccine injured and witnesses and statements regarding cases appeared and were reported in front of a congressional panel in Washington.