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If you are using Perusall in your Moodle 4 course we made the switch to version LTI 1.3 in August 2023. Follow these instructions from Perusal Support:

If a user was originally integrated into Perusall with LTI 1.1, the first time they launch into Perusall via LTI 1.3 integration, it will prompt them with a one-time "confirm merge" email. This means that their account was originally on a different integration and it is transitioning them to the new one. They will need to confirm the merge and relaunch and will be all set.
If a user originally had a course through the LTI 1.1 integration, that content is still available in their account under "my courses". Teachers can also copy course materials from a 1.1 course to a 1.3 course. 
For instructions on copying course materials from one course to another, see How do I use Perusall to teach the same course again?
With the 1.3 integration, grade sync settings now allows the instructors to choose whether Perusall should create gradebook columns automatically, OR manually (by the instructor building Deep-links in a content are of their course).  For more information, see Grade Sync in LTI 1.3.

See Perusall Support-Moodle Integrated LTI 1.3