Post COVID-19 vaccine deaths – Singapore’s early experience (As of 30 June 2021)

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Excerpts from “Post COVID-19 vaccine deaths – Singapore’s early experience”.

Forensic Sci Int. 2022 Mar; 332: 111199.

Published online 2022 Jan 19. doi: 10.1016/j.forsciint.2022.111199

PMCID: PMC8767909

PMID: 35078041

Post COVID-19 vaccine deaths – Singapore’s early experience

Audrey YEO,Benjamin KUEK, Mandy LAU, Shi Rui TAN, and Shijia CHAN

Abstract

Singapore has been using mRNA vaccines developed by Pfizer-BioNTech and Moderna as part of the nation’s COVID vaccination program since 30 December 2020. From 1 February 2021–30 June 2021, a total of 34 deaths that occurred within 72 h of the deceased receiving their COVID-19 vaccination were referred to the Forensic Medicine Division of the Health Sciences Authority of Singapore. Autopsies, histological sampling and ancillary investigations consisting of total tryptase level, Immunoglobulin E (IgE), and C-reactive Protein (CRP), were performed on 29 of these cases. Our study has shown no definite causative relationship between the mRNA vaccination and deaths of individuals who died within 72 h after receiving the vaccination, in particular with regards to anaphylactic reactions, myocarditis and pericarditis, and thrombotic complications. Further studies may consider increasing the incident time frame from 72 h to seven days post-vaccination or longer to include any potential delayed presentation of adverse effects.
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2. Methods

All coronial cases between 1 February 2021 and 30 June 2021 who had died within 72 h of receiving a dose of either the Pfizer-BioNTech or Moderna vaccine, or sustained neurological or cardiovascular compromise requiring medical resuscitation within 72 h of receiving the vaccine and subsequently demised after a period of hospitalization, were included in this study. There were no reported cases of individuals who had died or collapsed within 72 h of receiving their vaccination before 1 February 2021. Autopsies were performed according to established departmental procedures, and close attention was paid to look out for findings of anaphylaxis and local allergic reactions. Dissection of the vaccination site was performed if the vaccination site could be determined. Histological sampling was performed according to a departmental post-vaccination protocol ( Table 1), including specimens of all major organs and the injection site, if identified. Other ancillary investigations performed included levels of total tryptase, Immunoglobulin E (IgE), and C-reactive Protein (CRP). Post-mortem blood samples for these ancillary investigations were obtained by “milking” the vessels of the lower limbs and collecting the blood from the cut-ends of the femoral vessels during evisceration of the body. Histological slides were screened for the presence of eosinophilic infiltrations, myocarditis, and thrombosis.
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Our study is the Singapore study for the first six months of vaccine usage. The selection of the 72-hour post-vaccination time period for the study was primarily to investigate acute allergic responses, as it was the major concern when the government was advising the population to be vaccinated earlier in the year [47]. Delayed hypersensitivity reactions, myocarditis, pericarditis and thrombosis which may happen within this timeframe were also investigated. This study has shown no definite causative relationship between the mRNA vaccination and deaths of individuals who died or suffered neurological or cardiovascular collapse within 72 h after receiving the vaccination, in particular with regards to anaphylactic reactions, myocarditis and pericarditis, and thrombotic complications. There was no evidence of vaccine-induced thrombotic thrombocytopenia or dural venous sinus thrombosis in all cases. This is similar to the findings established by Elder et al. in their case series of deaths associated with the BNT162b2 in Hamburg, Germany [48].
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5. Conclusion

Our study has shown no definite causative relationship between the mRNA vaccination and deaths of individuals who died or collapsed within 72 h after receiving the mRNA COVID-19 vaccination with regards to anaphylactic reactions, myocarditis and pericarditis, and thrombotic complications. Further studies may consider increasing the incident time frame from 72 h to seven days post-vaccination or longer to include any potential delayed presentation of adverse effects.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767909/

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