MOH investigating case of 16-year-old who suffered cardiac arrest nearly a week after COVID-19 vaccination
SINGAPORE: The Ministry of Health (MOH) said on Monday (Jul 5) it is investigating a case of a 16-year-old boy who suffered cardiac arrest six days after receiving his first dose of COVID-19 vaccination.
MOH said it was alerted to the incident by Khoo Teck Puat Hospital (KTPH) on Jul 3.
The boy was treated at the hospital that day after he collapsed at home in the morning, following weightlifting at the gym.
He was subsequently transferred to National University Hospital (NUH), where he is in critical condition at the intensive care unit.
MOH said the teenager received his first dose of the Pfizer-BioNTech/Comirnaty vaccine on Jun 27. He was assessed by trained healthcare workers to be suitable for the vaccination, was observed on-site for about 30 minutes after vaccination and was well.
He was also well for the following five days after vaccination, said the ministry.
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"Prior to his collapse on Jul 3, he did weightlifting at the gym. MOH understands that he trains with very heavy weights which were above his body weight," said the ministry.
“We are in contact with the medical team in NUH who are providing close medical care for the patient. The preliminary diagnosis of his condition is an out-of-hospital cardiac arrest. Clinical and laboratory tests are in progress to understand the underlying cause," it added.
“We will also work with the medical team in NUH to determine if this might be linked to his COVID-19 vaccination. This will include a thorough consideration of whether there was acute severe myocarditis, which is severe inflammation of the heart muscles affecting the heart function, as a possible diagnosis."
The expert committee on COVID-19 vaccination will monitor the outcome of the investigation.
AVOID STRENUOUS PHYSICAL ACTIVITY A WEEK AFTER VACCINATION
In a separate statement on Monday, the expert committee said people who have been vaccinated, particularly adolescents and men under 30 years old, should avoid exercise or strenuous physical activity for a week after any dose of the jab.
This is an update from a previous advisory to avoid strenuous physical activity for a week after the second dose. The new advice was made given “emerging data on the small risk of myocarditis and pericarditis” observed after vaccination with mRNA COVID-19 vaccines, said the expert committee.
Vaccinated people should also seek medical attention promptly if they develop chest pain, shortness of breath or abnormal heartbeats, said the committee.
It added that those who are diagnosed with myocarditis after receiving an mRNA COVID-19 vaccine should not receive further doses of the vaccine.
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"While most persons with vaccine-related myocarditis observed locally and internationally have mild symptoms and make an uneventful recovery, it is possible that the condition may be aggravated by factors or strenuous activities that may affect the heart," said the committee.
Following "extensive deliberation", the expert committee said it continues to recommend mRNA COVID-19 vaccines for all eligible individuals, including adolescents and younger men.
The protective benefits from the mRNA COVID-19 vaccines continue to outweigh the vaccination risks and vaccinations should continue to remain voluntary, it added.
“COVID-19 is likely to become endemic in Singapore and around the world. Even with high vaccination rates in our population, settings with low overall levels of vaccination will continue to be susceptible to outbreaks.
“The risk of transmission and outbreak in settings such as schools or workplaces where there is close contact amongst individuals will likely be higher. Infection of unvaccinated individuals can lead to severe disease and long-term complications, including multisystem inflammatory syndrome in children,” said the committee.
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It added that the use of safe and efficacious COVID-19 vaccines in Singapore is of “paramount concern” and that it will continue to monitor local and international data to ensure the country’s vaccination recommendations are up to date based on the latest scientific evidence available.
12 CASES OF MYOCARDITIS OR PERICARDITIS FROM ALL DOSES
In a separate update on Monday, HSA said it received a total of 6,606 reports of suspected adverse reactions from the Pfizer-BioNTech/Comirnaty and Moderna COVID-19 vaccines as of Jun 30.
This represents 0.12 per cent of all doses administered in Singapore.
Out of this, 252 reports were assessed to be serious, including 12 reports of myocarditis and pericarditis.
Seven cases of myocarditis and pericarditis involved men aged below 30. This exceeded the expected numbers for this age group based on background incidence rates, said HSA.
“Although there is a small increased risk of myocarditis and pericarditis, the local incidence rate remains low,” said the agency, at 0.22 per 100,000 doses administered overall. The figure for men below 30 is 1.24 per 100,000 doses.
“All the cases in the younger age group below 30 years old responded well to treatment and had recovered or were discharged well from the hospital,” said HSA.
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HSA also said that out of about 32,000 people with a history of anaphylaxis who became eligible to receive the mNRA vaccines, about 13,000 have been vaccinated.
Authorities had on Jun 5 recommended that people with a history of anaphylaxis or allergic reactions to other drugs, food or insect stings can be inoculated with the vaccines.
The overall anaphylaxis incidence rate remained similar to that reported before the new recommendation came into effect, said the agency.
HSA’s safety update on the vaccines covers the two mRNA shots that are part of Singapore’s national vaccination programme. It does not include data on the Sinovac vaccine that is available under the Special Access Route.