![]() For comparative purposes, we thereafter determined the frequency of SCN5A variants in Thai SUD cases occurring 8–30 days after COVID-19 vaccination during the same period. The frequency of SCN5A variants in our cohort was 38% (5 of 13). ![]() Two had no variants, consistent with the filtering criteria. Six other SUD cases in our cohort harbored variants in other genes, which were previously reported to be associated with cardiac arrhythmias, cardiomyopathies, or SUD. Only 2 of our 5 SUD cases with SCN5A variants reported fever. §Compound heterozygous for p.Glu27Lys and p.Phe42Leufs∗19 in the HBB gene.įive cases harbored variants in SCN5A ( Table 1) 4 were men, aged between 23 and 46 years, who died within 3 days of the last COVID-19 vaccination. Cases with variants in non- SCN5A genes (n = 6) Schizophrenia with clonazepam, diazepam, fluoxetineĪrrhythmogenic right ventricular dysplasia Reported in patients in PubMed or ClinVar The remaining case had thalassemia, leading to hemochromatosis and liver cirrhosis. Another 6 were found to have cardiac causes including coronary atherosclerosis in 4 (31%), dilated cardiomyopathy (DCM) in 1 (8%), and arrhythmogenic right ventricular dysplasia in 1 (8%). In 6 cases (46%), the autopsy identified no explainable causes of death. Ten (77%) and 11 (85%) deaths occurred within 24 hours and 3 days of vaccination, respectively. Fever after vaccination was noted in the self-reported web-based registry in 3 cases (23%). There was no significant correlation between the type of vaccine and SUD (Online Supplemental Table S2). During the same period in Thailand, the number of administered doses of vaccines were 41,839,326 (41%), 14,091,514 (14%), 27,607,314 (27%), and 17,587,080 (18%) for AstraZeneca, Sinopharm, Sinovac, and Pfizer/BioNTech, respectively (no formal data for Moderna). SUD occurred after all types of vaccines used in Thailand, with 7 (54%), 2 (15%), 2 (15%), 1 (8%), and 1 (8%) deaths after receiving ChAdOx1 nCoV-19 (AstraZeneca), BBIBP-CorV (Vero Cells) (Sinopharm ), CoronaVac (Sinovac), BNT162b2 (Pfizer/BioNTech), and mRNA-1273 (Moderna), respectively ( Table 1). There was no significant correlation between the number of vaccine and SUD (Online Supplemental Table S1). The total number of individuals receiving 1, 2, and 3 doses of COVID-19 vaccines in Thailand during the same period were 51,295,617 (49%), 46,145,566 (44%), and 7,002,986 (7%) doses, respectively. Eight (61%), 4 (31%), and 1 (8%) died after receiving the first, second, and third doses of vaccine, respectively. No cases had a history of SUD in family members. Underlying diseases were reported in 5 patients, but none were arrhythmia. Thirteen cases comprising 10 men (77%) and 3 women (23%), aged between 23 and 72 years, were recruited ( Table 1 In addition, to be considered pathogenic, variants had to be reported in the literature in patients with BrS, cardiac arrhythmias, cardiomyopathies, or SUD. Minor allele frequencies of <1% were used for all other genes. ![]() 8 We therefore used minor allele frequencies of <5% as a filtering criterion for this SCN5A-SCN10A locus. The only unequivocal, major genetic locus responsible for Brugada syndrome (BrS) is SCN5A-SCN10A, 6, 7 and its common variants could have susceptible effects on the phenotype. 5 Briefly, the sequencing libraries were enriched using a SureSelect Human All Exon V7 kit (Agilent Technologies )” here for SureSelect Human All Exon V7 kit and were sequenced using Illumina HiSeq 4000 (Illumina, San Diego, CA])” for Illumina HiSeq 4000 device. Postmortem blood was obtained for genomic DNA extraction then, whole exome sequencing (WES) was performed as described previously. Genetic testing was approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University (institutional review board no. The research reported in this article adhered to Helsinki Declaration guidelines. Those in whom the cause of death was found to be natural were sent for genetic studies. ![]() No consent from relatives was required because the autopsy was legally mandated. All cases tested negative for severe acute respiratory syndrome coronavirus 2 by reverse transcription polymerase chain reaction. ![]() From April to December 2021, all cases of unexplained death occurring within 7 days of COVID-19 vaccination were sent for medicolegal investigation by forensic pathologists of the National Forensic Network comprising 9 medical centers throughout Thailand. ![]()
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