Quebec confirms 1st death related to rare AstraZeneca-linked blood clots, emphasizes benefits outweigh risks

The Quebec Health Ministry has confirmed the death of a woman in the province after the AstraZeneca-Oxford COVID-19 vaccine she received in early April led to a rare blood clot in her brain. 

Woman identified as 54-year-old Francine Boyer

Quebec Premier François Legault, centre, speaks during a news conference as Health Minister Christian Dubé, right, and Public Health Director Dr. Horacio Arruda look on. Quebec Health Ministry has confirmed the death of a woman in the province after the AstraZeneca-Oxford vaccine she received in early April led to a rare blood clot in her brain. (Jacques Boissinot/The Canadian Press)

Quebec has confirmed the death of a woman after the AstraZeneca-Oxford COVID-19 vaccine she received in early April led to a rare blood clot in her brain. 

The province's Ministry of Health said the woman's death was caused by a vaccine-induced immune thrombotic thrombocytopenia (VITT).

She has been identified by her family as 54-year-old Francine Boyer.

According to a news release sent out Tuesday evening, Boyer and her husband Alain Serres both took the AstraZeneca vaccine on April 9.

While he experienced no complications, she was hospitalized and later died on April 23.

The release states that in the days following her vaccination, Boyer suffered from severe fatigue and headaches. She was hospitalized locally and then transferred to the Montreal Neurological Institute as her condition worsened.

In the statement, Boyer's family encourages anyone who has been vaccinated to keep an eye out for reactions or unusual symptoms and to contact their doctor or public health if they have any concerns.

Quebec Premier François Legault offered his condolences. "It's sad … but we knew there was one chance in 100,000 that this could happen and we believe the benefits outweigh the risks." 

More than 350,000 people have received the vaccine in Quebec, the Health Ministry said.

Public Health Director Dr. Horacio Arruda said Boyer's death is within the vaccine's average risk, which is that serious complications arise in one in every 100,000 people vaccinated. 

Rare but severe

VITT is one of the very rare but possibly severe complications that can arise from some COVID-19 vaccines. It is estimated to occur in one out of every 100,000 to 250,000 people inoculated with the AstraZeneca-Oxford COVID-19 vaccine. 

Though extremely rare, VITT is much more severe than a typical blood clot, because it can cause cerebral venous sinus thrombosis (CVST), where veins that drain blood from the brain are obstructed and can potentially cause fatal bleeding.

Arruda said it's important to weigh the risk of vaccination against the much higher risk of serious complications related to COVID-19.

"It's still clear that this virus kills. It's still clear this virus will make you sick and that vaccines will protect you. But sometimes, unfortunately, there are complications," he said.

"It is very rare. We knew there was a possibility that it could happen."

Arruda said it was the first death in Canada related to the vaccine that he is aware of.

On Tuesday evening, the Public Health Agency of Canada and Health Canada issued a statement extending condolences to Boyer's family.

The statement said that the agencies are "gathering additional information and the details will be considered as part of ongoing monitoring of the risk of rare blood clots with low platelets following immunization" with the AstraZeneca vaccine.

Health Canada reiterated that "the benefits of the vaccine in protecting against COVID-19 continue to outweigh its
potential risks."

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The mechanism behind the rare blood clotting condition Boyer suffered isn't entirely clear, but the outcomes can often be dire — with traditional treatment methods, like the blood thinner heparin, actually making it worse.

The mortality rate of VITT is around 40 per cent, according to Canada's National Advisory Committee on Immunization (NACI). 

The Ministry of Health said she was one of two people in Quebec to have suffered from VITT, though she is the first to have died from it. 

The ministry said she was hospitalized as soon as she reported symptoms of VITT. According to NACI, those symptoms or warning signs include: 

  • Shortness of breath.
  • Chest or abdominal pain.
  • Leg swelling.
  • Severe headaches or blurred vision.
  • Skin bruising or a skin rash.

Provinces determine cut-off

Given the hot spots of infections across Canada and widely-circulating variants of concern, NACI has said the national age cut-off for AstraZeneca should be 30 years old.

NACI says the shot only makes sense for individuals if the "benefits outweigh the risks" associated with the blood clots that occur in rare instances post-vaccination. 

The advisory committee said the vaccine should also only be given to those without contraindications — any health conditions that would heighten the risk of the vaccine causing someone harm — and if the individual does not want to wait for an mRNA vaccine.

Provinces ultimately determine the age at which residents can receive the vaccines, and Quebec has determined the cutoff for AstraZeneca to be age 45. 

Dubé, Quebec's health minister, said Tuesday that the government was asking Quebecers over the age of 45 to make their own informed decision about the vaccine.

With files from Lauren Pelley and Adam Miller

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