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A 61-year-old man died from what is believed to be a combination of a severe allergic reaction (anaphylaxis) and Covid-19 respiratory tract infection last year, an investigation found.

The Singaporean man, Koh Choon Lim, died in hospital on Jul. 29, 2022, two days after he took four capsules of traditional chinese medication (TCM) medication Lianhua Qingwen Jiaonan, a day after he took Panadol tablets and after he received three injections from a clinic for allergic reactions.

The coroner's court held an inquiry into his death on Apr. 26, 2023.

Sick for more than a week

According to Shin Min Daily News, the Singaporean man, Koh Choon Lim, died in hospital on Jul. 29, 2022.

According to a police investigation officer who testified in court, Koh's son said Koh fell sick on Jul. 18, 2022, and was feeling giddy.

A week later, Koh was still feeling weak and lethargic.

Koh did an antigen rapid test (ART) on Jul. 26, and it showed that he was Covid-19 positive. He then took some Panadol tablets and fell asleep.

Not the first time he took the TCM pills

The next day, on Jul. 27, Koh still had a headache and a sore throat. He decided to take four capsules of Lianhua Qingwen Jiaonan, a type of Chinese proprietary medicinen that treats flu and cold symptoms.

It was not the first time Koh took the medicine. His son said he had previously eaten the medicine to "clear heatiness".

He woke up in the night with a sore throat, "so sore that he couldn't speak", and took Panadol tablets again before returning to sleep.

Clinic doctor gave him three allergy injections

Koh's family took him to the clinic later that day. The clinic doctor noticed his lips were swollen and believed it was due to an allergic reaction.

According to CNA, the doctor gave Koh two injections and advised him to go to a hospital. However, Koh refused.

The clinic doctor kept him for observation and allowed him to return home after the swelling subsided slightly after another injection.

Died in hospital a day after

Later in the afternoon, Koh appeared disorientated, and his family took him to Tan Tock Seng Hospital's Emergency Department.

He was transferred to the National Centre for Infectious Diseases (NCID) the next day, on Jul. 29, and passed away on the same day.

The cause of death was determined to be a combination of anaphylaxis, which is a severe allergic reaction, and a Covid-19 respiratory tract infection. Koh also had other medical conditions present.

Police suspect TCM pills caused allergy but cannot verify

The investigation officer said that Lianhua Qingwen Jiaonan medication was suspected to have caused Koh's allergy, but it cannot be confirmed through post-mortem means.

He said the police believed no foul play was involved and Covid-19 was the underlying cause of Koh's death.

State coroner Adam Nakhoda then asked an NCID department head, Monica Chan, who also testified in court, if the TCM pills could have caused Koh's allergic reactions.

Chan clarified, with the caveat that she was not an allergen expert, that Koh's body could have undergone sensitisation, a process where a person's body becomes sensitive to a given allergen, Shin Min and CNA reported.

And so, when Koh took the medicine this time, coupled with his Covid-19 infection, it could have resulted in an allergic reaction.

Son questions hospital

Shin Min reported that Koh's wife and son attended the inquiry.

His son did not understand why the hospital's doctors initially said Koh was not in a life-threatening condition and wanted an explanation.

Chan explained that Koh's vital signs were "not particularly abnormal" when he was admitted to the emergency department, according to CNA.

She added that Koh presented atypically, with an altered mental state and changes in behaviour, which were their main concerns. She said that Koh did not have low oxygen saturation, difficulty breathing nor narrowing airways.

Asked why the hospital tied him to a chair

Koh's son questioned why there was no medical record for around half an hour on the morning of Koh's death.

He also asked why the hospital tied Koh to a chair far from the nurse's bell.

Chan claimed Koh once pulled out his IV drip, and the nurses decided to tie him to the chair while doing frequent checks on him.

The coroner then asked the investigation officer to look into what had happened in the hospital and asked him also to investigate the TCM medicine Koh had taken.

The coroner will deliver his findings at a later date.

According to a Health Sciences Authority (HSA) advisory issued in November 2021, Lianhua Qingwen products have been approved in Singapore for the relief of cold and flu symptoms. They are not approved for the treatment of Covid-19.

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