A three-year-old boy died a few days after he received an influenza vaccination in a Singapore hospital in March 2023.
Almost half a year later, his grieving parents are still seeking answers.
When life couldn't move on
Mr and Mrs S are like any couple in Singapore.
However, it is difficult not to notice the sadness in their voices and the agony they try to hide in their eyes.
They told Mothership they wanted to remain anonymous, not because they are afraid.
Mr S said:
"We tried to move on, tried to work as usual, tried to go back to normal. But we don't go for outings. We didn't tell many people about our son's death. We don't want to have people realising that our son is not with us anymore. It's tiring trying to explain to people what happened when we couldn't even convince ourselves."
Trusted their doctor
It all began on Mar. 1, 2023.
They brought their son back to KK Women's and Children's Hospital for a check-up as he was previously hospitalised due a complication arising from his asthma.
He just had his first day in preschool.
During the check-up, a doctor checked their son's condition and noted he was recovering well.
They said she prescribed more medication for him and said if all continued to go well, she would reduce the dosage for him six months later.
Before they left, out of the blue, the parents were asked if their son had taken an influenza vaccine and if they would like him to take one.
Mr S said:
"They said it would be good for him. We trusted them."
Was told they only have to give medicine if he had fever from vaccine
After they waited to go into another room for the injection, a nurse handed them a document to sign.
They asked her to explain what the document was for, but the nurse apparently only said it was "something that had to be signed".
Not suspecting anything more, they signed the document and let the nurse administer the vaccine to their son.
After the vaccination, Mrs S asked the doctor if they had to look out for anything, like what not to let their son eat or any side effects they should know about.
They said the doctor only told them he might "run a fever", and all they had to do then was give him "fever-reducing medication".
She also prescribed some "fever-reducing medication" for them before they left for home.
Their son had a fever that very night — and things quickly got out of control.
Fever, then convulsions
The parents said it was around 10pm when they discovered he had a fever.
They did what they were told — give him the "fever-reducing medicine".
The fever didn't subside the following day, but it wasn't a high fever, and he still had an appetite for porridge, so while they were worried, they didn't realise something was wrong.
The boy could still speak to them normally.
Little did they know it was the last time they spoke with their son.
At around 1pm, he started convulsing uncontrollably.
They rushed him back to KKH.
The parents can never forget the events that unfolded after.
The night when the light went out in his eyes
Mr. S said he remembered his son suddenly coughed brown-coloured blood into the oxygen mask in the evening.
He remembered hearing his son's agonising moans.
He remembered seeing the light go out in his son's eyes.
The doctors put his son on life support after that night.
Mr S said:
"But deep down in my heart, I knew he was gone."
Day after day, they watched their son fade away.
Then they decided it was enough. They didn't want him to suffer anymore.
On Mar. 5, when they decided to discontinue life support, many doctors and nurses came to the ward.
They said some of the nurses cried.
Mr S said: "We are very grateful to them. The medical team took good care of my son the whole time. We are very grateful."
There was not much left of him
They decided against an autopsy.
Not because of tradition or superstitious customs but because there was already nothing much left of him — and they wanted what was left intact.
Mrs S was aggrieved. She wanted to describe what the illness did to her son to Mothership, but Mr S shook his head and stopped her.
"A doctor told me privately that what happened to my son was probably because his immune system turned against him," explained Mr S.
Months later, they didn't regret their decision of not having an autopsy conducted, even though it might have contributed to their struggle for answers.
"Cause of death"
The official cause of death was listed as "other viral specific encephalitis".
KKH explained in a letter to the parents that based on a CT scan and clinical findings, the "impression" was that their son had "acute fulminant encephalitis/ acute necrotizing encephalitis (ANEC)".
KKH also mentioned in the letter that their "records" showed that their son tested positive for Influenza A and human herpesvirus 6 (HHV-6).
While they said both are "known causes of severe neurological conditions such as ANEC", they believed that as the vaccine was not live attenuated, it was not known to cause ANEC.
Hospital representative compared situation to "striking lottery"
The parents sought answers from the hospital as to why their son died after taking a vaccine recommended by the hospital.
However, the initial response was lacking.
They met up with a representative who vehemently denied that their son's death had anything to do with the vaccine.
The representative agreed that while there are reported cases of people dying after taking vaccines overseas, he claimed the vaccines were not determined to be the cause of death.
The analogy he used triggered the family. They had recorded the conversation and showed it to Mothership.
Mr S said:
"He explained that some people strike the lottery after their car meets with an accident, but that doesn't mean that the car accident was the cause of them striking the lottery.
Our son passed away days before, and he thought comparing our son's death to striking the lottery was acceptable. Where is the compassion?"
Hospital apologises for insensitive remarks
While the hospital apologised for the representative's remarks in a subsequent correspondence, they denied that their vaccination policy had anything wrong.
They also claimed that the "post-vaccination counselling provided" to the parents "was appropriate".
From the correspondence the parents showed Mothership, the hospital said they had checked "medical records" to determine that the counselling was appropriate.
They also attached the "medical record" in their correspondence, which a nurse signed off.
"We all know it's a copy-paste. She couldn't have said all that within one minute. She didn't say it all," Mr S said.
The parents researched online and found a digital version of the leaflet that comes with the vaccine.
Mr S said he was shocked when it listed all the "severe allergic reactions" he never knew about, which he said was never told to them.
The "severe allergic reactions" of "unknown frequency" include "medical emergencies" such as blood pressure, breathing, and heart rate problems, which all might lead to a collapse.
It also stated that there might be swelling on any part of the body, "most apparent in the head and the neck", which may cause difficulty in swallowing or breathing.
"If I knew, I would never let my son take the vaccine."
All they want is an apology
The parents went around looking for answers. While they claimed many doctors agreed that there might be a possibility the vaccine could have caused the death, they said none of them were willing to put it down officially.
Mr S said: "Somehow, there was no evidence, even though there are many known cases of children dying after taking a flu vaccine."
He pointed out the case of Korean schoolchildren dying after taking flu vaccines in 2020.
They also highlighted the case to KKH, which replied that Korean authorities had found the vaccine safe.
The hospital also claimed that the Singapore authorities approved the vaccine their child took.
The child that only had three years to live
The boy, named after what Mr and Mrs S hope for him to become in the future, was born shortly before the Covid-19 pandemic.
Like many children who grew up during the pandemic, their son had little opportunity to mix with other children.
For most of his few short years, it was his parents and him.
"He was a very kind child," Mrs S said, recalling an incident on their first trip overseas. "When the pandemic subsided, we brought him overseas, and he saw snow for the first time."
While most children would probably play with snow, like building a snowman, she noticed he was building something with twigs instead.
She asked him what he was doing.
"He said he wanted to build a shelter for the rabbits," Mrs S said as tears welled up in her eyes. "He was worried they would fall sick in the cold weather."
After his death, his preschool showed them photos they took for him while he happily ate lunch and CCTV footage of him playing with other children on his first day of school.
"He looked healthy before the vaccination," Mr S said. "The school also confirmed that none of their children had influenza before or after his death."
Hopes other parents won't go through the same
Mr S said he and his wife still don't understand how his son could have died of influenza.
He said he is not suggesting that the vaccine had directly caused the influenza, but it might have somehow compromised his son's immune system.
"I keep thinking. Had he not taken the vaccine, would he still have died of influenza?"
Mr S said they believe that it all comes down to the fact that the hospital recommended his son, who was still recovering from a previous illness and still on medication, to take a vaccine his son did not have to take.
"Yes, we agreed to the vaccination. But we are laymen, not medical professionals. We did not know what we signed up for," he said. “We trusted what they told us, that the vaccination would be good for our son, for his asthma condition.”
The parents feel that the hospital took their child's vaccination too lightly and that procedures for recommending young patients for vaccines could be more stringent or at least have tests to check if they would be safe to take a vaccine.
According to their research, vaccinating young children, especially those with a medical history or recently recovered from an illness, has always been a contentious issue.
They claimed that several countries, such as a few of them in Europe, do not allow children to be vaccinated.
Regardless of what answers they get, Mr and Mrs S hope that, at the very least, something good will come out of this tragedy.
All they want is a certain "justice" for their son, an apology from the hospital for their son's death, and knowing that their son did not "die in vain".
They also plan to set up a support group for people who have lost their children to help one another and to prevent the loss of more innocent lives.
"We can only wish that he did not die in vain," the father said.
He showed Mothership a photo of him and his son and said that he hoped his son would fly high to the heavens, like the kite they lost that day, to a better place.
In response to queries, Associate Professor Chan Yoke Hwee, Chairman, Medical Board, KK Women's and Children's Hospital, told Mothership:
"KKH devotes itself to taking care of the health of children, for many decades now. We are very saddened by the passing of the patient. We feel for the parents. We have been and will continue to be in touch with the family to assist and support them in this difficult time.
The last thing we want is to get into a dispute with the parents, at this difficult time. We will just state the following facts:
First, Influenza vaccinations have been routinely administered to children with similar profile as the patient, based on established clinical guidelines.
Second, prior to receiving the vaccination, the patient was assessed to be well and suitable to receive the influenza vaccine. The patient had also received other mandatory childhood vaccinations previously and had no adverse events from these vaccinations.
Third, with the facilitation of MOH, an investigation was conducted into the cause of death. This was done by clinicians within and outside of KKH. It was found that the patient had passed on due to an influenza infection, which is not related to the influenza vaccine. Influenza infection, which usually causes upper respiratory tract infection, can also result in severe disease such as pneumonia and encephalitis. Unfortunately, the child did not have the benefit of vaccination protection at the point of infection.
We hope parents will continue to have their children take influenza vaccinations.
Singapore's National Childhood Immunisation Schedule (NCIS) recommends influenza vaccinations to all healthy children from six months old to under five years of age, and for at-risk children aged five and above with medical conditions that put them at higher risk of complications from infection.
Before the influenza vaccine is administered at KK Women's and Children's Hospital (KKH), the child will be screened for suitability while caregivers are given advice before and after the child's vaccination. Advice would include the possible reactions to look out for and when the child may need medical attention.
Common side effects like mild fatigue, fever and pain over the injection site usually resolve within three days. Medical attention is needed if the child develops more severe signs and symptoms, such as persistent fever even with medication."
Top image & All images via Mothership/Original work by Jessin Goh