On 7 July 2022 an investigation was commenced into the death of Andrew Etlered Nichols. The investigation concluded at the end of the inquest hearing on 25 October 2023 at Stourport Coroner’s Court, in the Worcestershire Coroner Area. The conclusion (a ‘narrative’ conclusion in Section 4 of the Record of Inquest) was determined as follows:

‘Andrew Nichols died as a direct result of blood clots forming in the vein of his leg and circulating to block the veins of his lungs. Andrew not receiving anticoagulation medication when discharged from hospital contributed to his death. Andrew’s immobility, which had occurred as a result of a very rare side-effect following vaccination, contributed to his death.’

Andrew Nichols was in his early fifties (he was 52 when he died in June 2022), with no significant past medical history, when he received a vaccination in April 2021, as part of the national programme in response to the Covid-19 pandemic. Andrew suffered an extremely rare and serious side-effect of vaccination, and within days developed the neurological condition acute disseminated encephalomyelitis (known as ADEM).

In consequence, Andrew spent over a year in hospital, mostly in intensive care, as he required respiratory, nutrition and organ support and was wholly dependent on professionals for daily care. Andrew was immobile and required hoisting when being moved out of bed. Early on in his hospital admission, Andrew suffered bilateral pulmonary emboli, which were thought to have developed owing to him having become acutely unwell and immobile (not vaccine-induced thrombotic thrombocytopaenia (VITT)). Andrew was commenced on anticoagulation medication and this continued during his stay in hospital.

At the inquest, evidence was given by a consultant haematologist, who stated that, owing to Andrew having two specific risk factors for the development of deep vein thrombosis (namely ongoing immobility and previous thrombosis/emboli), anticoagulation medication would remain clinically indicated, whether he remained in hospital or not. In May 2022, Andrew was discharged from hospital to a specialist neuro-rehabilitation community care centre. Upon discharge, the hospital did not include anticoagulation medication in the list of prescribed medication that Andrew should continue to receive in the community. At the inquest, the hospital accepted that to not do so was a failing on their behalf. It was not clear why this failing happened; however, a finding was made that the most likely reason was that clinicians routinely considered anticoagulation medication was prescribed for patients in hospital, but an assessment of whether it would continue to be required in the community would be made by professionals involved there. Andrew attended a different acute hospital on two further occasions (these were short admissions to provide respiratory support and to treat and monitor infection) later in May, and then in June 2022 – once again, Andrew received anticoagulation medication during his stay in hospital, but not upon discharge.

The inquest heard that the neurorehabilitation community care centre did not, at the time of Andrew’s death, perform their own assessments on new patients’ risk of venous thrombosis (VTE risk assessment), but instead were reliant on information being provided by hospitals and would facilitate prescribed medication being given to patients (including anticoagulation medication), in accordance with discharge information. The centre now has a new policy in place, requiring VTE risk and assessment to be considered when patients are discharged from hospital into their care. The inquest heard evidence from the Director of Services at the centre, who stated that she had spoken to colleagues at other similar community care organisations, who also did not routinely carry out VTE risk assessments on patients, as part of their practice.

Andrew suffered a fatal deep vein thrombosis and pulmonary embolism at the neurorehabilitation centre on 27 June 2022.

Following medical evidence heard at the inquest, the cause of death was determined in Section 2 of the Record of Inquest as:

1a – pulmonary embolism 1b – deep vein thrombosis 2 – acute disseminated encephalomyelitis (vaccine-induced)

Section 3 of the Record of Inquest (which answered how, when and where Mr Nichols came by his death) was determined as follows:

‘Andrew Nichols had no significant medical history at the time he received a vaccination in April 2021, as part of the national programme in response to the Covid-19 pandemic. Within a few days, Andrew became very unwell and was diagnosed with acute disseminated encephalomyelitis (ADEM), a severe neurological condition which had developed as a side-effect of vaccination. Andrew received specialist care for over a year, primarily in hospital, but latterly at a neuro-rehabilitation centre. Andrew had been prescribed anticoagulant medication whilst in hospital, owing to his immobility and risk of developing blood clots. Andrew should have continued to receive this medication, however, upon discharge from hospital to the rehabilitation centre, he did not. Andrew became acutely unwell on 27 June 2022, going into cardiac arrest. Despite prolonged attempts at resuscitation by nursing and paramedic professionals, Andrew was pronounced deceased later the same day, upon arrival at the Worcestershire Royal Hospital.’

‘Andrew Nichols died as a direct result of blood clots forming in the vein of his leg and circulating to block the veins of his lungs. Andrew not receiving anticoagulation medication when discharged from hospital contributed to his death. Andrew’s immobility, which had occurred as a result of a very rare side-effect following vaccination, contributed to his death.’