BERLIN (NewsNation Now) — The German state of Berlin is again suspending the use of AstraZeneca’s coronavirus vaccine for people under 60 due to reports of blood clots.

Berlin’s top health official, Dilek Kalayci, said Tuesday that the decision was taken as a precaution ahead of a meeting of representatives from all of Germany’s 16 states after the country’s medical regulator announced 31 cases of rare blood clots in people who had recently received the vaccine. Nine of the people died.

All but two of the cases involved women aged 20 to 63, the Paul Ehrlich Institute, Germany’s medical regulator, said.

Reports of an unusual form of a blood clot in the head, known as cerebral sinus vein thrombosis (CSVT), prompted several European countries to temporarily halt the use of the AstraZeneca vaccine earlier this month.

After a review by medical experts, the European Medicines Agency (EMA) concluded the benefits of the vaccine outweighed the risks but recommended that warnings about possible rare side effects should be provided to patients and doctors.

An EMA review covering 20 million people who took the AstraZeneca shot in Britain and the European Economic Area found seven cases of blood clots in multiple blood vessels and 18 cases of CVST.

Most European Union countries have since resumed use of the vaccine. But France broke with guidance from the EMA and said on March 19 it should only be given to people aged 55 or older. France said the decision was based on evidence that the clotting affected younger people.

Canadian Health Officials said on Monday they would stop offering AstraZeneca’s shot to people under 55 and require a new analysis of the shot’s benefits and risks based on age and gender.

Earlier Tuesday, two state-owned hospitals in Berlin — Charite and Vivantes — announced that they had stopped giving AstraZeneca’s coronavirus vaccine to female staff members under 55-years-old. The heads of five university hospitals in western Germany called for a temporary halt to the vaccine for all younger women, citing the blood clot risk.

Some 19,000 people work at the Charite hospitals and 17,000 at Vivantes, which operates clinics as well as care homes.

A spokeswoman for Charite said the step was necessary following reports of CSVT in women in Germany.

“Although no complications have occurred at the Charite after vaccinations with AstraZeneca, the Charite wants to take precautionary action here and wait for final assessments,” the spokeswoman said.

Vivantes also said the decision was precautionary.

Some 2.7 million doses of the AstraZeneca vaccine have been administered in Germany so far.