BERLIN (AP) — 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.

Reports of an unusual form of blood clot in the head, known as sinus vein thrombosis, 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 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.

Most European Union countries have since resumed use of the vaccine.