Concerns for German Chancellor Angela Merkel’s health grow once more as she was filmed struggling to keep her composure and visibly shaking during an official ceremony for the second time this month.

The incident happened during the formal appointing of the new justice minister in Berlin’s Bellevue Palace on Thursday morning. The chancellor began shaking while standing next to German President Frank-Walter Steinmeier, who was delivering a speech. The shaking stopped and resumed several times.

Merkel was visibly distraught and placed both hands on her chest, trying to control herself. Nevertheless, she continued with the ceremony, and later shook hands, smiled, and posed for photos with other officials.

At one point, the chancellor was offered a glass of water.

After the ceremony, Merkel’s spokesperson said the chancellor “is feeling well” and will attend the G20 meeting in Osaka, Japan on June 28-29, as planned.

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Angela Merkel was previously spotted shaking two weeks ago when she met Ukrainian President Volodymyr Zelensky. Her condition looked more severe that time, as the shaking seemed more violent. She told reporters then that she was just dehydrated and recovered after drinking several glasses of water.

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