He was admitted to Mount Elizabeth Hospital in Singapore and Tengku Faris was appointed the Regent of Kelantan on 25 May in the Sultan's absence.

[8] Sultan Muhammad V was elected by the Conference of Rulers on 14 October 2016 to become the next Yang di-Pertuan Agong, the head of state of Malaysia.

[9] Sultan Muhammad V was installed as the fifteenth Yang Di Pertuan Agong of Malaysia on 24 April 2017 in a ceremony held at the Istana Negara, Jalan Duta, Kuala Lumpur.

Sultan Muhammad V also granted a royal pardon to Anwar Ibrahim, the current Prime Minister of Malaysia, which paved way for him to return to the Dewan Rakyat once again in a by-election held later that year.

In an unprecedented move, Sultan Muhammad V became the first Yang di-Pertuan Agong to abdicate from the throne, effective 6 January 2019 while his term was to end on 12 December 2021.

[16] In late November 2018, it was reported that while on leave from the country, Sultan Muhammad V had married former beauty pageant winner Oksana Voevodina in Barvikha, Russia.

Media reported the birth of their son Tengku Ismail Leon Petra ibni Sultan Muhammad V on 21 May 2019.

[21] On 6 September he acknowledged that the marriage did take place;[22] Oksana had given birth to a son three months and half earlier.