588 results
78y · Female·Multiple organ failure secondary to sepsis and renal failure due to bronchopneum…
A 78-year-old woman with cognitive impairment, depression, and complex care needs fell at home on 11 February 2022. Her sons delayed seeking medical help for 4 days, during which she developed aspiration pneumonia and wa…
78y · Male·Complications of acute renal impairment in the setting of pelvic and lumbar frac…
Garry Ledger, 78-year-old South Australian visitor, died three weeks after falling on a Melbourne tram on 28 August 2025. While boarding tram route 16, he fell during tram acceleration while using his Myki card and befor…
48y · Male·Pulmonary thromboembolism
Guy Christian Mason, 48, died from a saddle pulmonary embolism on 17 September 2023, three days after discharge from patellar tendon repair surgery. He had sustained a significant knee injury with multiple ligament ruptu…
66y · Female·Acute oesophagitis complicated by gastrointestinal haemorrhage
A 66-year-old woman with cerebral palsy, dysphagia, and chronic reflux oesophagitis presented with acute gastrointestinal bleeding while in supported disability accommodation. She was treated conservatively with IV proto…
34y · Male·95% total body surface area burns and inhalational injury sustained in a vehicle…
TE, a 34-year-old male, died on 22 February 2024 from 95% total body surface area burns and inhalational injury sustained in a deliberate vehicle fire on the Monash Freeway. The coroner confirmed this was suicide, noting…
69y · Female·Exacerbation of chronic obstructive pulmonary disease and ischaemic heart diseas…
Lynette McHarry, aged 69, died on 15 August 2024 at Casey Hospital following complications from a preventable medication error at Mooraleigh Hostel residential aged care facility. On 4 August, she was mistakenly administ…
94y · Female·Drug toxicity (baclofen, gabapentin, oxycodone, pregabalin, zolpidem)
A 94-year-old residential aged-care resident died from drug toxicity after receiving another resident's medications. An agency nurse, unfamiliar with the patient and interrupted during medication preparation, failed to p…
72y · Male·Complications of suspected upper gastrointestinal tract haemorrhage, hospital ac…
A 72-year-old man with metastatic squamous cell lung cancer and multiple serious comorbidities was admitted to Ballarat Hospital in July 2024 with lethargy, fatigue, and rapid atrial fibrillation. Due to medication chart…
88y · Female·Infective complications arising from injuries sustained in low speed motor vehic…
Barbara Cameron, 88, died on 5 January 2026 from infective complications of injuries sustained in a low-speed motor vehicle accident on 29 October 2025. She was exiting her parked vehicle at a shopping centre car park in…
35y · Female·Respiratory failure secondary to community-acquired pneumonia in a woman with ce…
Danielle Pezzutti, age 35, with cerebral palsy, intellectual disability (Trisomy 5P), and dysphagia, died from respiratory failure secondary to community-acquired pneumonia. On 11 July 2024, she became unwell at day care…
18y · Male·Head injuries sustained in a motorbike incident
WQ, aged 18, died from head injuries sustained in a motorcycle accident on 31 December 2024 in the Alpine National Park near Licola, Victoria. After consuming significant quantities of alcohol (blood alcohol 0.14 g/100mL…
76y · Male·Traumatic head, ribs, pelvic and spinal injuries sustained in a motor vehicle in…
A 76-year-old man with schizophrenia, depression, Klinefelter syndrome, and poorly controlled diabetes was struck by a car as a pedestrian on 19 December 2024 while crossing Middleborough Road in Box Hill South outside a…
69y · Female·Urosepsis secondary to anuric acute renal failure and corona radiata infarct; co…
A 69-year-old diabetic woman presented to Maroondah Hospital Emergency Department on 9 June 2024 with severe right-sided abdominal pain and vomiting. CT imaging at 10:00am confirmed emphysematous pyelitis (gas-forming ki…
71y · Female·Cardiogenic shock due to sudden cardiac event, with scleroderma as contributing …
Pamela Dorothy Otway, aged 71 years, with significant intellectual disability from childhood and residing in Specialist Disability Accommodation, died of cardiogenic shock and ventricular standstill following a sudden ca…
65y · Female·Bronchopneumonia and rhinovirus infection in a woman with cerebral palsy and epi…
Lynn Maree Sturgess, aged 65, a long-term resident of supported disability accommodation with cerebral palsy and well-controlled epilepsy, was admitted to Bendigo Hospital with febrile illness in May 2025. She was diagno…
38y · Female·Pulmonary thromboembolism secondary to deep venous thrombosis due to promethazin…
Elizabeth Jean Hanlon, aged 38, died from pulmonary thromboembolism secondary to deep venous thrombosis following a promethazine overdose. She had complex mental health diagnoses including borderline personality disorder…
48y · Male·Complications of an intra-cranial haemorrhage
Darren Collyer, a 48-year-old man with Sotos syndrome, intellectual disability, epilepsy and anxiety, lived in specialist disability accommodation (SDA) in Melton. On 14 December 2023, a new unfamiliar staff member trigg…
87y · Female·Oesophageal perforation following an elective oesophageal dilatation, secondary …
87-year-old Helen Mahlis died from oesophageal perforation following an elective balloon dilation procedure at Epworth Richmond for treatment of achalasia. The coroner identified two contributing factors: use of a 35mm b…
55y · Male·Unascertained
A 55-year-old man with known HIV infection, who was homeless and vulnerable, was found unconscious in a hot bath at a friend's home in South Yarra and rapidly transported to hospital. He presented with profound shock, hy…
<1y · Male·Perinatal hypoxia
Baby R, born at 39 weeks 6 days via planned homebirth with private midwives, died from perinatal hypoxia on day 6 of life. The mother had significant obstetric risk factors: previous emergency caesarean section, macrosom…
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