385
Total cases
0%
Preventable or possibly preventable
0%
With coroner recommendations
0%
Escalation failure identified
Specialty tagging, error classification, and clinical flags are AI-generated and may contain inaccuracies. Always refer to the original finding.
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…
64y · Female·Urosepsis and pneumonia on a background of dementia and cognitive decline
Loretta Therese Ward, aged 64, was living in Specialist Disability Accommodation (SDA) under NDIS support due to Lewy Body dementia and cognitive decline when she developed progressive illness in late 2024. On 24 Februar…
1y · Female·Rapidly developing Streptococcus pneumoniae infection leading to invasive pneumo…
Arianna Maragol, a 16-month-old girl, died from rapidly developing Streptococcus pneumoniae infection leading to invasive pneumococcal disease while in childcare on 24 August 2018. Key clinical lessons emerged: (1) Pneum…
61y · Male·Pneumonia complicating Trisomy 21
Graham Peter Moore, a 61-year-old man with Down syndrome, epilepsy, and early-onset dementia living in residential care, died of pneumonia on 8 December 2025. He developed community-acquired pneumonia in late November, w…
85y · Male·Sepsis due to Staphylococcus aureus bacteraemia due to septic arthritis of left …
An 85-year-old man died in custody from sepsis due to Staphylococcus aureus bacteraemia arising from septic arthritis of the left shoulder, on a background of congestive heart failure. While receiving generally adequate …
53y · Male·Sepsis secondary to aspiration pneumonia
Giovanni John Miceli, a 53-year-old man with cerebral palsy and intellectual disability living in specialist disability accommodation, died from sepsis secondary to aspiration pneumonia. He had a known history of recurre…