This 75 year old male, an Iraqi National, was a detainee at the Central Baghdad Detainee Facility (Abu Ghraib). On May 11, 2004 he reportedly abruptly collapsed and became unconscious. Resuscitation was initiated and continued during transport to the facility hospital where he died. He had a past medical history significant for diabetes mellitus, hypertension and previous myocardial infarction. Cause of Death: Determined to be Severe Atherosclerotic Coronary Vascular Disease; Manner of Death: Natural.
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6159 x031.44 C XVI
I N4ME AND LOCATION OF HOSPITAL
HOSPITAL REPORT OF DEATH 'OR USE OF MS FORM. SEE AR 40-2: THE PROPONENT AGENCY IS OFFICE OF THE SURGEON GENERAL /16St4 DAD CgiurRA L./p cry-di i-fr5)
A3r/ of3 hi
f
Instructions - Medical Officer in attendance will:
',are, in one copy only, Items 1 through 10 and sign Item 11. SSend form, without delay to the Registrar or Administrative Officer or type entries.S of the Day, for necessary action and for preparation of required number of copies.
-S
SECTION A - ATTENDING MEDICAL OFFICER'S REPORT
PERSONAL DATA
1. PATIENT DATA (Patient's rarriSn lain will hr.Sred to imprint 2. TIME OF DEATH thfour-darmenth.rearl 3. MEDICAL EXAMINER/identifying data if available)S)(°-4 CORONER'S CASE
YES0./NO
1 5/ 1/IIg Y aoa, .
4. RELIGION 5. CHAPLAIN NOTIFIED
. YES0./NO
6. NAME, ADDRESS AND RELATIONSHIP OF RELATIVE OR FRIEND PRESENT AT DEATH
Patient's name (Last, first, middle initial) Grade,
Social Security Account No., Register Number and Ward Number
APPROXIMATE INTERVALCAUSE OF DEATH
BETWEEN ONSET
AND DEATH
7a. DISEASE OR CONDITION DIRECTLY LEADING TO DUE0
0 for as a consequence of)DEATH (This does not mean rhe mode of dying. e.g..I heart Were asthenia, etc. it means the disease. infilly, 144/4S4,601.1 gt1
.‘4
or Cantlaication which caused death(
,ete4gaddiltr, 45)4:e 444 DUE TO for asSconsequence of)
7b. ANTECEDENT CAUSES (Morbid conditions. it any. (1)
giving rise to the above cause, staling the underlying
conation testi
(2)
a.
8. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING
rel THE DEATH: BUT NOT RELATED TO THE DISEASE
. b.
ONDITION CAUSING IT
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9. DATE 10. TYPED OR PI-b)( }2Z •CiA:taFFICEFI DANCE
IN ATTENDANCE
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SECTION B • ADMINISTRATIV
TYPE OF ACTION HOUR DAY MONTH YEAR0. INITIALS OF RESPONSIBLE OFFICER
12. TELEGRAM TO NEXT OF KIN OR OTHER AUTHORIZED PERSON
11. POST ADJUTANT GENERAL NOTIFIED
14.
IMMEDIATE CO OF DECEASED NOTIFIED
15.
INFORMATION OFFICE NOTIFIED
16.
POST MORTUARY OFFICER NOTIFIED
17.
RED CROSS NOTIFIED
ls. OTHER /Specify/
19 .
SECTION C - RECORD OF AUTOPSY
200AUTOPSY PERFORMED III yes, give date and pineal 21. AUTOPSY ORDERED BY (Signaterel
• YES0U0NO
22.
PROVISIONAL PATHOLOGICAL FINDINGS
23.
DATE 24. TYPED NAME ANO GRADE OF PHYSICIAN PERFORMING 250SIGNATURE OF PHYSICIAN PERFORMING AUTOPSY
AUTOPSY
•
DATE 270TYPED NAME AND GRADE OF REGISTRAR 280SIGNATURE OF REGISTRAR
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PRISONER IN PROCESSING MEDICAL SCREEN
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NAME: DATE: corippAtt HISTORY BY TRANSLATOR: NO ISN: AGE
NAME OF TRANSLATOR:
1) DO YOU I-JAVE ANY NEW MEDICAL PROBLEMS 0' INJURIES NOW?
CrYi
‘Atvutk.O.W ,¦PCLIL7ek-ALA/IA-Z 1-3 (A3-ta-iQ.AN-k-a/i 4--L±LAA-Q-01k-/ W42_,L0L,a4x: 1SLC/U-2) HAVE YOU HAD TUBERCULOSIS? IF YES, N & HOW WERE YOUC Ct.AU cu. ol141,1.1-1-u) TREATED? 1,..) uoia..1 mitre
A) HAVE YOU HAD A COUGH FOR MORE THAN 2 WEEKS? NO (1p. 6' (.c(
B) HAVE YOU BEEN COUGHING BLOOD? i. yk v.+I_)10
C) HAVE YOU BEEN LOSING A LOT OF WEIGHT? YES (grVIOVU)
3) CHRONICMED,ICAL PROBLEMS ZPERTENSI(33'1 T DISEASE):ZJ-11.Zaa MailZh-fa-A-/c1Y-\
) ED CATION:
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VIC di •
5) RE YOU ABLE TO WALK UNASSISTED?ZS NO
6)ARE YOU ABLE TO FEED YOURSELF?ZNO 8) PULSE: LP 5ZBLOOD PRESSURE:ZRESPIRATORY RATE: 1C9
WEIGHT: 19 7ibs HEIGHT:
A YES TO QUESTIONS 1-4 REQU BN MD OR PA, UNLESS
MINOR PROBLEM FOR QUESTIO ESTIONS 6 OR 7 ALSO
REQUIRE MD/PA EVALUATION.
MD/PA FOLLOW UP NOTE ZDATE: /s 4-r/i o c_
ASSESMENT:
gZAft_ 0 i.
RECCOMENDATIONS:
J.7
MEDCOM - 520
04. c /02 - M.06
AUTHORIZED FOR LOCAL REPRODUCTION
MEDICAL RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE
DATE SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)
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DEPART./SERVICE RECORDS MAINTAINED ATSTATUSHOSPITAL OR MEDICAL FACILITY RELATIONSHIP TO SPONSORSSN/ID NO.
SPONSOR'S NAME
(For typed or written entries, give: Name - last, first, middle; ID No or SSN; Sex; [REGISTER NO[ WARD NO.
PATIENT'S IDENTIFICATION: /
Dare of Birth; Rank/Grade.
CHRONOLOGICAL RECORD OF MEDICAL CARE
RANK:
Medical Record STANDARD FORM 600 {REV. 6-97) Prescribed by GSA/ICMR
DOB:
USAPA V2.00
FIRMR 141 CFR) 201-9.202-1
I
MEDCOM - 521
DOD 003584
-
Theater Trauma Registry Record
• For use of this form, sea AR 40-66: the proponeat agency is MSG
AUTHORITY:.SOME REGULATION PURPOSE:.To provide a sundard mesas of documenting combat tram= for rare at ecbeloas 1-3ROUTINE USES;S
The "Blanket Routine Uses" sea forth at the beginning of the Army companion of systems of records notice apply.
DISCLOSURE:.This is I:faceted health information. HIPAA laws avoir
MTF DESIGNATION: 6 CO F
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FRIENDLY
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CIVILIAN (Host Country)
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SELF ACCIDENT
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SELF NON-ACCIDENT
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SPORTS-BgCgEATION
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PROTECTION‘.
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HELMET FLAK VEST CERAMIC PLATE EYE PROTECTION
OTHER:
MECHANISM OF INJURY:, . MVC.Q.BURN 1 ° r 3°.%TB S A.
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BLUNT TRAUMA...KNIFFJEDGE.. FALL.
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SINGLE FRAGMENT...CBRNE.Cl.EED
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MULTI FRAGMENT.. BLAST."ai OTHER /6-.
INJURY Description (Location, nature and size in cm. Be specific.) .
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CASUALTY NAME: CASUALTY SSN:
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Rank Date of Birth 999,c1cr —7 5 (5 Male 0 Female Nation
Service a US . USA.0 SOF
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OR Start Vent On 1:,1: si' ,"r„': ICU in.';'::".::C; DISPOSITION.EVACUATED to 0.URGENT
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MEDCOM - 522
o IS)/t
0423;Sc407K- itKe
ARMED FORCES INSTITUTE OF PATHOLOGY Office of the Armed Forces Medical Examiner
1413 Research Blvd., Bldg. 102 Rockville, MD 20850 1-800-944-7912
PRELIMINARY AUTOPSY REPORT
b)(6)-4
Name: . Autopsy No.: ME 04- 358 US Detainee #: bm4 AFIP No.: pending Date of Birth:01 JAN 1929 Rank: Iraqi National, Date of Death: 11 MAY 2004 Place of Death: Baghdad, Iraq Date of Autopsy: 17-18 MAY 2004 Place of Autopsy: LSA Anaconda Date of Report: 18 MAY 2004 Mortuary, Balad Iraq
Circumstances of Death: This 75 year old male, an Iraqi National, was a detainee at the Central Baghdad Detainee Facility (Abu Ghraib). On 11 May 2004 he reportedly abruptly collapsed and became uficonscious. Resuscitation was initiated and continued during
b)(6)-4Z
transport to the facility hospital where he died. Mr had a past medical history significant for diabetes mellitus, hypertension and previous myocardial infarction.
Authorization for Autopsy: Office of the Armed Forces Medical Examiner, IAW 10 USC 1471
Identification: Positive identification accomnfighed by (-cm-mark/1n to photographs and
3)(3)-1
reports supplied by the investigative agency ( Z LSA Anaconda, Balad, Iraq)
CAUSE OF DEATH: Severe Atherosclerotic Coronary Vascular Disease
MANNER OF DEATH: Natural
This is a preliminary report based on initial examination of the remains, a final report will follow.Z U t; L, cl
MEDCOM - 523
FY 4
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2
AUTOPSY RE ME04- 358
b)(6)-4
PRELIMINARY AUTOPSY DIAGNOSES:
I. Severe Atherosclerotic Coronary Vascular Disease
a.
Right Coronary Artery: 95% to pinpoint stenosis
b.
Left Coronary Artery: 80% stenosis with concentric calcification
c.
Proximal Left Descending Coronary Artery: 90% stenosis
d.
Status Post Remote Posterior Ventricular-Septal Infarction
e.
Severe Aortic Atherosclerosis
H. Aortic Aneurysm (8cc)
Cardiomegaly (810gm)
IV.
Marked Nephrosclerosis
V.
No external injuries noted
VI. Toxicology pending
Deputy Armed Forces Medical Examiner
JVN L t. 2
MEDCOM - 524