ARMED FORCES INSTITUTE OF PATHOLOGY Office of the Armed

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
1
Name: b)(6)-4
SSAN:
Date of Birth: BTB 1943
Date of Death: 8 FEB 2004
Date of Autopsy: 28 FEB 2004
Date of Report: 28 FEB 2004
Autopsy No.: ME 04-100
AFIP No.: Pending
Rank: Iraqi Civilian
Place of Death: Tikrit, Iraq
Place of Autopsy: BIAP Mortuary
Baghdad Airport, Iraq
Circumstances of Death: This believed to be 61 year old male Iraqi civilian was a
detainee of the U.S. Armed Forces at the Detention Central Collection Facility, Tikrit,
Iraq when he was discovered deceased in his bed when he failed to report to the morning
head count procedure. The decedent reported a medical history of diabetes and renal
disease at the time of his capture.
Authorization for Autopsy: Office of the Armed Forces Medical Examiner, IAW 10
USC 1471.
Identification: Identification is established by visual examination by CID agents.
CAUSE OF DEATH: Atherosclerotic Cardiovascular Disease
MANNER OF DEATH: Natural
PRELIMINARY AUTOPSY DIAGNOSES:
I.
Atherosclerotic Cardiovascular Disease
1. Moderate calcified atherosclerosis of the right coronary artery
(50% stenosis), the left circumflex (50% stenosis) and left
anterior descending branches of the left coronary artery (5075% stenosis).
2. Moderate aortic atherosclerosis with bilateral renal artery takeoff stenosis.
3. Bilateral renal atrophy with intraparenchymal arteriole
atherosclerosis and marked arterionephrosclerosis and cortical
cysts.
4. Cranial artery atherosclerosis of the vertebral, basilar, posterior
communicating and middle cerebral arteries.
These findings are preliminary, and subject to modification pending further investigation
and laboratory testing.
MEDCOM - 123
DOD 003250
2
AUTOPSY REPORT ME04-100
Mild to moderate decomposition.
III.
Toxicology pending.
bX6)-2
MAJ MC USA
Deputy Medical Examiner
MEDCOM - 124
DOD 003251
.
.„
CERTIFICATE OF DEATH (OVERSEAS)
Acte de. dikes (iYaiitie-med -
.
•
•
NAME OF DECEASED (Last. First. Middle) N m du decode (Nom et prenoms)
GRADE
X )-4
Grade
SOCIAL SECURITY NUMBER
Nuttier° de ('Assurance SeijialO
BRANCH OF SERVICE
Arnie
Iraqi Civilian
,ORGANIZATION
Organisation
DATE OF BIRTH
Date de naissance
NATION (e.g., United States)
Pays
Detainee in Iraq
SEX Sexe
0
Iraq
MALE I.■I bieU
Hin
FEMALE Ferninin
RACE Race - -
X . CAUCASOID
NEGROID
- - MARITAL•STATIjS Etat Civil
•
SINGLE
Caucasique
•
Celibetaire
;__•
•
MARRIED
Negriode .
. • •
OTHER (Specify)
Autra(Spectifier)
DIVORCED
bivorce
OTHER (Specify)
Autre (Specifier)
CATHOLIC
Catholique
Marie
SEPARATED
Separe
, „
WIDOWED
Veuf
NAME OF NEXT OF KIN
RELIGION _ CUlle
PROTESTANT
Protestant . ..
Nom du plus proche parent
JEWISH
RELATIONSHIP TO DECEASED
•
STREET ADDRESS Domicile a (Rue)
Juif
Parente du decode avec le susdil
CITY OR TOWN AND STATE (Include ZIP Code) Ville (Ocide postal cortiodS)
•
•
MEDICAL STATEMENT
-Declaration-medicate
INTERVAL sErWEE:H
ONPELAND.4EATH
Intervalle entre.
Yattaque.et le decies.
CAUSE OF DEATH lEnteronlY once cause per him)
Cause du dices (N'indiquer qu'une cause par ligne)
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH
Atherosclerotic Cardiovascular Disease
Maladie ou condition directement responsable de la mon!
i
MORBID CONDITION,: IF:
LEADING. TO PRIMARY CAUSE
Condition morbide, s'it ya lieu.
mertantala cause primaire
ANTECEDENT
CAUSES
s'yrremomes
UNDERLYING CAUSE, IF ANY.
GIVING RISE TO PRIMARY
•CAUSE
•Raison fondarnentale, VI y a lieu,
ayant suscite Is cause primaire
precurseurs
de la mart.
. . .
„
OTHER SIGNIFICANT CONDITIONS 2
Aulres conditions significatives`
MODE OF DEATH
AUTOPSY PERFORMED Autopsie effeetuee -
Condition de dimes
MAJOR FINDINGS OF AUTOPSY Condusions prindpales de rautoPsle
RYES Dui
n
NO Non
'CIRCUMSTANCES SURROUNDING DEATH DUE TO
.EXTERNAL CAUSES
Circonstances de la mod suscitees par des causes exlerieures
NATURAL
X
-'
Mort nettirelle
...
.
i •ACCIDENT
-
Mort. accidentege
NAME OF PATHOLOGIST
. •X6 )-2
.SUICIDE
Suicide
. .
,HOMICIOE
Nom du pathologisle
MAJ, MC, USA •
.
: b)(6)- 2
DATE
Homicide
.28
•DATE OF DEATH-(Hour --....r. no.luh. yowl..
Date de dikes (I'heure, le jour, le mos, fanners)
08 Feb 2004
-
-
.
PLACEOF DEAL H
. .
Date
Feb-2004
AVIATION ACCIDENT
♦
YES
Accident A Avion
Dui
•
IRI No. Non
Lieu de deces
Tikrit, Iraq
I HAVE VIEWED THE REMAINS OF THE DECEASED AND,DEATH OCCURRED AT THE TIME'INDICATED AND.FROM THE CAUSES AS STATED ABOVE.
.
lid examine lee restos mortels dude luntet )e.concius que le decits out survenu a rheure indiquee et a. la suite des causes enurnerees ci-dessys.
NAME OF MEDICAL OFFICER
Nom du medicin militaire ou du rnedicin sanitaire
13)(0,-2
Titre ou diplerne
Deputy Medical -Examiner
GRADE Grade
INSTALLATION OR ADDRESS
MAJ
DATE
TITLE OR DEGREE
Installation ou adresse
Dover AFB, 'DE 19902
Dale
.11 -'14 .11 t r.
,bX 13)-
. •
2
C)Lf
1 State disease, injury or complication which caused death, but not mode of dying such as heart failure, etc.
:2. state conditionecontrihuting to the death, but not related to the disease or condition causing death.,
. .
.
•I • Precise, la.nature•da la maladie, de la bless,ureou de te complication qui a contribud d mora,
la
!Pala non /a mentors de.reourt Celle qu 'un ant( du coeur, etc
2 Preclser Is condition qui a contribee a le mod, mals n'ayant .aucun rapport avec la maladie
ou a 1a condition qul a prorogue la mort.
IMP •Ik ' Inr.
.a. #1,01k A A
1 APR 77
----
,1 JAN72 AND DA FORM 3565-R(PAS), 26 SEP 75, WHICH ARE OBSOLETE.
MEDCOM - 182
DOD 003309