Coroner's Report for Otto Warmbier Deepens Mystery Surrounding His Death After North Korea Release

New details revealed in the coroner's report for college student Otto Warmbier deepens the mystery surrounding his death after his release from North Korea in June

New details revealed in the coroner’s report for college student Otto Warmbier deepens the mystery surrounding his death after his release from North Korea in June.

The Hamilton County Coroner’s report, obtained by PEOPLE on Wednesday, lists the cause of death as brain damage from a lack of oxygen from an unknown injury “more than a year prior to death.” The manner of death is written as “undetermined.” Otto’s parents declined an autopsy, so the investigation was limited to an external examination.

The report, which was carried out by coroner Dr. Gretel Stephens, also notes that his nose and ears show “no remarkable alteration” and that “the teeth are natural and in good repair,” contrary to Fred Warmbier’s statement on Tuesday that his son’s mouth looked as through “someone had taken a pair of pliers and rearranged his bottom teeth.”

Fred and Cindy Warmbier have not returned PEOPLE’s request for comment.

The coroner also found a collection of scars on Otto’s “well-developed, well-nourished” body. At least half of them were pale, indicating they were older. There was some evidence of medical therapy, such as a catheter and a newer scar consistent with that of a tracheostomy. It also notes a “large pigmented scar” on his right foot.

Kyodo

On Tuesday, Fred and Cindy Warmbier said they felt the need to speak out on their son’s death in the wake of North Korea’s threats against President Donald Trump and the United States.

“But now we see North Korea claiming to be a victim and that the world is picking on them and we’re here to tell you: North Korea is not a victim. They’re terrorists,” Fred said on Fox and Friends. “They kidnapped Otto. They tortured him. They intentionally injured him. They are not victims.”

The parents described seeing Otto for the first time after he was captured. Although they knew he had suffered brain damage, Fred and Cindy were hopeful that the right medical care could help him. However, they quickly learned the terrifying extent of his injuries.

Bill Pugliano/Getty

After a medical team boarded the plane that carried Otto back to the U.S., his family was allowed to see him. The University of Virginia student let out a “howling, involuntary, inhuman” sound that sent his mother and sister running from the aircraft.

Fred said his son was blind and deaf. Otto was “jerking violently” on a stretcher with a feeding tube out of his nose, and his mouth looked as through “someone had taken a pair of pliers and rearranged his bottom teeth.”

“They destroyed him,” Cindy said.

Kyodo

Otto was sentenced to 15 years of prison and hard labor for allegedly stealing a political propaganda poster from his Pyongyang hotel in January 2016.

He returned home to Cincinnati, Ohio, on June 13 in a coma after being “brutalized and terrorized by the pariah regime,” his family said at the time.

North Korean officials maintain that he contracted botulism and slipped intothe coma after taking a sleeping pill.

When he arrived in Ohio, he was transported by ambulance to the University of Cincinnati Medical Center where doctors discovered he had “severe injury to all regions of the brain” and described his current condition as “unresponsive wakefulness.”

Doctors have little information about what happened to him prior to his release as they’ve had no contact with North Korean medical authorities.