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AURORA, Colo. — The coroner who reviewed the August death of Elijah McClain said the cause and manner of his death could not be determined with certainty. However, “intense physical exertion and a narrow left coronary artery contributed to (his) death.” The report was released late Friday afternoon by the coroner’s office for Adams and Broomfield Counties. It suggested McClain — who had a rough altercation with police and was injected with the sedative ketamine before going into cardiac arrest and later dying — may have passed away due to a homicide, an accident or natural causes. “…the manner of death may be accident if it was an idiosyncratic drug reaction. It may be natural if the decedent had an undiagnosed mental illness that led to Excited Delirium, if his intense physical exertion combined with a narrow coronary artery led to an arrhythmia, if he had an asthma attack, or if he aspirated vomit while restrained.  It may be a homicide if the actions of officers led to his death (e.g. the carotid control hold led to stimulation of the carotid sinus resulting in an arrhythmia),” the report, signed by Dr. Stephen Cina, a forensic pathology consultant, said. The autopsy report said McClain had marijuana and ketamine in his system at the time of his death, but the coroner’s office could not rule out the presence of a psychoactive drug “at very low levels below the limit of detection of laboratory analysis since limited admission blood was available for exhaustive testing.” Cina also reported that although the ketamine was found at a therapeutic level in McClain’s system, he could not rule out an unexpected reaction to that drug. The report found that police officers used a carotid control hold while they were restraining McClain, and that could not be ruled out as a possible contributor to McClain’s demise. “The decedent was violently struggling with officers who were attempting to restrain him,” Cina wrote. “Most likely the decedent’s physical exertion contributed to his death. It is unclear if the officers’ actions contributed as well. It is also unclear whether the decedent aspirated vomit while restrained.” The attorney for McClain’s family said she has lots of questions about the report. “It’s very clear from the autopsy that had it not been for the conduct of the officers, Elijah (McClain) would be alive today,” said Mari Newman, the attorney for McClain’s family. Newman previously called the police interaction with McClain, “torture.” The FOX31 Problem Solvers reached out to the Aurora Police Department for a comment. “If you’d like a comment/thought about the coroners (sic) autopsy findings, we would suggest reaching out to their office, as they are the ones completed that report. This case is still active and ongoing and anything additional needs to be directed to the 17th Judicial District Attorney’s Office,” a media relations spokesperson wrote.